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Describing Primary Care in rural Western Province, Papua New Guinea

Mikaela Seymour , Maggy Mase, Maria Rumints, Belinda Yamkeok, Margaret Eko, Jamee Newland, Nalisa Neuendorf, Pamela Toliman, Angela Kelly-Hanku

Abstract

Primary health care is a fundamental pillar of a health system. In Papua New Guinea (PNG), it is the first or only health service in many communities. Despite this, there is insufficient knowledge about the outpatient ambulatory conditions. This clinical audit assessed the specific type and frequency of presentation to a rural health outreach patrol in Western Province, PNG. A retrospective clinical audit of the outpatient presentations between February and October 2021 occurred. All presentations were categorised using the International Classification of Disease 11 (ICD-11). Frequencies were used to determine the most common ICD-11 categories. The top five categories underwent further statistical analysis using odd ratios, assessing for associations with sex, district, and age. Of the 442 new ambulatory outpatient consults, 55% (n=243) were female, with a mean age of 30.3 years. The top five ICD-11 categories within this study were ‘signs, symptoms or clinical findings not otherwise defined’ 18.6% (n=82), ‘respiratory disease’ 12% (n=53), ‘disease of the digestive system’ 3% (n=50), ‘disease of the musculoskeletal system’ 10.9% (n=48), and ‘infectious or parasitic disease’ 9.7% (n=43). Patients less than 20 years were less likely to have undefined signs and symptoms (OR 0.4, 95% CI [0.2-0.8] and more likely to have infectious or parasitic conditions (OR 3.8 95% CI [1.4-9.9) than those greater than 40 years. They also experienced less musculoskeletal pathology (OR 0.2 95% CI [0.1 – 0.5]). The most common specific individual disease presentations were limb pain, tropical ulcer, gastro-oesophageal reflux symptoms (GORD), lower back pain and upper respiratory tract infection (URTI). Compared to the outpatient surveillance reporting form, 63.8% of clinical presentations in this audit would not have been known to the National Department of Health (NDoH) using the existing reporting system. The key findings of this audit demonstrate patients in rural locations in the Western Province of PNG present to their ambulatory clinic with conditions that are not currently captured by existing reporting. It suggests that the conditions that affect everyday life are often musculoskeletal as well as infectious, which was not previously reported in the literature.

MJ25005  Accepted 08 July 2025

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