The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms.

Rodrigo Rodriguez-Fernandez,Nawi Ng,Dwidjo Susilo,Rachel M Amiya,John Prawira,Michael J Bangs

doi:10.1186/s12889-016-3630-8

Rodrigo Rodriguez-Fernandez, Nawi Ng + Show 4 more

Open Access

https://doi.org/10.1186/s12889-016-3630-8

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Abstract

BackgroundAs the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia.MethodsDiagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities.ResultsOverall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed.ConclusionsThe high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries – a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.

Highlights

As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized
Non-communicable disease (NCD) such as heart disease, stroke, diabetes mellitus, cancer, asthma, and chronic respiratory diseases account for approximately 60 % of total mortality worldwide, with roughly 80 % of the chronic NCD deaths occurring in low- and middle-income countries (LMICs) [1]
Using novel visualization techniques, this study presents the complex weave of NCD-Infectious disease (ID) interconnectedness at work among employees of a major mining operation in a remote, generally under-resourced, area of Indonesia

Summary

Introduction

As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. Indonesia’s increasing NCD burden is in line with the growth of key metabolic risk factors including hypertension, high blood glucose, and obesity – primarily the influence of expanding lifestyle-related risk behaviours such as poor diet, physical inactivity, and smoking. This shifting disease burden is reflected in the ten leading causes of Indonesia’s disability-adjusted life years, ranked in 2010 as stroke, tuberculosis (TB), traffic accidents, diarrhoea, cardiac ischemia, diabetes, lower back pain, depression, respiratory infections, and neonatal encephalopathy [4]. This intersection of old and new disease paradigms has translated to an increased strain on the country’s existing health care system, which has had to expand its scope of services in order to deal with the increasing number of NCD cases while at the same time coping with the ongoing burdens of TB, malaria, and HIV and AIDS

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