Tuberculosis treatment and undernutrition on Daru Island, Papua New Guinea: A qualitative exploration of a local foodscape

A Persson; P Jops; J Cowan; M Kupul; R Nake Trumb; S S Majumdar; S Islam; H Nindil; W Pomat; S Bell; G Marks; M Bauri; S M Graham; A Kelly-Hanku

doi:10.1016/j.socscimed.2024.117631

Tuberculosis treatment and undernutrition on Daru Island, Papua New Guinea: A qualitative exploration of a local foodscape

Soc Sci Med. 2024 Dec 12:365:117631. doi: 10.1016/j.socscimed.2024.117631. Online ahead of print.

Authors

A Persson¹, P Jops¹, J Cowan², M Kupul², R Nake Trumb², S S Majumdar³, S Islam³, H Nindil⁴, W Pomat⁵, S Bell⁶, G Marks⁷, M Bauri⁸, S M Graham⁹, A Kelly-Hanku¹⁰

Affiliations

¹ Kirby Institute, UNSW Sydney, Australia.
² Papua New Guinea Institute of Medical Research, Papua New Guinea.
³ Burnet Institute, Melbourne, Australia.
⁴ Papua New Guinea National Department of Health, Papua New Guinea.
⁵ Kirby Institute, UNSW Sydney, Australia; Papua New Guinea Institute of Medical Research, Papua New Guinea.
⁶ Kirby Institute, UNSW Sydney, Australia; Burnet Institute, Melbourne, Australia.
⁷ School of Clinical Medicine, UNSW Sydney, Australia.
⁸ Western Province Provincial Health Authority, Papua New Guinea.
⁹ Burnet Institute, Melbourne, Australia; University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
¹⁰ Kirby Institute, UNSW Sydney, Australia; Papua New Guinea Institute of Medical Research, Papua New Guinea. Electronic address: a.kelly@unsw.edu.au.

PMID: 39700575
DOI: 10.1016/j.socscimed.2024.117631

Abstract

A substantial proportion of people with tuberculosis (TB)-one of the world's deadliest infectious diseases-live in resource-poor, food insecure settings. It is widely recognised that undernutrition significantly heightens vulnerability to TB, as well as contributes to poor treatment adherence and outcomes. However, more attention is needed to understand what shapes food insecurity and undernutrition in a particular setting. We use the concept of "foodscapes" to explore the distinct food environment on Daru Island, a recognised "hotspot" for multidrug-resistant TB in the Western Province of Papua New Guinea. Drawing on 128 qualitative interviews and 10 focus groups (conducted July 2019 and July 2020) with people with TB, family members, healthcare providers, community leaders and other stakeholders, we seek to elucidate the critical entwinement of food insecurity, people with TB, and their treatment experiences on Daru Island. We argue that potential solutions need to focus on the social and structural conditions that contribute to undernutrition in the first place, rather than on undernutrition itself.

Keywords: Food insecurity; Foodscapes; Papua New Guinea; Qualitative; Treatment; Tuberculosis; Undernutrition.