Prevalence and Correlates of Adherence to the Global Total Physical Activity Guideline Based on Step Counting Among 3- to 4-Year-Olds: Evidence From SUNRISE Pilot Studies From 17 Countries.

BACKGROUND: There is limited evidence from globally diverse samples on the prevalence and correlates of meeting the global guideline of 180 minutes per day of total physical activity (TPA) among 3- to 4-year-olds. METHODS: Cross-sectional study involving 797 (49.2% girls) 3- to 4-year-olds from 17 middle- and high-income countries who participated in the pilot phases 1 and 2 of the SUNRISE International Study of Movement Behaviours in the Early Years. Daily step count was measured using thigh-worn activPAL accelerometers. Children wore the accelerometers for at least one 24-hour period. Children were categorized as meeting the TPA guideline based on achieving ≥11,500 steps per day. Descriptive analyses were conducted to describe the proportion of meeting the TPA guideline for the overall sample and each of the sociodemographic variables, and 95% CIs were calculated. Multivariable logistic regression was used to determine the sociodemographic correlates of meeting the TPA guideline. RESULTS: Mean daily step count was 10,295 steps per day (SD = 4084). Approximately one-third of the sample (30.9%, 95% CI, 27.6-34.2) met the TPA guideline. The proportion meeting the guideline was significantly lower among girls (adjusted OR [aOR] = 0.70, 95% CI, 0.51-0.96) and 4-year-olds (aOR = 0.50, 95% CI, 0.34-0.75) and higher among rural residents (aOR = 1.78, 95% CI, 1.27-2.49) and those from lower middle-income countries (aOR = 1.35, 95% CI, 0.89-2.04). CONCLUSIONS: The findings suggest that a minority of children might meet the TPA guideline globally, and the risk of not meeting the guideline differed by sociodemographic indicators. These findings suggest the need for more surveillance of TPA in young children globally and, possibly, interventions to improve childhood health and development.

Sex and gender differences in social participation among community-dwelling older adults: a systematic review.

Background: Frequent social participation among older adults is associated with greater health. Although understanding how sex and gender influence social participation is important, particularly in developing sex-inclusive health promotion and preventive interventions, little is known about factors influencing engagement of older women and men in social activities. Aim: This study thus aimed to examine factors influencing social activities of older women and men. Methods: A mixed-method systematic review was conducted in nine electronic databases from inception to March 2023. The studies had to define social participation as activities with others and examine its influencing factors among community-dwelling older women and men. Data were analyzed using convergent synthesis design from a socio-ecological perspective. Results: Forty-nine studies, comprising 42 quantitative, five qualitative and two mixed method design were included. Themes identified concerned: (a) sociodemographic factors, (b) personal assets, (c) interpersonal relationships and commitments, (d) physical environment, and (e) societal norms and gender expectations. The findings identified the heterogeneous needs, preferences and inequalities faced by older women and men, considerations on sociocultural expectations and norms of each gender when engaging in social activities, and the importance of having adequate and accessible social spaces. Overall, this review identified more evidence on factors influencing social participation among women than in men. Conclusion: Special attention is needed among community care providers and healthcare professionals to co-design, implement or prescribe a combination of sex and gender-specific and neutral activities that interest both older women and men. Intersectoral collaborative actions, including public health advocates, gerontologists, policymakers, and land use planners, are needed to unify efforts to foster social inclusion by creating an age-friendly and sustainable healthy environment. More longitudinal studies are required to better understand social participation trajectories from a sex and gender perspective and identify factors influencing it. Systematic reviews registration: http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023392764].

Household food insecurity during the COVID-19 pandemic and associated socioeconomic demographic factors in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System.

INTRODUCTION: The COVID-19 pandemic had an unprecedented impact on global food security, but little is known about the impact on food security at the household level. We examined the prevalence and socioeconomic demographic factors for household food insecurity during the COVID-19 pandemic in Papua New Guinea. METHODS: Household socioeconomic demographic data from the Comprehensive Health and Epidemiological Surveillance System were collected from six main provinces in 2020 (37880 participants) and compared with the 2018 data (5749 participants). The prevalence of household food insecurity was estimated and stratified by household socioeconomic demographic characteristics. Multinomial logistic regression was conducted to estimate adjusted OR (aOR) and 95% CI of risk factors. RESULTS: The overall prevalence of household food insecurity increased from 11% in 2018 to 20% in 2020, but varied across provinces, with the highest level reported in Central Province (35%) and the lowest level in East New Britain Province (5%).Food shortages were 72% less likely among urban residents than those living in rural areas (aOR 0.28 (95% CI 0.21 to 0.36)). The risk of food insecurity was 53% higher among adults aged 25+ years with primary education (grades 3-8) than those with university education (aOR 1.53 (95% CI 1.09 to 2.13)). People from households in the poorest wealth quintiles were 80% more likely to report food shortage than those from the richest wealth quintile (aOR 1.78 (95% CI 1.29 to 2.45). CONCLUSION: The study provides evidence to develop policy and intervention to deal with food insecurity in emergency situations in the future.

Safe and effective profile of the VSTENT bioresorbable polymer sirolimus-eluting stent in the treatment of patients with de novo coronary artery lesions: a prospective, cohort, multicenter study.

Background: The drug-eluting stent was a significant stride forward in the development of enhanced therapeutic therapy for coronary intervention, with three generations of increased advancement. VSTENT is a newly developed stent manufactured in Vietnam that aims to provide coronary artery patients with a safe, effective, and cost-efficient option. The purpose of this trial was to determine the efficacy and safety of a new bioresorbable polymer sirolimus-eluting stent called VSTENT. Methods: This is a prospective, cohort, multicenter research in 5 centers of Vietnam. A prespecified subgroup received intravascular ultrasound (IVUS) or optical coherence tomography (OCT) imaging. We determined procedure success and complications during index hospitalization. We monitored all participants for a year. Six-month and 12-month rates of major cardiovascular events were reported. All patients had coronary angiography after 6 months to detect late lumen loss (LLL). Prespecified patients also had IVUS or OCT performed. Results: The rate of device success was 100% (95% CI: 98.3-100%; P<0.001). Major cardiovascular events were 4.7% (95% CI: 1.9-9.4%; P<0.001). The LLL over quantitative coronary angiography (QCA) was 0.08±0.19 mm (95% CI: 0.05-0.10; P<0.001) in the in-stent segment and 0.07±0.31 mm (95% CI: 0.03-0.11; P=0.002) in 5 mm within the two ends of the stent segment. The LLL recorded by IVUS and OCT at 6 months was 0.12±0.35 mm (95% CI: 0.01-0.22; P=0.028) and 0.15±0.24 mm (95% CI: 0.02-0.28; P=0.024), respectively. Conclusions: This study's device success rates were perfect. IVUS and OCT findings on LLL were favorable at 6-month follow-up. One-year follow-up showed low in-stent restenosis (ISR) and target lesion revascularization (TLR) rates, reflecting few significant cardiovascular events. VSTENT's safety and efficacy make it a promising percutaneous intervention option in developing nations.

Validating the InterVA-5 cause of death analytical tool: using mortality data from the Comprehensive Health and Epidemiological Surveillance System in Papua New Guinea.

OBJECTIVE: InterVA-5 is a new version of an analytical tool for cause of death (COD) analysis at the population level. This study validates the InterVA-5 against the medical review method, using mortality data in Papua New Guinea (PNG). DESIGN AND SETTING: This study used mortality data collected from January 2018 to December 2020 in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established by the PNG Institute of Medical Research in six major provinces. METHODS: The CHESS demographic team conducted verbal autopsy (VA) interviews with close relatives of the deceased, who died in communities within the catchment areas of CHESS, using the WHO 2016 VA instrument. COD of the deceased was assigned by InterVA-5 tool, and independently certified by the medical team. Consistency, difference and agreement between the InterVA-5 model and medical review were assessed. Sensitivity and positive predictive value (PPV) of the InterVA-5 tool were calculated with reference to the medical review method. RESULTS: Specific COD of 926 deceased people was included in the validation. Agreement between the InterVA-5 tool and medical review was high (kappa test: 0.72; p<0.01). Sensitivity and PPV of the InterVA-5 were 93% and 72% for cardiovascular diseases, 84% and 86% for neoplasms, 65% and 100% for other chronic non-communicable diseases (NCDs), and 78% and 64% for maternal deaths, respectively. For infectious diseases and external CODs, sensitivity and PPV of the InterVA-5 were 94% and 90%, respectively, while the sensitivity and PPV of the medical review method were both 54% for classifying neonatal CODs. CONCLUSION: The InterVA-5 tool works well in the PNG context to assign specific CODs of infectious diseases, cardiovascular diseases, neoplasms and injuries. Further improvements with respect to chronic NCDs, maternal deaths and neonatal deaths are needed.

Leading causes of deaths in the mortality transition in Papua New Guinea: evidence from the Comprehensive Health and Epidemiological Surveillance System.

BACKGROUND: Changing causes of deaths in the mortality transition in Papua New Guinea (PNG) are poorly understood. This study analysed community-level data to identify leading causes of death in the population and variations across age groups and sexes, urban-rural sectors and provinces. METHOD: Mortality surveillance data were collected from 2018-20 as part of the Comprehensive Health and Epidemiological Surveillance System (CHESS), using the World Health Organization 2016 verbal autopsy (VA) instrument. Data from 926 VA interviews were analysed, using the InterVA-5 cause of death analytical tool to assign specific causes of death among children (0-14 years), those of working age (15-64 years) and the elderly (65+ years). RESULT: Nearly 50% of the total deaths were attributed to non-communicable diseases (NCDs), followed by infectious and parasitic diseases (35%), injuries and external causes (11%) and maternal and neonatal deaths (4%). Leading causes of death among children were acute respiratory tract infections (ARTIs) and diarrhoeal diseases, each contributing to 13% of total deaths. Among the working population, tuberculosis (TB) contributed to 12% of total deaths, followed by HIV/AIDS (11%). TB- and HIV/AIDS-attributed deaths were highest in the age group 25-34 years, at 20% and 18%, respectively. These diseases killed more females of working age (n = 79, 15%) than males (n = 52, 8%). Among the elderly, the leading causes of death were ARTIs (13%) followed by digestive neoplasms (10%) and acute cardiac diseases (9%). CONCLUSION: The variations in leading causes of death across the populations in PNG suggest diversity in mortality transition. This requires different strategies to address specific causes of death in particular populations.

Social determinants of injury-attributed mortality in Papua New Guinea: new data from the Comprehensive Health and Epidemiological Surveillance System.

OBJECTIVE: This study reported the prevalence and sociodemographic distribution of mortalities attributed to injuries in Papua New Guinea (PNG). SETTING: As part of a longitudinal study, mortality data were collected from the population who live in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System, established in six major provinces in PNG. Verbal autopsy (VA) interviews were conducted by the surveillance team with close relatives of the deceased, using the WHO 2016 VA instrument from January 2018 to December 2020. PARTICIPANT AND INTERVENTION: Mortality data from 926 VA interviews were analysed, using the InterVA-5 diagnostic tool to assign specific cause of death (COD). Distributions of injury-attributed mortality were calculated and multinomial logistic regression analyses were conducted to identify sociodemographic factors and provide ORs, 95% CIs of estimates and p values. RESULT: Injury-attributed deaths accounted for 13% of the total deaths recorded in the surveillance population, with the highest proportion in Madang (22%), followed by Port Moresby and Central Province (13%). Road traffic accidents were the leading COD, accounting for 43% of the total injury-attributed deaths, followed by assaults (25%) and accidental falls (10%). Young adults (aged 15-24 years) accounted the largest proportion of injury-attributed deaths (34%) and were nearly six times more likely to die from injuries than those aged 75+ years (OR: 5.89 (95% CI: 2.18 to 15.9); p<0.001). Males were twice more likely to die from injuries than females (OR: 2.0 (95% CI: 1.19 to 3.36); p=0.009). Another significant sociodemographic factor associated with the increased injury-attributed mortalities included urban versus rural residence (OR: 2.0 (95% CI: 1.01 to 3.99); p=0.048). CONCLUSION: Young adults, particularly those who live in urban areas, were at the highest risk of dying from injuries. Public health policies and interventions are needed to reduce premature mortality from injuries in PNG.

Tuberculosis and HIV/AIDS-attributed mortalities and associated sociodemographic factors in Papua New Guinea: evidence from the comprehensive health and epidemiological surveillance system.

OBJECTIVE: Tuberculosis (TB) and HIV/AIDS are public health concerns in Papua New Guinea (PNG). This study examines TB and HIV/AIDS mortalities and associated sociodemographic factors in PNG. METHOD: As part of a longitudinal study, verbal autopsy (VA) interviews were conducted using the WHO 2016 VA Instrument to collect data of 926 deaths occurred in the communities within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System from 2018 to 2020.InterVA-5 cause of deaths analytical tool was used to assign specific causes of death (COD). Multinomial logistic regression analyses were conducted to identify associated sociodemographic factors, estimate adjusted ORs (AOR), 95% CIs and p values. RESULT: TB and HIV/AIDS were the leading CODs from infectious diseases, attributed to 9% and 8% of the total deaths, respectively.Young adults (25-34 years) had the highest proportion of deaths from TB (20%) and the risk of dying from TB among this age group was five times more likely than those aged 75+ years (AOR: 5.5 (95% CI 1.4 to 21.7)). Urban populations were 46% less likely to die from this disease compared rural ones although the difference was not significant (AOR: 0.54 (95% CI 0.3 to 1.0)). People from middle household wealth quintile were three times more likely to die from TB than those in the richest quintile (AOR: 3.0 (95% CI 1.3 to 7.4)).Young adults also had the highest proportion of deaths to HIV/AIDS (18%) and were nearly seven times more likely to die from this disease compared with those aged 75+years (AOR: 6.7 (95% CI 1.7 to 25.4)). Males were 48% less likely to die from HIV/AIDS than females (AOR: 0.52 (95% CI 0.3 to 0.9)). The risk of dying from HIV/AIDS in urban population was 54% less likely than their rural counterparts (AOR: 0.46 (95% CI 0.2 to 0.9)). CONCLUSION: TB and HIV/AIDS interventions are needed to target vulnerable populations to reduce premature mortality from these diseases in PNG.

Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries.

PURPOSE: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample. METHODS: This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density. RESULTS: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures. CONCLUSIONS: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

Non-communicable diseases attributed mortality and associated sociodemographic factors in Papua New Guinea: Evidence from the Comprehensive Health and Epidemiological Surveillance System.

BACKGROUND: Papua New Guinea (PNG) is undergoing an epidemiological transition with increased mortality from NCDs. This study examined NCDs-attributed mortality and associated sociodemographic factors in PNG. METHOD: Using WHO 2016 instrument, 926 verbal autopsy (VA) interviews were conducted in six major provinces from January 2018 to December 2020. InterVA-5 tool was used to assign causes of death (COD). Multivariable logistic regression analysis was performed to identify sociodemographic factors associated with mortalities from emerging and endemic NCDs. FINDING: NCDs accounted for 47% of the total deaths, including 20% of deaths attributed to emerging NCDs and 27% of deaths due to endemic NCDs. Leading CODs from emerging NCDs were identified including cardiac diseases, stroke, and diabetes. The risk of dying from emerging NCDs was significantly lower among populations under age 44y compared with population aged 75+y (OR: 0.14 [0.045-0.433]; p-value: 0.001). People living in urban areas were twice likely to die from emerging NCDs than those in rural areas (OR: 1.92 [1.116-3.31]; p-value: 0.018). People in Madang province were 70% less likely to die from emerging NCDs compared to those from East New Britain province (OR: 0.314 [0.135-0.73]; p-value: 0.007). Leading CODs from endemic NCDs included digestive neoplasms, respiratory neoplasms, and other neoplasms. Only children aged 0-4y had significant lower risk of dying from endemic NCDs compared to the population aged 75+y (OR: 0.114 [95% CI: 0.014-0.896]; p-value: 0.039). CONCLUSION: Public health interventions are urgently needed, prioritizing urban population and those aged over 44y to reduce premature mortality from NCDs.

Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol.

INTRODUCTION: 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. METHODS AND ANALYSIS: SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. ETHICS AND DISSEMINATION: The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

Evaluation of an automated insulated isothermal polymerase chain reaction system for rapid and reliable, on-site detection of African swine fever virus.

OBJECTIVE: To evaluate the utility of an automated insulated isothermal PCR (iiPCR) system for rapid and reliable on-site detection of African swine fever virus (ASFV) in swine biological samples. SAMPLE: Lymph node, tissue homogenate, whole blood, serum, spleen, and tonsil samples collected from swine in North and South Vietnam. PROCEDURES: Analytic sensitivity of the iiPCR system was determined by serial dilution and analysis of 2 samples (swine tissue homogenate and blood) predetermined to be positive for ASFV. Analytic specificity was assessed by analysis of 2 samples predetermined to be negative for ASFV and positive or negative for other swine pathogens (classical swine fever virus, porcine reproductive and respiratory syndrome virus, foot-and-mouth disease virus, and porcine circovirus type 2). Diagnostic performance of the iiPCR system for detection of ASFV was determined by analysis of the various tissue sample types. For all tests, a real-time PCR assay was used as the reference method. RESULTS: The iiPCR system was able to detect ASFV in swine blood or tissue homogenate at dilutions up to 106, whereas the real-time PCR assay was able to detect dilutions of up to 105 or 106. The iiPCR system had high analytic specificity for detection of ASFV versus other swine pathogens. Between 97% and 100% agreement was found between results of the iiPCR system for the various tissue samples and results of real-time PCR assay. CONCLUSIONS AND CLINICAL RELEVANCE: The evaluated iiPCR system was found to be a rapid, reliable, and sample-flexible method for ASFV detection and may be useful for disease surveillance and quarantine in national strategies for early ASF control.

Measuring Wasting and Stunting Prevalence Among Children Under 5 Years of Age and Associated Risk Factors in Papua New Guinea: New Evidence From the Comprehensive Health and Epidemiological Surveillance System.

Background: Papua New Guinea (PNG) has undergone a significant health transition, with the prevalence of non-communicable diseases increasing. Many children under 5 years of age suffer from the burden of malnutrition. While wasting and stunting still remain high, children who are overweight and obese are reportedly increasing. Objective: This study reports the prevalence of wasting, stunting, underweight, and overweight children under five in PNG and explores potential household and maternal socioeconomic factors associated with malnutrition. Method: Data were drawn from the Comprehensive Health and Epidemiological Surveillance System (CHESS) in PNG. Height and weight were directly measured, and wasting, stunting, overweight, and underweight statistics were determined using the 2006 WHO Standard Growth Standards. Household and maternal factors were assessed with parent interviews conducted by trained data collectors. Multivariate logistic regression analyses were conducted to report associations between selected socioeconomic correlates and child malnutrition outcomes. Result: The prevalence of wasting, stunting, underweight, and overweight children was 13.8, 46.5, 18.2, and 18%, respectively. Children from households with food shortage were more likely to be wasted than those from households without such an experience [OR: 1.43 (95% CI: 0.93-2.21)]. Children from the poor quintile were more likely to be stunted than those from the richest quintile [OR: 1.2 (95% CI: 0.79-1.82)]. Other factors associated with wasting included living in an urban vs. rural area [OR: 1.36 (0.77-2.4)], middle household wealth quintile vs. richest quintile [OR: 0.77 (0.38-1.55)], mothers in union with a man vs. mother unmarried or live in union [OR: 0.76 (0.4-1.42)], and male children vs. female [OR: 0.77 (0.53-1.11)]. Factors associated with stunting included residing in urban vs. rural areas [OR: 1.13 (0.8-1.6)], mother in union vs. single mother [OR: 0.86 (0.59-1.24)], and mothers with preparatory/elementary vs. mothers with vocational/college education [OR: 0.15 (0.02-1.01)]. Conclusion: An integrated approach is needed to comprehensively address the household socioeconomic factors at the household level, contributing to the improvement of child health and development in PNG.

Breastfeeding Rate, Food Supplementation, Dietary Diversity Among Children Aged 6-59 Months, and Associated Factors in Papua New Guinea.

Background: Along the socioeconomic changes in the past decades, Papua New Guinea (PNG) has undergone significant food transition. Little is known about the influence of household and maternal socioeconomic demographic factors on dietary intake and diversity among children under 5 years of age (CU5). Objective: This study aimed to examine breastfeeding rate, food supplementation, dietary intake, and diversity among children aged 6-59 months and to identify associations with household and maternal socioeconomic demographic factors in PNG. Method: Data from 2,943 children were extracted from the Comprehensive Health and Epidemiological Surveillance System database, operated by the PNG Institute of Medical Research and used to estimate breastfeeding rate, food supplementation, and dietary intake of CU5 in a typical week. Dietary diversity score (DDS) was used as a proxy indicator to measure nutrient adequacy. Associations of DDS with household and maternal socioeconomic and demographic factors were examined using multivariate logistic regression analysis. Result: The breastfeeding rate among children aged 6-8 months was 85% (70% in urban and 90% in rural sectors), and 50% of children of this age group were fed with supplementary foods. Twenty percent of children aged 6-23 months were currently breastfed and received solid, semisolid, and soft foods three times or more per day. Forty-eight percent of children aged 6-59 months had a total DDS below the average level (23 scores). Place of residence, mother's education, and household wealth were associated with dietary diversity among studied children. Children in urban areas are 10% more likely to have a lower level of total DDS than those in rural areas (OR: 1.11 [0.79-1.56]; p-value: 0.5). Children whose mothers had a primary education level were 1.6-fold more likely to have a lower level of total DDS than children whose mothers had vocational training or college education (OR: 1.63 [0.68-3.92]; p-value: 0.28). Children from the poorest households were 1.2-fold more likely to have a lower DDS than those from the richest households (OR: 1.22 [0.79-1.87]; p-value: 0.37). Discussion: A range of factors has been identified, contributing to the eating behaviors among CU5 in PNG, in which mother's education and household wealth are among the most important determinants of childhood dietary diversity as they have a direct effect on accessibility to and affordability of a variety of foods at the household level. Conclusion: Evidence-based integrated and comprehensive approaches are needed to improve women education and household wealth, contributing to the improvement of food diversity among young children in PNG.

Estimating Child Mortality at the Sub-national Level in Papua New Guinea: Evidence From the Integrated Health and Demographic Surveillance System.

BACKGROUND: Child mortality is an important indication of an effective public health system. Data sources available for the estimation of child mortality in Papua New Guinea (PNG) are limited. OBJECTIVE: The objective of this study was to provide child mortality estimates at the sub-national level in PNG using new data from the integrated Health and Demographic Surveillance System (iHDSS). METHOD: Using direct estimation and indirect estimation methods, household vital statistics and maternal birth history data were analysed to estimate three key child health indicators: Under 5 Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) for the period 2014-2017. Differentials of estimates were evaluated by comparing the mean relative differences between the two methods. RESULTS: The direct estimations showed U5MR of 93, IMR of 51 and NMR of 34 per 1000 live births for all the sites in the period 2014-2017. The indirect estimations reported an U5MR of 105 and IMR of 67 per 1000 live births for all the sites in 2014. The mean relative differences in U5MR and IMR estimates between the two methods were 3 and 24 percentage points, respectively. U5MR estimates varied across the surveillance sites, with the highest level observed in Hela Province (136), and followed by Eastern Highlands (122), Madang (105), and Central (42). DISCUSSION: The indirect estimations showed higher estimates for U5MR and IMR than the direct estimations. The differentials between IMR estimates were larger than between U5MR estimates, implying the U5MR estimates are more reliable than IMR estimates. The variations in child mortality estimates between provinces highlight the impact of contextual factors on child mortality. The high U5MR estimates were likely associated with inequality in socioeconomic development, limited access to healthcare services, and a result of the measles outbreaks that occurred in the highlands region from 2014-2017. CONCLUSION: The iHDSS has provided reliable data for the direct and indirect estimations of child mortality at the sub-national level. This data source is complementary to the existing national data sources for monitoring and reporting child mortality in PNG.

Measuring unmet need for contraception among women in rural areas of Papua New Guinea.

Located in the South West Pacific region, with a population of 7.5 million, Papua New Guinea (PNG) is among a group of Pacific countries with sub-optimal health status. The maternal mortality ratio is 171 per 100,000 live births. Unmet need for contraception and family planning services, although poorly understood in PNG, may be one of the underlying causes of poor maternal health. This study set out to measure the prevalence and trends in unmet need for contraception and the identified socioeconomic factors associated with contraceptive use among women of reproductive age (15-49 years) in PNG. Data available from the Integrated Health and Demographic Surveillance System (IHDSS) were used in this study. A sub-population data set was extracted of 1434 women who gave birth in the preceding two years and resided in four rural surveillance sites: Asaro, Hides, Hiri and Karkar. Analyses of unmet need for contraception were performed with respect to birth spacing and limiting the number of births. Unmet need for contraception was 34% for the previous birth, 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and utilisation of contraceptives are required.

Diarrhoeal disease surveillance in Papua New Guinea: findings and challenges.

Diarrhoeal diseases are among the leading causes of morbidity and mortality in the Western Pacific Region. However, data on the major causes of infectious diarrhoea are limited in many countries within the Region, including Papua New Guinea. In 2013-2014, we conducted surveillance for acute diarrhoeal illness in four provinces in Papua New Guinea. One rural health clinic from each province participated in the surveillance activity. Samples were sent to central laboratories and batch analysed for bacterial and viral gastrointestinal pathogens that are commonly associated with diarrhoea. Across the four sites, the most commonly detected pathogens were Shigella spp., Campylobacter spp. and rotavirus. In this paper, we report the results of the surveillance activity and the challenges that we faced. The lessons learnt may be applicable to other parts of the Region with a similar socioeconomic status.

The epidemiological transition in Papua New Guinea: new evidence from verbal autopsy studies.

BACKGROUND: Recent economic growth in Papua New Guinea (PNG) would suggest that the country may be experiencing an epidemiological transition, characterized by a reduction in infectious diseases and a growing burden from non-communicable diseases (NCDs). However, data on cause-specific mortality in PNG are very sparse, and the extent of the transition within the country is poorly understood. METHODS: Mortality surveillance was established in four small populations across PNG: West Hiri in Central Province, Asaro Valley in Eastern Highlands Province, Hides in Hela Province and Karkar Island in Madang Province. Verbal autopsies (VAs) were conducted on all deaths identified, and causes of death were assigned by SmartVA and classified into five broad disease categories: endemic NCDs; emerging NCDs; endemic infections; emerging infections; and injuries. Results from previous PNG VA studies, using different VA methods and spanning the years 1970 to 2001, are also presented here. RESULTS: A total of 868 deaths among adolescents and adults were identified and assigned a cause of death. NCDs made up the majority of all deaths (40.4%), with the endemic NCD of chronic respiratory disease responsible for the largest proportion of deaths (10.5%), followed by the emerging NCD of diabetes (6.2%). Emerging infectious diseases outnumbered endemic infectious diseases (11.9% versus 9.5%). The distribution of causes of death differed across the four sites, with emerging NCDs and emerging infections highest at the site that is most socioeconomically developed, West Hiri. Comparing the 1970-2001 VA series with the present study suggests a large decrease in endemic infections. CONCLUSIONS: Our results indicate immediate priorities for health service planning and for strengthening of vital registration systems, to more usefully serve the needs of health priority setting.

Correction: Socio-economic status and behavioural and cardiovascular risk factors in Papua New Guinea: A cross-sectional survey.

[This corrects the article DOI: 10.1371/journal.pone.0211068.].

Socio-economic status and behavioural and cardiovascular risk factors in Papua New Guinea: A cross-sectional survey.

BACKGROUND: Risk factors for cardiovascular disease (CVD) are negatively correlated with socio-economic status (SES) in high-income countries (HIC) but there has been little research on their distribution by household SES within low-and middle-income countries (LMICs). Considering the limited data from LMICs, this paper examines the association between behavioural and cardiovascular risk factors and household SES in Papua New Guinea (PNG). METHODS: Reported here are results of 671 participants from the 900 randomly selected adults aged 15-65 years. These adults were recruited from three socioeconomically and geographically diverse surveillance sites (peri-urban community, rural Highland and an Island community) in PNG in 2013-2014. We measured their CVD risk factors (behavioural and metabolic) using a modified WHO STEPS risk factor survey and analysis of blood samples. We assessed SES by education, occupation and creating a household wealth index based on household assets. We calculated risk ratios (RR) and their 95% confidence intervals (CI) using a generalized linear model to assess the associations between risks and SES. FINDINGS: Elevated CVD risk factors were common in all SES groups but the CVD metabolic risk factors were most prevalent among homemakers, peri-urban and rural highlands, and the highest (4th and 5th) wealth quintile population. Adults in the highest wealth quintile had high risks of obesity, elevated HbA1c and metabolic syndrome (MetS) that were greater than those in the lowest quintile although those in the highest wealth quintiles were less likely to smoke tobacco. Compared to people from the Island community, peri-urban residents had increased risks of increased waist circumference (WC) (RR: 1.67, 95%CI: 1.21-2.31), hypertension (RR: 2∙29, 95%CI: 1∙89-4.56), high cholesterol (RR: 2∙22, 95%CI: 1∙20-4∙10), high triglycerides (RR: 1∙49, 95%CI: 1∙17-1∙91), elevated HbA1c (RR: 5∙54, 95%CI: 1∙36-21∙56), and Metabolic syndrome (MetS) (RR: 2∙04, 95%CI: 1∙25-3∙32). Similarly, Rural Highland residents had increased risk of obesity (Waist Circumference RR: 1∙70, 95%CI: 1∙21-3∙38, Waist-Hip-Ratio RR:1∙48, 95%CI: 1∙28-1∙70), hypertension (RR: 2∙60, 95%CI: 1∙71-3∙95), high triglycerides (RR: 1∙34, 95%CI: 1∙06-1∙70) and MetS (RR: 1∙88, 95%CI: 1∙12-3∙16) compared to those in the rural Island site. INTERPRETATION: CVD risk factors are common in PNG adults but their association with SES varies markedly and by location. Our findings show that all community members are at risk of CVD weather they are part of high or low SES groups. These results support the notion that the association between CVD risk factors and SES differ greatly accordingly to the type of SES measure used, risk factors and the population studied. In addition, our findings contribute further to the limited literature in LMIC. Longitudinal studies are needed to monitor changes in rapidly changing societies such as PNG to inform public health policy for control and prevention of NCDs in the country.