Title
Socio-demographic factors associated with diarrhoea among children under-5-years in Papua New Guinea

Introduction
Diarrhoea remains a significant global health challenge among children under 5 years (CU5). Limited research exists on diarrhoea prevalence and correlates among CU5 in Papua New Guinea (PNG). This study aimed to describe prevalence and identify socio-demographic factors associated with diarrhoea among CU5 in PNG.

Methods
This cross-sectional study used two data collection waves: 2016 (n=4,143 children in Central, Eastern Highlands, and Hela provinces) and 2019 (n=4,123 children in Central, Eastern Highlands, Madang, National Capital District and East New Britain provinces). For 2016, the independent factors included surveillance sites, child age, place of birth, child stool disposal and house roof material. For 2019 the independent factors were surveillance sites, child age, childhood vaccination status and drinking water treatment. The dependent factor was diarrhoea prevalence within 2 weeks prior to data collection. Binary logistic regression analysis was performed with unadjusted odds ratios at 95% confidence level (p≤0.05).

Ethical approval was obtained from the University of Wollongong Social Science Human Research Ethics Committee (#2023/231), PNG Institute of Medical Research Institutional Review Board (#2403), and the PNG Medical Research Advisory Committee (#24.4). Informed consent was given by the children's parents/caregivers.

Results
In 2016, 286/2185 (13.1%) CU5 had diarrhoea. Diarrhoea odds were 4 times higher in Hela province compared to Central province [OR: 4.44, 95% CI: (1.11, 17.73)] and 12 times higher in children aged 0-12 months compared to 48-59 months [OR: 12.83, 95% CI: (1.01, 162.94)].

In 2019, 308/3492 (8.8%) CU5 experienced diarrhoea. The odds of diarrhoea were 4.6 times higher among children in Eastern Highlands compared to those in Central province [OR: 4.59, 95% CI: (1.19, 17.71)]. Children aged 24-35 months [OR: 6.16, 95% CI: (1.48, 25.65)] and 36-47 months [OR: 23.33, 95% CI: (5.91, 92.16)] had higher odds of diarrhoea compared to children aged 48-59 months. Unvaccinated children had nearly 4 times higher odds of diarrhoea compared to vaccinated children [OR: 3.96, 95% CI: (1.31, 11.97)].

Conclusion
Children from the Highlands provinces, children in the younger age groups (0-12, 24-35, 36-47 months old), and lack of childhood vaccinations were associated with higher diarrhoea odds in PNG. Targeted public health interventions focused on vaccination coverage, water, sanitation and hygiene infrastructure in rural and urban settings needs strengthening to reduce the burden of childhood diarrhoea. Effective prevention measures are essential for better child health outcomes in PNG.

Key words
Children under-5 years old, diarrhoea, socio-demographic factors, Papua New Guinea

Background: The COVID-19 pandemic has exacerbated mental health challenges worldwide, disproportionately affecting older adults. While Japan has one of the most rapidly ageing populations, limited longitudinal evidence exists on how the pandemic altered mental health trajectories and whether it widened existing socioeconomic inequalities.
Methods: We analyzed five waves (2019–2023) of nationally representative panel data to assess changes in psychological distress and subjective well-being among adults aged ≥65 years. Psychological distress was measured using the Kessler-6 (K6) scale, and subjective well-being by self-reported happiness. Linear mixed-effects models with individual-level random intercepts were used to estimate within-person changes over time. Interaction terms between year and income level were included to evaluate differential impacts across socioeconomic strata. Models were adjusted for age, sex, marital status, household composition, personality traits, smoking, alcohol use, and BMI.
Results: Psychological distress (K6) increased significantly during the COVID-19 period (2020–2021) compared to the 2019 baseline (p < 0.01) and remained elevated through 2023, with only partial post-pandemic recovery. Self-reported happiness declined during the pandemic and did not return to pre-COVID levels.The rise in distress was significantly greater among individuals in the lowest income quintile (time × income interaction, p < 0.01), indicating widening mental health inequalities. Distress was consistently higher among those living alone, while cohabitation with a spouse or family was protective. Personality traits also moderated the impact: individuals with lower conscientiousness or higher neuroticism experienced more persistent increases in distress, independent of other covariates.
Conclusions: COVID-19 amplified mental health disparities among older adults in Japan, especially across socioeconomic and psychosocial lines. These findings underscore the need for collaborative and equitable public health responses that recognize the intersection of mental health, ageing, and social inequality, to protect vulnerable older populations in future crises.

Abstract
Background:

Over the past few decades, global gains in life expectancy have not been distributed evenly. Countries in sub-Saharan Africa and South Asia continue to experience high rates of premature mortality, largely driven by infectious diseases, neonatal conditions, and maternal mortality. Traditional summary measures such as life expectancy at birth often mask important changes in adult survival. This study leverages the modal age at death—a measure highlighting the most common age at death within a population—to provide a more nuanced understanding of mortality transitions, especially in resource-limited settings.

Methods:

We analyzed demographic and cause-of-death data from 11 Health and Demographic Surveillance System (HDSS) sites across eight countries in sub-Saharan Africa and South Asia (including South Africa, Mozambique, Malawi, Kenya, Ethiopia, Ghana, Burkina Faso, and Bangladesh). Causes of death were assigned using standardized verbal autopsy interviews and interpreted with the InterVA probabilistic model. We estimated the modal age at death for all-cause and leading cause-specific mortality using advanced statistical smoothing techniques (P-splines), allowing for robust comparison across regions, time, sex, and cause.

Results:

Our findings reveal marked regional disparities in the leading causes of mortality and the modal age at death. In Southern Africa, substantial declines in HIV/AIDS mortality have been accompanied by increasing modal ages at death, particularly following the introduction of antiretroviral therapy (ART). However, cardiovascular diseases and other non-communicable diseases (NCDs) are becoming more prominent causes of adult death. In South Asia, NCDs—especially cardiovascular disease—predominate, with modal ages at death consistently higher than in most African sites. West and East African sites continue to experience high burdens of infectious diseases, with slower increases in the modal age at death. Across all regions, women generally experience higher modal ages at death than men, reflecting both biological and social determinants.

Discussion:

This study demonstrates the value of the modal age at death as a sensitive indicator for capturing shifts in adult longevity and cause-specific mortality in low-resource settings. Our findings highlight the importance of sustained investment in both infectious disease control and NCD prevention, as well as the need for strengthened health systems capable of responding to evolving disease patterns. The research draws on international collaboration across HDSS networks and illustrates how harmonized, community-based data can inform public health leadership and policy, particularly in contexts where official vital registration is weak or absent.

Conclusion:

By applying innovative demographic methods and cross-site data harmonization, this study provides new insights into mortality transitions and the effectiveness of interventions such as ART in extending adult survival. These results can support policymakers, practitioners, and advocates in designing context-specific strategies that address both persistent and emerging health challenges, contributing to the conference’s broader aim of fostering leadership and collaboration to connect a divided world

Papua New Guinea (PNG) is one of Australia's closest and most important partners due to close historical ties and geographic proximity, and plays an important role in the health security and stability of the Pacific. Since 2019, there has been ongoing collaborative research and skill exchange between the Australian Defence Force Malaria and Infectious Disease (ADFMIDI) and Papua New Guinea Defence Force (PNGDF) Health Services. Efforts have focussed on surveillance of both non-communicable (NCD) and communicable diseases (CD) to inform PNGDF Health Services on health status and practices of PNGDF and their families. This in turn informs PNGDF health policy and practice and informs ADF health support plans for PNG deployments.

We have successfully conducted bacterial antimicrobial resistance (AMR) surveillance and cardiovascular disease and diabetes risk assessments among PNGDF in various locations of PNG with annual surveys over the last 3 years. We have also conducted environmental risk assessments of presence of disease vectors and infectious pathogens in the working and living environment of PNGDF and their families.

Results have identified areas of risk requiring intervention, including antibiotic prescription practices, nutrition counselling, disease vector control and correct access to ground water. This has led to several combined public health training workshops to design appropriate interventions and policy, as well as capacity building to maintain ongoing surveillance and investigations led by the PNGDF.

Through a continuous dialogue, key challenges such as funding, access to health and laboratory infrastructure, and health misinformation were discussed and factored into planned preventative strategies. Strong health messaging at individual level and among at risk populations were a primary approach, with use of both mobile applications and one-on-one counselling. Capacity building for low cost mobile laboratories to conduct surveillance were also effective.

A sustained commitment with agreed goals on clear health outcomes have led to a fruitful and mutually beneficial health engagement between the two groups and has become a model for future health engagements with other international regional partners.

Background: Globally, Deaf communities face significant barriers in accessing mental health resources due to social exclusion and systemic marginalization. In Bangladesh, these challenges are further exacerbated by a historical neglect of Deaf mental health, reflected in the absence of relevant research. Recent studies also highlight a critical gap in the literature, noting limited research on Bangladeshi sign language and a general lack of comprehensive datasets on Bangladeshi sign vocabulary. This study aimed to explore the mental health understanding and struggles of the Deaf community in Bangladesh, with the goal of co-developing culturally and linguistically appropriate digital mental health tools in collaboration with Deaf individuals, sign language interpreters, and mental health professionals.

Methods: Two exploratory workshops were conducted to investigate the experiences and mental health awareness of Deaf individuals (n=12), and their caregivers (n=4), facilitated by sign language interpreters (n=4). These workshops revealed a significant gap in Bangla Sign Language vocabulary related to mental health. In response, the research team initiated the development of the first digitally delivered Bangla Mental Health Sign Language Bank through an adapted Delphi study and focus group approach. The three-phased Delphi study involved mental health professionals (n=9), Deaf individuals (n=5), and sign language interpreters (n=3) to identify and prioritize essential mental health terms. This was followed by three focus groups with Deaf individuals (n=6) and sign language interpreters (n=4) to collaboratively develop the final sign language bank digitally.

Results: Qualitative findings from the workshops revealed five major themes: social stigmatisation and discrimination, social isolation, denial of healthcare support, inability to express emotions, lack of mental health support, and the supportive role of family and mental health awareness. These exploratory insights informed the development of an accessible and inclusive digital mental health resource—the Bangla Mental Health Sign Language Bank—through a participatory action research approach. The co- development process of the sign language bank is detailed in this paper.

Interpretation: This research explored the mental health struggles of the Deaf community and presented a novel digital resource to ensure a shared understanding of mental health terms among the Deaf community. It can pave the way to design future digital tools to support the mental health of Deaf communities in Bangladesh and similar settings.

Abstract
Background: Health system responsiveness (HSR) is the ability to respond to universal legitimate expectations of service consumers. This contributes to achieving short and long-term health sector goals, such as universal health coverage. However, no comprehensive summary of evidence exists on how HSR can achieve universal maternal health services. Therefore, we aim to examine the successes, challenges, and strategies of HSR toward universal maternity care in East Africa.
Methods: We conducted a mixed-methods systematic review of studies published from 1 January 2020 to 8 June 2024. Articles were searched using six databases: Medline, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest. We used three main search terms: HSR, maternal health, and East Africa. A mixed-methods appraisal tool was used to assess the quality and methodological validity of the studies. We then analysed and synthesised the data using the World Health Organization HSR framework components.
Results: A total of 72 articles (23 quantitative, 15 mixed-method, and 34 qualitative) were included. This review revealed that the responsiveness of obstetric services ranged from 45.8% to 75.6%. Challenges contributing to poor HSR, include limited decision-making autonomy, breaches of confidentiality, non-dignified care, poor communication, delay in care, and unhygienic maternity care. However, maintaining confidentiality, providing abuse-free care, permitting companions, and ensuring informed consent improved responsiveness.
Conclusion: Low HSR continues to be a challenge for universal access to maternal healthcare services in East Africa. The challenges to providing a responsive health system reduced the quality of care and limited essential support during maternity care. Ensuring responsive maternity services requires continuous attention from policymakers, managers, and healthcare providers. Strengthening HSR will promote inclusive, effective, and respectful care that safeguards women's rights and ensures equitable care regardless of their circumstances.
Keywords: East Africa, Health System Responsiveness, Maternal Health Service, Universal