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.

'Social screens' and 'the mainstream': longitudinal competitors of non-organized physical activity in the transition from childhood to adolescence.

BACKGROUND: Physical activity (PA) tends to decline during late childhood and adolescence. In Australia, this decline has been shown to occur particularly in non-organized PA (e.g. active play and informal sport). Using a social marketing approach, segments of youth may be identified and targeted based on their profile of alternative activities that compete with non-organized PA during the transition to adolescence. The objectives of this study were to identify and describe segments of youth whose participation in non-organized PA declined between 11 and 13 years, based on changes in other potential competing activities during this period. METHODS: Data were sourced from Waves 4 and 5 of the Longitudinal Study of Australian Children. Participation in non-organized PA and thirteen alternative activities (e.g. video games, homework, sleep) were measured using 24-h time-use diaries. Analyses were limited to participants whose non-organized PA had declined between 11 and 13 years (n = 1043). Two-stage cluster analysis was conducted and segments were described using chi-square and t-tests. RESULTS: Among the analytic sample, average non-organized PA participation declined by 87 min/day between 11y and 13y (p < 0.001). Two segments were identified (κ = 0.66). The 'Social Screens' segment (n = 143) had large increases in texting, emailing and social media use (+ 56 min/day, p < 0.001) and other internet use (+ 32 min/day, p < 0.001). Conversely, 'the Mainstream' segment (n = 900) had smaller increases in a wider range of activities, including other PA (organized PA, active transport, active chores/work) (+ 16.0 min/day, p < 0.001), homework/study (+ 9.5 min/day, p < 0.001) and electronic gaming (+ 6.7 min/day, p < 0.05). 'Social Screens' were more likely to attend public school, live in urban areas and have more advanced pubertal development (girls only). 'The Mainstream' were more likely to participate in PA and out-of-school activities. CONCLUSIONS: The 'Social Screens' segment had a much larger increase in texting, emailing, social media and other internet use, and lower participation in overall PA and out-of-school activities, compared with 'the Mainstream'. Future research may trial PA promotion strategies to replace benefits that this segment may seek in competing activities (e.g. social PA apps).