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.

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.

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.

Physical activity and screen time in out of school hours care: an observational study.

BACKGROUND: This study aimed to describe, and identify predictors of, physical activity and screen time in children attending out of school hours care (OSHC). METHOD: Twenty-three randomly selected OSHC centres (n = 1068 children) participated in this observational, cross-sectional study. Service directors completed interviews regarding policy, training, scheduling and equipment related to physical activity and screen time. Children's activity behaviours (moderate to vigorous physical activity (MVPA), light physical activity, sedentary time and screen time) were measured using standardised direct observation. RESULTS: Directors' interviews revealed a lack of formal policy guiding physical activity and screen time. Time spent in activity behaviours varied widely among OSHC services; for example, average time spent in MVPA ranged from 4 to 49% of the session, time spent sedentary ranged from 31 to 79%, and screen time accounted for 0 to 41%. MVPA was inversely associated with total sedentary time (p < 0.001). Higher screen time was associated with OSHC services being larger in size (p = 0.04), offering screen activities on a daily basis (as opposed to less than daily; p = 0.001), offering screen activities prior to 5 pm (as opposed to offering screen activity 5 pm or later; p = 0.02), and having a larger number of screen devices available (p = 0.08). CONCLUSION: Physical activity and screen time practices in OSHC services are currently ad hoc and variable. In future, development of guidelines, policy and intervention programs may help improve physical activity and screen time in the OSHC setting.

Evaluation of Actical equations and thresholds to predict physical activity intensity in young children.

Abstract This study examined the validity of current Actical activity energy expenditure (AEE) equations and intensity cut-points in preschoolers using AEE and direct observation as criterion measures. Forty 4-6-year-olds (5.3 ± 1.0 years) completed a ~150-min room calorimeter protocol involving age-appropriate sedentary behaviours (SBs), light intensity physical activities (LPAs) and moderate-to-vigorous intensity physical activities (MVPAs). AEE and/or physical activity intensity were calculated using Actical equations and cut-points by Adolph, Evenson, Pfeiffer and Puyau. Predictive validity was examined using paired sample t-tests. Classification accuracy was evaluated using weighted kappas, sensitivity, specificity and area under the receiver operating characteristic curve. The Pfeiffer equation significantly overestimated AEE during SB and underestimated AEE during LPA (P < 0.0125 for both). There was no significant difference between measured and predicted AEEs during MVPA. The Adolph cut-point showed significantly higher accuracy for classifying SB, LPA and MVPA than all others. The available Actical equation does not provide accurate estimates of AEE across all intensities in preschoolers. However, the Pfeiffer equation performed reasonably well for MVPA. Using cut-points of ≤6 counts · 15 s(-1), 7-286 counts · 15 s(-1) and ≥ 287 counts · 15 s(-1) when classifying SB, LPA and MVPA, respectively, is recommended.

Results from Australia's 2014 Report Card on Physical Activity for Children and Youth.

BACKGROUND: Like many other countries, Australia is facing an inactivity epidemic. The purpose of the Australian 2014 Physical Activity Report Card initiative was to assess the behaviors, settings, and sources of influences and strategies and investments associated with the physical activity levels of Australian children and youth. METHODS: A Research Working Group (RWG) drawn from experts around Australia collaborated to determine key indicators, assess available datasets, and the metrics which should be used to inform grades for each indicator and factors to consider when weighting the data. The RWG then met to evaluate the synthesized data to assign a grade to each indicator. RESULTS: Overall Physical Activity Levels were assigned a grade of D-. Other physical activity behaviors were also graded as less than average (D to D-), while Organized Sport and Physical Activity Participation was assigned a grade of B-. The nation performed better for settings and sources of influence and Government Strategies and Investments (A- to a C). Four incompletes were assigned due to a lack of representative quality data. CONCLUSIONS: Evidence suggests that physical activity levels of Australian children remain very low, despite moderately supportive social, environmental and regulatory environments. There are clear gaps in the research which need to be filled and consistent data collection methods need to be put into place.

Dietary outcomes of the healthy dads healthy kids randomised controlled trial.

Fathers have not been exclusively targeted in family-based lifestyle programmes. The aim was to determine whether dietary intakes of fathers and children can be improved, following an intervention targeting fathers. Overweight and obese fathers (n=50, 21-65 years, body mass index [mean ± standard deviation] 33.3 ± 4.1) and their children (5-12 years) were recruited. Dietary intake was assessed at baseline and 6 months (n=35) by food frequency questionnaire. Linear mixed models determined differences by time. Fathers significantly reduced portion size (P=0.03) but not energy intakes, whereas children reduced energy intakes (kJ) (P=0.02). There is an opportunity to target fathers as to improve child intakes.