Tropical Population Health Unit

Hesitancy about the COVID-19 vaccine in high-income countries can be caused by diverse psychological and social factors. Few studies on vaccine concerns have examined the interplay of the effects of mental disorders, social and economic factors, gender and refugee status. To investigate these issues, this article reports findings from the 2023 wave of a longitudinal study involving 709 women who are mothers of young children in Australia, both refugees and Australian-born. Respondents were asked if they had any worries or fears about receiving the COVID-19 vaccine. In previous waves they completed standardized assessments of mental health and sociodemographic factors. An open-ended question provided insights into the reasons for self-reported vaccine concerns. Descriptive statistics and binary logistic regression analyses were conducted, and demographic adjusted logistic regression undertaken separately for Australian-born and refugee women. Formal comparisons of effect sizes between Australian-born and refugee women were performed, with Cohen's d quantifying the magnitude of these differences. Qualitative responses were coded by topic and ranked by frequency. More than half of the respondents reported worries about receiving a COVID-19 vaccine. Concerns were significantly higher for younger age women, those with a lower educational level and those with a history of mood disorder, panic disorder or separation anxiety disorder. Vaccine hesitancy was associated with poorer quality of life, living difficulties and disability among refugee women only. Separation anxiety disorder and a younger age were associated with an increased odds among Australian-born women only. The newness of the vaccine and concern about side effects were the greatest concerns among respondents who reported hesitancy. Young mothers with mental health problems and lower education need to be sensitively targeted to improve COVID-19 vaccine uptake. Mental health and public health professionals need to be aware of differences reported for women from refugee background. Improved quality of life and economic status will increase vaccine uptake among socioeconomically challenged communities.

Objectives: Western Australia’s unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19.Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics.Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS.Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.

The international border between Australia and Papua New Guinea (PNG) serves as a gateway for the delivery of primary and tertiary healthcare for PNG patients presenting to Australian health facilities with presumptive tuberculosis (TB). An audit of all PNG nationals with presumptive TB who presented to clinics in the Torres Strait between 2016 and 2019 was conducted to evaluate outcomes for PNG patients and to consider the consistency and equity of decision-making regarding aeromedical evacuation. We also reviewed the current aeromedical retrieval policy and the outcomes of patients referred back to Daru General Hospital in PNG. During the study period, 213 PNG nationals presented with presumptive TB to primary health centres (PHC) in the Torres Strait. In total, 44 (21%) patients were medically evacuated to Australian hospitals; 26 met the evacuation criteria of whom 3 died, and 18 did not meet the criteria of whom 1 died. A further 22 patients who met the medical evacuation criteria into Australia were referred to Daru General Hospital of whom 2 died and 10 were lost to follow-up. The cross-border movement of people from PNG into Australia is associated with an emergent duty of care. Ongoing monitoring and evaluation of patient outcomes are necessary for transparency and justice.

A scoping review was undertaken to examine current Australian federal, state and territory government health policy documents to ascertain their relevance to midlife and older adult sexual health. It was found that the sexual health of midlife and older adults was not specifically referred to in most documents reviewed. Existing policy has a focus on risk, not wellbeing, in relation to sexual health, and an emphasis on reproduction, which excludes midlife and older people. This paper provides evidence of absence of sexual health policy relating to the needs of midlife and older adults in Australia. Without a policy that specifically addresses the sexual health of midlife and older adults they will continue be overlooked in health promotion planning and sexually transmissible infection testing strategies. We recommend the development of Australian sexual health policy that supports and promotes good sexual relationships and sexual health specific to the needs of midlife and older adults. Key words: policy; sexual health; public health; sexuality and relationships; midlife; baby boomer; older adult; ageing; aging; scoping review

BackgroundIndoor residual spraying is key to dengue control in Cairns and other parts of northern Queensland, Australia, where Aedes aegypti is prevalent, but the strategy faces challenges with regards to slow application time and, therefore, community coverage. A faster potential improvement might be the use of polyethylene netting impregnated with the volatile pyrethroid metofluthrin (SumiOne™). This formulation was assessed in rooms in three houses in Cairns, Australia. One emanator was placed in each room and cages of 10 female Aedes aegypti were exposed at distances of 1 and 3 m. Knockdown and landings on a human hand were counted before metofluthrin exposure and at 10, 30, 60, 90 and 120 min during exposure. In addition, two trials continued over 48 h of exposure to assess the long-term sublethal effects of metofluthrin on caged mosquitoes.ResultsPercentage landing rates fell to 0–2.5% in the first 10 min of exposure. Knockdown was most evident between 10 and 30 min (54% at 1 m and 33% at 3 m). Distance from the emanator strongly affected the results: mosquitoes at 3 m exhibited less knockdown and more landings than those at 1 m. As room volume increased, knockdown decreased and the number of landing increased. There is a cumulative mortality and landing inhibition and, for mosquitoes exposed to metofluthrin for > 48 h, mortality was 100% at 1 m and 90% at 3 m. Of those still alive, a small number continued to land and bite. After being removed from metofluthrin-treated rooms, exposed insect cages were found to reducing landing rates for up to 2 h.ConclusionsDespite only moderate levels of knockdown during the initial hours of exposure, metofluthrin emanators were effective in reducing mosquito landing rates, especially within 1 m, even when exposed on an open veranda. The evaluation methods and results described in this paper will help inform the optimal conditions of deployment of metofluthrin emanators. These devices have the potential to reduce contact between humans and urban disease vectors faster than indoor residual spraying so supplement our current arsenal of dengue control tools.

To protect Australian amphibian biodiversity, we have identified and prioritised frog species at an imminent risk of extinction from chytridiomycosis, and devised national management and research priorities for disease mitigation. Six Australian frogs have not been observed in the wild since the initial emergence of chytridiomycosis and may be extinct. Seven extant frog species were assessed as needing urgent conservation interventions because of (1) their small populations and/or ongoing declines throughout their ranges (southern corroboree frog (Pseudophryne corroboree, New South Wales), northern corroboree frog (Pseudophryne pengilleyi, Australian Capital Territory, New South Wales), Baw Baw frog (Philoria frosti, Victoria), Litoria spenceri (spotted tree frog, Victoria, New South Wales), Kroombit tinkerfrog (Taudactylus pleione, Queensland), armoured mist frog (Litoria lorica, Queensland)) or (2) predicted severe decline associated with the spread of chytridiomycosis in the case of Tasmanian tree frog (Litoria burrowsae, Tasmania). For these species, the risk of extinction is high, but can be mitigated. They require increased survey effort to define their distributional limits and to monitor and detect further population changes, as well as well-resourced management strategies that include captive assurance populations. A further 22 frog species were considered at a moderate to lower risk of extinction from chytridiomycosis. Management actions that identify and create or maintain habitat refugia from chytridiomycosis and target other threatening processes such as habitat loss and degradation may be effective in promoting their recovery. Our assessments for some of these species remain uncertain and further taxonomical clarification is needed to determine their conservation importance. Management actions are currently being developed and trialled to mitigate the threat posed by chytridiomycosis. However, proven solutions to facilitate population recovery in the wild are lacking; hence, we prioritise research topics to achieve this aim. Importantly, the effectiveness of novel management solutions will likely differ among species due to variation in disease ecology, highlighting the need for species-specific research. We call for an independent management and research fund of AU$15 million over 5 years to be allocated to recovery actions as determined by a National Chytridiomycosis Working Group of amphibian managers and scientists. Procrastination on this issue will likely result in additional extinction of Australia’s amphibians in the near future.

We examined parent-child relationship quality and positive mental well-being using Medical Research Council National Survey of Health and Development data. Well-being was measured at ages 13–15 (teacher-rated happiness), 36 (life satisfaction), 43 (satisfaction with home and family life) and 60–64 years (Diener Satisfaction With Life scale and Warwick Edinburgh Mental Well-being scale). The Parental Bonding Instrument captured perceived care and control from the father and mother to age 16, recalled by study members at age 43. Greater well-being was seen for offspring with higher combined parental care and lower combined parental psychological control (p < 0.05 at all ages). Controlling for maternal care and paternal and maternal behavioural and psychological control, childhood social class, parental separation, mother’s neuroticism and study member’s personality, higher well-being was consistently related to paternal care. This suggests that both mother–child and father–child relationships may have short and long-term consequences for positive mental well-being.

Background: The nature and extent of pesticide exposure among women living in developing countries is likely to be different from women living in developed countries because of the differences in crops grown, nature of agriculture practices, education, behaviour, culture and the types and methods of pesticide use. However, few studies of pesticide exposure in females have been conducted in developing countries such as Yemen. Aims: The study aims to describe pesticide exposure among female agricultural workers living in Sana'a governorate and Sana'a city, Yemen. Methods: In this cross–sectional study a questionnaire was distributed to obtain information on pesticide exposure among 540 women who had a daughter enrolled in high school during 2011-2012. Women were asked about exposure before and after marriage. The change from being single to married may potentially lead to changes in the behaviours and type of work on the farm because of increases in household responsibilities after marriage. Results: Forty two precent of 410 women who returned the questionnaire reported working on a farm during their lifetime. Among these women the, 47% and 69% of women who reported working on a farm before and after marriage respectively indicated that pesticides were used on the farm where they worked. Among women who reported working on farms where pesticides were used before marriage, 45% reported not using any personal protective equipment, whereas 33% reported not using personal protective equipment after marriage. The most commonly pesticide reported to be used in the farms was the banned pesticide, dimethoate. Conclusions: The results of this study indicate that women working on farms in Yemen are likely to be exposed to pesticides. Hence, educational programs regarding the safety and use of pesticides and legislation promoting the use of safer pesticides is needed.

Performance evaluation of CIDARS on dengue fever outbreak detection, China HongLong Zhanga#, Zhongjie Lia#, Shengjie Laia, Archie Clementsb, Wenbiao Hub*, Weizhong Yanga* a Key Laboratory of Surveillance and Early-warning on infectious Disease, Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing 102206 b School of Population Health, The University of Queensland, Brisbane 4006 QLD, Australia #: These authors contributed equally *Correspondence? Weizhong Yang: yangwz@chinacdc.cn Wenbiao Hu: w.hu@sph.uq.edu.au Background For more effective prevention and control of dengue fever (DF), a China Infectious Disease Automated-alert and Response System (CIDARS) was used to identify possible early warning signals of DF outbreaks at country level in China. Aims This study aims to evaluate the performance of the CIDARS early warning system for DF. Methods In CIDARS a time series moving percentile method was used to detect the outbreak of DF. If the cases of reported DF are over 50 percentile of historical data, an early warning signal will be generated and sent to the local county CDC staff who are responsible for certifying and investigating the signals. In this study, descriptive analysis was used to display the spatial and temporal patterns of DF reported cases and early warning signals of DF during the study period. Sensitivity, specificity and timeliness were employed to assess the performance of DF early warning in CIDARS.Results There were 651 reported DF cases in China between 1st January 2009 and 31st December 2011. 58 signals were mostly occurred between August and December and distributed in Guangdong (35), Zhejiang (7) and Guangxi (4) provinces. 93.10% signals were responded within 24 hours. There were 9 outbreaks of DF recorded during study period with 8 (88.9%) outbreaks detected by CIDARS. The average time of outbreaks detection by CIDARS was 0.63 day. Conclusions CIDARS is a useful platform to detect the DF outbreak at early stage. More accurate algorithms could be tested to reduce the negative signals.