Childhood diarrhoea and acute respiratory infection in Samoa and Tonga -  analysis of national surveys with public health implications.     — The Association Specialists
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  3. Childhood diarrhoea and acute respiratory infection in Samoa and Tonga -  analysis of national surveys with public health implications.    

Childhood diarrhoea and acute respiratory infection in Samoa and Tonga -  analysis of national surveys with public health implications.     (23956)

Tracey L Boyce 1 , Maria E Castellanos 2 , Maxine Whittaker 2 , Satupaitea Viali 3
  1. College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
  2. College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
  3. Oceania University of Medicine, Apia, Samoa

 

Background: Diarrhoea and acute respiratory infection (ARI) are leading causes of morbidity and mortality in children under five globally. However, comparative epidemiological evidence from Pacific Island countries remains limited. Small island nations are often assumed to share similar public health profiles, yet these countries each have unique cultural and environmental contexts. This study compared socio-economic factors associated with diarrhoea and ARI within and between Samoa and Tonga.

 

Methods: A secondary data analysis of the UNICEF 2019-2020 Multiple Indicator Cluster Surveys  (MICS)  Round 6 for Samoa and Tonga was performed. The prevalence of diarrhoea and ARI in children under five was calculated for each country. Complex survey bivariate and multivariate logistic regression models were used, incorporating child sample weights, stratification and clustering. Variables included age, sex, residence, region, household wealth, hygiene, water quality, malnutrition, cooking fuel, Hib vaccination, and household smoking.

 

Results: Diarrhoea prevalence in children under 5 was 4.3% in Samoa and 3.3% in Tonga, while ARI prevalence was 2.4% and 2.1% respectively. Despite similarities between the countries, risk profiles differed. In Samoa, residing on Savai'i island was protective for both diarrhoea and ARI, suggesting possible place-based infrastructure influences. In Tonga, diarrhoea and ARI were both associated with age, and also with male sex and maternal smoking for ARI – these associations were absent in Samoa.

 

Conclusion: Rigorous comparative epidemiological analysis of MICS data between Pacific Island nations, even with low outcome prevalence, can generate important policy-relevant insight that could be obscured in broader regional analysis. The absence of strong associations with many of the traditional socio-economic determinants suggests that cultural practices or environmental factors may play a more substantial role and cross-country comparisons can highlight these context-specific differences. In turn, this can support the development of targeted prevention strategies and guide future research priorities in Pacific Island settings.