Aims and Scope Journal of Public Health and Emergency (J Public Health Emerg; JPHE; jphe.amegroups.com; ISSN: 2520-0054) is an open access, international, peer-reviewed online journal. It publishes original research articles and reviews on public health and emergency, including health improvement, health protection, service improvement, acute injury, sudden illness, etc. It aims to advance the research, policy, practice, and education of public health and emergency medicine. JPHE is indexed and covered by Web of Science [Emerging Sources Citation Index (ESCI)], and Scopus, and received its latest impact factor of 1.4 for the year 2025. We accept Original Articles as well as Review Articles, Editorials and other articles listed in the Author Instructions. All the submission and review process are managed through OJS system, an electronic system that ensures a rapid turnaround of manuscripts from submission to publication. JPHE is published by AME Publishing Company, with support from Wolters Kluwer (the journal content will be made available on Wolters Kluwer Health’s Lippincott and Ovid platforms). JPHE is sponsored by Jiangsu Provincial Center for Disease Control and Prevention (JSCDC) JPHE is co-sponsored by Nanjing Prevention and Treatment Center for Occupational Diseases (NJCOD) Changzhou Center for Disease Control and Prevention (CZCDC) Suzhou Center for Disease Control and Prevention (SZCDC) Zhangjiagang Center for Disease Control and Prevention (ZJGCDC) SIP Centers for Disease Control & Prevention (SIPCDC) Heron SKYTE Testing Services Indexing and Archiving Journal of Public Health and Emergency is indexed and covered by Web of Science [Emerging Sources Citation Index (ESCI)] Scopus Google Scholar Ovid Digital Preservation Portico Information for Authors JPHE is a member of Committee on Publication Ethics (COPE) and it follows the Committee on Publication Ethics (COPE)'s guidelines and the ICMJE recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journal. Manuscripts submitted must be the original work of the author(s) and must not be published previously or under consideration for publication elsewhere. Submission Turnaround Time In-house review: 1-3 weeks. External peer review: 1-3 months. Publication Ahead of Print: within 1 month after being accepted (with APC payment received). Formal publication: within 1-3 months after being accepted (with APC payment received). Original Articles are listed as priority. Publication Schedule Published continuously from Jan 2017 to Dec. 2021, JPHE now follows a quarterly publication model (March, June, September, December). Open Access Statement Journal of Public Health and Emergency is a peer reviewed, open access journal. All content of the journal is published under the Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). All articles published open access will be immediately and permanently free for all to read, download, copy and distribute as defined by the applied license. Free access and usage Permitted third party reuse is defined by the CC BY-NC-ND 4.0 license. This license allows users to copy and distribute the article, provided: this is not done for commercial purposes and further does not permit distribution of the Article if it is changed or edited in any way. the user gives appropriate credit (with a link to the formal publication through the relevant DOI) and provides a link to the license but not in an any way implying that the licensor is endorsing the user or the use of the work. no derivatives including remix, transform, or build upon the material was allowed for distribution. The full details of the license are available at https://creativecommons.org/licenses/by-nc-nd/4.0/ Copyright For open access publishing, this journal uses an exclusive licensing agreement. Authors will transfer copyright to AME Publishing Company, but will have the right to share their article in the same way permitted to third parties under the relevant user license, as well as certain scholarly usage rights. For any inquiry/special circumstance on the copyright, commercial usage or adaptation of JPHE articles, please contact: permissions@amegroups.com For reprint order, please contact: sales@amegroups.com Support for Authors to Comply with Funding Body Mandates We work with authors of research articles supported by funding bodies with open access mandates to ensure that authors can meet their funders’ requirements for public access to research results. In addition, we offer further support for authors who are required to comply with funding body mandates, including but not limited to: All articles published open access will be immediately and permanently free for everyone to read, download, copy and distribute. If a specific open access license is needed, please contact the editorial office for confirmation before submission. Example of statements in a published article: https://jgo.amegroups.org/article/view/76355/html. No copyright is claimed for any work of the U.S. government. Example of statements in published articles: https://actr.amegroups.org/article/view/8875; https://med.amegroups.org/article/view/8358/html. Contact with Editorial Office Aisling Luo, Corresponding Editor, Journal of Public Health and Emergency Email: jphe@amegroups.com Publisher Information JPHE is published by AME Publishing Company. Address: Hong Kong branch office: Flat/RM C 16F, Kings Wing Plaza 1, NO. 3 on Kwan Street, Shatin, NT, Hong Kong, China. Updated on July 10, 2026
AB165. Integrative Group Health Visits (IGHV) for managing healthy blood sugar
Background: Type 2 diabetes mellitus (T2DM) is a growing global epidemic, requiring creative, more sustainable strategies to equip patients with knowledge and tools that allow them to better manage their blood glucose control and prevent disease progression. Studies indicate that empowering diabetic patients through group education and social support enhances self-care and improves glycemic control. Integrative Group Health Visits (IGHV) offer health education to empower individuals with (pre)diabetes. The objective of this study is to describe the development and implementation of an IGHV model for patients with diabetes and prediabetes. Methods: The study describes the development and implementation of IGHV for diabetic and prediabetic patients at an Integrative Health Sciences University. A 6-week virtual group visit series conducted in Fall 2024 was the first IGHV series for diabetic patients and was developed based on a previously implemented IGHV model for chronic pain. It aimed to blend conventional medicine with complementary approaches, drawing on tools from Traditional Chinese Medicine, Occupational Therapy, Nutritional, Ayurvedic, and Chiropractic perspectives, all while integrating mindfulness and movement-based interventions. Each week, participants engaged in physical and mindfulness activities, discussed topics related to presentations on integrative and alternative care methods for T2DM, and received take-home tools they could apply to their current care regimen. The sessions supported a safe environment and community-friendly setting to encourage patients to share experiences and interchange ideas. Results: Fifteen patients enrolled and on average 5–6 patients attended each visit. Feedback from both participants and facilitators of the group visits was positive. Participants reported an increase in their knowledge on Diabetes and the benefits of various complementary approaches in managing healthy blood sugars. Conclusions: IGHV may be a useful additional tool for TCM practitioners to empower their patients. There were several limitations and challenges in the implementation of IGHV. Recruitment, retention, and engagement of participants require meticulous planning, dedicated personnel, and financial support. We also need to find solutions for billing such services.
AB164. Progress and gaps in U.S. colorectal cancer screening, 2008–2022: insights from 1.3 million BRFSS respondents
Background: Colorectal cancer (CRC) incidence is rising in adults < 50 years, now accounting for nearly one-tenth of new U.S. cases. In response, the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45 years in 2021. To learn whether screening behavior has kept pace, and where inequities may remain, we interrogated recent national survey data. Methods: Behavioral Risk Factor Surveillance System files for 2008–2022 (~1.3 million respondents) were pooled. Adults aged 45 to 79 years who answered colonoscopy/sigmoidoscopy items (HADSIGM3/4 or SIGMSCPY + COLNSCPY) formed the analytic set. A custom R function (scrVSage) computed crude screening prevalence within eight 5-year age bands for each race/ethnicity, sex, income, and insurance stratum. Year-specific proportions and absolute gaps were visualized to track change over time. Results: Overall screening prevalence climbed from 58% in 2008 to 69% in 2022, an 11-percentage point (p.p.) increase. The Black-White gap narrowed from +6.4 p.p. to −0.8 p.p., indicating practical parity. Disparities remained sizable for Hispanics (−9.1 p.p.) and Asians (−11.3 p.p.) in 2022. Across all years, being insured or having household income ≥$75,000 conferred ~20 p.p. higher screening than being uninsured or earning <$25,000, with no evident narrowing. Recency analysis showed Black respondents slightly less likely than White respondents to be ≥10 years overdue (5.9% vs. 10.1%). Sex differences were small (<2 p.p.). Uptake increased in every five-year age band, including the newly eligible 45 to 49 group. Conclusions: U.S. CRC screening has improved steadily since 2008, and the historic Black-White disparity has effectively closed. Hispanic, Asian, low-income, and uninsured continue to have lower screening prevalence.
AB163. Promoting safe drinking water through interactive education: a community-based initiative in Pallewela, Sri Lanka
Background: In Sri Lanka, water resources face significant depletion and degradation due to anthropogenic activities. In the target area of Pallewela, Western Province, the community’s water supply is heavily dependent on groundwater sources, which are increasingly threatened by pollution and over-extraction. Observations from local partners at the University of Kelaniya identified two critical behavioral issues: a prevalent practice of not boiling water before consumption and water contamination from improper waste disposal. This project aimed to address this knowledge-practice gap by designing and implementing interactive, sustainable educational tools for the wider community. Methods: An on-site educational initiative was implemented in Pallewela in June 2025, in collaboration with a local medical school. The project engaged over 100 participants, including elementary school students and the broader public at a central community temple, with the community leader in attendance. The intervention comprised two core interactive components designed for sustainability. The first was a hands-on bacteria-staining workshop, where participants were taught how to use staining kits on locally collected water samples to visualize and compare microbial content between untreated and boiled water under portable microscopes. The second was an original educational card game, inspired by a traditional pastime, which taught players to match water sources with safe treatment methods. To ensure lasting impact, a supply of staining kits and card games was donated to the local school and temple. Program engagement and immediate knowledge transfer were assessed through facilitated discussions and structured observation. Results: Following the activities, participants, including community leaders, successfully articulated the importance of boiling water for safety. The hands-on microscope session effectively demonstrated the health risks of unboiled water. Both the workshop and the card game demonstrated broad appeal and comprehensibility, engaging a diverse audience of children and adults despite language barriers. Observational feedback confirmed high levels of participation and understanding. The donation of materials equipped the community to continue the educational activities independently, promoting sustained dissemination of the public health message. Conclusions: Interactive, hands-on educational tools, including a practical microbiology demonstration and a culturally tailored card game, can effectively engage entire communities and convey critical messages about safe drinking water. By training participants and leaving resources for continued use, this approach demonstrates a sustainable model for fostering better water habits and empowering local health advocacy.
AB162. Impact of limited access to medications in hereditary angioedema on treatment timeliness, disease control, and health-related quality of life: findings from an international patient survey
Background: Hereditary angioedema (HAE) is a rare genetic disorder characterised by recurrent episodes of swelling. In recent years, there are various emerging on-demand treatment (ODT) and prophylaxis options. However, access to these HAE-specific medications varies across regions, and its impact from a patient perspective remains elusive. The objective of this study is to investigate the access to treatment for HAE patients in Argentina, South Africa, and Hong Kong and how this affects patient outcomes. Methods: We surveyed HAE patients from three localities, namely Argentina, South Africa, and Hong Kong in late 2024. Their demographic features, current treatment, factors related to treatment decisions, disease activity, control [by Angioedema Control Test (AECT)], and impact on health-related quality of life [HRQoL; by Angioedema Quality of Life Questionnaire (AE-QoL)] were collected and analyzed. Results: A total of 98 HAE patients [32 (32.7%) from Argentina, 30 (30.6%) from Hong Kong, and 36 (36.7%) from South Africa] responded. In country without access to HAE-specific medications (South Africa), there were significantly more patients without ODT (22.2% vs. 0.0%, P<0.001) and required other secondary ODT (P<0.001), such as fresh frozen plasma (30.6% vs. 0.0%). There was also significantly more usage of second-line, non-HAE-specific prophylactic agents (P<0.001), including androgens/steroids (41.7% vs. 4.8%) and tranexamic acid (16.7% vs. 0.0%). The no access group was significantly less likely to always immediately treat their HAE attacks (0.0% vs. 20.4%, P=0.01), with access/cost-related reasons such as cost concerns (34.6% vs. 7.4%, P=0.004), and anxiety over inability to refill medications before next attack (65.4% vs. 25.9%, P<0.001). Regarding disease control, the no access group was significantly less likely to be attack-free in the past 3 months (16.7% vs. 46.8%, P<0.001). Their AECT and AE-QoL scores were also significantly worse (respectively 8.6±4.3 vs. 14.8±3.0 and 49.0±20.9 vs. 7.3±15.5, both P<0.001), with fewer patients having well-controlled HAE (AECT ≥10; 40.6% vs. 86.7%, P<0.001). Conclusions: Limited access to HAE medications remains pervasive in certain regions, with substantial, negative impacts on treatment timeliness, disease control, and HRQoL.
AB161. Unveiling the black cap: a phenomenological inquiry into the hardships faced by Filipino nurses working overseas
Background: Filipino nurses have become vital contributors to healthcare systems worldwide, often driven by the promise of financial stability, career advancement, and improved working conditions. However, their migration journeys also involve complex emotional, cultural, and professional challenges. Despite the breadth of research on migrant healthcare workers, studies rarely examine the lived experiences of Filipino nurses overseas, leaving their personal and professional struggles underrepresented. Much of the discourse centers on economic contributions and workforce integration, often overlooking the everyday hardships these nurses endure. This study addresses that gap by examining the layered realities of Filipino nurses working abroad and how these experiences shape their well-being and professional identity. Methods: Conducted using a descriptive phenomenological design, the research involved nine Filipino nurses, each with at least five years of overseas work experience. Participants were selected through purposive maximum variation sampling to capture diverse roles and locations. Data were gathered through semi-structured online interviews and analyzed using Colaizzi’s [1978] seven-step method. Rigor was maintained through bracketing, transcript validation, and thematic clustering. Ethical clearance was obtained from the Angeles University Foundation (AUF) Ethics Review Committee, and the manuscript was submitted to the university library’s Turnitin service, which yielded a 1% similarity report. Results: Four themes emerged from the data analysis: (I) “Professional Pressures of Wearing the Black Cap”, highlighting licensure challenges, ethical dilemmas, and excessive workloads; (II) “Sociocultural Struggles Under the Black Cap”, which captured language barriers and cultural adjustment; (III) “The Black Cap’s Emotional Burdens”, reflecting stress, emotional exhaustion, and prolonged separation from family; and (IV) “The Black Cap’s Spiritual Shadows”, emphasizing spiritual strain experienced while working abroad. The “Black Cap” metaphor symbolized the unseen weight carried by Filipino nurses—honorably worn yet heavy with sacrifice. Conclusions: This study provides a deeper understanding of the complex realities faced by Filipino nurses working overseas. By foregrounding their lived experiences, the findings help bridge existing research gaps and offer valuable insights for developing more inclusive nursing education, responsive curricula, and compassionate support systems that better prepare and sustain Filipino nurses in the global nursing workforce.
AB160. Evaluation of Roblox-based community simulation as a learning tool in community health nursing: a descriptive mixed-method study
Background: The future of education is being reshaped, a transformation sparked by a global disruption. This led to the rapid adoption of virtual learning tools in nursing education, particularly in community health nursing (CHN), where immersive, hands-on experiences are essential. However, there is limited research exploring how digital platforms like Roblox can replicate the participatory and community-based processes of Community Organizing Participatory Action Research (COPAR). Thus, this study aimed to evaluate the educational utility of a Roblox-based community simulation as a learning tool in CHN from multiple perspectives. Methods: An explanatory sequential mixed-methods design was employed, beginning with the collection of quantitative data through three instruments: the Technology Acceptance Model (TAM) questionnaire for learners, the app checklist for educators for clinical instructors, and the educational app evaluation tool for experts. Descriptive statistical analysis was conducted to determine frequencies, means, and patterns across the three respondent groups. This was followed by a qualitative phase involving focus group discussions, which were analyzed using Braun and Clarke’s six-phase thematic analysis to capture participants’ insights and contextual feedback on the Roblox-based community simulation. Purposive sampling was utilized for selecting learners with prior exposure to the simulation, while total enumeration was applied for clinical instructors and experts to ensure full inclusion of those who met the study’s criteria. The study underwent ethical review and plagiarism scanning using Turnitin. Results: Key findings revealed strong convergence among all groups on the simulation’s educational value, ease of use, engaging nature, and its alignment with curriculum standards. Experts and clinical instructors uniquely emphasized the simulation’s cultural authenticity and potential to support higher-order thinking, while learners and experts highlighted its role in overcoming barriers to learning. Conclusions: These insights resonate with David Kolb’s Experiential Learning Theory, demonstrating how the simulation facilitated concrete experiences, reflective observation, abstract conceptualization, and active.
AB159. Rural physician deployment programs in five Southeast Asian countries: a narrative review
Access to healthcare is a known challenge in rural populations globally, driven by an imbalance of physician distribution between urban and rural areas. This disparity is particularly pronounced in Southeast Asia, where physician deployment programs have been implemented to address it. This narrative review examined the structure, incentives, retention outcomes, and impact of such programs in Thailand, Malaysia, Indonesia, the Philippines, and Vietnam. Results showed that approaches varied across countries: Thailand and Malaysia adopted compulsory service models, while Indonesia, the Philippines, and Vietnam opted for optional or semi-compulsory approaches. All programs used financial incentives and career benefits to attract physicians. Thailand’s program demonstrated the highest retention rates—52.5% in the regular track and 78.2% in the special track—compared to the Philippines’ 18%, while specific data for Indonesia, Malaysia, and Vietnam were limited. Nonetheless, during the periods of implementation, improvements in rural healthcare access and service coverage were reported in Thailand, Indonesia, Malaysia, and Vietnam. Malaysia’s program, however, has not been thoroughly evaluated. Overall, the evidence suggested a positive association between rural physician deployment programs and improved health service metrics in underserved regions. However, data on long-term retention and direct impacts on rural health indicators are lacking and warrant further research. These findings underscore the importance of continuous evaluation to optimize the effectiveness of such programs across Southeast Asia.
AB158. Open burning of plastic waste and its effects on health in rural areas of Sri Lanka
Background: Plastic waste open burning is an escalating yet underreported threat to environmental and public health, particularly in rural regions with limited formal waste systems. In Sri Lanka’s rural areas, this remains a routine disposal method. It is largely unregulated, posing serious local health risks and contributing to broader transboundary pollution. Methods: This study investigates the extent and health impacts of plastic waste open burning in rural Sri Lanka through a combination of primary and secondary resources. In the first section, country-, rural-, and village-level statistics are examined to acknowledge national plastic waste trends. In the second section, to understand the environmental and health effects brought by plastic open burning, levels of different pollutants near plastic burning areas are compared with the World Health Organization (WHO)’s air quality standards. Types of diseases that can be caused by each pollutant are also listed. Besides, to understand the local context, we conducted on-site air quality tests in Pallewela, Sri Lanka. As particulate matter ≤2.5 µm (PM2.5) dominates among the pollutants, further analysis of how intensified PM2.5 exposure increases health and hospitalization risks is presented. Results: In the first section, data show that Sri Lanka mismanages 89% of its annual 260,000 tonnes of plastic waste, 2.78 times the global average. In rural areas, 74% of plastic waste is mismanaged, with 11.5% openly burned. This causes environmental contamination, with 60% of sand and 70% of surface water samples in affected regions containing microplastics. Though national figures for open burning seem scarce, the practice remains widespread in rural areas due to gaps in waste collection systems. This is supported by our 2025 cross-sectional field study in Pallewela, where primary data from 100 households revealed that 97% of plastic waste is openly burnt. The second section of the study shows that pollutants released near plastic burning sites, including carbon monoxide (CO), PM2.5, dioxins, furans, volatile organic compounds (VOCs), and nitrogen oxides (NOx), are significantly higher when compared to WHO benchmarks. Clear correlations were also found between exposure to these pollutants and increased chances of pulmonary, respiratory, and cardiovascular diseases. Furthermore, research demonstrates that per 1 μg of PM2.5/m3 increases health and hospitalization risks of all-cause respiratory diseases, asthma, chronic obstructive pulmonary disease (COPD), acute upper respiratory infection, influenza, and pneumonia by 0.36% to 0.79%. Conclusions: This study helps fill a critical data gap and underscores the urgency for both local and global efforts to eliminate plastic open burning, advance waste management, and safeguard public health.
AB157. Perception and practices on waste management of nurses in a selected hospital in Angeles City: a narrative photovoice study
Background: Healthcare waste (HCW), a by-product of healthcare facility operations, poses serious infection and environmental risks—especially in resource-limited settings. Nurses, as both generators and frontline handlers of HCW, play a vital role in its management. Despite Department of Health guidelines mandating color-coded segregation and proper disposal, challenges persist due to gaps in training, resources, and policy enforcement. However, limited research explores how nurses perceive and practice HCW management within Philippine hospitals. Methods: This study investigated nurses’ perceptions and practices on HCW management in a selected hospital in Angeles City using a qualitative, narrative-photovoice design. Seven nurses with at least three months of clinical experience were purposely and referentially recruited. Photovoice, a participatory method where participants use photography to reflect on issues, guided data collection. Participants captured images of HCW processes and responded to SHOWeD questions to interpret their photos. Semi-structured interviews were transcribed and analyzed using Braun and Clarke’s six-phase thematic analysis, with reflexivity to preserve authentic participant voices. Results: Five themes emerged: (I) “Slipping Through the Cracks of Safe Waste Practices”; (II) “Making Do Amid the Mess of Broken Systems”; (III) “Building Competence through Knowledge and Experience”; (IV) “Walking the Clean Line with Integrity and Responsibility”; and (V) “Sorting Out the Clutter for Cleaner Communication and Systemic Waste Management”. While nurses showed dedication and creativity, they were often hindered by limited training, lack of supplies, and heavy workloads. Conclusions: The study highlights nurses’ critical role in HCW safety, but also the structural barriers they face. To address this, the researchers recommend regular HCW training, consistent provision of standardized bins, strengthened policy enforcement through audits, and the creation of interprofessional leadership committees. These actions can improve compliance, protect health workers and patients, and promote sustainable HCW practices.
Background: Low- and middle-income countries (LMICs) face numerous barriers towards accessing basic healthcare. This is exacerbated by resistant educational, social, and economic issues that persist within rural areas. Such is seen in the Sri Ramakrishna Village of Haputale, Sri Lanka. The living population reside in mountainous regions with minimal infrastructural development and work laborious tea production jobs. Long distances to healthcare facilities, combined with familial and work duties, result in villagers neglecting themselves and prevent access to the distant healthcare services to begin with. To tackle this issue, the Student Innovation for Global Health Technology (SIGHT) group at the Hong Kong University of Science and Technology provided a student platform to create potential solutions for the Sri Ramakrishna Village. One project was the HapuTele project, a telemedicine initiative, aiming to connect villagers with doctors through a single platform. In a global health context, telemedicine is a powerful tool which unifies physical and economic barriers by providing universal access through a digital medium. Methods: A low-code platform was leveraged to rapidly develop a scalable application tailored to local needs, seamlessly unifying consultations, data handling, and prescriptions into a single platform. A low-code approach facilitated rapid adaptations, addressing user feedback and local conditions, such as simplifying interfaces and automating prescriptions to comply with Sri Lanka’s regulatory requirements. Literature Review prior to on-sight implementation also suggested further social and educational barriers would be experienced. Thus, collaboration with local non-government organizations (NGOs) was necessary for translation and overcoming implementation barriers. Results: Despite the deployment of a digital platform, on-sight implementation indicated a digital platform to only be one of several components that needed to be addressed. Further issues such as additional information technology (IT) training, internet infrastructure, and social barriers were also key aspects that had to be addressed. Certain software design choices also faced unexpected resistance and required workarounds. Conclusions: HapuTele’s deployment highlights telemedicine’s potential to bridge healthcare access gaps in LMICs. However, it also reveals the complexities of implementing technology-driven solutions in resource-scarce settings. All new settings possess unique challenges and barriers to overcome, with many being technology-adjacent. The implementation of simpler digital solutions can act as a strategy to improve global health equity. Projects like HapuTele help to bring awareness to students and locals on the significance of preserving health under different contexts. Furthermore, such projects require continuous support and patience in order to overcome the many barriers that have resulted in these health disparities.
AB155. Exploring families’ knowledge, attitudes, and determinants of practice regarding advance care planning in a selected community in Angeles City
Background: Advance care planning (ACP) allows individuals to make informed decisions about their future healthcare, yet it remains underutilized in the Philippines due to cultural beliefs, limited awareness, and the lack of legal and institutional support. ACP is often discussed only with elderly or terminally ill patients in hospitals, rather than being promoted as a routine, family-centered process across all ages. This study aimed to explore the knowledge, attitudes, and determinants of ACP practice among Filipino families in a selected community in Angeles City. Methods: A descriptive research design with multi-stage sampling was used to survey 377 household heads aged 18 and above who had lived in the community for at least six months. A validated questionnaire adapted from Cheng et al. [2022] was used to assess ACP knowledge, attitudes, behavioral intentions, and influencing factors. After receiving ethical clearance from the Ethics Review Committee, the questionnaire was administered in a selected community in Angeles City. The questionnaires were administered and retrieved from February 13, 2025 to March 22, 2025. This questionnaire also underwent cultural validation from a progressive care nurse, social insurance officer III, and community health nurse. The data from 377 respondents were statistically analyzed in the Statistical Package for the Social Sciences (SPSS) version 30 using frequency, percentage, mean (M), standard deviation, and ranking. Results: The results showed that respondents had moderate knowledge of ACP, with a M score of 5.31. While they were aware of basic patient rights such as accepting or refusing treatment, many lacked understanding of formal legal tools like advance directives (ADs). Attitudes toward ACP were generally favorable; respondents agreed that ACP enhances preparedness (M =4.41), reduces family burden (M =4.40), and improves quality of life (M =4.35). However, willingness to engage in formal documentation scored slightly lower (M =3.97). Behavioral intentions to participate in ACP were influenced most by family members, particularly children and spouses, and healthcare professionals. Emotional discomfort, religious beliefs, and cultural norms were identified as key barriers to engagement. Conclusions: The findings underscore the importance of integrating ACP into routine community health education and nursing practice, encouraging proactive dialogue regardless of age or illness status. Moreover, there is a pressing need for national policies that support ACP implementation and accessibility across different settings. Culturally sensitive approaches and family-centered communication strategies are essential to normalize ACP and empower individuals to make values-based healthcare decisions. Future research should also explore region-specific barriers and facilitators to ACP, in order to develop culturally appropriate strategies that enhance community engagement and promote informed healthcare decision-making.
AB154. Challenges of nurse leaders in public and private hospitals within Pampanga: a descriptive phenomenological exploration
Background: Nurse leaders are pivotal in bridging administrative policies with clinical practice to ensure the delivery of quality patient care. However, the increasing complexity of healthcare environments presents significant challenges that can affect their performance, staff morale, and institutional efficiency. As they balance administrative responsibilities, support their teams, and meet organizational goals, understanding their challenges becomes essential to improving leadership development and healthcare outcomes. This study explored the management-related challenges faced by nurse leaders across six key areas: administrative demands, organizational structure, professional development, roles and responsibilities, interpersonal communication, and work environment. Methods: A descriptive phenomenological design was utilized, involving five purposively selected nurse leaders from public and private hospitals in Pampanga. Data collection methods included semi-structured interviews and unstructured observations. Ethical approval was secured from the Ethics Review Committee, and the study passed a plagiarism check with a 1% similarity score, ensuring academic integrity. Bracketing was applied prior to data collection to minimize researcher bias. Colaizzi’s method guided data analysis, ensuring credibility and trustworthiness of findings. Results: Six major themes emerged: (I) administrative pressures—increasing demands from upper management and complex administrative duties; (II) structural limitations—organizational and systemic constraints; (III) professional growth demands—the need for continuing education amidst institutional limitations; (IV) leadership role strain—expanded responsibilities beyond defined roles; (V) communication complexities—intergenerational and interdepartmental communication gaps; and (VI) afflicting work conditions—burnout, staffing shortages, and resource inadequacies. Conclusions: The findings highlight the multifaceted challenges faced by nurse leaders in balancing leadership expectations with limited institutional support. Addressing these issues through organizational policy reforms, leadership training, mentorship programs, and improved communication systems is crucial to strengthening nursing leadership. Empowering nurse leaders enhances healthcare delivery, supports workforce sustainability, and ensures effective management in increasingly complex healthcare settings.
AB153. Kakaluluan (poverty): a mixed-method approach to understanding poverty perceptions and awareness among Kapampangan families
Background: Poverty in the Philippines remains a complex and multidimensional phenomenon, particularly among families enrolled in the Pantawid Pamilyang Pilipino Program (4Ps), the country’s flagship conditional cash transfer initiative. Among Kapampangan households in Angeles City, poverty is experienced not only as material deprivation but also as a social and symbolic condition shaped by cultural narratives and lived realities. Understanding how beneficiaries perceive and conceptualize poverty is essential in designing responsive and empowering poverty alleviation strategies. Methods: This study employed an explanatory sequential mixed-method design. The quantitative phase involved 117 4Ps beneficiaries who completed two validated instruments: the Poverty Perception Scale (PPS) and the Poverty Awareness Scale (PAS). Quantitative findings informed the qualitative phase, which consisted of unstructured, in-depth interviews guided by a grand tour question. Concept coding and thematic analysis were used to analyze qualitative data and identify recurring patterns in participants’ lived experiences. Ethical clearance was obtained from the Ethics Review Committee, and originality was verified using Turnitin plagiarism detection software. Results: Quantitative findings indicated moderately positive perceptions of living conditions among participants. However, respondents predominantly attributed poverty to individual-level factors such as lack of effort or weak work ethic, with limited acknowledgment of structural determinants including policy gaps, unequal access to services, and labor market constraints. Qualitative findings revealed persistent experiences of food insecurity, difficulty accessing healthcare, dependence on informal debt, and emotional fatigue. This contrast highlights a dissonance between perceived self-sufficiency and the ongoing realities of systemic deprivation. Conclusions: Despite enduring structural hardships, Kapampangan 4Ps beneficiaries tend to internalize personal responsibility narratives of poverty. Addressing this gap requires strengthening Family Development Sessions through poverty literacy modules, community-based education, transparency initiatives, and anti-stigma interventions. Enhancing critical awareness may support sustainable empowerment and more holistic poverty reduction outcomes.
AB152. Lived experiences of Filipino healthcare providers deployed in the 2023 earthquake response in Türkiye
Background: Earthquakes are catastrophic events that result in significant loss of life and damage to infrastructure. On February 6, 2023, a magnitude 7.8 earthquake struck Türkiye, prompting the country to declare a Level 4 alarm and call for international aid. As part of the Philippine Inter-Agency Humanitarian Contingent, Filipino healthcare providers were deployed to Türkiye to deliver urgent medical assistance. Despite their contributions, there is a lack of research documenting their experiences. Thus, this study aimed to explore the lived experiences of Filipino healthcare providers during their deployment to Türkiye in the 2023 earthquake response. Methods: To capture these experiences, the researchers employed a descriptive qualitative design using a phenomenological approach. Six participants from a selected hospital in Pampanga were chosen through purposive sampling and participated in unstructured interviews guided by the grand tour question: “What are your experiences during your deployment in Türkiye last 2023?”. Data collection continued until saturation was reached following Colaizzi’s method. Bracketing and ethical considerations were strictly observed throughout the research process. The study was reviewed and approved by the Angeles University Foundation Ethics Review Committee and underwent a plagiarism scan to ensure academic integrity. Results: Five major themes emerged: (I) “Trials in Turmoil”—physical, logistical, and emotional challenges faced in a disaster environment; (II) “Crossing Time and Terrains”—adaptation to cultural differences and extreme conditions; (III) “Rising Above Adversity”—demonstrations of resilience and adaptability; (IV) “Compassion in Action”—providing humanitarian care amid crisis; and (V) “From Ground Zero to Global Hero”—professional fulfillment and national pride gained from their service. Conclusions: The findings revealed that Filipino healthcare providers’ deployment was characterized by significant physical and emotional challenges, alongside profound professional fulfillment and personal growth. Participants demonstrated adaptability, innovation, resilience, and compassion in delivering care under extreme conditions. These findings provide valuable insights for strengthening disaster preparedness, informing policy development, and enhancing psychosocial and operational support systems for healthcare providers engaged in international humanitarian missions.
AB151. Decoding menstruation: a multi-level analysis of period stigma and its implications on well-being
Background: Menstruation continues to be a heavily stigmatized topic with taboos and superstitions emanating from all regions of the world. These perceptions of menstruation have taught young girls, women, and global menstruators to be ashamed or embarrassed of their cycle. This inherent shame associated with menstruation forces menstruators to hide their periods and/or remain discreet when on their cycle due to negative societal consequences they may experience. Instead of portraying menstruation as a natural biological process, some cultures and geographic regions view it as a cursed time. The menstrual cycle is a time when menstruating girls and women are in a particularly vulnerable state, and rather than asserting differential treatment, society should be supporting and uplifting them. We aim to explore the significance of menstrual stigma on aspects of daily living. Methods: A literature review was conducted to establish a working definition of menstrual health and to identify key themes surrounding the stigma of menstruation. Findings were used to complete a multi-level analysis of the implications of menstrual stigma on all aspects of daily life for menstruators worldwide. Results: Period stigma affects physical health, mental health, education, inclusion, gender equity, and human rights. In regions of Nepal, India, and Indonesia, menstruating individuals are forced to isolate themselves from their family/community and are prevented from carrying on in normal daily activities. Activities such as praying, cooking, and bathing are restricted, and women may be forced into seclusion. In other regions, periods can trigger a range of human rights violations from child marriage to sexual violence. Young menstruators may be forced to leave school or quit educational pursuits altogether, leaving them vulnerable with limited future job prospects and earning opportunities. Conclusions: Menstrual stigma has a cascading impact on the lives of young girls, women, and menstruators globally. In order to combat stigma, menstruation must be normalized and taught to others just as it is, a normal biological process, and with notions of uncleanliness and abnormality associated with it removed. Furthermore, including non-menstruators in the conversation, such as fathers, brothers, uncles, and male classmates, is crucial. Having open conversations with non-menstruators and educating them on the unseen implications menstrual stigma has on girls, women, and menstruators in their lives is imperative. These are small yet sustainable steps toward changing the outdated dialogue associated with menstruation and menstrual health hygiene.
AB150. Beyond the liver, across borders: MASLD among East and Southeast Asian countries
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern in East and Southeast Asia, where rapid urbanization, dietary changes, and increasing obesity, diabetes, and hypertension fuel a rising disease burden. Unique genetic predispositions, including PNPLA3 and TM6SF2 variants, further accelerate disease progression in these populations. Despite the escalating burden, MASLD remains underdiagnosed and undertreated, especially in low-resource settings with limited healthcare access. In this paper, we aim to synthesize the current status of MASLD in East and Southeast Asia and highlight gaps and challenges to better improve diagnosis and management. Methods: This narrative review synthesized evidence from online journal repositories, focusing on MASLD epidemiology, prevalence, genetic contributions, dietary influences, and healthcare challenges across East and Southeast Asia. Results: MASLD prevalence varies widely across the region, with urbanized areas and higher-income countries reporting greater rates. Although genetic variants contribute to disease susceptibility, environmental and socioeconomic determinants—such as diet, access to care, and comorbidity burden—play substantial roles. High-risk subgroups, including children, older adults, lean MASLD, and individuals with metabolic comorbidities, face unique vulnerabilities, worsened by the scarcity of population-specific epidemiologic data. Limited incorporation of MASLD management into primary care and unequal access to diagnostic tools impede timely diagnosis and intervention. Conclusions: Strengthening primary healthcare capacity and integrating MASLD into existing metabolic disease programs are essential to improving early detection, risk stratification, and treatment across East and Southeast Asia
AB149. Books, bonds, and better health: public libraries as a third place for promoting the health and well-being of community-dwelling older people
Background: Community resources such as public libraries, which often serve as informal “third places” for social engagement, may promote health and well-being in older adults. They could contribute to global healthy ageing efforts, yet longitudinal evidence on their health impact remains limited. This study examines the longitudinal association between frequency of public library visits and 44 health and well-being outcomes in community-dwelling older men and women. Methods: Data from >12,000 (range, 12,124–12,896) relatively healthy, community-dwelling Australians aged 70+ years were analyzed. Frequency of library visits was assessed at baseline and categorized as never, ≤3 times per month, or ≥ once per week. An outcome-wide analytical approach was used to evaluate 44 health outcomes across physical, cognitive/major health events, psychological, social, and behavioral domains. These outcomes were measured ~2 years post-baseline or >7 years for time-to-event outcomes. All analyses were gender-disaggregated and adjusted for multiple covariates, including pre-baseline outcome values. Results: At baseline, participants had a mean age of 75.2 years (±4.3 years; range, 70–95 years), and 54.5% were women. Library visits were more common among women than men. Compared to non-users, library users showed better physical and cognitive outcomes (e.g., reduced risk of dementia), greater social well-being (e.g., higher participation in cultural activities), and healthier behaviors (e.g., increased fruit and vegetable intake). No associations were observed for most psychological outcomes. Gender differences were found: men had stronger associations with reduced disability and mortality >7 years follow-up, while women had greater social and behavioral benefits (e.g., lower risk of social isolation, higher physical activity) but a higher falls risk at 2-year follow-up. Conclusions: These findings suggest that public libraries, which are accessible and often overlooked community resources, may support healthy ageing. Integrating libraries into public health strategies could provide a scalable and cost-effective way to improve health and well-being in older populations.
AB148. Knowledge, awareness, and behavior on the heat index among residents of selected communities in Angeles City: an embedded sequential study
Background: Extreme heat, intensified by climate change, poses growing health risks globally and in tropical countries like the Philippines. Between 2000 and 2019, heat exposure contributed to an estimated 489,000 deaths annually, with Asia accounting for nearly half. In early 2024, the Philippines recorded 77 heat-related illnesses and 7 deaths, mostly among the youth, reflecting the urgent need for effective community adaptation. The heat index, a measure combining temperature and humidity, offers a more accurate gauge of perceived heat stress than temperature alone. Despite frequent extreme heat events, limited research explores how Filipino communities interpret and respond to heat index warnings. This study addresses that gap by examining residents’ knowledge, awareness, and behavior regarding the heat index in selected communities in Angeles City. Methods: An embedded sequential mixed-methods design was used. A validated 28-item questionnaire was administered to 396 residents, followed by semi-structured interviews with six purposively selected participants. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were processed using Colaizzi’s method. Triangulation was applied for interpretation. The study underwent ethics review and plagiarism screening. Results: Most residents understood environmental and health-related aspects of the heat index but had gaps in recognizing its psychological and socioeconomic effects. Awareness levels were high and often translated into adaptive behaviors like hydration, weather monitoring, and staying indoors. Statistically significant differences were found based on age, sex, and education. Qualitative analysis revealed themes of experience-based knowledge, perceived inequality, emotional and physical impacts, and culturally rooted coping strategies. Conclusions: Residents adapted instinctively despite limited formal guidance. Public health efforts must bridge knowledge gaps by anchoring heat index education in lived realities and integrating localized, culturally sensitive interventions into nursing and community health strategies. Findings support broader climate-health strategies in similarly affected regions.
AB147. Knowledge, attitude, and practices on rabies management across demographic groups of residents in selected communities in Angeles City: a descriptive comparative study
Background: Rabies remains a preventable yet fatal disease in the Philippines, with Angeles City reporting a high incidence of animal bites. Despite existing laws and programs, gaps in awareness and preventive behavior persist. This study aimed to examine the knowledge, attitudes, and practices (KAP) on rabies management across demographic groups to inform nursing-driven community interventions that advance primary health care. Methods: A descriptive comparative design using stratified cluster sampling was employed. A total of 407 residents from three communities completed a 71-item questionnaire. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 30, utilizing descriptive and inferential statistics. Results: Most respondents were middle-aged (74%), female (66.8%), and high school graduates (29.5%), with 57.7% reporting pet ownership. Knowledge was generally high (85.3% in the top quartile), yet misconceptions regarding rabies transmission and treatment persisted. While 95.09% recognized the importance of vaccination, some endorsed harmful practices such as killing unvaccinated animals. Knowledge scores varied significantly by educational attainment (P=0.002), while attitudes remained positive (98.5%). Practices were moderate, particularly in pet confinement. Conclusions: Findings underscore the need for nursing-led community health initiatives in partnership with veterinary services, proper training of barangay health workers, and consistent seminars on responsible pet ownership to enhance rabies prevention. These strategies not only strengthen disease prevention but also enrich nursing students’ community and clinical experiences, aligning with efforts to transform nursing education, advance practice, and strengthen primary health care.
AB146. The relationship of literacy, anxiety, and general attitudes on artificial intelligence among nurses in the three cities of Pampanga
Background: The present-day society is influenced by artificial intelligence (AI), as it adapts human intellect and can imitate tasks such as the intricacies of decision-making. However, there may be factors that influence the integration of AI, which are still being explored and show great potential in contributing to healthcare development. This study described nurses’ literacy, anxiety, and general attitudes toward AI and determined the relationship among these variables in Angeles City, Mabalacat City, and the City of San Fernando, Pampanga. Examining the relationship between these variables is essential in understanding whether nurses are willing to integrate AI into nursing practice. Methods: A descriptive-correlational design was employed involving 496 nurses from both government and private hospitals. Participants were selected through purposive sampling, and data collection was conducted following ethical clearance. Three validated instruments were utilized: the Artificial Intelligence Literacy Scale (AILS), the Artificial Intelligence Anxiety Scale (AIAS), and the General Attitudes Toward Artificial Intelligence Scale (GAAIS). Descriptive statistics, the Shapiro-Wilk test, and Spearman’s rank correlation coefficient were applied using SPSS Statistics version 26. The study underwent a plagiarism scan to ensure its originality and integrity. Results: AI literacy had an overall mean of 4.60 [standard deviation (SD) =0.71] and scored highest in the evaluation and ethics subdomains. AI anxiety had a mean of 4.32 (SD =1.12), with significant concerns related to sociotechnical blindness and job replacement. General attitudes toward AI were slightly favorable with a mean score of 3.04 (SD =0.45), with nurses acknowledging its potential. Spearman’s correlation showed a significant positive relationship between AI literacy and general attitudes (ρ=0.225, P<0.001), and between AI anxiety and general attitudes (ρ=0.137, P=0.002). No significant correlation was found between AI literacy and anxiety (ρ=0.009, P=0.85). Conclusions: The findings suggest that increased literacy contributes to more favorable attitudes, but anxiety can stem from deeper, unresolved uncertainties. Meanwhile, AI anxiety does not significantly influence AI literacy. These results highlight the importance of targeted educational interventions and support programs to enhance nurses’ confidence and readiness in integrating AI into clinical practice.
AB145. Development and application of a risk assessment system in determining individuals’ susceptibility to type 2 diabetes mellitus: a quantitative study in a selected community in Angeles City, Philippines
Background: The incidence of type 2 diabetes mellitus (T2DM) continues to rise globally, with many individuals remaining undiagnosed until complications develop. Standard diagnostic methods such as glycated hemoglobin, fasting plasma glucose, and oral glucose tolerance tests are effective but often inaccessible and costly in community settings, leading to delayed detection and treatment. This study aimed to develop and apply a risk assessment system to identify individuals at risk of developing T2DM in a selected community in Angeles City, providing a cost-effective screening tool to support early prevention and nursing-led health initiatives. Methods: A cross-sectional descriptive design was conducted in two phases following approval from the Ethics Review Committee (ERC). Phase 1 involved system development and evaluation by community health nurses using a 16-item questionnaire assessing usability, information quality, and interface design. Phase 2 involved applying the system to 372 community residents using another 16-item questionnaire to generate individual risk profiles. Data were analyzed using percentage, frequency, mean, and standard deviation. Results: The risk assessment system achieved “best imaginable” ratings in usability, information quality, and interface design, demonstrating its appropriateness for community use. Risk stratification revealed that 42.74% of respondents were at low risk, 37.37% at slightly elevated risk, 10.48% at moderate risk, 8.60% at high risk, and 0.81% at very high risk for developing T2DM. Respondents displayed high levels of perceived self-efficacy, perceived severity, and behavioral beliefs, while perceived susceptibility scored lowest, indicating a gap in awareness about personal risk. Conclusions: The developed system offers a non-invasive, low-cost tool for identifying T2DM susceptibility and empowering early preventive action. Integrating such tools into nursing practice can enhance community screening programs, guide tailored health education, and strengthen primary health care. Raising awareness of personal susceptibility is vital to fostering proactive health behaviors, reducing disease burden, and advancing community-based nursing interventions.
AB144. Demographic and geographic diversity in chronic spontaneous urticaria clinical trials through a health equity lens: insights from 39 studies
Background: Approximately 0.9% to 1.4% of the population worldwide has a history of chronic spontaneous urticaria (CSU), which often remains suboptimally controlled with substantial biopsychosocial burden. While clinical trials have transformed CSU management, racial and ethnic disparities exist in the enrollment of trial participants. In 2016, the United States Food and Drug Administration published guidance regarding the collection and reporting of race and ethnicity data in clinical trials. However, its impact on CSU trials remains unknown. This study aims to characterise patient recruitment in CSU trials and explore the effect of the 2016 guidance if any. Methods: We performed a search of phase II/III clinical trials for CSU on the United States National Library of Medicine clinical trial registry (ClinicalTrials.gov). Information including dates, locations, and participants’ demographics (age, sex, race, and ethnicity) were retrieved for analysis. The characteristics of trials between 2002–2016 and 2017–2023 were compared. Results: A total of 39 trials involving 9,768 patients were included for analysis. Overall, Europe and the Americas were the most involved regions, respectively participating in 29 (78.4%) and 23 (62.2%) of the analyzed trials. Participation significantly increased in both Western Pacific (26.3% vs. 66.7%, P=0.01) and South-East Asia (0.0% vs. 22.2%, P=0.046). Among the 22 completed trials with available results, only 54.5% (12/22) reported participants’ races, with 73.0% (2,642/3,620) of the participants being White. Reporting of racial data significantly improved from 25.0% (3/12) to 90.0% (9/10, P=0.004) between the two periods, with a significant change in racial makeup (White: 76.1% vs. 72.7%, Asian: 16.9% vs. 22.1%, Black: 3.2% vs. 2.0%, P<0.001). Ethnicity data was only available in 5 (22.7%) trials, where Hispanic/Latino participants constituted 7.2% (39/538) of the total with a significant increase (0.0% vs. 8.3%, P=0.01), although the reporting of which did not. Conclusions: Persistent, albeit improving racial and ethnic disparities remain in CSU trials. Collective efforts are warranted to promote health equity in dermatological research.
AB143. Behind bars, beyond silence: screening mental health in female inmates using SRQ-20 and national guidelines
Women serving time in prisons are at higher risk of health problems than the general population. Factors such as past trauma, limited access to health services, environmental stress, lack of privacy, and the same daily routine often result in mental health disorders going undetected and undertreated. Furthermore, issues such as stigma often make it difficult for female inmates to seek help for their health. This study aims to evaluate the mental health status and determine psychological needs based on national screening guidelines in female inmates at the Class IIA Malang Women’s Correctional Institution. he study’s findings were obtained using the 20-item Self-Report Questionnaire (SRQ-20) and the Indonesian Ministry of Health’s “Is Your Mental Health Okay?” checklist, with 29 female inmates as respondents. The results showed that 21 participants (53.8%) indicated they were experiencing psychological distress, and 20 participants (51.3%) were recommended for psychological counseling, indicating a significant psychological burden experienced by female inmates. The provision of inclusive health services, regular check-ups, and adequate referrals are essential for the recovery and empowerment of inmates. Correctional institutions must also strive to eliminate the stigma associated with mental health problems, especially those that commonly occur in inmates, to create a safe and supportive environment for these inmates.
AB142. Association between sociodemographic factors and HIV knowledge among Hong Kong citizens: a cross-sectional study
Background: HIV, as with other sex-related issues, has long been a taboo that Hong Kong citizens avoid talking about due to Chinese traditions, hence leading to an unwillingness to understand such topics and causing insufficient understanding about such diseases. The increasing proportion of late presenters, especially people who are older, in Hong Kong indicates that HIV knowledge and testing rates in the society are suboptimal and require improvement. We aim to investigate the association between sociodemographic factors and human immunodeficiency virus (HIV) knowledge among Hong Kong citizens. Methods: Through self-administered online questionnaires, the relationship between sociodemographic factors and HIV knowledge is investigated. The questionnaire contains an 18-question quiz regarding HIV knowledge, including its transmission and prevention methods. Sociodemographic information, such as age, sex, personal relationships with HIV patients, etc., is also collected in the questionnaire. The results of the quiz and the sociodemographic information and then processed, and statistical tests such as the Mann-Whitney U test are performed to obtain the results. Results: A total of 483 responses were collected. The median age of the participants is 45 years, with an interquartile range of 35–56 years, with 45.1% of them being male. 50.9% of participants are married, and 71.8% of participants have received tertiary education. 19% of participants are working or have worked in medicinal and/or social welfare-related fields, and 5.4% of participants have personal relationships with HIV patients. The median score attained by the participants is 10 out of a maximum score of 19, with the scores resembling a symmetric, bell-shaped distribution centered around a peak of around 9–10. The most significant sociodemographic factors that affect HIV knowledge are age (P<0.001), education (P<0.001), having medical and/or social work (P<0.001), and relationships with HIV patients (P<0.001). Conclusions: To conclude, sociodemographic factors do have effects on HIV knowledge among Hong Kong citizens, with certain factors having a more apparent effect than others. In addition, there exist patterns for certain groups of citizens; for example, those who are older and have a lower educational level generally have a lower HIV knowledge level. The government may focus more resources and policies, such as promotional campaigns, on these groups to alleviate the problem.
AB141. Beyond parenthood: lived experiences of single and childfree senior citizens
Background: In the Philippines, aging without children is often perceived as unfortunate due to strong cultural expectations that emphasize marriage and parenthood as essential life milestones and primary sources of support in later life. These norms reinforce traditional family structures and may marginalize individuals who remain single and childfree. While international literature on voluntary childlessness is increasing, studies that explore the lived experiences of single and childfree senior citizens within the Philippine context remain scarce. This study aimed to explore and describe the lived experiences of single and childfree senior citizens residing in Angeles City, Pampanga. Methods: This study employed a descriptive phenomenological design. Eight purposively selected senior citizens who were single and without children participated in the study. Data were collected through face-to-face unstructured interviews guided by the central question: “How are your experiences living as a single and childfree senior citizen?” Ethical approval was obtained from the institutional review committee, and bracketing was observed to minimize researcher bias. Data saturation was achieved, and Colaizzi’s method was utilized for data analysis. The final manuscript underwent plagiarism screening to ensure academic integrity. Results: Four major themes emerged from the analysis: (I) “Roads Not Taken”, which described reasons for remaining single and childfree, including prioritizing family responsibilities, valuing independence, and past relationship experiences; (II) “Life in the Quiet Lane”, which reflected both emotional challenges and a sense of inner peace associated with aging alone; (III) “A Safety Net of Support”, highlighting reliance on extended family, friendships, and financial preparedness; and (IV) “Redefining Happiness”, illustrating how faith, purposeful living, and personal interests contribute to life satisfaction. Conclusions: The findings demonstrate that aging without traditional family roles involves both challenges and opportunities. Single and childfree senior citizens develop resilience and meaning through nontraditional life paths. These insights underscore the need for inclusive aging policies and community-based support systems that recognize diverse life choices and promote well-being among older adults.
AB140. Study of local microorganism variations on the quality of liquid organic fertilizer made from chicken feather waste
Background: Chicken feather waste negatively impacts human health and the environment. One way to lessen the negative impact is by using chicken feathers as liquid organic fertilizer. The aim of this research is to analyze the differences in adding several types of local microorganisms to the quality of liquid organic fertilizer made from chicken feather waste. Methods: This study uses experimental research with four treatments and six replications using a non-factorial completely randomized design (CRD). The independent variables are the types of local microorganisms, namely from pineapple skin, rice washing water, and banana stems. The dependent variables are the temperature, pH, organic carbon, color, and aroma. Data analysis used the Kruskal-Wallis test (significance level <0.05), followed by the Dunn test (significance level <0.05) if significant. Results: The study found that the highly effective intervention was the addition of local microorganisms from pineapple peel, which produced yellow-colored fertilizer with a pleasant aroma, a temperature of 26.4 ℃, a pH of 4.19, and an organic carbon content of 0.49%. Conclusions: The organic carbon content produced in this study did not meet the minimum technical requirements for liquid organic fertilizer established by the Ministry of Agriculture of the Republic of Indonesia No. 261/KPTS/SR.310/M/4/2019, which is a minimum of 10%. Nevertheless, this study can play a role in organic waste management, and the research product can be categorized as a soil conditioner.
AB139. Enhancing and monitoring HIV treatment adherence in Indonesia through a telemedicine mobile app: pilot development
Background: Adherence to antiretroviral therapy (ART) is a critical component in the management of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Numerous challenges influence diminished patient adherence, from healthcare management issues, stigma, and patients’ personal constraints. These persistent barriers threaten long-term treatment outcomes and highlight the need for scalable, patient-centered approaches that can support continuity of care beyond conventional face-to-face services. In this context, telemedicine has emerged as a promising strategy to enhance access, monitoring, and engagement in ART adherence, particularly in resource-limited and stigmatized settings. This study aims to develop a telemedicine-based mobile application and assess its usability as a tool for monitoring adherence to ART. Methods: The study was conducted as a preliminary study by utilizing the Analyze-Design-Development-Implement-Evaluate (ADDIE) framework. Usability was measured by content and media experts’ validation and targeted prospective users by the System Usability Scale questionnaire. Results: Research findings indicate the prototype effectively meets patients’ expectations to increase adherence to their medication schedules, facilitates online consultations with healthcare providers, and improves social support among patients via the peer-support feature. This application garnered favorable assessments from both users and experts. Validation by material experts indicated a feasibility score of 89%, which was categorized as “very good”, whereas validation by media experts yielded a score of 88.57%, which was also classified as “very good”. The usability test results indicate an average score of 77.29%, classified as “acceptable”. Conclusions: The development has the potential to serve as an innovative tool to enhance ART adherence and facilitate technology-based HIV/AIDS management, particularly in Indonesia.
AB138. Factors associated with health-related quality of life (HRQoL) among public school teachers in Peninsular Malaysia
Teachers play a pivotal role in nurturing the future generation, shaping educational quality and developing human capital. However, rising demands, including long hours, large class sizes, and emotional strain, have taken a toll on their physical and mental well-being. This cross-sectional study assessed health-related quality of life (HRQoL) among public school teachers in Peninsular Malaysia. Among 11,057 teachers recruited in the study, the mean scores for Physical Component Summary (PCS) and Mental Component Summary (MCS) were 47.59 and 48.88, respectively, suggesting that, on average, teachers in this sample report a moderate level of HRQoL. Multivariable analysis showed lower PCS scores among female teachers (B=−1.60), those aged 50–59 years (B=−1.17), and those with obesity (B=−2.60); while high physical activity improved PCS (B=0.52). MCS scores were higher in older teachers (≥60 years: B=3.93), but significantly lower among teachers with extremely severe stress (B=−8.45) and depression (B=−8.85). These findings highlight demographic, lifestyle, and mental health influences on HRQoL. Targeted interventions by policymakers, school administrators, and health professionals may help improve the mental health and well-being of the teaching workforce, such as workplace wellness programs, age-appropriate health screenings, routine physiological screening, and counseling.
AB137. Global approaches to preventing congenital syphilis: a United States policy and health equity perspective
Background: Congenital syphilis (CS) is a preventable yet resurging public health crisis in the United States. Despite the availability of reliable screening and treatment, reported cases of CS increased by over 755 percent between 2012 and 2022. This alarming trend reflects deeper systemic and structural failures within maternal health and public health infrastructures. Our objective is to examine the systemic and structural drivers contributing to the rise of CS in the United States and to assess how international public health models inform more effective prevention strategies. Understanding these drivers is critical to informing evidence-based interventions and reducing health inequities. Methods: This study investigates the systemic and structural contributors to rising CS rates in the United States through a systematic literature review of peer-reviewed studies published within the past decade. Public health models and prenatal screening frameworks in the United States were compared with those in the United Kingdom, Canada, and Brazil. Key areas of focus included access to prenatal care, syphilis screening policies, healthcare financing, and structural inequities affecting maternal health outcomes. Results: The analysis demonstrates that universal prenatal screening protocols and accessible, publicly funded prenatal care systems in the United Kingdom and Canada have effectively limited CS incidence. In contrast, Brazil and the United States continue to experience elevated CS rates due to economic inequality, fragmented healthcare delivery, and underfunded public health systems. In the United States, nearly 40% of mothers of infants diagnosed with CS received no syphilis screening during pregnancy. These gaps disproportionately affect marginalized populations due to systemic racism, limited Medicaid coverage, and longstanding distrust in healthcare institutions. Beyond perinatal outcomes, evidence also indicates adverse long-term neurodevelopmental, cognitive, and behavioral outcomes among adolescents with in utero exposure to syphilis, underscoring the lasting consequences of inadequate prevention. Conclusions: This study highlights the urgent need for comprehensive, upstream interventions to address the resurgence of CS in the United States. Recommended strategies include expanding Medicaid coverage to improve prenatal care access, establishing nationwide syphilis screening mandates, increasing investment in sexually transmitted infection prevention initiatives, and strengthening culturally competent, community-based outreach efforts. By integrating lessons from international public health systems, these approaches offer a viable path to reducing CS incidence, advancing health equity, and improving long-term outcomes for vulnerable populations.
AB136. Traction alopecia in Black women: understanding emotional impact and cultural competency
Background: Traction alopecia is a form of hair loss caused by repeated tension on the scalp, typically from tightly styled hair. While it can affect individuals of all backgrounds, it disproportionately impacts Black women. This study focuses on how the condition hinders femininity and self-expression. It also considers the historical and social significance of hair in Black communities. However, the psychosocial and cultural implications of this condition remain overlooked in clinical and public health research. Methods: This study employed a comprehensive literature review and insights gathered from an interview. The literature review examined existing research on traction alopecia, psychosocial outcomes, and hair practices among Black women. The interview explored personal experiences with traction alopecia and the use of traditional remedies. Results: The findings indicate that many Black women with traction alopecia rely on community knowledge and traditional remedies, often due to a lack of culturally competent healthcare providers and social determinants that limit access to medical care. Common traditional remedies for traction alopecia include natural oils, herbal treatments, and scalp massages. The condition is associated with emotional distress and impacts self-perception and social identity. Conclusions: Reliance on traditional remedies is linked to limited access to culturally competent healthcare and broader social determinants that restrict care. Traction alopecia affects emotional well-being and shapes how Black women navigate identity in a society that stigmatizes natural hair. Culturally sensitive and holistic healthcare practices are urgently needed to support emotional well-being, build trust, and improve health outcomes for Black women with traction alopecia.
AB135. United in crisis: India’s COVID-19 message to the world
Background: The coronavirus disease 2019 (COVID-19) pandemic called for unified public health responses worldwide, particularly in large, diverse, and densely populated countries. India’s early response uniquely combined visual storytelling, symbolic gestures, and mass communication to influence public behavior and signal collective responsibility at scale. This abstract examines how these symbolic strategies framed risk, solidarity, and resilience during the first national lockdown in 2020 and how they contributed to public health communication beyond conventional text-based advisories. Methods: This poster is based on a narrative illustration inspired by national government campaigns, grassroots initiatives, and media-driven symbolism during India’s 2020 lockdown. Key themes were derived from public health advisories, Ministry of Health and Family Welfare (MoHFW) updates, televised addresses, and observed public actions such as the “Janata Curfew”, lighting diyas, displaying national colors, and honoring frontline workers. The visual elements were organized to depict the sequence of events, the emotional tone of India’s early pandemic messaging, and the interaction between state communication, community response, and media amplification. Results: India’s symbolic health messaging appeared to trigger mass citizen participation, increase trust in public health guidance, and promote community solidarity across regions and socio-economic groups. Collective actions such as clapping for frontline workers, lighting lamps on balconies and using widely recognized national figures in health messages helped bridge scientific advice with emotion, identity and a sense of shared sacrifice in a high-density, multilingual population. At the same time, the experience highlighted persistent challenges related to misinformation, digital divides, stigma and unequal access to timely, accurate information, which sometimes diluted or distorted the intended messages. Conclusions: India’s early pandemic response illustrates the global value of culturally resonant, emotionally engaging public health communication when combined with clear, consistent and evidence-based content. Visual symbols, unity campaigns and frontline narratives can function as powerful tools to influence protective behaviors, sustain public morale and reinforce trust in health institutions, but they must be accompanied by transparent risk communication strategies and efforts to reach marginalized and digitally excluded communities. These lessons may inform future crisis communication frameworks in other low and middle-income settings.
AB134. The effectiveness of education for people with shoulder pain: a systematic review
Background: Clinical guidelines endorse patient education as a first-line treatment for shoulder pain; however, its effectiveness remains unclear. Evidence from other musculoskeletal conditions suggests that patient education provides small, short-term improvements in pain and function. Therefore, this systematic review aimed to investigate the effectiveness of education for people with shoulder pain. Methods: We searched several databases (e.g., MEDLINE, Embase, CENTRAL, CINAHL) and trial registries from inception to 25th May 2023. Randomized controlled trials investigating any education for people with shoulder pain were included for this study. Primary outcomes were pain and disability. We used the Physiotherapy Evidence Database (PEDro) scale to assess the methodological quality of included literatures. Meta-analysis was not appropriate due to heterogeneity. Results: We included 14 trials (eight had high methodological quality). The one trial on rotator-cuff related shoulder pain did not assess pain or disability but found best practice education (vs. structure-focused education) increased reassurance and intentions to stay active. The one trial on adhesive capsulitis found daily reminders, encouragement, and education about exercise via text did not improve pain and disability compared to no education. For post-operative shoulder pain, two (of four) trials found education reduced some measure of pain, but none found an effect on disability or any other outcomes. For ‘shoulder complaints’ (i.e., mixed or unclear diagnosis), no trials found education was more effective than home exercise or no education for improving pain or disability. Conclusions: Some forms of education appear to improve reassurance, treatment intentions, perceived treatment needs, recovery expectations, and knowledge, but their effect on pain and disability is unclear. High-quality trials are needed to resolve uncertainty surrounding the benefit of education for shoulder pain, particularly rotator-cuff-related shoulder pain and adhesive capsulitis.
AB133. Urbanization and double burden of malnutrition at the household level in South and Southeast Asia: insights from night-time lights data
Background: Urbanization is rapidly reshaping the socio-economic and health landscapes of South and Southeast Asia, presenting both opportunities and significant public health challenges. Among the most pressing is the double burden of malnutrition (DBM), the co-existence of undernutrition and overnutrition within the same households or populations. This phenomenon underscores that urban growth, while associated with improved infrastructure and economic development, does not uniformly translate into better nutritional outcomes. This perspective aims to explore spatial patterns of DBM using night-time light (NTL) satellite data as a proxy for urbanization in Bangladesh, Cambodia, and Nepal. Methods: We conducted a spatial analysis of DBM in relation to urbanization by integrating demographic and nutrition survey data with NTL satellite imagery. NTL intensity served as a proxy for urban growth and economic activity, allowing us to identify areas of high urbanization and assess their overlap with DBM prevalence at the population and household levels. Results: DBM affects approximately 12–14% of households in Nepal, Bangladesh, and Cambodia. Areas with high NTL intensity are associated with higher rates of household-level DBM. Urban centers such as Dhaka in Bangladesh and Kathmandu in Nepal emerge as prominent DBM hotspots, demonstrating a clear spatial overlap between urbanization and malnutrition. Conclusions: Integrating NTL data into public health planning can enhance the identification of high-risk areas and guide targeted, context-specific interventions. Addressing DBM in urbanizing regions requires cross-sectoral policies that combine nutrition-sensitive urban planning with inclusive food systems and social protection strategies.
AB132. Left behind thrice: a theory integration review of disabled female refugees left at the crossroads of discrimination and gender-based violence
Background: Women and girls with disabilities, particularly refugees, face heightened risks of gender-based violence (GBV) due to intersecting vulnerabilities encompassing their gender, disabilities and displacement. Despite growing recognition of unique risks faced by them, there remains a lack of comprehensive theoretical integration which addresses this ‘triple vulnerability’, as existing research often treats these vulnerabilities in silos. A theory integration review was conducted to identify the theoretical gaps for understanding this ‘triple vulnerability’. Methods: Various strings of keywords were used for a total of 10 subsets of intersections between the three domains, namely, refugee, GBV, and disability, across databases PubMed, Scopus, and BioMed Central. The inclusion criteria included studies from any three domains and studies focusing only on one domain published from 2000 to 2025. The exclusion criteria were studies published in non-English languages and case reports, duplicate publications, and conference abstracts. Relevant theories were filtered and mapped to four themes following thematic analysis: structural oppression, institutional oppression, interpersonal oppression, and individual vulnerability. Results: It was found that there is a lack of theories used in studying the subsets “GBV + disability” and “disability + refugee + GBV”. After integrating the theories with major themes synthesized from existing literature, it was shown that there was a lesser number of theories relevant to “individual vulnerability” and “institutional oppression”. This reflects a lack of integrated models studying the health systems addressing the complex needs of disabled female refugees. Furthermore, theoretical frameworks are still non-existent in studying the inadequate inclusion in humanitarian and healthcare programming for disabled refugee females. Conclusions: This research serves to guide future targeted interventions such as disability-inclusive humanitarian programming to systematically aid disabled refugee females. Future theoretical models may integrate gender-responsive health support systems to address intersectional vulnerabilities and ensure permanent accountability for inclusive health support programming and disabled refugee-centric healthcare models.
AB131. Strengthening local nutrition systems through governance: implementation of the First 1,000 Days (F1KD) Nutrition Systems Roadmap by the Zuellig Family Foundation (ZFF)
Background: The First 1,000 Days (F1KD)—from pregnancy to a child’s second year—are critical for child’s health and development. In the Philippines, malnutrition persists due to weak local health and nutrition systems. To address this, the Zuellig Family Foundation (ZFF) created the F1KD Nutrition Systems Roadmap, a governance-based tool aligned with the World Health Organization’s health system building blocks, helping local government units (LGUs) strengthen systems and improve nutrition outcomes. The F1KD Nutrition Systems Roadmap aims to: (I) assess current gaps hindering positive health and nutrition outcomes; (II) guide LGU actions to improve local nutrition systems; and (III) monitor progress to sustain ongoing improvements. Methods: In the preparatory phase, key LGU staff conduct self-assessment using documents and interviews to evaluate local system readiness and governance. During implementation, evaluators validate on-site and score indicators, producing color-coded results showing system functionality. Post-implementation involves analysis of findings to inform key actions to sustain or improve the LGU’s F1KD Nutrition System. Results: The roadmap was implemented in five provinces, 36 cities/municipalities, and 16 barangays across ZFF program sites. Most areas showed improved assessment scores from baseline to endline. The project team validated results through document reviews and facility inspections, followed by mentoring to address gaps. This process also recognized local progress and supported better nutrition outcomes. To site, stunting and wasting rates generally declined across five provinces. Conclusions: The F1KD Nutrition Systems Roadmap provides a clear framework that unifies local efforts into strategic actions to combat malnutrition. This governance-driven approach has led to systemic improvements and enhanced nutrition outcomes across various government levels. With its adaptable framework and demonstrated impact, the roadmap offers a scalable model for improving child nutrition systems across diverse contexts within the Philippines, and potentially in other low- and middle-income settings.
AB130. YouTube as a source of health information on dengue: a cross-sectional observational study
Background: Dengue remains a pressing public health issue, particularly in tropical regions. As digital health-seeking increases, YouTube has become a widely used but largely unregulated platform for health communication. This study assessed the accuracy, quality, and reliability of dengue-related YouTube videos using two validated tools: modified DISCERN (mDISCERN) and the Global Quality Score (GQS). Methods: A cross-sectional observational analysis was conducted in May 2025. Using five dengue-related search terms, 454 videos were retrieved; after eligibility screening, 107 unique English-language videos were evaluated. Metadata and engagement metrics were extracted. Two reviewers independently scored videos using mDISCERN and GQS, with discrepancies resolved by a third reviewer. Descriptive statistics, Kruskal-Wallis tests, and Spearman correlations were used to compare uploader types and examine associations. Results: News agencies contributed the most videos (43.9%) but demonstrated only moderate reliability and quality (good reliability: 14.0%; excellent quality: 10.3%). Hospitals, health websites, and physician-uploaded videos showed higher mean scores (GQS ≥4.0; mDISCERN ≥3.1). No significant differences in quality across uploader types were observed (mDISCERN: P=0.78; GQS: P=0.27). Quality was positively associated with video duration (r=0.403, P<0.001) but not with views, likes, or comments. Overall, 32.7% of videos showed good reliability and 32.7% showed excellent quality. Conclusions: YouTube contains valuable dengue-related content, but reliability and quality vary widely. Higher-quality institutional and physician-generated videos appear less visible, underscoring the need for interdisciplinary and platform-level strategies to amplify evidence-based health information during outbreaks.
AB129. Use of data in policies at the nexus of climate and health
Background: Climate change poses serious public health risks, necessitating the integration of environmental, climate, and health data into policymaking. In Thailand, multiple governmental agencies are responsible for implementing policies related to climate change and health. However, the extent to which data are used in these policies remains unclear. Therefore, this study aimed to map existing policies to relevant agencies, assess the types and extent of data use in these policies, and identify enablers and barriers to using data in policymaking. Methods: We conducted a targeted search across various ministries to identify and review relevant policy documents and map stakeholders and their roles. Subsequently, a cross-sectional online survey was administered among stakeholders from relevant ministries to identify (I) scopes and their roles; (II) types and uses of data in policymaking; and (III) enablers and barriers. Lastly, two rounds of stakeholder consultations were held. Data were analyzed using a mixed-methods approach, with thematic analysis for qualitative data and descriptive statistics for quantitative data. Results: A total of 288 documents were identified, including 184 regulations, 94 policies, and 10 reports and guidelines. Most policies involved multiple ministries, local governments, citizens, academic institutions, national committees, and international organizations. Policy development processes incorporated data-driven analysis, stakeholder engagement, relevant authorities’ involvement, and alignment with parent laws. However, data remain fragmented, and data utilization remains limited. The public health sector makes minimal use of socioeconomic data, while health data is rarely integrated into the energy and transport sectors. Technology and political factors were the most frequently cited enablers and barriers, respectively. Conclusions: Thailand has established a broad framework linking climate, health, and environmental policies. Stakeholders operate at both national and international levels, primarily serving as information providers. Policy decisions are evidence-based. However, challenges persist in implementation, resourcing, enforcement, and evaluation.
AB128. Urban renewal strategies in an aging society: cross-sectoral integration of architectural design and community-based healthcare
Background: Taiwan is projected to become a super-aged society by 2025, with over 20% of its population aged 65 years and above. This demographic shift poses significant challenges to urban infrastructure, spatial planning, and health service delivery. Using Taipei City as a case study, this research explores how urban renewal can serve as a platform for integrating architectural innovation with community-based healthcare, aiming to create resilient, age-friendly urban environments. The study proposes a transition from conventional land redevelopment toward a more inclusive and health-oriented urban renewal model. Five key design strategies are identified: (I) smart green buildings for energy efficiency and environmental sustainability; (II) health-promoting architecture that enhances indoor environmental quality; (III) pandemic-resilient infrastructure with infection control features; (IV) universal design for accessibility and age inclusiveness; and (V) embedded smart medical devices to support remote health monitoring and emergency care. On the healthcare side, the research advocates for localized service models, including community-based rehabilitation centers, neighborhood family clinics, and integrated referral systems between primary and tertiary care. These approaches aim to enhance care accessibility, continuity, and responsiveness, particularly for older adults seeking to age in place. Methods: This study employs a qualitative research design combining policy analysis, case studies, and cross-disciplinary expert interviews. It analyzes Taiwan’s Long-Term Care 2.0 and 3.0 policy frameworks and compares them with international ageing guidelines to clarify institutional and spatial implications. Three senior housing and community care facilities—Chang Gung Senior Village, Shin Kong Senior Housing, and New Taipei Silver Future City—are examined to assess real-world implementation. In addition, semi-structured interviews with ten experts from healthcare, architecture, urban renewal, and home care provide practical insights and support triangulation of policy intentions and on-site experiences. Results: The research findings reveal that urban renewal holds substantial potential as a health promotion mechanism in ageing societies. By incorporating age-friendly spatial design, community-based healthcare, and long-term care services, urban renewal can evolve from a purely physical redevelopment instrument into a comprehensive platform for preventive health intervention. The study identifies five core design principles for aging housing: universal design, reversible design, pandemic-resilient buildings, smart technologies, and integrated community healthcare. However, evaluation of the current system shows that floor area ratio incentive schemes—despite offering bonuses of up to 170% for accessibility, green building features, and public facility contributions—remain heavily focused on hardware-based subsidies. Incentives for software services and cross-domain integration are insufficient, limiting the effective introduction of community health centers and day care services. Expert interviews strongly support the adoption of reversible design, family doctor systems, fall warning technologies, and walk-in bathtubs, while calling for institutional innovations such as an all-age universal housing label and a dedicated health-oriented urban renewal framework to embed health promotion into redevelopment policy. Conclusions: The integration of built environment design and healthcare delivery within urban renewal not only addresses the needs of an aging population but also improves cities’ overall public health preparedness. The study concludes with policy recommendations for institutionalizing health-integrated urban renewal practices, and highlights the necessity of cross-sector collaboration among urban planners, public health professionals, medical providers, and local governments. This research contributes to global discussions on healthy cities and sustainable aging by providing a replicable model that bridges the gap between spatial planning and healthcare systems in the context of demographic transition and public health risk.
AB127. Unequal Access, unequal outcomes: disparities in availability and accessibility to self-injectable adrenaline for pediatric anaphylaxis in Asia-Pacific
Background: Pediatric anaphylaxis is under-investigated in Asia-Pacific, with its management remains under-reported. This study aims to report and compare the management practice of pediatric anaphylaxis among Asia-Pacific localities. Methods: Data from the Asia-Pacific Research Network for Anaphylaxis, a prospective regional pediatric anaphylaxis registry with 16 participating centers from Hong Kong, Singapore, Thailand, and Qingdao, were analyzed. The management strategies across regions were compared. The outcomes of patients with and without self-injectable adrenaline before anaphylaxis were also contrasted. Results: A total of 721 anaphylaxis episodes in 689 patients, spanning from 2019 to 2022, were included. Overall, while adrenaline was administered in 434 (60.2%) episodes, only 64 (8.9%) were given pre-hospital adrenaline. Almost all patients in Thailand (95.8%, 113/118) and Singapore (93.3%, 237/254) received adrenaline, whose usage was significantly lower in Hong Kong (30.1%, 66/219) and Qingdao (13.8%, 18/130; P<0.001). Only 89 (12.3%) children owned an adrenaline device before an episode of anaphylaxis, with significantly different rates of ownership among regions (P<0.001): 18.9% (48/254) children in Singapore possessed a device, followed by 15.3% (18/118) in Thailand, 10.5% (23/219) in Hong Kong, and none in Qingdao. Compared to individuals without an adrenaline device before an anaphylactic event, those who owned one had significantly higher overall (80.9% vs. 57.3%, P<0.001) and pre-hospital use of adrenaline (49.4% vs. 3.2%, P<0.001) shorter time to first-dose administration (mean: 73.4±98.2 vs. 159.8±476.5 minutes, P<0.001), lower proportion of severe anaphylaxis (World Allergy Organization grade 4–5 reactions; 9.0% vs. 18.4%, P=0.03), and reduced length of admission (mean: 1.0±0.7 vs. 2.3±7.5 days, P<0.001). Conclusions: Disparities in anaphylaxis management persist in Asia-Pacific, likely due to limited adrenaline autoinjector access in developing countries, as well as underuse in developed regions. Patients who owned an adrenaline device demonstrated significantly better outcomes than those who did not.
AB126. Understanding students’ navigation of health spaces in three Chinese cities: a qualitative and network survey study
Background: Migration is one of the defining issues of our time. Politics, violence, restrictive definitions of citizenship, the rise of ethno-nationalist states, and climate change have driven large-scale population movements. While much attention is given to migration from developing to developed countries, the reality is more complex—most global migration is regional or occurs between developing countries. China, for example, has become an increasingly important destination for migrants, including a growing number of African student migrants. In 2018, there were 492,185 African students in China, and this number is projected to rise significantly. Like other migrants, African students face considerable challenges in accessing health care. Research has shown that student migrants encounter barriers related to affordability, accessibility, language, miscommunication, and stigma. In 2024, we launched a study to examine the specific challenges faced by Tanzanian students in accessing health care in three Chinese cities. Methods: Sixty in-depth interviews and a network survey were conducted. Using the concept of patient navigation, the study examines how students locate and access health services, as well as the role of social networks in this process. Results: Preliminary findings from qualitative interviews suggest that Tanzanian students perceive the quality of health services as average. They report bureaucratic and language-related barriers, inadequate insurance coverage, and experiences of discrimination. Conclusions: This study contributes to the understanding of health-seeking behavior and highlights the critical role of social networks in accessing care among a growing segment of African student migrants in China.
AB125. Understanding patient satisfaction in virtual outpatient care: insights from a statewide survey in Australia
Background: Outpatient services help bridge the care gap between primary and tertiary healthcare. However, little is known about how clinical context affects patient experience in virtual care, particularly since its rise during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study is to examine associations between clinician-patient communication, appointment purpose, clinical discipline, and patient satisfaction with virtual care, including overall rating, willingness to use virtual care again, and perceived helpfulness. Methods: This retrospective cross-sectional study analyzed data from Virtual Care Surveys conducted in 2020–2022 by the Bureau of Health Information (New South Wales Ministry of Health), which captured patient experiences with phone and video-based care in public hospital outpatient clinics. Outcomes were coded as negative experiences. Analyses applied population weighting, and regression models were adjusted for patient characteristics and survey year to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results: Among 7,513 respondents with complete data reporting virtual care appointments and gender (representing 354,698 patients; mean age 56 years, 59% female), key predictors of negative virtual care experiences included clinicians not listening carefully [AORs (95% CI): 3.7 (2.1, 6.7) (poor rating), 2.2 (1.3, 3.7) (unwillingness), 7.7 (3.9, 15.2) (unhelpfulness)], and patients lacking trust/confidence in clinicians [AORs (95% CI): 5.9 (3.7, 9.7), 1.9 (1.1, 3.1), 2.9 (1.5, 5.5), respectively]. Among the purposes of the appointment, receiving medical diagnosis and advice was related to perceived unhelpfulness [AOR (95% CI): 1.9 (1.0, 3.5)]. No associations were found for clinical discipline; however, clinicians lacking preparedness increased the odds of experiencing negative outcomes. Positive experiences were more likely to be reported among patients aged 65 years and above, females, those from non-English- speaking backgrounds, individuals living in remote areas, and those with more frequent use of virtual care (P<0.03). Conclusions: Virtual care was broadly accepted across outpatient services in New South Wales. However, patient satisfaction was influenced by the quality of communication and clinician preparedness. Targeted training, particularly for diagnostic consultations, may enhance virtual care experiences in Australia and inform best practices globally.
AB124. Understanding mental health literacy among pre-university students in Malaysia: a mixed-methods protocol
Background: Mental health issues among late adolescents in Malaysia have emerged as a growing public health concern, particularly during the transitional pre-university period. Despite increasing awareness of adolescent mental health, mental health literacy (MHL) in this age group remains poorly understood. Many students are unable to recognize symptoms, access reliable information, or navigate appropriate help-seeking pathways. There is a clear need for context-specific research that considers not only individual knowledge but also cultural attitudes, behavioral norms, and environmental influences shaping MHL. This study draws on Social Cognitive Theory to address these gaps and contribute to evidence-informed mental health promotion among youth in low- and middle-income settings. The objectives of this study are to: (I) assess the level of MHL among pre-university students aged 18–19 years in Negeri Sembilan; (III) identify key personal, behavioral, and environmental determinants of MHL; (III) explore students’ lived experiences and help-seeking perceptions; and (IV) provide locally relevant insights to inform institution- and community-based interventions. Methods: A convergent mixed-methods design will be employed. The quantitative arm will consist of a cross-sectional survey involving 350 students using validated tools measuring MHL, self-efficacy, health literacy, social support, and cultural beliefs. In parallel, 10–15 students will be purposively selected for in-depth interviews to examine contextual influences on mental health understanding and help-seeking behavior. Quantitative data will be analyzed using descriptive and inferential statistics (SPSS), while qualitative data will undergo thematic analysis (using NVivo software). Ethical approval is currently being sought from Universiti Putra Malaysia’s Human Research Ethics Committee. Results: Findings will offer a comprehensive understanding of the multifactorial influences on adolescent MHL, supporting the development of culturally sensitive, equity-oriented interventions in line with global mental health priorities. Conclusions: This study will explain why awareness does not always translate to help-seeking among Malaysian pre-university students. By integrating quantitative metrics with pre-university students’ perspectives, the findings will provide the necessary local evidence to shift from generic awareness campaigns to targeted and culturally sensitive mental health interventions.
AB123. Turning down industrial noise: a collaborative hearing conservation initiative for palm mill workers
Background: Occupational noise-related hearing disorders (ONRHD) remain a critical health concern in the palm oil industry. Despite regulatory frameworks, implementation gaps persist due to limited targeted interventions. This study aims to develop and validate a tailored Hearing Conservation Program (HCP) for palm oil mill workers using a multi-method approach. Methods: The development of the HCP involved triangulation of various data sources. A literature review was conducted to understand the local and international regulatory requirements and to review various research on the HCP. A walk-through survey and document review were carried out to understand work processes, work practices, and organizational behavior in the palm oil mills. An in-depth interview with program users, implementers, and policymakers was also conducted to explore the barriers and facilitators to various strategies for preventing ONRHD in the mills. Content validation of the HCP was conducted by five expert panel members, who assessed its relevance, comprehensiveness, and clarity. The HCP training component was pre-tested among 30 palm oil mill workers. Results: A comprehensive HCP was developed, incorporating seven key elements. The content validation demonstrated excellent agreement among experts. The Scale-Content Validity Index/Average (S-CVI/Ave) scores for comprehensiveness and relevance were 1.000 and 0.975 for clarity. Corrections were made based on feedback before pre-testing. In the pre-test phase, more than 96% of participants agreed that the materials were clear and understandable. Minor refinements were made, but the training materials were retained in their final form based on overall positive feedback. Conclusions: The development and validation of the HCP demonstrated strong content validity and acceptability among end users. These findings support its implementation and evaluation of the program in the second phase of the study, emphasizing the importance of evidence-informed occupational health interventions in the palm oil industry. This contributes to global efforts to prevent ONRHD and to promote workers’ health equity.
AB122. Trends of ICD-10 diagnosis at the emergency department of public hospitals in Malaysia
Background: Emergency departments (EDs) in Malaysia play a critical role in healthcare delivery, managing a wide range of conditions. Developing diagnosis-related groups (DRGs) for emergency care requires a comprehensive understanding of the patterns of disease presentation. This study examines the use of International Classification of Diseases, 10th Revision (ICD-10) codes in EDs across Malaysia to inform DRG development. Methods: This cross-sectional study was based on a functional exercise conducted by the Ministry of Health Malaysia over a 6-week period from June to July 2022. Data were collected from 13 public hospitals, including various hospital types (state, major specialist, minor specialist, and non-specialist hospitals) across Peninsular Malaysia, Sabah, and Sarawak. Systematic random sampling was used to select emergency care episodes, resulting in 9,942 records. Ethical approval was obtained from the Medical Research and Ethics Committee, Ministry of Health Malaysia (approval dated 29 June 2022). The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. Sample size calculation using OpenEpi determined a minimum requirement of 1,512 records with a 99.99% confidence level, adjusted to 1,814 samples to account for a 20% attrition rate. Results: Respiratory diseases were the most frequently reported conditions, accounting for 21.2% of cases. The analysis identified 946 unique ICD-10 codes, with a significant number used infrequently. Codes with fewer than five presentations constituted 73.7% of all codes, while the top 20 diagnoses represented 42.9% of all records. Systematic ICD-10 coding revealed key areas where DRGs could be developed to enhance resource allocation in emergency care. Conclusions: The study highlights the diversity in diagnoses within Malaysian EDs and underscores the need for tailored DRGs to optimize healthcare resources. Future research should expand data collection to capture seasonal trends and refine the development of principal diagnosis lists to support DRG categorization.
AB121. Trends and climatic drivers of leptospirosis in Malaysia, 2012–2022: spatiotemporal analysis
Background: Leptospirosis remains a significant zoonotic disease in Malaysia, where climatic and environmental factors influence transmission dynamics. However, comprehensive national analyses of spatiotemporal patterns and their relationship to climate remain limited. The objective of the study is to describe the demographic characteristics, spatiotemporal patterns, and density; identify spatiotemporal clustering and hotspots; and determine the association between climatic conditions and state-level leptospirosis incidence in Malaysia from 2012 to 2022. Methods: A retrospective ecological study was conducted using 51,564 leptospirosis cases reported across Malaysia from 2012 to 2022. Demographics and spatiotemporal patterns were presented accordingly, and density was assessed using kernel density estimates (KDE). Spatiotemporal clustering and hotspots were identified using the nearest neighbor index (NNI), spatial autocorrelation (Global Moran’s I), local indicators of spatial association (LISA), and Getis-Ord Gi* statistics. Associations between climatic factors and annual state-level incidence were determined using a generalized linear mixed model (GLMM). Results: Most cases were in males (68.1%) and Malay Bumiputera (62.6%), with a median age of 30 years. Case numbers peaked in 2014–2016 and 2022, with higher density observed in parts of Peninsular Malaysia and Sarawak. Spatial clustering was seen every year (NNI 0.19–0.28; Moran’s I 0.02–0.21). LISA found persistent hotspots in rural areas of Sarawak, while others appeared intermittently. Getis-Ord Gi* confirmed the persistence and spread of these high-risk areas. Temperature was inversely associated with leptospirosis incidence [incidence rate ratio (IRR) =0.88; 95% confidence interval (CI): 0.78–0.99], while rainfall, humidity, and flooding were not statistically significant. Conclusions: The local climate and environment strongly shape leptospirosis in Malaysia, with certain areas consistently experiencing higher risk. Focusing prevention efforts in these hotspots, while considering ongoing changes in climate and environment, can improve disease control. These strategies may also be useful for managing leptospirosis and similar diseases in other countries with changing environments.
AB120. Through the lens of grief: a phenomenological study on widowhood among middle-aged and older adults
Background: Widowed individuals are often sidelined in healthcare, despite experiencing grief shaped by cultural, spiritual, social, and gendered factors. While global health efforts prioritize maternal and child health, this focus reveals a care gap for grieving individuals, whose needs remain largely invisible. Existing research on grief is Western-centric, overlooking how cultural and gender expectations influence bereavement in non-Western contexts like the Philippines. In local healthcare, grief responses often focus on visible symptoms, neglecting the deeper emotional and psychosocial impact of widowhood. This study explores how Filipino norms, gender roles, and support systems shape grieving and coping, synthesizing the participants’ lived experiences informing inclusive, culturally sensitive grief care practices in Philippine nursing and mental health. Methods: This descriptive phenomenological study explored the lived experiences of nine interviewed widowed individuals for at least 5 years in Quezon City, Philippines, selected through purposive sampling. Data were thematically analyzed. Trustworthiness was ensured through reflexivity, triangulation, member checking, and an audit trail. Ethical measures included informed consent, confidentiality, and psychological support. Results: The study revealed themes underscoring the gendered nuances, physical symptoms, and emotional burden in grieving, the role of support systems, maladaptive coping mechanisms, and fragmented care in bereavement contexts. Filipino widows’ and widowers’ experiences reflect a quiet, culturally shaped resilience. Grief was not absent, but differently expressed—intertwined with caregiving roles, spiritual beliefs, and social expectations. These findings demonstrate that grief is complex, manifesting as a biopsychosocial process. Conclusions: The study explored how culture, gender, and support systems shape grief among widowed Filipinos, revealing biopsychosocial impacts, gendered coping, and care gaps. Advocating culturally grounded, gender-responsive, community-based interventions in nursing, it aligns with Sustainable Development Goals (SDGs) 3 and 11 and answers a global call for shared solutions, emphasizing that recognizing grief as a mental health issue fosters inclusive, resilient healthcare systems.
AB119. Evaluating sustainable resilience in public health programs
Background: In a world where every aspect of global public health is affected by climate change, health interventions are required to include climate resilience as an outcome or impact in the planning and evaluation of programs. Since 40% of the world’s population is highly vulnerable to the impacts of climate change, the penultimate task is to make the transition to plan and design for adaptation and resilience. For the most vulnerable, every aspect of public health is affected by climate change, yet health interventions, whether embedded in larger development programs or as stand-alone projects, do not include resilience to climate impacts as an outcome. This has led to a patchwork of approaches often without clear connections between the nature of the climate-related hazard, the specific health vulnerabilities of the population, the adaptation (interventions), and measurable and specific outcomes that enhance resilience and promote the sustainability of improved health. This study will illustrate a theory of change that explicitly identifies climate effects and places sustainable resilience at the center of the design and evaluation of health programs. This Theory of Sustainable Resilience (TOSR) will allow health program evaluators to systematically capture changes in risk, vulnerability, and resilience in natural and human systems. Methods: Case studies are used to illustrate evaluation with respect to risk reduction, resilience, and the dynamic relationship between resilience and long-term sustainable impacts. Qualitative and quantitative assessment tools surface relevance, strategy, elements of systems resilience, and the conditions that drive sustainable resilience. Results: Two case studies, malaria prevention and food security/nutrition, illustrate this conceptual framework for evaluation. Conclusions: TOSR guides evaluators and planners to embed climate effects into health programs, tying the climate shock to the adaptive response (the intervention), and the intervention to the outcomes of reduced vulnerability and increased transformative resilience. Effectiveness in the TOSR is determined by reduced vulnerability and increased resilience, where resilience is transformative, dynamic, and sustainable. Climate change is addressed as systems change, reframing health interventions not only as technical fixes but to invest in communities’ capability to plan, govern, manage, and innovate. Transformative resilience is a necessary condition for sustainable resilience. Assessing the sustainability of transformative resilience requires a commitment to ex-post evaluation. Examining what has been learned from the design and implementation of the intervention after the end of the program and how these ‘learnings’ have been integrated back into program design is evidence of the community’s capability to continuously adapt and enhances the likelihood of streams of benefits. This framework should be tested, tweaked, and extended across public health programs.
AB118. The sudden surge of lymphatic filariasis cases in Tuaran: a cross-sectional study
Background: Lymphatic filariasis (LF) is a vector-borne neglected tropical disease that remains endemic in several regions of Malaysia, particularly in Sabah. The predominant causative parasite is Brugia malayi. Tuaran District had no previously recorded cases of LF until 2023. However, a sudden emergence of 40 confirmed LF cases in 2024 raised concerns regarding undetected transmission and limitations in local surveillance as well as early response efforts. This study aims to describe the sociodemographic characteristics and spatial analysis of LF cases in Tuaran District, Sabah, from 2020 to 2024. It aims to outline the public health response and preventive measures implemented during the surge in the number of confirmed cases. Methods: This cross-sectional study was conducted using secondary data from the Vector Control Unit, Tuaran District Health Office, covering a 5-year period from 2020 to 2024. Data sources included case notifications, field investigation records, community screening outcomes, and entomological investigation findings. Results: The first LF case was detected in 2023. Active case detection involved 394 residents across four localities, resulting in 38 individuals testing positive. In Tuaran, LF cases were more common among adults aged ≥40 years and those with outdoor jobs. Up till 2024, only 43.9% of positive cases received treatment. Spatial analysis shows LF cases clustering around villages within the Tamparuli sub-district, particularly where the landscape is dominated by plantations and forest margins. Entomological investigation at three sites showed no active vector presence. Public health interventions focused on morbidity management, continuous case surveillance, and targeted community health education. Conclusions: LF remains a significant public-health burden. Sabah still has endemic implementation units and sporadic cases, underscoring the need for more resources, consistent access to diagnostics and treatment, stronger community entomological surveillance, and better integration of local actions with national strategies.
AB117. The role of AI and digital technologies in access to diagnostics in crisis-prone areas: a scoping review
Background: Health systems across the globe face mounting challenges due to compounded crises such as poverty, infectious disease outbreaks, climate disasters, and reductions in external aid. Fragile and displacement-affected border regions across low- and middle-income countries (LMICs) exemplify these pressures, where large-scale population movements and constrained access to affordable healthcare place sustained stress on diagnostic and treatment services, particularly for communicable diseases. Artificial intelligence (AI) and digital technologies are increasingly recognized as transformative tools for improving access to health services in LMICs, particularly in diagnostics, telemedicine, supply chain management, and epidemic forecasting. These technologies, when adapted to local contexts, can help overcome systemic barriers and improve health outcomes in resource-constrained settings. Methods: This scoping review maps the landscape of AI and digital technologies used for diagnostics, with a focus on how these technologies engage with challenges faced by displaced and migrant populations. It synthesizes evidence on technology characteristics, implementation contexts, stages of deployment, effectiveness, and integration with health systems to inform the development of sustainable and decentralized diagnostic systems. The review delves deeper into countries that comprise the Association of Southeast Asian Nations (ASEAN) as they face complex health crises driven by poverty, climate change, infectious diseases, natural disasters, and the withdrawal of external aid. The Thailand-Myanmar border region, in particular, is challenged by a large influx of displaced people, the termination of external assistance, and reduced free medical services. These factors strain health systems and highlight the urgent need for innovative, resilient approaches. Results: The results show that human-centered design approaches—actively involving end-users such as patients and frontline health workers—are critical for effective and ethical deployment, especially among marginalized populations. However, challenges remain, such as limited high-quality data for AI model training, weak infrastructure (electricity, connectivity), low AI literacy, and the deployment of “black-box” AI systems with low explainability and community trust. Conclusions: This scoping review will inform a project that will (I) identify issues surrounding access to diagnostics on the National Essential Diagnostics List (NEDL) for populations in crisis-prone areas, particularly at the Myanmar border in Thailand; and (II) explore how AI and other digital technologies could support the development of self-reliant systems for health in this context. This study underlines the importance of collaboratively designing AI and digital solutions with local stakeholders that are informed by cultural contexts, and grounded in principles of equity, resilience, and sustainability.
AB116. The relationship of light physical activity on overall well-being among older persons in Metro Manila
Background: With the rise of the aging population in the Philippines, promoting holistic well-being in older persons is increasingly important. Light physical activity (LPA)—such as walking and household chores—has been associated with numerous health benefits, yet its relationship with specific well-being domains remains underexplored in the Filipino context. This study aimed to determine the correlation between LPA and the four domains of well-being—physical, psychological, social, and environmental—among older persons residing in Metro Manila. Methods: A quantitative descriptive correlational design was employed. Fifty-two participants aged 65 years and above, from both institutional and community-based settings, were selected via convenience sampling. Data were gathered using the Physical Activity Scale for the Elderly-Filipino Version (PASE-F) and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). Statistical analyses, including Spearman’s rho (ρ) correlation, were conducted using Statistical Package for the Social Sciences (SPSS) version 30. Results: The results revealed a weak positive correlation between LPA and physical well-being (ρ=0.151, P=0.30), psychological well-being (ρ=0.134, P=0.33), and environmental well-being (ρ=0.143, P=0.31). The social well-being domain showed the weakest association (ρ=0.017, P=0.91). All observed correlations were weak, with P values ranging from 0.30 to 0.91. These findings indicate that while LPA is positively associated with well-being scores, the strength of these associations is weak. Conclusions: While LPA was associated with favorable well-being scores across all domains, the lack of statistically significant relationships suggests that physical activity alone may not independently influence older persons’ holistic well-being. The study highlights the need for integrated health strategies that combine physical activity with social, emotional, and environmental support systems to enhance overall quality of life among older adults in the Philippines.
AB115. The pandemic agreement as a legal milestone for One Health: significance and challenges ahead
Background: The coronavirus disease 2019 (COVID-19) pandemic highlighted the interdependence of human, animal, and environmental health. The recognition of this interdependence has been further reinforced by the growing awareness of climate change as a risk multiplier, exacerbating health threats by accelerating ecological degradation and influencing zoonotic spillover. The Pandemic Agreement, adopted in May 2025, represents the first legally binding instrument to adopt the One Health approach. This study examines the significance and future challenges of the Pandemic Agreement in implementing the One Health approach. Methods: The study combines a literature review on the normative basis and governance challenges of the One Health approach with a survey of relevant soft law instruments and an examination of the text and negotiating history of the Pandemic Agreement. It also considered the impact of general principles and approaches in multilateral environmental agreements (MEAs) as a benchmark for assessing the One Health approach. Results: The Pandemic Agreement builds on the work of the Quadripartite Organizations [Food and Agriculture Organization of the United Nations (FAO), United Nations Environmental Programme (UNEP), World Health Organization (WHO), and World Organisation for Animal Health (WOAH)] in advancing the One Health approach and introduces legally binding obligations for its implementation, alongside related provisions on prevention and surveillance. However, these obligations are generally assessed as broad and relatively weak, raising questions about their added legal value compared to existing efforts and soft law instruments. Nevertheless, experience from MEAs suggests that even general obligations can shape treaty practice over time. The development of guidelines, recommendations, and decisions by the Conference of the Parties could play a critical role in further operationalizing the One Health approach under the Agreement. Conclusions: The Pandemic Agreement is a legal milestone in promoting the implementation of the One Health approach. However, given the weakness of the related legal obligations, effective implementation of the approach would require continued efforts within the treaty regime after the Agreement enters into force.
AB114. The languages of care: experiences of immigrant speakers of five mother tongues in the Canadian Perinatal Healthcare System
Background: Respectful and inclusive health services are globally acknowledged as a key indicator of maternal-newborn optimal outcomes. However, social factors such as cultural background, immigration status, and racism are core barriers to equitable access to high-quality care. Among these social factors, language is identified as a significant barrier to respectful perinatal care, particularly among immigrants. Canada is a country with a long tradition of welcoming immigrants and promoting the arrival of newcomers from all over the world. However, this positive attitude is not always consistent with immigrants’ experiences navigating the health system. Thus, we present the design of an ongoing analysis that aims to examine how allophone languages limit or expand access to respectful perinatal care for birthing people in Canada. Methods: The Research Examining the Stories of Pregnancy and Childbearing in Canada Today (RESPCCT) is a Canada-wide study on the experiences of perinatal care. Using validated person-centered measures, more than 6,000 participants from diverse identities, backgrounds, and circumstances reported on respect, autonomy, and mistreatment during pregnancy. Through thematic analysis inspired by constructivist social theories, we are reviewing participants’ open-ended responses. In this paper, we present our innovative approach to qualitative analysis of a large number of open-ended responses to a cross-sectional survey that goes beyond the limits of quantitative content analysis to achieve deeper meaning-making. Results: To contextualize the responses of Arabic, traditional and simplified Chinese, Spanish, and Punjabi-speaking immigrant participants, we considered their scores on the Mothers on Respect (MOR), My Autonomy in Decision Making (MADM), and Mistreatment Index (MIST-7) tools. These patient-reported outcome measures allowed us to connect lived experiences with language as a cultural marker. This explanatory process unveiled and unpacked the role that language played during their perinatal care experience, revealing how mother tongues interplay with (I) cultural safety, (II) informed consent access, (III) non-verbal communication, (IV) verbal communication from care providers, and (V) supportive behaviors and conditions of treatment. Conclusions: We outlined the methodology for a qualitative data analysis focusing on language contributions to respectful perinatal healthcare. Expected final results will uncover insights into culturally sensitive healthcare practices that reduce discrimination and enhance cultural safety.
AB113. The impact of particulate matter on chronic obstructive pulmonary disease exacerbation: a retrospective study from Teaching Hospital of the University of Sumatera Utara, Medan, Indonesia
Background: Chronic obstructive pulmonary disease (COPD) affects millions of individuals worldwide. COPD exacerbation—which is the acute deterioration of respiratory symptoms and may be brought about by exposure to particulate matter (PM)—often results in increased hospitalization admissions and reduced quality of life. In Indonesia, industry emissions and forest fires are important contributors to air pollution. The objective of this study is to better understand the relationship between air quality and COPD exacerbation in Medan, Indonesia. Methods: We obtained medical records of all COPD patients hospitalized at the Teaching Hospital of the University of Sumatera Utara, Medan, Indonesia from 2023 to 2024. Data on daily PM2.5 and PM10 were obtained from the Meteorological, Climatology, and Geophysical Agency. We compared the monthly-aggregated time-series trends of the hospitalizations for exacerbated COPD with PM2.5 and PM10. Results: A total of 438 patient records were included in this study (81.7% male, mean age 57.3 years old). Data from April each year were excluded due to public holiday and tradition of returning to hometown, which leads to low hospitalization rates and might introduce bias. An increase in COPD exacerbation was observed during September–October in 2023, while the peak in 2024 occurred in October. Levels of PM2.5 and PM10 both peaked in October 2023 and May 2024, indicating possible short-term pollutant accumulation during the transitional dry to rainy season. Correlation analysis revealed a significant positive association between COPD exacerbation and PM2.5 (Spearman ρ=0.53, P=0.01), but not with PM10 (Spearman ρ=−0.39, P=0.07). Conclusions: PM2.5 exposure plays a significant role in the rise of COPD exacerbation. These findings highlight the importance of air pollution mitigation to prevent COPD exacerbation. To obtain a better understanding of the spatial-temporal variations in environmental influences on COPD, similar studies should be conducted in other regions with diverse air pollution profiles and land use patterns.
AB112. The effects of skin-to-skin contact on maternal postnatal attachment in lying-in clinics in Metro Manila
Background: Maternal postnatal attachment is critical for infant development. Studies show that skin-to-skin contact (SSC) beyond Essential Intrapartum and Newborn Care (EINC) improves maternal responsiveness (Potgieter and Adams, 2019), instinctive maternal behaviors, and psychological well-being (Feng and Zhang, 2023). This highlights SSC’s role in establishing the foundation for future mother-child relationships. This study aims to determine the effects of daily structured, uninterrupted 1-hour SSC on maternal attachment towards their newborn, highlighting their emotional bonding. Methods: A quasi-experimental design with a pretest-posttest nonequivalent group was utilized. Participants included postpartum mothers selected via convenience sampling from lying-in clinics in Metro Manila, all mandatorily practicing EINC. Inclusion criteria included at least 20 years old, literate, with healthy full-term newborns, no delivery complications, and living with a relative. Exclusion criteria included mother-infant perinatal complications, with toddlers, and residing outside Metro Manila. The 60 participants were equally divided into two groups; the intervention group performed 1-hour SSC daily, while the control group continued their routine care for 2 weeks. The Mother-to-Infant Bonding Scale (MIBS) was used, with 8 adjectives rated on a 4-point Likert scale, wherein lower scores indicate stronger bonding. Results: A t-test analysis revealed significantly decreased mean scores of both intervention (2.8 to 0.93) and control groups (3.13 to 1.83), suggesting improved attachment. An item-level analysis of each adjective revealed no significant changes in the items “Loving” and “Joyful”. “Resentful” and “Dislike” significantly improved; the control group showed greater decline in “Resentful” and the intervention group in “Dislike”. Only the control group significantly improved for “Neutral or felt nothing” while only the intervention group significantly improved in “Protective” and “Disappointed”. Although scores for “Aggressive” significantly declined in both, the intervention group had a greater decrease. Conclusions: Structured SSC demonstrated potential in enhancing maternal attachment by reducing negative responses and promoting protectiveness, remaining a valuable adjunct for fostering maternal-infant bonding.
AB111. The determinants of non-alcoholic fatty liver disease (NAFLD) among adolescents in Peninsular Malaysia: a longitudinal closed cohort study
Background: Non-alcoholic fatty liver disease (NAFLD) affects up to 16% of adolescents globally, yet longitudinal data from Asian populations are scarce. This study examined prevalence trends and determinants of NAFLD over two time points among Malaysian adolescents. Methods: Data were drawn from the Malaysian Health and Adolescents Longitudinal Research Team (MyHeART) study at age 15 years (Wave 1, 2014) and age 17 years (Wave 2, 2016). NAFLD was assessed using the hepatic steatosis index (HSI). Associations between sociodemographic, adiposity, and lifestyle factors (physical activity, dietary intake, snacking habits, sleep duration, smoking) with NAFLD were analyzed using generalized estimating equations (GEE). Results: Among 530 participants, NAFLD prevalence was 2.6% at Wave 1 and 3.6% at Wave 2. Prevalence increased among males (3.7% to 6.8%) but showed a slight decline in females (2.2% to 2.0%). Significant determinants included a higher body fat percentage [adjusted odds ratio (OR), 2.35; 95% confidence interval (CI): 1.41–3.92], frequent snacking (adjusted OR, 1.89; 95% CI: 1.11–3.22), and low physical activity (adjusted OR, 0.67; 95% CI: 0.45–0.98). Conclusions: High body fat percentage, frequent snacking, and low physical activity have the strongest relationship with NAFLD among Malaysian adolescents. This requires future intervention planning.
AB110. The cost-effectiveness of artificial intelligence-assisted colonoscopy as a primary or secondary screening test in population-based colorectal cancer screening programmes: a Markov modelling study
Background: The study provided the cost-effectiveness of using artificial intelligence (AI) colonoscopy in different population-based colorectal cancer (CRC) screening strategies. The study aimed to provide insights into the potential benefits and economic implications of incorporating AI colonoscopy into CRC screening programs. Methods: To evaluate the cost-effectiveness of different population-based CRC screening strategies, including the use of AI-aided colonoscopy, by comparing incremental cost-effectiveness ratios (ICERs) and various outcome measures such as loss of cancer-related life-years, prevention of CRC cases, life-years saved, and total cost per life-year saved. Data from international literature and the government gazette were accessed to calculate relevant cost and performance estimates. Results: The ICER of fecal immunochemical test (FIT) + colonoscopy, FIT + AI colonoscopy, colonoscopy, and AI colonoscopy was US$138,539, US$122,539, US$203,929, and US$180,444, respectively. When compared with FIT + colonoscopy, use of FIT + AI colonoscopy could lead to significantly smaller total loss of cancer-related life-years (5,355 vs. 5,327), a higher number and proportion of CRC cases prevented (120 vs. 132, 3.7% vs. 4.1%), more life-years saved (280 vs. 308), and lower total cost per life-year saved (US$944,008 vs. US$854,367). FIT + AI colonoscopy had the lowest ICER (US$122,539) and dominated across all other strategies (−US$36,462 vs. FIT + colonoscopy). When colonoscopy is adopted as a primary screening test, AI colonoscopy dominated conventional colonoscopy (ICER −39,040). Conclusions: These findings show that FIT followed by AI colonoscopy is the most cost-effective strategy in population-based CRC screening programmes.
AB109. The correlation between confidence, complacency, and convenience as factors of pentavalent vaccine hesitancy: a descriptive-correlational study among Filipino mothers
Background: Vaccine hesitancy remains a pressing global health issue, particularly in low- to middle-income countries like the Philippines. This study investigates the correlation between the World Health Organization (WHO)’s 3C model (confidence, complacency, and convenience) and pentavalent vaccine hesitancy among Filipino mothers. The research responds to a growing need to understand behavioral and systemic barriers to vaccination in urban poor communities. Specifically, it aims to determine the association between each of the 3Cs and pentavalent vaccine hesitancy in selected barangays in Quezon. Methods: A quantitative, non-experimental correlational design was utilized, employing adapted Likert-scale tools. Eighty-five Filipino mothers aged 18 years and above with at least one child aged 0–1 year participated through convenience sampling. Data were analyzed using Spearman’s rho to measure correlations between each factor and vaccine hesitancy. Results: Confidence and complacency were identified as significant predictors of vaccine hesitancy (r=−0.257, P=0.02; r=0.304, P=0.005, respectively). Confidence was characterized by trust in healthcare providers and vaccine efficacy, whereas complacency reflected a perceived low risk of illness. Convenience-related factors (e.g., cost and distance) demonstrated a weak correlation with vaccine hesitancy (r=0.192, P=0.08). Conclusions: Vaccine hesitancy is shaped by psychosocial and contextual factors. Public health efforts must prioritize restoring trust and addressing risk misperception to improve vaccine uptake. These findings contribute to global strategies for equitable healthcare and informed, community-based immunization programs.
AB108. Temporal trends in the triglyceride-glucose index among adults with type 2 diabetes in Malaysia: a population-based analysis [2011–2019]
Background: The triglyceride-glucose (TyG) index is a simple surrogate marker of insulin resistance and is increasingly recognized for its role in cardiometabolic risk assessment. However, little is known about temporal trends in TyG levels among patients with type 2 diabetes mellitus (T2DM), especially across ethnic and demographic subgroups in Southeast Asia. The objective of this study is to examine the trends of the TyG index from 2011 to 2019 among adults with T2DM receiving care in public primary care settings in Malaysia, stratified by age, sex, and ethnicity. Methods: This retrospective cohort study used registry data from T2DM patients attending government primary care clinics between 2011 and 2019. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Descriptive and regression analyses evaluated overall temporal trends and the trend by sex, age group, and ethnicity across three-time intervals. Restricted cubic spline models assessed potential nonlinear patterns. Results: A slight but significant decrease in mean TyG index was seen over the study period (P<0.001). Among 161,759 patients, younger individuals had consistently higher TyG values (P<0.001). Both males and females showed a similar modest decline (P<0.001). TyG levels varied by ethnicity (P<0.001), with Malays highest and Chinese lowest. However, the small effect sizes for sex, age, and ethnicity indicate these factors explain only a minor part of the variation in TyG index. Conclusions: This study found a modest but significant decline in the TyG index among Malaysian adults with T2DM from 2011 to 2019. TyG levels varied by age, ethnicity, and sex, with younger individuals and Malays showing higher values. However, these demographic factors explained only a small part of the variation. Further research is needed to identify other factors and develop targeted interventions to reduce insulin resistance and cardiometabolic risk.
AB107. Synergistic antimicrobial potential of lemongrass and Cuban oregano: a comparative evaluation of efficacy for potential disinfectant use
Background: The emergence of antibiotic-resistant microorganisms, particularly Escherichia coli, underscores the need for alternative infection control strategies. This study investigated the antibacterial activity of oregano (Plectranthus amboinicus) and lemongrass (Cymbopogon citratus), both rich in phenols and flavonoids with antimicrobial properties. Methods: Macrobroth dilution susceptibility testing was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the samples. To evaluate the interaction between the antimicrobial agents, the fractional inhibitory concentration (FIC) index was calculated. This approach allowed the assessment of whether the combined agents exhibited synergistic, additive, or antagonistic effects. The study specifically hypothesized that combining the agents would enhance antimicrobial activity through synergistic interactions, resulting in improved inhibition and bacterial killing compared to the effects of each agent used alone. Results: However, statistical analyses showed that the MIC data were not normally distributed (P<0.001) and that the assumption of homogeneity of variances was violated (P<0.001). Treatment type significantly influenced MIC (P=0.001), whereas concentration (P>0.05) and the treatment–concentration interaction (P>0.05) did not show significant effects. Post hoc comparisons revealed significant differences between bleach and lemongrass extract (P=0.009) as well as between bleach and oregano extract (P=0.02), while no significant difference was observed between lemongrass and oregano extracts (P=0.60). Overall, the results indicated additive rather than synergistic effects, with bleach demonstrating bactericidal activity. Conclusions: Although the combination was effective in inhibiting bacterial growth, it cannot fully replace bleach for complete microbial eradication. However, the results indicate its potential as a natural disinfectant, particularly for use in less critical or low-risk settings where harsh chemical disinfectants are not required.
AB106. Sustainable eye care and behavior change in health professionals: advancing climate-smart ophthalmology in Asia and beyond
Background: Ophthalmology is one of the most resource-intensive medical specialties, with frequent outpatient visits, centralized care systems, and widespread use of single-use equipment contributing significantly to healthcare’s environmental footprint. As climate change intensifies, there is an urgent need to embed sustainability into eye care systems without compromising clinical outcomes or access. This study explores how sustainability can be operationalized in eye care through systems-level reforms and clinician-led behavior change. It identifies practical interventions, highlights best practices across Asia-Pacific and beyond, and examines behavior change strategies that enable clinicians to adopt greener practices in their routine work. Methods: A qualitative synthesis of 30 peer-reviewed and grey literature was conducted from April to May 2025, drawing on case studies from India, Ireland, Singapore and the UK. Behavior changes enablers and barriers were examined using the Capability, Opportunity, Motivation-Behavior (COM-B) model and the Behavior Change Wheel to understand how sustainability practices can be adopted by clinicians in high-volume, time-constrained settings. Emerging insights informed the development of a proposed framework for identifying sustainability touchpoints. Results: While numerous cost-effective and scalable green interventions exist, according to the COM-B model, clinician uptake is hindered by barriers including lack of awareness, institutional inertia, and resource constraints. Based on these findings, a 5Ps framework—patient, provider, pharmaceutical, procurement, and policy—was proposed to help identify key entry points for greening the eye care ecosystem. Conclusions: Transitioning to climate-smart eye care requires both system-level reforms and clinician engagement. The 5Ps framework offers a novel, actionable pathway to reimagine eye care in the era of climate change. By aligning systems change with behavioral insights, it can guide institutions across Asia and beyond toward greener, more environmentally sustainable ophthalmology.
AB105. Eco-directed sustainable prescribing in Malaysia: knowledge, awareness, and attitudes among medical students
Background: Polypharmacy, the use of five or more medications, is prevalent among older adults, which poses significant risks, including poor adherence, adverse drug events, and unnecessary medication use. Consequently, amplifying environmental harm through inappropriate medication disposal. These challenges highlight an urgent need to explore a globally advancing prescribing paradigm, the eco-directed sustainable prescribing (EDSP). EDSP integrates safe prescribing practices with planetary health principles. While pharmaceutical disposal behavior has been studied, no direct studies have yet examined awareness, attitudes, or implementation of EDSP in Malaysia. This pioneer and multipronged study will focus on medical students and aim to bridge clinical safety, patient empowerment, and planetary health. The objectives of this study are to assess understanding of medication prescribing and the impact on the environment among medical students; assess awareness and understanding of EDSP among medical students; and assess attitudes toward the environmental impacts of medication prescribing and disposal practices. Methods: A cross-sectional study will be conducted among 100 medical students (recruited with purposive sampling) enrolled at Malaysian medical universities. A structured self-administered questionnaire will be used, comprising Likert-scale items alongside open-ended questions. Quantitative data will be analyzed using descriptive and inferential statistics, while open-ended responses will undergo thematic analysis to provide additional context and insights. Discussion: This initial phase will explore the intersection of EDSP practices and prescribing practices among medical students, with future phases possibly examining patient-level and healthcare professionals’ dynamics to generate evidence-based frameworks. Integrating eco-conscious prescribing within medical education and healthcare aligns with Malaysia’s universal health coverage goals and contributes to global healthy ageing and sustainability agendas.
AB104. Strengthening the global supply of medical products through South-South cooperation: China’s dual role in the provision of long-lasting insecticidal nets for Malaria prevention in Africa
Background: Access to long-lasting insecticidal nets (LLINs) remains a critical challenge in malaria-endemic regions of Africa. China, home to a growing number of WHO-prequalified LLIN manufacturers, has become a key supplier within international procurement systems, while also promoting South-South cooperation (SSC) in health. This study investigates China’s dual role in LLIN provision: (I) its function as a global manufacturing hub; and (II) how World Health Organization (WHO)-prequalified Chinese LLIN manufacturers contribute to equitable access to LLINs in Africa through SSC. Methods: The study draws on semi-structured interviews with respondents from international procurement and financing organizations, China’s LLIN manufacturing sector, African national malaria control programmes, and implementing and development partner organizations. Interview data were thematically analyzed using a qualitative research approach and triangulated with secondary sources. Results: The findings indicate that China supplies a substantial share of global LLINs through vertically integrated and cost-efficient production systems, supported by a large skilled labor force, strong upstream material integration, and stable supply chains. Beyond large-scale manufacturing, Chinese manufacturers also support local LLIN production in East Africa through technical assistance and capacity-building, thereby strengthening the regional resilience of LLIN supply chains. Conclusions: This study contributes to the literature on the global supply of medical goods and SSC by illustrating how an emerging economy—China—has evolved from a manufacturing base into a development partner in global health. These practices expand access to preventive technologies and help clarify the operational dimensions of SSC in practice. The findings suggest that emerging economies can shape more equitable global health systems not only as suppliers, but also as contributors to South-South learning and knowledge exchange, advancing universal access to LLINs and broader progress toward universal health coverage (UHC).
AB103. Strengthening primary care networks for universal health coverage: an evidence-based technical assistance approach integrating systems and design thinking
Background: Universal health coverage (UHC) implementation faces challenges in achieving integrated primary care delivery, particularly in resource-constrained settings where fragmented service networks undermine service coverage and quality. Primary care facilities (PCFs) often lack systematic assessment mechanisms and collaborative governance structures necessary for effective care coordination and sustainable health system strengthening. This intervention enhanced Guimaras Unified Health Network’s capacity for UHC implementation through: (I) comprehensive facility assessments using systems thinking frameworks; (II) design thinking approaches for evidence-based solutions and improved care coordination; and (III) building local leadership capacity for sustainable and integrated health system governance. Methods: We implemented a 15-month technical assistance intervention using an integrated Input-Process-Output-Outcomes framework combined with human-centered design principles. The methodology included deploying a comprehensive Primary Care Facility Assessment Tool across five PCFs examining service delivery, financing, and governance dimensions; multi-stakeholder engagement through Project Core Teams and Community Advisory Groups; and participatory workshops and collaborative solution development through patient journey mapping and care pathway redesign. Results: Facility assessments revealed specific capacity constraints affecting service integration and care coordination within the province-wide network. Non-health determinants, including leadership, financing, and human resource capacity, significantly impacted service delivery capacity. Participatory workshops generated evidence-informed solutions addressing identified bottlenecks, including reimagined patient pathways for vulnerable populations and strengthened referral mechanisms. This methodology enhanced stakeholder ownership, established sustainable feedback mechanisms, and aligned local priorities with UHC requirements while building adaptive governance capacity. Conclusions: This integrated systems and design thinking approach demonstrates effective strategies for strengthening primary care networks essential for UHC implementation. The methodology provides a replicable framework combining systematic assessment with collaborative innovation, offering actionable guidance for health facility heads, system managers, and technical assistance providers seeking to enhance care coordination, improve service quality, and build sustainable governance capacity for UHC.
AB102. Strengthening Department of Health (DOH) regional core teams in North Luzon, Philippines: how the Bayang Malusog Program empowers health leaders to accelerate universal health coverage
Background: Universal health coverage (UHC) implementation was upended by the pandemic, halting health systems integration efforts to operationalize UHC. Regional health leaders lead the UHC implementation and have a significant stake in the provinces’ health systems integration work. This paper aims to document the key results, implementation experiences, and lessons learned from the Bayang Malusog (Healthy Nation) Program across selected Department of Health (DOH) regional offices in North Luzon, with the goal of informing future strategies for strengthening local health systems and advancing UHC. Methods: This paper talks about a fast-tracked leadership training program for the DOH regional UHC core teams in North Luzon, Philippines, aimed at improving leadership skills and technical knowledge, while also recording how the regional UHC core team helps speed up the implementation of UHC. Applying the 70-20-10 learning and development framework, participants received training, coaching, mentoring, and technical assistance. These provided them with strategies that they applied immediately to collaborate with provincial and other stakeholders. Results: Improved leadership and technical competencies gained from the program resulted in the creation of effective regional UHC core teams in the Cordillera Administrative Region (CAR), Ilocos, and Cagayan Valley regions, which improved technical support and involved PhilHealth officers and other national government agencies in UHC implementation. These improvements resulted in achieving faster integration of the health system and more local officials committing to UHC implementation in CAR, Cagayan Valley, and the Ilocos region. Conclusions: Integrating leadership training and technical sessions, mentoring, coaching, and hands-on practicum was key in strengthening participants’ capacity and ensuring the effective application of lessons in UHC implementation.
AB101. “Stranded and overlooked”: a systematic review of the multi-dimensional impact of COVID-19 on non-domestic migrant workers in the ASEAN region
Background: The unprecedented coronavirus disease 2019 (COVID-19) pandemic disproportionately affected migrant workers in the Association of Southeast Asian Nations (ASEAN) region, exposing deep-rooted social inequalities. While some studies have examined the effects of COVID-19 on migrant workers, there remains a lack of consolidated evidence or systematic analyses of the multifaceted impact of COVID-19 on their lives. This systematic review synthesizes available evidence on the multidimensional impact that COVID-19 had, particularly on non-domestic migrant workers. Methods: We searched Scopus, PubMed, Web of Science, PsycINFO, and ProQuest for studies examining how COVID-19 affected non-domestic migrant workers, with a specific focus on different domains of human security. Five reviewers independently screened studies, extracted data, assessed risk of bias, and evaluated the quality of evidence using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings were synthesized using meta-aggregation and categorized using the human security framework. Results: Out of 867 studies screened, 44 studies met the eligibility criteria and were included in the synthesis. Overall, findings indicated that non-domestic migrant workers were systematically excluded from national healthcare planning and pandemic preparedness efforts, exacerbating their pre-existing vulnerabilities during the COVID-19 pandemic. COVID-19 and consequent containment measures applied by governments worsened barriers to healthcare and legal protection, amplified food and water insecurity, and further deepened economic precarity and discrimination of migrant workers. Social ties and informal community networks played a crucial role in mitigating some of the adverse effects of COVID-19 containment measures. Conclusions: Findings emphasize the urgent need for inclusive systems and crisis response strategies that recognize, protect, and address the needs of migrant workers in future public health emergencies.
AB100. Socioeconomic and health correlates of mental health outcomes among women with and without HIV in Mozambique: evidence from the 2022−2023 Demographic and Health Survey
Background: Mental health disorders are a growing public health concern in sub-Saharan Africa, disproportionately affecting women, particularly those living with human immunodeficiency virus (HIV) in Mozambique. However, data on the determinants of depression, anxiety, and suicidal ideation in this population remain limited. This study assessed the association between socioeconomic and health-related factors and symptoms of depression, anxiety (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7), and suicidal ideation among reproductive-age women in Mozambique, stratified by HIV status. Methods: We analyzed nationally representative data from the 2022–2023 Mozambique Demographic and Health Survey (DHS), including 9,301 women aged 15–49 years. Bivariate associations were assessed using Chi-squared and t-tests. Univariate and multivariate logistic regression models were used to identify correlates of mental health outcomes. Results: Among 9,301 reproductive-age women in Mozambique, 6.5% reported moderate to severe depressive symptoms, 6.7% reported anxiety symptoms, and 2.2% endorsed suicidal ideation. HIV-positive women had a higher prevalence of all mental health symptoms compared to HIV-negative women. Poorer self-rated health, lower wealth, history of sexually transmitted infections (STIs), and experience of sexual violence were significantly associated with depressive and anxiety symptoms. In multivariate models among HIV-positive women, younger age, lower wealth, poor self-reported health, and STI history were independently associated with higher odds of depression and anxiety. Suicidal ideation was predicted by experience of sexual violence and depressive symptom severity. Geographic disparities in mental health outcomes were also observed. Conclusions: Mental health interventions in Mozambique should target socioeconomically disadvantaged women and integrate HIV care with mental health screening and support.
AB099. Socio-demographic profile and knowledge, attitude, and skills on palliative and hospice care among nurses in Metro Manila
Background: Palliative and hospice care play a vital role in improving the quality of life for individuals with chronic and life-limiting illnesses. The significance of palliative care services is magnified by the rapidly growing populations of patients with chronic diseases, locally and internationally. This study aimed to determine the relationship between nurses’ socio-demographic profiles and their levels of knowledge, attitudes, and skills in providing palliative and hospice care. Methods: This research utilized a descriptive-correlational research design, and data were collected from 230 registered nurses in Metro Manila through a validated survey. Results: Results revealed that nurses (n=230) have passed the quiz (172 out of 230), have a positive attitude [weighted mean (WM): 3.00, standard deviation (SD) =0.82], and have good skills (WM: 3.06, SD =0.75) towards palliative care. However, gaps in knowledge and skills were evident, particularly in pain management and end-of-life communication. Significant positive correlations were found between years of experience and knowledge levels (r=0.13, P=0.043), while attitude was notably positively related to highest educational attainment (r=0.14, P=0.047). However, the level of skill had a negative correlation with previous experience of loss (r=−0.28, P=0.001). Conclusions: Comprehensive education and targeted training programs are essential for enhancing nurses’ competence in providing end-of-life care. Integrating palliative care into undergraduate nursing curricula, along with expanding professional development opportunities, is recommended to strengthen the delivery of compassionate, patient-centered care and contribute to improved global health outcomes.
AB098. Social support and quality of life in Malaysian dementia care: a systematic literature review
Background: Malaysia faces a growing public health challenge due to population ageing, with dementia prevalence projected to triple by 2050. Aligned with Sustainable Development Goal (SDG) 3: good health and well-being, this systematic review synthesizes Malaysian empirical evidence on how different forms of social support influence quality of life (QoL) outcomes among people living with dementia (PLwD) and their caregivers. The review examines emotional, informational, tangible, and multimodal social support interventions reported between January 2015 and April 2025. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data extraction covered study design, type of social support, outcome measures, and effect sizes. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal checklists. A narrative synthesis and vote-counting approach were applied, supplemented by a forest plot of effect sizes from randomized controlled trials (RCTs) targeting caregiver burden. Results: Emotional (n=3) and informational (n=4) support interventions were most frequently examined. These interventions consistently reduced anxiety and depression and improved caregiver QoL. However, methodological limitations remain, particularly in the measurement of patient-centered QoL outcomes and the evaluation of financial and tangible support mechanisms. Conclusions: The findings indicate that low-cost, scalable telephone- and mobile health (mHealth)-based psychoeducational interventions are effective in reducing caregiver burden in Malaysia. To strengthen equitable and sustainable dementia care systems, policymakers should prioritize pilot research on tangible support mechanisms, such as conditional cash transfers and respite care vouchers, and mandate the inclusion of patient-reported QoL outcomes in future clinical and community-based trials. These actions are essential for achieving SDG 3 and advancing inclusive dementia care across the Global South.
AB097. Social capital and social support as moderators in the association between perceived discrimination and mental health among Filipino domestic workers in Macao
Background: Migrant domestic workers (MDW) face a heightened risk of poor mental health while working abroad, partly due to perceived discrimination. Social networks, including cognitive and structural social capital and perceived social support, are often viewed as protective. However, findings are mixed, with some studies reporting paradoxical effects, namely higher social capital or support associated with worse mental health. The objective of this study is to assess whether social capital and social support moderate the association between perceived discrimination and symptoms of anxiety and depression among Filipino MDWs in Macao, China. Methods: A total of 1,362 Filipino MDWs in Macao completed self- administered surveys between November 2016 and August 2017, using respondent-driven sampling. Demographics, perceived discrimination, anxiety and depression, cognitive and structural social capital, and perceived social support were collected. Multiple linear regression assessed the association between perceived discrimination and mental health, and tested moderation by social capital and social support. Results: Perceived discrimination was positively associated with both depression (β=0.22, P<0.001) and anxiety (β=0.20, P<0.001). Structural social capital showed a positive independent association with depressive symptoms (β=0.07, P=0.003), whereas cognitive social capital was independently associated with higher anxiety symptoms (β=0.24, P=0.041). Perceived social support showed no significant difference with either mental health outcome. No moderating effects of social capital or social support were observed in the association between perceived discrimination and mental health. Conclusions: Perceived discrimination is a robust predictor of anxiety and depression among Filipino MDWs. While elements of social capital were independently associated with mental health outcomes, these associations varied by domain and outcome, and no buffering effects were found for social capital or social support. Further research is needed to explore the roles of social networks in this population and to inform interventions aimed at reducing discrimination and strengthening social resources.
AB096. School-time exposure to ambient PM2.5 in Thailand: a nationwide spatiotemporal analysis
Background: Fine particulate matter ≤2.5 µm (PM2.5) is a significant environmental health risk to children, and avoidance of exposure is universally recommended. However, estimates of school-time PM2.5 exposure in Thailand to inform outdoor activity scheduling remain limited. This study examined ambient PM2.5 exposure patterns at schools during school hours across Thailand in 2024. Methods: A nationwide descriptive analysis and pattern visualization of ambient PM2.5 at schools were conducted from January to December 2024. School hourly PM2.5 levels were estimated using inverse distance weighted (IDW) interpolation based on air quality monitoring data from the Pollution Control Department (PCD) and the Bangkok Metropolitan Administration (BMA). School-time exposure was defined as a 10-hour average (7.00–17.00) on weekdays. Monthly and regional exposure patterns were visualized. A mean 10-hour PM2.5 concentration <25 µg/m3 was defined as a low-exposure period, based on the 2021 World Health Organization (WHO) 24-hour interim target 4. Results: A total of 29,082 public schools nationwide were included. The national mean ± standard deviation (SD) school-hours PM2.5 concentration was 27.3 ± 15.4 µg/m³. PM2.5 exhibited clear seasonal variation, peaking during the dry season (March–April) and declining during the wet season (June–November). School semester 2 (November–March) overlapped with higher PM2.5 levels, whereas the school break (mid-March to mid-May) coincided with a decreasing trend. Spatially, average school-time PM2.5 exceeded the 2021 WHO daily guideline (15 µg/m3) across all regions, with the highest levels in the North and the lowest in the South. Conclusions: In 2024, a nationwide low PM2.5 exposure period at Thai schools occurred between June and November. Rescheduling outdoor school activities to this period may reduce PM2.5 exposure without disrupting education. Further time-series analysis incorporating meteorological factors is warranted.
AB095. Scaling up the Baby-Friendly Hospital Initiative in support of maternal and newborn health: study protocol
Background: Optimal breastfeeding practices are essential for improving health outcomes across the lifespan. They protect children from infectious diseases and chronic conditions, while also supporting maternal health by reducing the risk of reproductive cancers and aiding postpartum recovery. The World Health Organization/United Nations Children Fund’s Baby-Friendly Hospital Initiative (BFHI), based on the Ten Steps to Successful Breastfeeding (the Ten Steps), is an evidence-based framework that significantly improves exclusive and sustained breastfeeding rates. Despite global uptake and ‘in principle’ adoption in Australia, BFHI implementation remains very limited in scale. This study aims to assess the equitable availability and accessibility of BFHI-accredited hospitals and the Ten Steps across Australia, and to evaluate the value that maternity care consumers place on BFHI-aligned practices. Methods: We use geospatial modelling and a social fragmentation index to examine the distribution of BFHI-accredited facilities and their relationship to breastfeeding and health outcomes. Discrete choice experiments are conducted to determine the economic value consumers assign to BFHI practices. Results: Preliminary analysis suggests disparities in access to BFHI-accredited care, with serious implications for breastfeeding outcomes. Consumers expressed a clear preference for BFHI-aligned maternity care, highlighting the perceived value of supportive hospital practices and community support for breastfeeding. Conclusions: These insights support the need for targeted resources and system-wide strategies to enhance BFHI implementation. These findings will inform the development of a streamlined “Tenth Step” guide to connect new mothers with breastfeeding support services after hospital discharge. By strengthening the BFHI’s Tenth Step and quantifying the value of its practices, this project supports broader adoption of BFHI across the Australian health system. The anticipated outcomes include improved equity in breastfeeding support, enhanced maternal and child health, and reduced reliance on formula feeding—contributing to both improved public health and environmental sustainability.
AB094. RodentWatch as a smart integrated platform to raise awareness and control for advanced leptospirosis management
Background: Leptospirosis has been shown to cause fever, liver or kidney failure, and even death in humans, particularly those residing in tropical countries. In agriculture, it can create economic loss, as it can cause abortion and decreased milk production among farm animals. Six Indonesian provinces in Java reported confirmed leptospirosis, with 920 cases and 122 reported deaths in 2019. In North Sumatera, an area with tropical climate and high rainfalls, surveillance on wild rodents showed infestation of pathogenic Leptospira spp. covered up to 33.9% prevalence and necessitates a smart and targeted monitoring approach. The objective of this study is to assess the small pilot trial application of RodentWatch as the integrated platform for leptospirosis management in Medan Tuntungan subdistrict, as one of the subdistricts in Medan, the capital city of North Sumatera, among the local stakeholders and the local community as the end-users. Methods: RodentWatch is a platform that provides end-to-end approach for leptospirosis management. Secondary data on case reports, community risk factors, and awareness levels from health and veterinary aspects were collected to initiate its development. Furthermore, spatial layers of key biophysical factors were prepared as inputs to create a leptospirosis risk prediction model. Alongside, a digital storytelling strategy was developed to raise awareness among community and stakeholders. Results: Preliminary data indicate that leptospirosis is not part of the main targeted work programs among local stakeholders despite its risk. Through small survey among local residents, most respondents (58.6%) have encountered wild rodents wandering around their neighborhood, yet most were not aware of leptospirosis as a rodent-borne disease. Furthermore, reported data found positive leptospirosis cases among pets from a local veterinary clinic, indicating underreported situation and potential active risk of transmission to farm animals. From early development of digital storytelling, pilot trial showed community has improved understanding of leptospirosis and its associated risk such as poor hygiene and temperate environment. Conclusions: Comprehensive and smart approach is needed for leptospirosis management. RodentWatch is a platform that has the potential to spearhead management from the ground to the health system.
AB093. Relationship of 3Qs to the clinical decision-making of fourth-year student nurses in a private higher education institution in Baguio
Background: Clinical decision-making (CDM) is a vital nursing function that ensures safe and effective patient outcomes. While cognitive abilities are foundational, non-cognitive traits such as emotional quotient (EQ), adversity quotient (AQ), and social quotient (SQ) may also influence students’ decision-making processes. However, limited literature has explored these traits in relation to CDM, particularly among student nurses in the Philippine context. This study aims to determine the relationship between EQ, AQ, and SQ to the CDM abilities of fourth-year student nurses, as well as the levels of these variables. Methods: A descriptive-correlational design was used among 218 fourth-year nursing students from a private higher education institution in Baguio, selected through systematic random sampling. Standardized tools assessed EQ, AQ, and SQ, as well as CDM. Data were collected through printed surveys and analyzed using weighted mean and Spearman’s rho. Results: There was a statistically significant moderate positive correlation between each quotient and CDM (EQ: r=0.44, P<0.001; AQ: r=0.51, P<0.001; SQ: r=0.51, P<0.001). Most students demonstrated a high level of CDM [mean (M) =79.75], a high level of AQ (M =48.75), and a high level of SQ (M =71.00). The EQ had a moderately high level (M =92.75). EQ, AQ, and SQ are positively associated with CDM. Conclusions: Integrating these non-cognitive traits into nursing education may enhance students’ CDM, improve patient outcomes, and strengthen readiness for real-life clinical practice.
AB092. Reclaiming narratives in global health: knowledge as resistance in the documentation of health in Palestine during genocide [2023–2025]
Background: The destruction of Gaza’s health system, including hospitals, personnel, and data infrastructure, has extended alongside deliberate efforts to delegitimize Palestinian health institutions and health data through suppression and the mainstream media’s smear campaign. In this context, academic publishing becomes a critical space for documenting public health realities, affirming the credibility of Palestinian voices, giving them space to tell their story, and resisting erasure through evidence. This study aims to (I) map the volume and characteristics of peer-reviewed health publications on Palestine between 2023 and 2025; (II) identify authorship patterns and institutional affiliations; and (III) analyze the thematic and ethical positioning of this literature in the context of ongoing genocide. Methods: A bibliometric and qualitative content analysis was conducted on 491 peer-reviewed articles retrieved using PoP with the keywords “Palestine”, “Gaza”, and “health”. VOSviewer was used to generate keyword co-occurrence and co-authorship network visualizations. Citation analysis and affiliation mapping were performed, with special attention to the role of Palestinian diaspora scholars and international solidarity networks. Results: There was a marked increase in publications during the genocide period, with themes shifting from service delivery to trauma, health system collapse, forced displacement, and excess mortality. The most cited articles defended the credibility of Gaza’s Ministry of Health and reframed mortality reporting as both scientific and ethical acts. Co-authorship networks highlighted increasing international solidarity, yet Gaza-based researchers remained underrepresented due to infrastructural and political constraints. Conclusions: In contexts of political violence and disinformation, health publishing becomes a form of epistemic resistance. Bibliometric analysis reveals how, when ethically grounded, academic outputs can defend suppressed knowledge systems, mobilize humanitarian attention, and advance justice in global health.
AB091. Psychosocial impacts of surgical complications on surgeons: evidence and structural modelling considerations
Background: Surgical complications not only endanger patient outcomes but also traumatize the involved surgeon emotionally, psychologically, and socially. These “second victims” often endure lasting stress that may impair their well-being (WB) and follow-up clinical performance. The psychosocial impacts of this problem, however, remain under-explored in low- and middle-income settings. The research seeks to investigate the emotional and behavioral impact of surgical complications on practicing surgeons, pinpoint contributory psychosocial risk factors, and examine how coping mechanism (CM) usage influences outcomes. It also determines the interrelationship among the primary variables using structural equation modeling (SEM). Methods: Guided by evidence from 19 relevant studies, the study assessed emotional responses such as guilt, worry, and withdrawal, and behavioral adaptations such as hyper-cautious practice and avoidance. Utilizing the application of SmartPLS, a structural model was developed for assessing the effect of complication severity, institutional support, emotional resilience (ER), and CMs on surgeons’ WB. Results: The research identified that younger, less experienced, and work-life balance- compromised surgeons were most vulnerable to adverse emotional responses. Severe complications significantly predicted depressive symptoms and behavioral changes. The structural model confirmed that institutional support and adaptive coping significantly enhanced ER (P<0.001), while repressive behaviors indicated poorer outcomes. Conclusions: Surgical complications place a major psychosocial load on surgeons that is underestimated in policy and training materials. Solutions aimed at emotional preparedness, peer support networks, and organizational compassion are the key. These findings offer a blueprint for international surgical systems to improve their safeguarding and empowerment of their surgical staff, thus improving provider WB and patient safety.
AB090. Progression of metabolic syndrome among initially healthy university workers in Indonesia: a longitudinal observation
Background: Metabolic syndrome (MetS) is a rising public health issue in Asia, linked to urban lifestyle changes and occupational risks. University workers, often overlooked in prevention efforts, may be particularly vulnerable due to sedentary work patterns. This study examines the progression of MetS among initially healthy university employees in Indonesia, aiming to provide early evidence to inform workplace health interventions in academic institutions. Methods: We analyzed Medical Check-Up (MCU) data from a large state university in Indonesia for 2018, 2021, and 2023. Subjects included were employees without MetS in 2018 who had complete data across all three years. MetS was defined as central obesity plus at least two of the following: hypertension, atherogenic dyslipidemia (AD), and hyperglycemia. Descriptive and trend analyses were performed. The Medical and Health Research Ethics Committee of Universitas Gadjah Mada has granted ethical approval for this study under the approval number KE/FK/0057/EC/2025. Results: Out of 2,194 employees screened in 2018, 156 fulfilled the criteria. At baseline, none had MetS. By 2021, 29.49% developed MetS, with a slight decrease to 28.85% in 2023. Obesity and AD increased more sharply between 2018 and 2021, while hypertension and hyperglycemia also rose but followed different patterns. Participation in routine MCU was low across the three periods, potentially contributing to undetected cases. Conclusions: This study highlights a significant rise in MetS among initially healthy university workers, underscoring the need for targeted prevention strategies. Improving engagement in regular health monitoring programs is critical for early detection and intervention, particularly in academic institutions in middle-income countries facing a growing non-communicable disease burden.
AB089. Prevalence and risk factors of child malnutrition in climate-sensitive coastal regions, Bangladesh
Background: Despite considerable progress in eliminating malnutrition, Bangladesh continues to experience a high prevalence of child malnutrition, particularly in climate-vulnerable coastal regions. This study aimed to investigate the current prevalence of child malnutrition and identify its associated risk factors across the coastal regions of Bangladesh. Methods: A cross-sectional survey was conducted in three purposively selected coastal districts representing distinct coastal parts of Bangladesh. Data were collected from 469 randomly selected households using a three-stage cluster sampling approach, including anthropometric measurements of children aged 6–59 months and structured interviews with their mothers. Multivariable logistic regression was performed to identify the risk factors of child malnutrition. Results: The study revealed that more than half of the children (54.4%) were stunted, 1 in 4 (25.2%) were underweight and nearly 1 in 10 (9.4%) were wasted, with 61.6% experiencing at least one form of anthropometric failure. Multivariable logistic regression showed that children aged 24–35 months were 54% [adjusted odds ratio (AOR) =0.46; 95% confidence interval (CI): 0.22–0.98] and 48–59 months 60% (AOR =0.40; 95% CI: 0.18–0.88) less likely to be malnourished compared to those aged 6–11 months. Higher odds were observed among children from poor households (AOR =2.15; 95% CI: 1.07–4.30), food-insecure households (mild: AOR =2.13; severe: AOR =3.66), and those lacking basic drinking water (AOR =2.66) or sanitation (AOR =1.93) facilities. Children born to underweight mothers had 2.77 (AOR =2.77; 95% CI: 1.09–7.04) times higher odds of being malnourished compared to their normal counterparts. Conclusions: Findings of the study highlight the persistent burden of child malnutrition in coastal Bangladesh, focusing on the significant influence of household poverty, food insecurity, inadequate water, sanitation, and hygiene (WASH) access, and maternal undernutrition. Targeted and multisectoral interventions addressing these intersecting vulnerabilities are essential to improve child nutritional outcomes in climate-sensitive coastal settings.
AB088. Predicting COVID-19 mortality risk across SARS-CoV-2 variants in Melaka, Malaysia: a 3-year retrospective study
Background: As of March 2023, over 761 million coronavirus disease 2019 (COVID-19) cases and 6.8 million deaths have been reported globally. Malaysia recorded over 5 million cases and 30,000 deaths within the same period. The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with differing transmissibility, virulence, and immune escape properties has complicated pandemic control. This study investigates variant-specific mortality risk factors to support health system preparedness in future outbreaks in Melaka, Malaysia. Methods: This retrospective ecological study utilized secondary surveillance data of confirmed COVID-19 cases reported in Melaka, Malaysia, from March 2020 to March 2023. Data were obtained from the Melaka State Health Department and included cases with confirmed SARS-CoV-2 variants. The collected variables included sociodemographic characteristics, comorbidities, clinical symptoms, vaccination status, and outcomes. A universal sampling method was applied, and the data were analyzed using SPSS software. Descriptive statistics were used to summarize case characteristics, followed by univariate and multivariate logistic regression analyses to identify factors independently associated with COVID-19 mortality Results: Among 1,146 cases, the mean age was 48.2 years (±22.6 years), and 52.1% of the cases were male. Omicron was the most common variant (86.8%). Most cases were symptomatic (89.6%) and had at least one comorbidity (54.7%), with the most common conditions being hypertension (31.2%) and diabetes mellitus (24.1%). The overall mortality rate was 2.9%. Multivariate analysis identified several factors significantly associated with death: Delta variant infection [odds ratio (OR) =3.43; 95% confidence interval (CI): 1.07–11.03], age ≥65 (OR =2.66; 95% CI: 1.13–6.24), unvaccinated status (OR =4.36; 95% CI: 1.58–12.04), and shortness of breath (OR =4.39; 95% CI: 2.01–9.62). Conclusions: This study highlights the elevated mortality risk associated with the Delta variant, advanced age, being unvaccinated, and respiratory distress. These findings underscore the importance of targeted vaccination, early identification of high-risk individuals, and adaptive health system planning to improve responses to future variant-driven outbreaks.
AB087. Post-Super Typhoon Odette: exploring health system challenges and adaptation strategies on Halian Island, Surigao Del Norte, Philippines
Background: Geographically isolated islands in the Philippines face significant health system challenges, worsened by natural disasters such as Super Typhoon Odette. These challenges undermine health interventions and the resilience of the healthcare system. This study explores the health system challenges and adaptation strategies employed on Halian Island in response to Super Typhoon Odette, examining how the local health system adapted to maintain healthcare delivery amidst disaster disruptions. Methods: A qualitative case study approach involved in-depth interviews with healthcare providers, local government officials, and community members. Data were analyzed thematically to identify challenges and adaptation strategies framed by General Systems Theory and the concept of Adaptation. Results: Political dynamics impede healthcare delivery, with volunteer healthcare staff appointed based on affiliations rather than competency. The island’s healthcare staff is overburdened, using personal resources for medical expenses and coordinating remotely with the Rural Health Unit (RHU) for complex cases. The health center is underutilized due to insufficient volunteer healthcare staffing, leading residents to seek care at some of the healthcare staff’s residences. Strong Pacific waves delay medical transport, resulting in preventable deaths. Climate risks, such as land loss and worsening storm surges, heighten vulnerabilities. Disaster preparedness remains reactive, with no evacuation center and increasing reliance on external aid. Conclusions: Halian Island’s health system needs more preparation for future climate crises. Strengthening governance, disaster preparedness, and climate adaptation strategies is essential for building resilience in vulnerable island communities and ensuring effective healthcare delivery amid climate challenges.
AB086. Planetary health and food sustainability in Africa: opportunities, challenges and strategic pathway
Background: Africa has tremendous potential for sustainable food production but also faces significant barriers like socioeconomic inequality, climate change, and environmental degradation, which threaten planetary health and food security. This study examines the nexus between planetary health and food sustainability and identifies opportunities, challenges, and strategic interventions to improve food systems in Africa. Methods: We conducted a comprehensive literature search of peer-reviewed articles on PubMed, Scopus, and Google Scholar databases and publicly available grey literature to analyze the state of food sustainability across Africa with no limit to publication date. Using an analytical approach, data from eligible studies were extracted and categorized thematically, followed by a narrative synthesis approach to integrate and summarize the findings under relevant headings. Results: Findings reveal that traditional agricultural practices like agroforestry, intercropping, crop rotation, and rotational grazing are crucial for preserving ecological integrity and enhancing soil fertility. However, climate change has significantly impacted agricultural productivity, with sub-Saharan Africa experiencing a 33% decline in productivity growth over the past decade. Environmental stressors, such as deforestation, unsustainable land use, and loss of biodiversity, have increased food insecurity and threatened livelihoods. Technological advancements like climate-smart agriculture, artificial intelligence (AI)-driven precision farming, greenhouse and vertical farming, digital agriculture platforms, and Internet of Things (IoT)-enabled devices are promising solutions. However, their adoption is limited by high costs, poor infrastructure, and lack of technical training. Socioeconomic disparities persist, with smallholder farmers facing limited access to credit, quality seeds, fertilizers, and land tenure security. Policy and governance challenges include the fragmented implementation of regional frameworks, underfunded agricultural sectors, and weak institutional capacity. Conclusions: Strengthening local food systems, promoting equitable resource access, investing in climate-smart technologies, and fostering international cooperation are crucial for food sustainability in Africa, enhancing resilience, reducing hunger, and promoting global health.
AB085. Pandemic vulnerability among indigenous populations in Malaysia: a scoping review of structural inequities and public health response
Background: Indigenous populations in Malaysia, including the Orang Asli in Peninsular Malaysia and native communities in Sabah and Sarawak, have historically experienced systemic marginalisation and limited access to healthcare. Their vulnerability during pandemics is shaped not only by geography or poverty, but also by long-standing structural inequities and cultural invisibility within public health systems. Despite heightened risk, there is limited synthesis of evidence on how pandemics have affected these communities and whether national responses have been inclusive. This scoping review aims to map existing evidence on pandemic vulnerability among Indigenous populations in Malaysia, identify key drivers of vulnerability, and examine how national public health responses have addressed or overlooked their needs. Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) framework. Systematic searches were undertaken across MEDLINE, PubMed, Embase, Web of Science, Google Scholar, and grey literature sources, including government and non-governmental organisation (NGO) repositories. Eligible sources published between 2020 and 2025 reporting on pandemic impacts [e.g., coronavirus disease 2019 (COVID-19), influenza A virus subtype H1N1 (H1N1), severe acute respiratory syndrome (SARS)] among Indigenous populations in Malaysia were included. Data were extracted to capture vulnerability domains, community and institutional responses, and gaps in health system inclusivity. Results: Using the PRISMA-ScR methodology, a limited number of relevant sources were identified and analysed. Findings indicate that Indigenous communities, particularly the Orang Asli, experience substantial socioeconomic and structural vulnerabilities that heighten pandemic impact, including: (I) persistent poverty and lower educational attainment; (II) limited access to basic infrastructure, healthcare, and telecommunications; and (III) geographical isolation and cultural marginalisation. Despite these challenges, Indigenous communities demonstrated notable resilience through self-initiated public health measures and culturally appropriate communication strategies. Conclusions: This scoping review highlights the complex interplay between structural inequities, Indigenous resilience, and public health responses during pandemics in Malaysia. Persistent socioeconomic disadvantages limit the effectiveness and accessibility of mainstream public health interventions, underscoring critical gaps in equitable health provision. At the same time, the findings reveal the adaptive capacity of Indigenous communities, who mobilised culturally grounded strategies to protect community health. These insights emphasise the need for inclusive, culturally responsive public health planning that meaningfully engages Indigenous populations in future pandemic preparedness and response.
AB084. Occupational safety and health for long-term care workers in Taiwan: a literature review and future research perspectives
Background: As Taiwan’s population ages, the demand for long-term care (LTC) has grown rapidly, prompting the government to enact the “Long-Term Care Services Act” in 2015 to improve service quality and accessibility. While existing LTC research has largely focused on service delivery, workforce retention, and manpower allocation, studies in occupational safety and health (OSH) highlight significant workplace hazards and risks faced by frontline care workers. Yet these two research streams rarely intersect in Taiwan, leaving OSH concerns insufficiently incorporated into LTC workforce and policy discussions. This gap underscores the need to examine potential shortcomings in current OSH protections for care workers. Methods: A narrative review was conducted using English and Chinese studies published between 2010 and 2025, retrieved from PubMed, Scopus, Web of Science, and Airiti-Library with keywords on LTC workers and OSH in Taiwan. Government press releases and reports from the Ministry of Labor and the Administration for Long-Term Care were also examined to contextualize policy developments. Results: Nine empirical studies, mainly cross-sectional surveys, documented substantial physical and psychosocial burdens among LTC workers, including musculoskeletal strain related to lifting and transferring, time pressure, emotional stress, and fatigue. Moreover, two policy evaluations identified gaps in institutional prevention strategies, limited use of ergonomic aids, and weak connections between OSH requirements and LTC payment or accreditation systems. Government reports further noted persistent staffing shortages, elevated injury risks, and fragmented oversight between OSH and LTC authorities, revealing structural deficiencies in protecting the LTC workforce. Conclusions: Current evidence shows that LTC workers in Taiwan face significant workplace hazards that are insufficiently addressed under existing OSH and labor protection frameworks. The disconnect between OSH research and LTC policy contributes to gaps in prevention, oversight, and workforce safeguards. Strengthening the integration of OSH principles into LTC regulation, payment design, and workforce management is essential for improving the safety, sustainability, and equity of the LTC system.
AB083. Occupational dust-related diseases and policy responses: Taiwan’s recent experience
Background: New manufacturing processes have contributed to new types of occupational dust-related diseases. The objective of this study was to review the case reports and epidemiological studies on dust-related diseases published, recent statistics of workers’ compensation, and policy responses undertaken by the occupational health authorities. Methods: We conducted a narrative literature review of peer-reviewed medical case reports and epidemiological studies published in Chinese and English between 2014 and 2024. We also examined recent occupational compensation statistics and performed an archival analysis using press releases, official guidelines, reports, and educational materials issued by the Ministry of Labor of Taiwan. Results: Over the past 10 years, researchers in Taiwan published 24 medical case reports on pneumoconiosis, documenting a total of 29 cases, with recent cases predominantly linked to the artificial stone industry. During the same period, 12 epidemiological studies were published, primarily with national health insurance records, labor insurance data, and hospital medical records, to identify geographic patterns, high-risk industries, and temporal trends. The number of occupational lung disease cases and compensation claims fluctuated but showed a downward trend in recent years, showing differences between epidemiological data. In recent years, the occupational health authorities have issued administrative orders and guidelines regarding dust hazards, mostly in the form of financial subsidies and guidance, to encourage businesses to invest in dust control and personal protective equipment. Conclusions: The occupational health community and labor authorities are concerned about dust exposures and their occupational health impacts. However, policy measures are not mandatory, and whether they can effectively prevent dust-related diseases remains to be further explored.
AB082. Nutritional consequences of cesarean births: exploring the link to the double burden of malnutrition in South and Southeast Asia
Background: The rising prevalence of caesarean section (C-section) deliveries in South and Southeast Asia may be an emerging driver of the double burden of malnutrition (DBM), defined as the coexistence of maternal overweight/obesity and child undernutrition within the same household. Although concerns about this potential link are growing, empirical evidence on the association between C-section births and DBM in this region remains limited. The aim of this study is to examine the association between C-section births and DBM in selected South and Southeast Asian countries. Methods: We used nationally representative data from the 2022 Demographic and Health Surveys of Bangladesh, Cambodia, and Nepal. The analysis included mother-child pairs involving women aged 15–49 years with at least one child, both having valid anthropometric measurements and reported delivery methods. We used Chi-squared tests and analysis of variance (ANOVA) for initial analysis and then applied a two-level logistic regression to account for household-level clustering. Results: Our sample consisted of 4,132 pairs from Bangladesh, 3,836 from Cambodia, and 2,596 from Nepal. The results showed that C-section deliveries were associated with higher likelihood of DBM in Bangladesh [adjusted odds ratio (AOR) =2.60; 95% confidence interval (CI): 1.55, 4.37] and Nepal (AOR =1.72; 95% CI: 1.09, 2.70). This relationship was particularly evident when breastfeeding was delayed, whereas longer breastfeeding durations appeared to have a protective effect. Additionally, DBM was more prevalent in urban areas across all three countries. Conclusions: Our study found that C-section deliveries increase the risk of DBM, especially when breastfeeding was delayed. This evidence suggests that C-sections can influence long-term nutritional outcomes for both mothers and children, potentially worsening malnutrition in South and Southeast Asian countries. Addressing this issue requires reducing unnecessary C-sections, encouraging early breastfeeding, and supporting postpartum weight management. Strengthening integrated maternal and nutrition care, particularly in urban areas, is vital to advancing global nutrition goals and promoting intergenerational health equity. Further country-specific research is needed to inform culturally appropriate, evidence-based interventions.
AB081. Nutrition leadership in practice: a governance approach through the Pook Malusog Nutrition Governance Program of the Zuellig Family Foundation
Background: Despite years of effort, malnutrition in the Philippines remains high, making it unlikely to reach near-zero stunting by 2030. To help address this, the Zuellig Family Foundation’s Pook Malusog program works with local governments, empowering governors and mayors to lead effective “First 1,000 Days” nutrition interventions and drive sustainable improvements. It aims to strengthen local governance for effective nutrition management, ensure inclusive delivery of nutrition services, and promote positive food, health, and nutrition behaviors among target populations. Methods: This program used the Pook Malusog framework, combining leadership training, coaching, and hands-on fieldwork. Local chief executives and their teams assessed nutrition systems using the First 1,000 Days technical roadmap, based on World Health Organization (WHO)’s Six Building Blocks plus social determinants. Assessment results guided targeted coaching and support to help leaders implement tailored nutrition improvements. Results: Pook Malusog was implemented in five provinces and 40 municipalities, training 177 local leaders and improving nutrition governance. Stronger leadership led to partnerships that improved resources and service delivery, with all participating local government units (LGUs) showing progress in governance and nutrition services under the “First 1,000 Days” roadmap. Within 6 months, early health gains were reported, including fewer nutritionally at-risk pregnant women, reduced stunting and wasting, and prevention of low birth weight. All pilot provinces saw declines in stunting and wasting rates. Stunting rates in the cohort provinces improved by 2 percentage points per year, outperforming the national average of 1 percentage point per year. Conclusions: The Pook Malusog Program demonstrates that strong local leadership and systems-based approaches improve nutrition outcomes. It offers a scalable model for strengthening local capacity to achieve national nutrition goals.
AB080. More than connected: rethinking global health through indigenous relationality
Background: Global health frameworks increasingly acknowledge the interconnections between people, place, and environment, yet often overlook the spiritual, ethical, and values-based dimensions that are central to Indigenous understandings of health. This study examines how Indigenous values conceptualize wholistic health and offer critical insights into dominant global health frameworks. Methods: This study draws on interviews with 18 Indigenous participants from diverse Nations and geographic regions to explore a set of interrelated Indigenous values that form the foundation of wholistic health from an Indigenous perspective. In this context, health is framed not as an individual state, but as a dynamic, balance across physical, mental, spiritual, and community dimensions, extending to natural and spiritual realms. These values are not treated as isolated concepts, but as interrelated principles that guide relationships, responsibilities, and collective wellbeing over time. Using narrative inquiry and grounded theory, the research contrasts Indigenous perspectives with dominant Western models such as One Health, EcoHealth, and Planetary Health. While these frameworks acknowledge ecological interdependence, they often remain focused on human-centred outcomes and rarely engage with Indigenous ethical systems or expanded definitions of community. The study develops a conceptual model grounded in Indigenous values that redefines community to include human, other-than-human, and spiritual relationships. This relational framing addresses systemic health inequities by centring Indigenous knowledge systems and ethics; it responds to environmental degradation by emphasizing reciprocal responsibilities toward land, water, and other-than-human beings. Results: The analysis identified a coherent set of interrelated values that together constitute the ethical and epistemological foundation of Indigenous wholistic health. The resulting model illustrates how wellbeing arises from relationships of care and responsibility across human, other-than-human, and spiritual dimensions. The findings call for policies and partnerships that move beyond symbolic inclusion toward meaningful collaboration, power-sharing, and shared ethical foundations. Conclusions: A shift toward Indigenous values and ethics is necessary to build global health systems that are accountable, ethically grounded, and guided by cultural and ecological integrity.
AB079. Modifying effect of particulate matter (PM10) on the association between ambient temperature and cause-specific mortality in Klang Valley
Background: Extreme temperatures and air pollution are well-established environmental risk factors for mortality. While the independent effects of temperature have been extensively studied, less is known about how air pollution, particularly particulate matter less than 10 µm (PM10), may modify temperature-related mortality in tropical urban settings. This study aims to assess the short-term effects of ambient temperature on non-accidental, cardiovascular, and respiratory mortality in Klang Valley, Malaysia, and to examine the modifying role of PM10. Methods: A time-series analysis was conducted using daily mortality, temperature, and air pollution data from 2008 to 2023. Distributed lag non-linear models (DLNMs) with quasi-Poisson regression were used to estimate cumulative temperature-mortality associations across a 21-day lag period. Analyses were stratified by PM10 category using a cut-off based on the World Health Organization 24-hour Air Quality Guideline (WHOAQG) 2021 (45 µg/m3). Heat and cold effects were evaluated by comparing the 99th vs. 90th percentile and 1st vs. 10th percentile temperatures, respectively. Results: Approximately 33% of days exceeded the WHOAQG level. Non-accidental mortality increased at both heat [relative risk (RR): 1.07; 95% confidence interval (CI): 1.04–1.11] and cold extremes (RR: 1.11; 95% CI: 1.06–1.17) without clear modification by PM10. Cardiovascular mortality was more strongly associated with cold, rising by 17% (RR: 1.17; 95% CI: 1.07–1.27); however, this association diminished under both PM10 levels. In contrast, respiratory mortality increased at high temperatures (RR: 1.35; 95% CI: 1.22–1.50), with risks significantly elevated across PM10 categories. Conclusions: Temperature extremes significantly impact mortality in Klang Valley, with varying effects by cause of death. PM10 modifies these associations, particularly enhancing heat-related respiratory mortality. These findings highlight the need for integrated public health strategies that address both temperature and air pollution to protect vulnerable populations in tropical urban environments.
AB078. Mental health disparities by sex: unraveling determinants and changes during the resettlement process
Background: Significant sex differences in mental health have been observed among resettled refugees, yet how these disparities and their determinants evolve over time remains unclear. This study sought to unravel determinants and changes in mental health disparities by sex in a quantitative way. Methods: Data were drawn from Waves 1 [2013–2014], 5 [2017–2018], and 6 [2023] of the 10-year Building a New Life in Australia (BNLA) cohort. Post-traumatic stress disorder (PTSD) and high-risk of severe mental illness (HR-SMI) were measured using the PTSD-8 and Kessler-6 scales. Fairlie decomposition was used to quantify the disparity (total predicted probability difference) and the contribution proportion of individual determinants (explained difference/total predicted probability difference × 100%). Results: A total of 2,261 refugees were included at Wave 1, with 1,833 (81.1%) and 905 (40.0%) followed up at Waves 5 and 6. Female refugees consistently experienced poor mental health, with a total predicted probability difference decreasing from the initial (Wave 1, 8.33%) to middle stage (Wave 5, 4.61%), then increasing in the long term (Wave 6, 6.31%). Determinants varied across waves, but poor status of physical health-related factors was a persistent contributor (e.g., total contribution of predicted probability difference: PTSD 57.42%, 70.95%, 60.05%). Family conflict contributed at the initial (contribution proportion: HR-SMI 4.53%) and long-term stages (PTSD 8.68%), while financial hardship (PTSD 13.41%; HR-SMI 24.07%), marital status (HR-SMI 25.82%), and family concerns (PTSD 8.39%) were key at the middle stage. Unmet support or help during coronavirus disease 2019 (COVID-19) was a major contributor at Wave 6 (PTSD 23.93%; HR-SMI 8.39%). Conclusions: Sex disparities in refugee mental health require sustained attention and tailored, stage-specific strategies. Providing necessary physical health care and addressing family conflict (initial/long-term stage), financial hardship (middle stage), and female- specific needs during crises like COVID-19 is essential for promoting mental health equity.
AB077. Mental health as a “security concern, ethical imperative, and wise investment”: a qualitative study exploring framings in global mental health
Background: Mental health, as an emerging key global health issue, is subject to being framed in different ways within the realm of global mental health (GMH) policymaking and practice. This study adopts the theoretical framework and findings from a review on the formation of global health priorities to examine how the three dominant framings, i.e., securitisation, moralisation, and technification, shape mental health issues in GMH. This paper also considers the actors involved in advancing and contesting these framings through the pursuit of various forms of collective action. Methods: The study adopts a qualitative approach. Thematic analysis was performed on data derived from semi-structured key informant interviews with 38 GMH actors. Results: The results provide empirical support to the three framings in global health prioritisation. Additionally, inductive coding reveals emergent sub-themes and additional actors who contribute to or challenge the dominant frames in the securitisation, moralisation, and technification of mental health. Insights suggest that framings of mental health co-exist and are advanced and contested by a range of actors including governments, international organizations, civil society, academia, the media, and religious leaders and faith communities. Conclusions: Being cognizant of the ways in which mental health is framed and the actors involved in advancing or challenging particular framings of mental health is crucial to designing and implementing mental health care policies, interventions, and systems that equitably serve the needs of individuals and populations at the community, (sub-)national, and international levels. It is essential to activate a context-sensitive and relevant network of GMH stakeholders who can leverage their positions and expertise to effect tangible outcomes and improvements in the mental health and lives of persons with lived experience.
AB076. Maximizing nursing leadership in achieving global health goals in the Western Pacific Region
Background: The Western Pacific Region (WPR) is home to nearly a third of the global nursing workforce. Regional disparities are apparent, threatening progress towards global health goals. Though nurses are recognized as essential players, there exists limited data on how nursing leadership is maximized to achieve these goals. The objective of the study is to describe nursing leaders’ perceptions on challenges and solutions in their countries, and the role of nursing leadership in addressing global health challenges. Methods: A 6-week online global health nursing leadership course was implemented with participants from World Health Organization (WHO) WPR countries. Participants answered a discussion forum to identify challenges, how they address these challenges, and how nursing leaders contribute to addressing global health challenges as part of the module synthesis. Thematic analysis was used on the text to identify themes. Results: Eighteen nursing leaders across eleven countries in WPR contributed their answers. The following themes emerged as their challenges: workforce shortages and maldistribution; migration and retention; burnout, mental health, and workload; education and training constraints; gender and equity gaps; and policy and systems support. They identified the following to address nursing challenges: expanding and strengthening the nursing workforce; countries are investing in education reforms to align with international standards; enhancing leadership, policy engagement, and governance; improving well-being, working conditions, and gender equity; and aligning with the WHO Global Strategic Directions for Nursing and Midwifery [2021–2025]. Lastly, participants identified how nursing leadership contributes to addressing global health challenges through: policy influence and system-level reform; innovative education and workforce development; research and evidence-based practice; community empowerment and people-centered care; and advocacy, visibility, and cultural transformation. Conclusions: Local and contextualized knowledge, experience, and expertise of nurse leaders in their respective countries and practice settings should be recognized to maximize the existing workforce’s ability to identify challenges and opportunities for achieving global health goals in the WPR.
AB075. Maternal, newborn, and child health service delivery for Myanmar migrants along the Thailand-Myanmar Border from an implementation science perspective
Background: Multiple factors affect access to maternal, newborn, and child health (MNCH) services among Myanmar migrants who cross the Thailand-Myanmar border. Implementation science frameworks such as the Practical, Robust Implementation, and Sustainability Model (PRISM) can guide the design, implementation, and evaluation of programs by mapping out context and key outcomes to measure. The objective of this study is to summarize the current evidence on MNCH service delivery, including barriers and facilitators for migrants from Myanmar along the Thailand-Myanmar border to guide policy and program development. Methods: Two independent reviewers systematically searched on PubMed, Embase, and Scopus, without date limitations. Studies were included if they involved (I) migrants from Myanmar at the Thailand-Myanmar border, and (II) reported on health outcomes, service delivery, or health financing for participants aged less than 18 years old and those who were pregnant. Published studies as of 17 February 2025 were included without language restrictions. Findings were summarized using PRISM. Results: A total of 101 studies, published from 1989 to 2025, were included from 1,451 records. The majority of the studies were conducted in Tak province (90%). Infectious diseases were most commonly evaluated (23%). Recipient characteristics were well characterized: insecure legal status in Thailand, poor literacy, mobile work arrangements, and long distances to health facilities. Organizational characteristics involved healthcare capacity limitations. Recipients value culturally sensitive services, mobile clinics near workplaces, and informal support networks. Providers expressed high commitment to service delivery despite manpower challenges. A network of public and non-governmental service providers facilitated service delivery, but restrictive pathways in Thailand for nationality verification were reported. Intervention outcomes varied across studies, with treatment outcomes, nutritional status, and mortality more commonly reported as effectiveness measures. Conclusions: Contextually relevant factors and key outcomes for consideration were synthesized using PRISM. This, coupled with active multi-sectoral stakeholder engagement, can guide the development of contextually relevant MNCH programs along the Thailand-Myanmar border.
AB074. Management of open fractures in Sri Lanka using AEFIX: a frugal innovation approach to improve trauma care equity
Background: Sri Lanka faces over 38,000 road accidents annually, causing more than 8,000 serious injuries, especially open fractures needing external fixation. Delayed care can result in disability, amputation, or death. Access remains limited due to the high cost, clamps alone make up 90% of system costs, and shortages of surgical personnel. AEFIX clamps offer a breakthrough: made entirely of aluminum, they provide a durable, functional alternative at just 1% of the standard external fixation price. This study aims to assess the safety, effectiveness, and patient outcomes of the AEFIX external fixator compared to locally available devices in Northern Province, Sri Lanka. Methods: A prospective multicenter randomized non-inferiority trial began in May 2025 and will run for one year at orthopedic units in Northern Sri Lanka. Fifty patients with open femur and/or tibia fractures will be recruited and randomized to receive AEFIX fixators or standard external fixators. Ethical approval (J/ERC/24/157/NDR/0317), National Medicines Regulatory Approval (CTM/046/2025), and Sri Lanka Clinical Trial registration (SLCTR/2025/018) have been obtained. Patients will be followed during admission and at 1.5-, 3-, and 6-month post-procedure. Results: Preliminary results from the first group of recruited patients (n=5) indicate that the device performs well in this clinical setting. Post-operative X-ray examination confirmed improved fracture alignment, and there were positive signs in healing and low complication rates up to this point. Preliminary results with low-cost AEFIX clamps are promising. This trial will assess outcomes and costs of AEFIX, supporting broader efforts to improve trauma care in low-resource settings. Conclusions: Sri Lanka faces a high burden of complex fractures from road traffic injuries. This study is a warranted step toward expanding access to affordable, high-quality external fixation options. This project is supported by the SingHealth Duke-NUS Musculoskeletal Science Academic Clinical Programme Grant Award (13/FY2023/P2/13-A153).
AB073. Machine learning model enhances predictive capability of modified early warning system
Background: Early recognition of impending systemic failure and the provision of appropriate medical care are critical for timely clinical intervention. The modified early warning system (MEWS) is an essential tool for identifying patients at risk of clinical deterioration. However, with the increasing complexity of patient conditions—such as advanced age, multiple chronic diseases, and other risk factors—automated warning systems often generate excessively frequent alerts, resulting in a high rate of false alarms. By applying predictive modeling, critical risk factors can be detected at an early stage, thereby supporting clinical decision-making and improving the overall quality of patient care. The objective of this study is to develop and validate an enhanced predictive model that extends the traditional MEWS framework by incorporating demographic and clinical risk factors to improve early detection of impending systemic failure. We aim to identify critical predictors of patient deterioration at an earlier stage and to improve risk stratification accuracy compared with conventional MEWS-based alerts. By integrating predictive modeling results into clinical decision support, this approach seeks to reduce false alarms, support timely and informed clinical decision-making, and ultimately enhance the quality and safety of patient care. Methods: Retrospective data of cases in the chest wards of a medical center about 4,108 patients from January to June 2021. Features used the patient’s intervention measures and comorbidity parameters during hospitalization to understand the patient’s physical condition, and used machine learning (ML) to let the computer learn and judge, and then predict the patient’s final condition. Four model evaluation indicators were used, and XGBoost was the best prediction model, so it was adopted as the final model for prediction in this study. Results: The relationship between all feature values and the predicted target death is moderately correlated with signing do not resuscitate (DNR), the shift time of the nursing station, and the patient’s age. Among the comorbidities, diabetes, hypertension, heart failure, and renal failure have a greater impact. The staff accepts the MEWS easily because of the clear design. The incidence of cardiopulmonary resuscitation (CPR) was reduced from 2.42% to 1.58% after application of the MEWS in 2022. The MEWS helped the improvement of the clinical outcomes in our study. Conclusions: The establishment of the MEWS system is the basis for improvement. Comorbidities are graded according to disease severity to more accurately predict the impact of comorbidities.
AB072. Listening beyond words: a phenomenological study on parenting a child with autism
Background: Parenting a child with autism spectrum disorder (ASD) brings emotional, financial, and social challenges. Caregivers face overwhelming responsibilities, limited resources, and persistent stigma. Despite growing awareness, support systems remain inadequate, leaving families with minimal help. Understanding their lived experiences is essential for shaping effective support systems and policies. The objective of this article is to explore the lived experiences of parents caring for children with ASD to inform the development of supportive interventions and policies. Methods: This qualitative phenomenological study explored the experiences of 11 parents of children aged 3 to 15 years with a formal ASD diagnosis. Participants were selected using purposive snowball sampling. Exclusion criteria included non-parental caregivers, lack of diagnosis, or conditions affecting participation. Semi-structured interviews were conducted in person or online, based on preference. Thematic analysis identified recurring patterns while maintaining ethical standards and confidentiality. Results: Seven core themes emerged: “Unveiling Autism Realities” captured the initial shock and grief; “A Heart that Knows No Bound” reflected emotional strain and deep love; “The Price of Unconditional Love” highlighted financial and caregiving burdens; “Strength in Solitude” revealed isolation due to limited support; “A Spark in the Shadows” emphasized faith as a coping tool; “Nurturing the Spectrum” involved creative parenting and sacrifice; and “A Journey of Small Victories” showcased resilience through progress. These themes reveal both struggles and adaptive strengths. Conclusions: The study highlights the urgent need for accessible support, affordable care, financial aid, inclusive education, and increased public awareness. Strengthening support networks and government programs is vital. Further research should explore long-term impacts and assess existing services. Collaboration among families, professionals, and policymakers is key to improving outcomes for those affected by ASD.
AB071. Larvicidal activity of Annona squamosa (Atis) leaves extract on Aedes aegypti
Background: Vector-borne diseases (VBDs), particularly mosquito-borne diseases, pose a substantial threat to the population in the world. Mosquito vector control measures are crucial for preventing dengue by stopping the spread of mosquito populations and enhancing environmental sanitation to improve public health services, but no successful preventive measures have been recorded for dengue vector control. Hence, possible alternatives to chemical larvicides have been explored, including plant alcoholic extracts. The general objective of this study is to determine the larvicidal efficacy of Annona squamosa ethanolic leaf extracts against third instar larvae of Aedes aegypti and the specific were the following: to determine mortality rates of Aedes aegypti larvae, at 2-hour intervals for a total duration of 24 hours, to measure the mean difference in mortality rates of the Aedes aegypti larvae across several Annona squamosa ethanolic leaf extract concentrations versus the positive and negative controls; and to determine the lethal dose 50% (LD50) of Annona squamosa ethanolic leaf extract against Aedes aegypti larvae. Methods: Three replicates of varying concentrations of Annona squamosa ethanolic extract (i.e., 10%, 40%, and 70%) versus positive (novaluron) and negative controls (tap water) were used to determine larval mortality. Results: Greatest larval mortality was noted using the 70% concentration (i.e., 24% versus the observed values of 20% and 8%, respectively, for the 40% and 10% ethanolic concentrations). Relative to the controls, the mean differences in the mortality rates of the Aedes aegypti larvae across the leaf ethanolic concentrations were statistically significant (i.e., P value <0.05). There was an increasing trend in larval mortality over time, but LD50 was not achieved. Conclusions: This epidemiologic experiment showed a significant difference using the experimental intervention and controls, as it displayed the mean difference in mortality across the various ethanolic leaf extract concentrations, compared to positive and negative controls. The proportion of Aedes aegypti larval death at 2-hour intervals over 24 hours showed that the mortality rate of larvae generally increased over time. Although the study did not reach the LD50 due to the short period of observation (i.e., 24 hours only), Annona squamosa leaf extract still had 24% larval death in the study. Hence, the different Annona squamosa ethanolic leaf extracts could be used as alternative botanical larvicides against Aedes species.
AB070. Integrating health and ethics in climate adaptation: a global review of National Adaptation Plans (NAPs)
Background: As the climate crisis intensifies, national adaptation strategies—including National Adaptation Plans (NAPs), National Adaptation Programmes of Action (NAPAs), and related policy documents—play a critical role in shaping how countries protect public health. These documents are key instruments for defining climate-health priorities, yet little is known about the extent to which they include concrete health interventions or address the ethical imperatives of equity and vulnerability. This study examines how national adaptation strategies globally integrate health-related interventions and ethical considerations. It aims to identify which countries are addressing health comprehensively, which interventions are prioritized or overlooked, and how vulnerable populations are represented (or neglected) in climate adaptation planning. Methods: A total of 123 national adaptation documents (NAPs, NAPAs, and related strategies) were reviewed. ChatGPT-Pro was used for initial content extraction, followed by manual coding and qualitative synthesis. Documents were assessed for five health-related intervention categories: disaster risk reduction, health workforce training, heat adaptation, mental health, and vaccination. Mentions of vulnerable groups were also analyzed. Results: Only 10% of countries addressed four or more of the five key health themes. Disaster risk reduction (91%) and health workforce training (81%) were the most commonly included interventions. In contrast, mental health (11%) and vaccination (17%) were severely underrepresented. While vulnerable groups such as women, children, and the elderly were mentioned in many strategies, few included targeted interventions to address their specific needs, highlighting a gap between recognition and action. Conclusions: Despite growing recognition of climate-health risks, most national adaptation strategies fall short of comprehensive or equity-focused responses. Strengthening the ethical and programmatic integration of health in these strategies is critical to ensure inclusive and just climate adaptation.
AB069. Insomnia in a primary care setting: a cross-sectional study of prevalence and associated factors among adult patients
Background: Insomnia is a rising global health concern, affecting 16.2% of adults and contributing to significant physical, psychological, and social consequences. As the first point of contact, primary care plays a crucial role in early detection and intervention. In Malaysia, data on insomnia in primary care are limited and outdated, despite evolving diagnostic criteria and recognition of its burden. This study aims to determine the prevalence and associated factors of insomnia to inform targeted prevention and management strategies. Methods: A cross-sectional study was conducted at a university-based primary care clinic in Kuala Lumpur between December 2024 and March 2025. A total of 453 adult patients were recruited via systematic random sampling. Data collected included sociodemographic variables; depression and anxiety assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7); financial distress measured using the Financial Well-Being Scale (FWS); and insomnia severity using the Insomnia Severity Index (ISI). Multivariable logistic regression was performed to identify factors associated with clinical insomnia. Results: The median age of participants was 55 years, with the majority being female (60.3%). Insomnia symptoms were present in 38.8% of participants, with 13.2% having clinical insomnia and 25.6% subthreshold insomnia. Multivariable analysis showed that clinical insomnia was significantly associated with younger age (18–34 years) [adjusted odds ratio (aOR) =3.91; 95% confidence interval (CI): 1.25–12.19; P=0.02], non-Malay ethnicity (aOR =2.52; 95% CI: 1.30–4.89; P=0.006), financial distress (aOR =3.08; 95% CI: 1.15–8.34; P=0.03), and the presence of depression or anxiety (aOR =6.25; 95% CI: 3.06–12.73; P<0.001). Conclusions: Insomnia is highly prevalent in primary care and is associated with younger age, non-Malay ethnicity, and financial and psychological distress. These findings provide updated prevalence estimates and highlight the need for greater recognition and awareness of insomnia in primary care settings to support early detection and more effective management.
AB068. Influence of job demands and resources on nurses’ compassion fatigue: mediating roles of self-compassion, resilient coping, and compassion satisfaction
Background: Compassion fatigue poses significant challenges to nurses’ well-being and the quality of patient care, particularly in high-demand, low-resource settings. The Job Demands-Resources (JD-R) model emphasizes the influence of workplace conditions on employee outcomes; however, the mechanisms linking these factors to compassion fatigue remain underexplored. This study examines how job demands and resources affect compassion fatigue, with self-compassion, resilient coping, and compassion satisfaction as mediators. Methods: This cross-sectional study involved 493 nurses recruited from three public hospitals in the Klang Valley. Data were collected via an online survey form comprising sociodemographic information and validated Malay versions of the Professional Quality of Life Scale (ProQOL-M), Copenhagen Psychosocial Questionnaire (COPSOQ-M), Self-Compassion Scale (SCS-M), and Brief Resilient Coping Scale (BRCS-M). Data analysis included descriptive statistics, partial least squares structural equation modelling (PLS-SEM), and Importance-Performance Map Analysis (IPMA) using SmartPLS version 4.0.8.5. Results: Structural equation modelling revealed that job demands significantly increased compassion fatigue (β=0.496, P<0.001), while job resources had no direct effect (β=0.003, P=0.95). Self-compassion mediated the effects of job demands (β=0.057, P=0.02) and job resources (β=−0.024, P=0.03) on compassion fatigue. Compassion satisfaction mediated the effect of job resources on compassion fatigue (β=−0.050, P<0.001), and serial mediation via self-compassion and compassion satisfaction was also significant (β=−0.009, P=0.01). The serial mediation effect from job resources through resilient coping and compassion satisfaction was significant (β=0.018, P=0.001), indicating indirect protective effects. Conclusions: The study reveals that personal and professional resources significantly buffer the impact of job demands on compassion fatigue among nurses. These findings provide evidence for policymakers to develop targeted interventions that enhance self- compassion, resilient coping, and compassion satisfaction. Embedding these elements into workforce policies can reduce compassion fatigue, enhance nurse well-being, and reinforce the healthcare system’s ability to deliver sustainable, high-quality care.
AB067. Inequity in the utilization of health services in Thailand due to the structural determinants of health: a systematic review
Background: The utilization of health services in Thailand increased significantly after the implementation of universal health coverage (UHC) in 2002. However, evidence suggested that the structural mechanisms that generate social stratification affected the utilization of health services despite UHC. This study aims to examine the effects of the structural determinants on health inequities in Thailand using the Commission of Social Determinants of Health (CSDH) conceptual framework as a theoretical guide. Specifically, the study assesses the effects of socioeconomic status, education, gender, ethnicity, and occupation on the utilization of health services. Methods: This systematic review was conducted in Medline, Global Health, Scopus, and Web of Science. The inclusion criteria consisted of quantitative studies that analyzed and quantified the difference in health service utilization between population subgroups stratified by the structural determinants. Results: A total of 19 studies were included in this review. The results showed that the poor utilized health services more than the rich, but there is a rich-poor disparity in tertiary care services. People with high-income occupations and higher-level education utilized more health services than their lower counterparts. Women are more likely than males to utilize health services. Ethnic minority migrants and stateless populations have the lowest level of health service use compared to Thais, and the presence of health insurance does not necessarily increase the utilization of health services in this group. Maternal and Child Health services have the least inequity gap due to high service coverage, while dental service use showed substantial pro-rich inequity. Conclusions: The structural determinants of health contribute to inequities even after the implementation of UHC. To further close the inequity gap, future policy should focus on ensuring adequate and timely referral from primary health centers to specialist care, removing barriers to access care for ethnic minority migrants and stateless populations, and reducing the scarcity of dental resources in rural areas.
AB066. Incidence and factors associated with toddler mortality in Malaysia from 2018 to 2022
Background: Malaysia achieved the Sustainable Development Goal (SDG) 3.2 target of reducing under-5 mortality by 1984. However, toddler mortality (ages 1–4 years) has remained stagnant at 8–9 per 1,000 live births since 2000. This plateau signals an urgent need to investigate factors contributing to toddler deaths, particularly the distinction between preventable and non-preventable causes. This study aimed to (I) determine the incidence of toddler mortality in Malaysia from 2018 to 2022; (II) identify the causes of preventable and non-preventable deaths; and (III) examine the sociodemographic, parental, and environmental factors associated with these deaths. Methods: A retrospective cohort study was conducted using secondary data from the Malaysian Ministry of Health’s Stillbirth and Under-5 Mortality Death Form [2018–2022]. Logistic regression was used to identify factors associated with preventable deaths. Results: A total of 3,002 toddler deaths were reported, of which 56.6% were preventable. Injuries and external causes made up 18.6% of deaths—primarily drowning, asphyxia (40.7%), head trauma (29.9%), and motor vehicle accidents (17.2%). Females had higher odds of preventable death [odds ratio (OR) =1.236, 95% confidence interval (CI): 1.069–1.430]. Toddlers from Indigenous West Malaysia (OR =0.274, 95% CI: 0.159–0.472) and Indigenous Sabah (OR =0.566, 95% CI: 0.443–0.724) had lower odds than Malays. Higher maternal age (25–34 years: OR =1.578, 95% CI: 1.248–1.994; >34 years: OR =1.786, 95% CI: 1.396–2.286) and tertiary education (OR =4.663, 95% CI: 3.454–6.296) were linked to increased odds. Similarly, paternal age >34 years (OR =1.728, 95% CI: 1.171–2.550) and tertiary education (OR =5.851, 95% CI: 4.156–8.236) showed higher risk. Families receiving social welfare support (OR =4.067, 95% CI: 1.472–11.235) also had greater odds of preventable death. Conclusions: This study highlights key risk factors and causes of toddler mortality in Malaysia, offering evidence to inform targeted prevention strategies. Enhancing child safety, addressing social vulnerabilities, and improving intersectoral coordination are essential to reducing preventable toddler deaths.
AB065. Improving donor human milk safety: evaluation of pre- and post-pasteurization controls in a community-based human milk bank in the Philippines
Background: Breastfeeding is a cost-effective, high-impact intervention for health, nutrition, and disaster risk reduction, and is the biological norm for infant feeding. However, illness, maternal death, or separation can disrupt breastfeeding and the mother-child connection, leaving vulnerable newborns without access to their mother’s own milk (MoM). In such cases, human milk banks (HMBs) serve a critical role in providing safe donor human milk (DHM), directly contributing to Sustainable Development Goal (SDG) 3 by reducing preventable neonatal mortality. In the Philippines, ensuring the microbiological safety of DHM remains a challenge, particularly for emerging non-hospital-based facilities like the Laguna Human Milk Bank (LHMB). Established in 2022, LHMB operates through community-based donors rather than inpatient mothers, and continues to refine its processing systems, unlike hospital-based HMBs with established standardized protocols. From July 2024 to April 2025, LHMB processed 58 DHM pools, with only 10% passing quality standards, exposing critical operational gaps. The objective is to evaluate the pre- and post-pasteurization microbiological safety of DHM pools processed by LHMB to identify critical control gaps and inform practical quality system improvements aligned with SDG 3. Methods: A retrospective review was conducted on 58 DHM pools using internal records and pasteurizer logs. Microbial results were analyzed pre- and post-pasteurization, alongside process mapping and review of Holder pasteurization cycles (62.5 ℃ for 30 minutes). Machine-generated logs were examined for discrepancies in heat duration recording. Results: Pre-pasteurization testing failed in 48 of 58 pools (83%), confirming that the majority of contamination occurs early in the process. Only 4 of 58 pools (7%) failed post-pasteurization testing. Analysis of pasteurization logs revealed under-reporting of heat duration. Machine cycles ran correctly, yet software recorded insufficient time (typically ≥10 minutes), creating a data integrity risk that could misclassify safe milk as non-compliant. Conclusions: Microbial contamination predominantly occurred before pasteurization, compounded by inaccuracies in process documentation. Recommended interventions include strengthened donor hygiene education, improved sanitation and cold-chain protocols, machine calibration, and verification of pasteurization records. Through integration of these measures within a resource-limited, community-based setting, the LHMB can strengthen its capacity to provide safe DHM as a bridge when a mother’s own milk is temporarily unavailable, helping protect vulnerable infants, support mother-child dyads in returning to breastfeeding, and contribute to SDG 3 by reducing avoidable neonatal mortality.
AB064. Implementing planetary health into the nursing curriculum: a multi-methods study protocol
Background: In 2015, the legally binding Paris Agreement set a target to limit temperature rise to 1.5 ℃ with a cap of 2 ℃. This is unlikely to be achieved. Healthcare staff will be working in a changing global climate. Education must inform students about the impacts of healthcare activities upon climate change. The objective of this study is to plan, implement, and evaluate the implementation of planetary health into the nursing curriculum at the University of Auckland (UoA), including implementation of Indigenous traditional knowledge related to planetary health. Methods: A single-site, multi-methods research study. Methods include an Integrative Review, a pre-and post-implementation observational study assessing student awareness of planetary health and the relevance to nursing, implementation of Planetary Health into the pre-registration nursing curriculum in the UoA/Waipapa Taumata Rau School of Nursing (SoN), and a post-implementation qualitative evaluation. This work will describe two studies within the wider project: study 1: pre-registration nursing students’ knowledge and attitudes towards planetary health, human health, environmental sustainability, and relevance to nursing (the PlaN study). Study 2: integration of planetary health into the pre-registration nursing curriculum. Process evaluation (the PlaN PE study). Discussion: This will be the first time planetary health is included in the pre-registration nursing curriculum in the SoN at UoA. Understanding current knowledge, attitudes, and awareness will inform us about how to embed planetary health into the curriculum in a meaningful way, while preparing the nursing workforce and nurse leaders of the future. This project is unique in that it is placed in Aotearoa New Zealand, where the bicultural worldview of Te Ao Māori has a strong influence on health care education and practice. Therefore, the project will include indigenous knowledge to support actions to benefit planetary health. Trial Registration:
AB063. Impact of social determinants of health on patient outcomes of a medical mobile clinic in the Philippines
Background: Health inequities remain a persistent issue in the Philippines, particularly in geographically isolated and disadvantaged areas (GIDAs). ABC’s for Global Health (ABCGH) operates a medical mobile clinic (MMC) in Pampanga to deliver primary care services to underserved communities. Recognizing that non-medical factors significantly affect health outcomes, this study aimed to evaluate the impact of social determinants of health (SDH) on patients served by the MMC. Methods: A cross-sectional study was conducted from July 2019 to July 2020 across 15 communities in Pampanga served by the MMC. The clinic focused primarily on non- communicable diseases such as hypertension and diabetes. A total of 487 adult patients, with or without existing disease, participated in the study. Health outcomes were measured using the Short Form-36 (SF-36) survey, which categorizes physical and mental health across eight domains. Statistical analyses included logistic regression and Chi-squared tests at a 95% confidence level. Results: Social determinants such as age, comorbidities, education, employment status, social class, living conditions, and access to public services (e.g., healthcare, education, transportation, waste management) significantly influenced SF-36 health scores. Key associations were observed in physical health domains—physical functioning, role limitations, pain, and general health—as well as in mental health domains—vitality, emotional well-being, and social functioning. Physical component scores (PCS) were associated with age, comorbidities, education, and social class, while mental component scores (MCS) were influenced by education and social class. Conclusions: This study affirms that health outcomes are shaped not only by access to healthcare but by a range of intersecting social determinants. To improve patient outcomes, interventions must extend beyond clinical care to address systemic inequities in education, employment, and living conditions—underscoring the need for integrated, multi-sectoral health strategies in GIDA communities.
AB062. Health system interventions for migrants and displaced populations in a changing climate: a global scoping review
Background: Climate change increasingly impacts health systems and widens health inequities. It also drives human migration and displacement, and affects the health of migrant and displaced populations, who face financial, legal, and cultural challenges in accessing quality healthcare. Despite the intertwined nature of these phenomena, efforts to build climate-resilient and migrant-sensitive health systems are often isolated. This study identified specific health system interventions that address climate change hazards and the health needs of refugees, migrants, and displaced populations globally. Methods: A global, scoping review was conducted to identify such interventions documented from 2014 to 2024 in peer-reviewed and grey literature publications. The review included English-language publications describing specific health system interventions addressing climate change and the health needs of refugee, migrant, and displaced populations. These were then further categorized by the World Health Organization health system building blocks framework. Results: Ninety-five interventions were identified across 56 publications, after screening 3,255 peer-reviewed studies and 3,928 grey literature documents. Although the majority were short-term, reactive responses (e.g., service delivery during climate-related emergencies), some interventions addressed the longer-term health needs of climate-affected displaced and migrant populations, establishing mechanisms which could be sustained beyond a disaster event for protracted or slow-onset crises. The review found new innovative interventions were emerging, but that many familiar, documented interventions can be adapted to meet the needs of migrant populations displaced or otherwise affected by climate change. Conclusions: While immediate and ad-hoc actions emerged, it is urgent to implement integrated, system-wide approaches to proactively strengthen health systems to improve the health of displaced and migrant populations in a changing climate. Migrant populations must be included when building climate-resilient and environmentally sustainable health systems, as must climate-related considerations when building migrant-inclusive health systems.
AB061. Health literacy profile of current and future healthcare professionals: Bruneian context
Background: To deliver holistic, patient-centered care, healthcare professionals (HCPs) must understand and address the diverse health literacy (HL) needs of their patients. This requires HCPs to have a strong foundation in HL themselves. The objective of this study is to determine and compare the HL profile of current and future HCPs in Brunei Darussalam. Methods: This cross-sectional study assessed HL levels using the 9-domain Health Literacy Questionnaire (HLQ) with ad-hoc demographic questions. Future HCPs were students enrolled in medicine, dentistry, pharmacy, nursing, and midwifery undergraduate programs at the PAPRSB Institute of Health Sciences (PAPRSBIHS), Universiti Brunei Darussalam (UBD). Current HCPs included practicing doctors, dentists, pharmacists, nurses, and midwives in hospitals and community-based clinics in government setting. Mean HL scores were compared across groups, including those with and without formal HL training. Statistical analyses, including Kruskal-Wallis and independent t-tests, were performed using R Version 4.1.1 and RStudio Version 1.4.1717 for macOS. Ethical approval was obtained from the Medical and Health Research and Ethics Committee (MHREC), Ministry of Health, Brunei Darussalam. Results: Both current and future HCPs generally agreed with statements related to HL, with current HCPs showing slightly higher overall scores. This may reflect their practical experience, continuing education, and established professional networks. Future HCPs showed strengths in finding and understanding health information, likely due to academic training. No statistically significant differences were observed across professional roles or courses, suggesting consistent HL education. Formal training significantly improved scores among current HCPs but was less impactful among future HCPs, highlighting a need for better integration of HL education in undergraduate programs. Conclusions: Formal HL training enhances current HCPs’ HL, but greater emphasis is needed in undergraduate curricula. Equipping HCPs with HL skills is key to improving patient communication and outcomes. Tailored training should be part of continuous professional development. Enhancing HL among HCPs globally is essential for reducing health disparities and strengthening health systems worldwide.
AB060. Governing health, neglecting minds?—a policy gap analysis of mental health in pandemic governance
Background: The coronavirus disease 2019 (COVID-19) pandemic revealed how mental health, especially among frontline and non-medical frontline workers, who has often been overlooked in pandemic policies and approaches. Global health frameworks such as the World Health Organization (WHO) Pandemic Agreement and International Labour Organization (ILO) guidelines have begun to incorporate mental health into Occupational Safety and Health (OSH) agendas, while limited study focus on people such as frontline worker’s mental health in large-scale international events in an exclusive pandemic setting. The objective of this study is to investigate how mental health has been reflected in pandemic policy frameworks and to explore how non-medical frontline workers lived experiences and feedback can inform more inclusive pandemic governance. Methods: This study develops a conceptual framework linking policy design, frontline discretion, and mental health outcomes, drawing upon Policy Feedback Theory (PFT), Street-Level Bureaucracy (SLB), and Event System Theory (EST). Based on this model, a mixed-method survey was designed to assess the perceptions, stress, coping mechanisms, and policy feedback of non-frontline workers (NFWs) who supported COVID-19 countermeasures at the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Results: Preliminary findings from policy document analysis show that mental health and well-being concerns were largely absent from earlier pandemic strategies related to mass gatherings (MGs). Semiconductor interviews suggest that non-medical frontline workers experienced significant emotional strain, such as anxiety, fatigue, and isolation, especially under restrictive “bubble” policies. These psychological challenges were often unaddressed in official protocols, and in some cases, led to declining morale or reduced willingness to comply with infection control measures. Conclusions: This study reveals a growing but uneven recognition of mental health in pandemic governance and MGs. While recent policy frameworks begin to address mental health and well-being, the past experiences and feedback of non-medical frontline staff remain underrepresented. By identifying these gaps and capturing perspectives from Olympic contexts, this research offers insights to inform more inclusive and equitable planning for future mass-gathering and pandemic governance as well.
AB059. Governance at the climate-mental health interface: a policy and stakeholder analysis in Singapore and the Philippines
Background: Climate change and mental health are increasingly recognized as interlinked global challenges. Southeast Asia (SEA) is especially vulnerable, given its varying health system capacities and socioeconomic disparities. Singapore and the Philippines offer contrasting contexts shaped by differing political structures, healthcare systems, and climate risks, providing a unique opportunity for comparative analysis to inform evidence-based, context-sensitive policymaking. This study explores how Singapore and the Philippines address the climate change and mental health intersection in national policy. It maps policies at this intersection, including broader climate and health policies, evaluating their strengths and limitations and identifying opportunities for improved policy responsiveness. The goal is to generate actionable recommendations to guide national-level strategies that better integrate mental health within climate change adaptation. Methods: Using the policy analysis triangle framework, this study examined policy content, actors, context, and processes. Document analysis was complemented by 20 semi-structured interviews with experts in climate change and mental health from both countries. Data were analyzed using hybrid thematic analysis, incorporating both inductive and deductive approaches. Results: Preliminary findings indicated that although climate-health intersections were more explicitly acknowledged in the Philippines, owing to its high disaster-risk profile, mental health remains implicit or overlooked in both countries. Stakeholders emphasized the pressing need for robust evidence to support policymaking and to prevent worsening mental health outcomes. Strengthening the recognition of mental health as a climate issue was critical to advancing planetary health and fostering resilient responses to climate change in SEA. Conclusions: Integrating mental health into climate policy is essential for building truly resilient and equitable health systems. As SEA confronts escalating climate threats, proactive, evidence-informed policymaking at this intersection can drive transformative change toward planetary health.
AB058. From wok to wellness: validating a reliable tool to measure healthy cooking behavior in Malaysia
Background: Unhealthy dietary habits, driven by a shift from home-cooked meals to dining out, are contributing significantly to Malaysia’s rising burden of non-communicable diseases. Food handlers play a critical role in shaping the dietary quality outside home through their cooking behavior. However, validated instruments to assess healthy cooking behavior among food handlers are scarce. This study aimed to validate the Healthy Cooking Index in Malay (HCI-M) to assess healthy cooking behavior among Malaysian food handlers. Methods: The tool underwent a rigorous adaptation process involving local contextualization of cooking practices, content validation, forward-backward translation by experts, face validity, test-retest, and principal component analysis (PCA) among the study population. Eligible participants were adult food handlers involved in cooking, proficient in Malay, recruited through purposive sampling from food premises at Universiti Malaya, Kuala Lumpur and Kota Marudu, Sabah. Fast food and bakery establishments were excluded. Participants completed a self-administered questionnaire. Data were analyzed through Statistical Package for the Social Sciences (SPSS) and FACTOR statistical software. Results: The HCI-M demonstrated good item-level content validity index (I-CVI) and excellent scale-level content validity index (S-CVI) (I-CVI =0.86 and S-CVI =0.96, respectively). The items were well-understood by the target group and revised further after debriefing. Test-retest reliability showed acceptable to excellent agreement across items (kappa >0.40). PCA confirmed three meaningful components (eigenvalue >1) with all items loading above 0.4, and total variance explained was 53%. Conclusions: The HCI-M is a valid and reliable tool to assess healthy cooking behavior among Malaysian food handlers. It will guide in designing effective interventions to improve and monitor healthy cooking behavior among food handlers, which can potentially reduce diet-related disease risk at the population level.
AB057. From fieldwork to policy insight: longitudinal review of environmental health practices in Gianyar, Bali (December 2021–June 2025)
Background: Environmental sustainability is a key determinant of public health. In rapidly developing areas like Gianyar, Bali—where tourism and urbanization are accelerating—maintaining a healthy environment presents critical challenges. Since December 2021, students from the Faculty of Medicine and Health Sciences, Universitas Warmadewa, have conducted fieldwork in community health centers (CHCs), focusing on environmental health. This study synthesizes findings from 50 student-led projects conducted through June 2025 to identify environmental health risks, practices, and policies in Gianyar’s primary healthcare settings. The aim is to inform evidence-based strategies for promoting sustainable environmental health. Methods: A longitudinal synthesis was carried out using data from 50 student field studies over 3.5 years. These involved environmental risk mapping, waste management assessments, sanitation audits, and interviews with healthcare workers and community members. Thematic analysis was applied to qualitative data, while descriptive statistics summarized quantitative findings. Stakeholder consultations were held to validate insights and assess policy relevance. Results: Common issues identified included improper waste segregation (78% of CHC), irregular sanitation practices (61%), and low environmental health literacy in surrounding communities. Improvements were noted following student-led interventions such as health promotion activities and community education. Collaboration between students, health officers, and local government supported minor policy revisions, especially in waste management protocols. Conclusions: Sustained student engagement in community-based environmental health efforts has provided valuable insights and contributed to incremental policy change. The Gianyar experience illustrates how academic-community partnerships can support environmental sustainability in primary health care. This model may be applicable to similar regions across Southeast Asia.
AB056. Fragile bubble of “positive living”: an ethnographic study of transitions of status and normalcy among men who have sex with men (MSM) living with HIV in urban Shanghai
Background: As global public health increasingly frames human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) as a manageable chronic disease, there remain gaps in understanding how this framing is adapted, experienced, and internalized by people living with HIV (PLHIV), particularly in non- Western sociocultural contexts. In China, although HIV/AIDS-related policies and treatment access have improved, stigma and stereotypes, especially toward men who have sex with men (MSM) with HIV, persist. These individuals remain largely marginalized and socially invisible. The objective of this study is to show that while “positive living”, a more upbeat and non-pathological view of HIV/AIDS, is possible, it is highly conditional and sustained only through specific support systems and environments. Methods: This research draws on one year of ethnographic fieldwork at a Shanghai-based non-governmental organization (NGO) supporting PLHIV. It is based on approximately 530 hours of participant observation, including daily NGO activities, PLHIV tea-parties, art support group sessions, meetings with artists and counselors, and the HIVxART exhibition. It also includes 32 in-depth interviews with MSM living with HIV, NGO staff, and art support group team members. These data explore how young MSM with HIV perceive HIV/AIDS, navigate life after status transitions, and test the boundaries of visibility within a fragile yet reassuring “bubble” created by the NGO and its allies. Results: This study finds that “positive living” emerges through collective labor. From full acceptance to strategic invisibility, participants express a spectrum of responses to their HIV status. The NGO fosters emotional resilience and a sense of normalcy by offering safe spaces for sharing, identity-building, and community bonding. Yet, this bubble is precarious: it can rupture when funding is threatened or when identity exposure risks emerge. Conclusions: This study demonstrates how the chronic disease narrative of HIV/AIDS intersects with local moral worlds, PLHIV’s complex identities, and lived experiences. It calls for culturally responsive, socially embedded HIV care, which recognizes the conditions and labor required to build and sustain “normalcy” in stigmatized populations.
AB055. Filipino mothers assumed roles on essential toddler care: implication on universal child health care
Background: To foster growth and development to toddlers, it includes age-appropriate self-care and provision of age-appropriate toys and activities from primary caregivers such as parents or family members. The mothers as primary caregivers of a toddler child in the Philippines, her key roles never stop, instead, it only evolves and enriches. Universal health care includes a comprehensive range of services, from health promotion and prevention throughout the childhood period, including the first 3 years of life. The purpose of this study is to determine the various home-based and community-based care activities performed by the mothers to children ages 12 to 36 months old. Methods: To identify essential toddler care activities performed by mothers, concept synthesis and face-to-face interviews were done for the first time and multigravida mothers to determine their assumed roles. From the results of these interviews, a tool was developed identifying childcare activities rendered by mothers as perceived by the mothers as needed or essential and considered with highest priorities. An instrument, Mother’s Assumed Toddler Care Role Instrument (MATCaRI), was developed to establish the components of basic care to essential toddler care activities. Results: To examine the major elements and define the construct of essential toddler care, a content validation index was performed, resulting in 0.87 (P=0.05), which included 12 components, and reliability testing resulted in Cronbach α=0.82 with 25 items surveyed on adolescent and multigravida mothers in the provinces of Cavite and Occidental Mindoro, Philippines. Conclusions: Mothers’ key roles in toddler care enrich and are evolving, including optimal child health activities and services, such as home care activities, provision of safety, preventive or early intervention services for developmental and behavioral problems, acute and chronic care, coordination and follow-up for developmental problems provided by health professionals, family, and community for children ages 12 to 36 months. These findings can support the World Health Organization (WHO)’s recommendation to use a primary health care (PHC) approach grounding on what areas of toddler care mothers can be capacitated for the improvement of health services they need, where and when they need them.
AB054. Extreme heat and gender-based violence: a systematic review of the evidence
Background: Climate change is increasing the frequency and severity of heatwaves across the world, as well as raising ambient air temperatures, which has profound consequences for human health. Women and girls, especially those already facing social and economic disadvantage, are disproportionately impacted by rising heat due to the exacerbation of gender inequalities, unequal power dynamics, discriminatory social norms, and unequal access to resources and livelihoods—all of which can increase their risk of gender-based violence (GBV). GBV is widely recognised as a global public health crisis, yet its critical intersection with climate change has received limited attention in policy and research. The objective of this study is to synthesise the global quantitative evidence on the association between increased ambient temperatures and heatwaves with different forms of GBV, including intimate partner violence (IPV), sexual violence and early marriage. Methods: We conducted a systematic review following a Prospero-registered protocol (CRD42025645675). We searched academic and grey literature to identify quantitative studies published between 1983 and 2024. Results: We identified 23 eligible studies, the majority of which (n=20) reported a statistically significant positive association between higher temperatures and more reports of GBV. Notably, IPV and sexual violence were the most frequently reported outcomes. Three key pathways that link extreme heat to GBV were identified: (I) heightened economic and psychological stress; (II) increased exposure to enabling environments, such as displacement or disrupted services; and (III) the exacerbation of existing structural inequalities. Despite significant findings, evidence quality varied and reporting on intersecting risk factors such as gender, age, and disability status was limited. Conclusions: These findings highlight the critical role of climate change as a threat multiplier for GBV. Addressing climate change through mitigation and adaptation strategies must be gender-responsive and consider the disproportionate impacts on women, especially related to increased risk of GBV.
AB053. Exploring health identity transformation in type 2 diabetes mellitus
Background: Type 2 diabetes mellitus (T2DM) requires sustained self-management and, for many people, a deeper psychological reorientation as they integrate the illness into their sense of self. Health identity transformation (HIT) refers to the cognitive, emotional, and behavioral integration through which individuals reconstruct how they understand themselves as a person living with a chronic condition. Although diabetes literature has emphasized adherence and self-management behaviors, the identity work that underpins sustainable behavior change remains underexplored. This study aims to explain the process of HIT and the conditions that shape it among adults with T2DM. Methods: This qualitative study will use grounded theory. Adults aged 18 years or older with a T2DM diagnosis for at least one year will be purposively recruited from outpatient clinics at a tertiary hospital in Thailand. Data will be collected through semi-structured, in-depth interviews and analyzed using constant comparative methods with iterative sampling, memoing, and theoretical coding to develop an explanatory model of HIT. Ethical approval will be obtained prior to data collection. Results: The study is expected to generate a grounded model describing stages and mechanisms of HIT in T2DM, including key facilitators (e.g., diabetes education, social support, and self-efficacy) and barriers (e.g., stigma, emotional burden, and competing life demands). The findings will identify clinically actionable leverage points for identity-based and person-centered interventions. Conclusions: By clarifying how adults with T2DM reconstruct health identity over time, this study will provide a conceptual foundation for nursing and interdisciplinary care to support sustained self-management and more personalized chronic disease services.
AB052. Exploring health and well-being among refugee and migrant women in Greece: a mixed-methods study with women and key informants
Background: Greece has often been viewed as a gateway to Europe for many fleeing war and conflict, as it shares borders with Albania, Bulgaria, North Macedonia, and Turkey by land and shares its coast with Italy, Egypt, and Libya. As of March 2nd, 2025, the United Nations High Commissioner for Human Rights (UNHCR) reported 6,205 new migrant arrivals, of which 5,753 arrived by sea on the Aegean islands and 452 arrived on land (UNHCR, 2025). As of March 2nd, 2025, there are 9,054 migrants and refugees living in closed controlled-access centers awaiting processing (e.g., migrant camps, government-provided facilities). Of these 9,054 migrants, women and children account for 21% and 37% of the demographic, respectively (UNHCR, 2025). Increased migration has led to overcrowding, creating long-standing implications for health/wellness, healthcare delivery/access, and accessibility of local aid. We aim to identify current gaps in services, systemic barriers, and highlight potential opportunities for future health programming. Methods: A mixed-methods study framework was used to: (I) report real-time data on refugee/migrant women’s health and well-being; (II) identify unmet needs and gaps in available services for refugee/migrant women; (III) assess the relationship between different variables such as legal status and length of stay in camps with health/well-being, if any; and (IV) gain insights from key stakeholders working locally in Greece with refugees and migrants. Results: A sample of 27 refugee and migrant women participated in structured quantitative surveys, representing voices from: Cameroon, Côte d’Ivoire, Egypt, Eritrea, Ghana, Morocco, Nepal, Nigeria, Pakistan, Somalia, Syria, and Uganda. With 52% being recognized refugees, 22% being asylum seekers, and 26% being migrants both regular (e.g., family reunification) and irregular (e.g., no status, asylum case rejected, all asylum appeals exhausted, etc.). Preliminary findings show the following 5-item World Health Organization (WHO-5) Well-Being Index score trend observed from (highest to lowest): refugees > asylum seekers > migrants. A sample of nine key informants participated in semi-structured qualitative interviews, including non-governmental organization (NGO)/grassroots organization personnel (n=4), translators/cultural mediators (n=2), and healthcare professionals (n=3). Informants’ reports echoed women’s experiences in and outside migrant camp settings, highlighting concerns associated with personal safety, access to medical care, and integration. Conclusions: Recognized refugees report better overall health and well-being compared to asylum seekers and migrants. Asylum seekers and migrants have little to no access to healthcare, public benefits, are unable to apply for work, and run the risk of detainment if caught by police. Lack of social protections, constant fear of detainment, and the inability to afford basic necessities directly affect the physical and mental well-being of these women and their families. Our findings suggest the need for enhanced psychosocial support services, assistance with social integration, and expanded access to public services (e.g., primary care, chronic disease management) for all women on the move, including asylum seekers and migrants.
AB051. Experiences of occupational injuries and illness and their aftermath among migrant contract workers in Taiwan: a qualitative study
Background: Migrant contract workers are employed to address labor shortages in specific sectors in Taiwan. While migrant workers were known to have a higher risk of occupational accidents than native workers, their post-injury experiences and their interactions with key stakeholders—such as employers, brokers, and government agencies—have not been thoroughly studied. This study aimed to explore their experiences after encountering occupational injuries or illnesses. Methods: We conducted in-depth interviews with 40 migrant workers who had sustained occupational injuries or work-related illnesses in Taiwan. Participants included 13 Vietnamese, 17 Indonesians, 8 Filipinos, and 2 Thais. Among them, 31 were factory workers, 4 were live-in care workers, 4 were fishery workers, and 1 was an agricultural worker. Additional information was gathered from interviews with five staff members from brokerage agencies and 10 representatives of non-governmental organizations (NGOs). Results: Most participants suffered temporary disabilities, and some experienced permanent disabilities. Although the majority expressed satisfaction with the medical care provided under Taiwan’s National Health Insurance program, many reported high psychological distress due to financial hardship and employment insecurity. Some workers also encountered hostile attitudes and adverse treatment by employers, including denial of work-relatedness of injuries, refusal to provide wage compensation during recovery, coercion to return to work prematurely, demanding contract termination, failure to provide accommodation and food during recovery, and even threats of deportation. While brokers often provided immediate assistance, their actions were largely constrained by employers’ decisions and authority. Conclusions: The right to a safe workplace and access to fair compensation are fundamental labor rights that should not differ based on nationality or contract status. This study highlights significant gaps in occupational safety protections, occupational health services, and social support systems for migrant contract workers in Taiwan, underscoring the need for policy reform and targeted interventions.
AB050. Evaluating the quality of life impact through vision improvement in resource-poor areas in East Africa
Background: Visual impairment is one of the most common non-communicable causes of disability worldwide. Ninety-four million people suffer from cataracts, disproportionately in resource-poor settings with barriers to eye health services. Untreated cataracts can lead to social isolation, decreased economic productivity, increased risk of injury, and overall decrease in quality of life. This study aims to examine the extent that cataract surgery delivered at a field hospital affects vision-related quality of life (VRQOL) in Djibouti, and the determinants of VRQOL improvement. Methods: A survey was administered to cataract patients assessing VRQOL at baseline and 2 months postoperatively. Patients completed face-to-face surveys using a translated “World Health Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire”, containing subscales (overall vision, visual function, general function, and psychosocial impact). Results: Five hundred and forty-two patients completed the surveys, with 73.4% (n=398) exhibiting improvement in visual acuity. On average, the overall score improved by 18.21 [standard deviation (SD) =18.78, P<0.001], representing 22.76% of total possible score improvement. Of the subscales, overall activity improved by 1.55 (SD =2.04, P<0.001), 19.38% of total possible improvement. General function improved by 11.53 (SD =12.42, P<0.001), 24% of total possible improvement. Visual function improved by 1.70 (SD =263, P<0.001), representing 21.25% of total possible improvement. Psychosocial impact improved by 3.42 (SD =4.08, P<0.001), representing 21.38% of total possible improvement. Multivariable regression identified significant predictors of VRQOL change as visual improvement (B=−1.870, P=0.03) and baseline score (B=−1.014, P<0.001). Sex and age were not significant variables in the regression model across all subscales. Conclusions: Cataract surgery delivered in a field setting leads to significant improvement in the field hospital setting, as it would be expected in a regular health service, notably in the general function subscale. The intervention significantly improves outcomes regardless of age and sex in a socially inequitable, resource-poor society like Djibouti. Improvement in women’s health can lead to broader, equitable impact in household and community outcomes. Health care providers can consider policies encouraging cataract surgery regardless of age, as VRQOL will have significant improvement. In a society like Djibouti that is experiencing a demographic shift into aging populations, health policymakers must identify determinants that improve outcomes of age-related conditions, and monitor the outcomes of health interventions targeting the aging population.
AB049. Environmental health priorities for climate change adaptation: new practical efforts to reduce the environmental burden of disease in Asia
Background: Asian countries are increasingly facing severe threats from climate change, which significantly contributes to environmental health risks and the Global Burden of Disease (GBD). In this context, the region’s strategic objective is to minimize population exposure to environmental health hazards associated with climate change and mitigate their impact on disease burden. This study aims to demonstrate an integrated approach to environmental health assessment through cross-sectoral data integration and regional collaboration. We highlight the application of intervention models tailored to specific communities and geographic contexts, reflecting the diverse environmental exposures and health determinants across Asia. Methods: We employed disability-adjusted life years (DALYs) as the primary metric for quantifying disease burden using publicly available data. This included an analysis of years of life lost (YLL) and years lived with disability (YLD), assessed through incidence and mortality rates. Attributable risks were estimated based on parameters established for the World Health Organization (WHO) Western Pacific Region. For air pollution, we calculated attributable risk using local particulate matter with an aerodynamic diameter of 10 micrometers or less (PM10) concentrations and corresponding relative risk values. Results: We outline a regional agenda that identifies key priorities and gaps to support both immediate and long-term strategies for reducing the environmental components of GBD. We present the methodological framework used to define these environmental health priorities and discuss how they inform scientific investments and policy decisions aimed at reducing environmentally attributable disease burdens. Conclusions: Quantifying the environmental burden of disease is essential for informing healthcare policy and risk mitigation strategies in Asia. The epidemiological transition reflected in our findings underscores the growing significance of non-communicable diseases (NCDs) linked to chronic environmental exposures. These insights provide a roadmap for targeted interventions and evidence-based decision-making in the face of accelerating climate and environmental challenges.
AB048. Environmental footprint of dialysis in Thailand: a life cycle assessment to inform green health policy
Background: Dialysis is a life-sustaining treatment for end-stage renal disease. In Thailand, peritoneal dialysis (PD) is prioritized under universal health coverage (UHC) due to its accessibility and cost-effectiveness. However, the environmental impacts of PD and hemodialysis (HD) have not been comprehensively evaluated in the Thai context. This study aimed to assess and compare the environmental burdens of both modalities using a life cycle assessment (LCA), contributing evidence for climate-resilient and sustainable health systems. Methods: An LCA was conducted using SimaPro software version 10.2.0.0 to estimate environmental impacts across four stages: manufacturing, supply chain, service delivery, and waste management. The ReCiPe 2016 midpoint and endpoint methods were applied to quantify effects on disability-adjusted life years (DALYs), species loss, and natural resource depletion. Emission data were collected from PD and HD manufacturers (Baxter and Fresenius), Thailand Post (logistics), five dialysis centers (energy and travel), and the national medical waste agency. Carbon emissions per treatment session were calculated, and key emission hotspots identified. Results: Preliminary analysis identified significant environmental hotspots in both dialysis modalities. Per-session carbon footprint estimates showed PD produces lower emissions than HD, mainly due to reduced energy use and simpler logistics. These findings will inform a forthcoming green health technology assessment (HTA) that integrates environmental criteria into cost-effectiveness evaluations. Conclusions: PD was found to have a lower environmental footprint per session than HD. These results emphasize the importance of incorporating environmental performance into clinical and policy decisions under UHC. The study contributes to the global movement toward sustainable healthcare by providing evidence to support greener procurement, treatment choices, and health policy planning in low- and middle-income countries.
AB047. Enhancing sexuality education to prevent HIV transmission among Filipino young key populations: a policy analysis
Background: Human immunodeficiency virus (HIV) is growing rampant among vulnerable populations in the Philippines. Projected estimates show that the Philippines experienced a 555% increase in new HIV infections between 2010 and 2024. Current projections reveal that 46% of new infections in 2024 were from the 15–24 years age group, also referred to as the young key population (YKP). YKPs, especially those belonging to the adolescent age bracket, are more likely to engage in risky behavior and have difficulties in accessing HIV-related services. It is thus important to guide them toward safe sexual practices. While there are existing policies for education campaigns on HIV, there are no clear guidelines for their standardization and implementation. Comprehensive sexuality education (CSE) is already included in secondary and tertiary education curricula, as mandated by the HIV and acquired immunodeficiency syndrome (AIDS) Policy Act of 2018, yet it is not effectively delivered to the students due to censorship, hesitancy of teachers to convey messages, or inadequate knowledge among teachers in sexuality education. This analysis aims to examine policy alternatives which can improve the implementation of CSE among YKP attending schools. Methods: A policy analysis which adopted the 2013 US Centers for Disease Control and Prevention Policy Analytical Framework was conducted in order to determine alternatives which could improve the coverage and effectiveness of CSE for YKP. Results: Review of secondary literature and insights from policy and programmatic informants yielded the following policy alternatives: (I) no change but reinforce implementation; (II) issue guidelines on prescribed modules and add feedback mechanisms; (III) regulate educators through certification requirements; and (IV) build partnerships with institutions and organizations who can dispatch peer educators. The second and fourth alternative received the highest score based on five domains. Conclusions: Issuing national guidelines for the implementation of age-appropriate CSE, along with creating evaluation mechanisms to measure the effectiveness of education, can ensure that the youth are receiving quality health education which they can apply in their practice and behavior. Outsourcing peer educators through partnerships may be effective without exhausting internal manpower.
AB046. Ethical safeguard reporting in Malaysian pediatric oral health research: a scoping review
Background: Pediatric oral health research in Malaysia is guided by national and international ethical standards. However, its frequent classification as minimal risk may contribute to limited transparency in reporting child assent. This scoping review examined the extent and clarity of reporting on ethics approval, parental consent, and child assent in Malaysian pediatric oral health publications. Methods: A systematic search of PubMed, Web of Science, SCOPUS, MyJurnal, and the National Medical Research Register (NMRR) was conducted following the PRISMA-ScR guidelines. Results: A total of 71 articles met the inclusion criteria. Ethics approval was reported in 88.7% (n=63) and parental consent in 91.5% (n=65) of studies. Child assent, however, was documented in only 6.9% (n=5), with reporting first appearing in publications from 2021 onwards. Among the studies that documented assent, 60% (n=3) used written assent forms and 40% (n=2) relied on implied assent, with only one study providing detailed procedural description. Reporting of ethics approval and parental consent increased over time, rising from under 50% in 2001–2005 to over 95% after 2015. Conclusions: While ethics approval and parental consent are consistently reported in Malaysian pediatric oral health research, documentation of child assent remains limited and inconsistently detailed. Strengthening adherence to national ethical guidance and enhancing support from researchers, ethics committees, and journal editors will be essential to improve transparency and promote child-inclusive research practices.
AB045. Energy intake, diet diversity, and nutritional status of preschool-aged orphans in institutional care: an explanatory sequential study in Metropolitan Manila
Background: The number of orphans in the Philippines continues to rise due to the impacts of the coronavirus disease 2019 (COVID-19), natural disasters, teenage pregnancy, lack of education, and poverty. Preschool-aged children already face undernutrition, with increasing cases of underweight, stunting, and wasting. Orphans are especially vulnerable due to the absence of individualized family-based care. However, their nutritional health remains underexplored. This study aims to assess the nutritional status of preschool-aged orphans and the nutritional value of meals served in selected institutional care facilities (ICFs) in Metropolitan Manila, as well as to identify factors influencing these outcomes. Methods: An explanatory sequential research design was used. Thirty-two children from four ICFs were selected through purposive sampling. Nutritional status was assessed using weight-for-age (WFA) Z-scores. Dietary intake was measured using a 3-day non-consecutive weighted food recall. Total energy intake (TEI) and dietary diversity score (DDS) were utilized to represent the macronutrient and micronutrient content of each food item. Qualitative data were collected from caregiver interviews and analyzed thematically. Results: Thirty-one percent (n=10) of children were underweight. Despite exceeding the recommended TEI, DDS was below the recommended threshold. Diets were high in ultra-processed foods (UPFs), mainly from donations. DDS revealed low intake of dark green leafy vegetables, legumes, nuts, seeds, and organ meats. No significant relationships were found between TEI, DDS, and WFA. TEI had a weak positive correlation with WFA, while DDS showed no correlation. Thematic analysis highlighted the need for registered nutritionist-dietitians (RNDs), structured meal planning, healthier food donations, and enhanced nutrition education for caregivers. Conclusions: Preschool-aged orphans in ICFs experience excessive energy intake but inadequate dietary diversity. Interventions should be made to promote balanced diets, assign qualified personnel, and increase caregiver nutrition knowledge.
AB044. Empowering university students on tackling global health issues
Background: Student Innovation for Global Health Technology (SIGHT) is an interdisciplinary undergraduate education platform at Hong Kong University of Science and Technology (HKUST) that transforms the passion and creativity of students to develop sustainable solutions for global health problems. On its 10th anniversary, highlights SIGHT’s strong user engagement by completing over 30 projects across eight countries, involving over 500 students. The objective of this article is to detail SIGHT’s integrative pedagogical model and demonstrate, through a case study, how it guides students to develop and implement sustainable, community-embedded health technologies. SIGHT provides an integrative learning experience (experiential learning courses, team projects, study trips, peer-mentoring, leadership training, intern program) that transcends the borders of disciplines, geography, and culture. A wide range of global health projects aim to deliver social impact to resource-limited communities. Pedagogically, SIGHT integrates the essences of experiential learning, design thinking, and integrative learning, operating on the principle that impact-driven projects bring the best out of students. Methods: Constraints breed creativity and health problems provide an ideal context for students to innovate. Nevertheless, the SIGHT teaching team spends substantial effort to identify appropriate project sites and liaise with partners to ensure that the scope of projects makes it feasible for students to make a tangible contribution. Results: The SIGHT team guides students to appreciate the importance of social, cultural, and economic factors that contribute to the acceptance of technology. SIGHT approach emphasizes prototyping real-life technology solutions through direct implementation experiences, as demonstrated by a recent development of telemedicine and digital data collection platforms in a rural tea estate in Sri Lanka. These initiatives ensured sustainability by engaging stakeholders like medical teams, vocational centers, and youth volunteers; students trained staff and youth to maintain the system and build long-term capacity while digitizing health screenings and connecting patients to remote doctors. SIGHT has developed a holistic, sustainable stakeholder engagement model that actively connects local communities, vocational partners, and medical teams to enable successful on-the-ground technology implementation, while providing students with immersive learning experiences, recognizing first-hand experience, and the value of an interdisciplinary team in tackling global health problems. Conclusions: Over a decade, SIGHT has successfully transformed student passion into tangible global health impact through interdisciplinary, experiential learning. Its sustainable model proves that constraint-driven innovation, coupled with deep stakeholder engagement, effectively develops both real-world solutions and future changemakers.
AB043. Empowering farmers as agents of change for planetary health: a participatory action research among honey guava farmers in Indonesia
Background: Health-sustainable precision agriculture (H-SPA) offers a transformative approach for Indonesian smallholder farming and environmental sustainability. Its adoption is often hindered by top-down technology transfer models, overlooking farmers’ realities, local knowledge, and ecological context. This leads to unsustainable practices and minimal community impact. The objective is to explore how participatory methodologies empower farmers as change agents for planetary health in H-SPA implementation for honey guava cultivation in Langkat, Sumatera Utara. It examines how bottom-up engagement fosters local H-SPA stewardship, promoting eco-friendly practices and community resilience. Methods: A participatory action research (PAR) approach engaged Teluk and Karang Gading communities via extensive socialization and co-learning from February to August 2025. Six of 25 initial farmers (24%) committed long-term participation. Data included participatory observation during engagement and focus group discussions (FGDs). Thematic analysis evaluated shared H-SPA understanding, PAR principles, team roles, and initial motivations. Results: The project established a multi-stakeholder PAR team, rooted in mutual respect and inclusive dialogue, evidenced by six farmer volunteers. Iterative FGDs dismantled traditional hierarchies, fostering shared H-SPA understanding and leading to co-developed roles as co-researchers and positive role models. Strong initial commitment, driven by solving agricultural challenges and reducing environmental impact via H-SPA, was demonstrated. Capacity-building within the PAR framework enabled farmers to adopt drone and sensor technology, promote ecological pest management, and become continuous community learning providers for planetary health. Conclusions: This study highlights PAR’s profound value in promoting H-SPA adoption. This good practice is crucial for fostering climate-friendly food systems, integrating health, Agri-Technology, and building farmer community resilience in Indonesia.
AB042. Employers’ perceptions, practices, and relational dynamics in migrant domestic work in Macao, China: a qualitative study
Background: Employers of migrant domestic workers (MDWs) manage a distinctive employment context due to the intimate nature of domestic work. MDWs often live in their employer’s home, completing household duties and providing caretaking, merging a home and a workplace. However, most research has focused on the MDW experience, with relatively little attention paid to employers despite the central role employers play in MDW well-being. Understanding the employer perspective is essential to capture their challenges, management practices, and to provide a comprehensive view of this unique workplace relationship to improve employer and MDW well-being. In this qualitative study, we aim to explore the employer perspective and develop a conceptual framework of employers’ perceptions, practices, and relational dynamics in MDW. Methods: From July 2017 to April 2018, one-on-one in-depth interviews were conducted among 26 employers of MDWs using a semi-structured interview guide. Questions covered the employer’s perspective on MDW employment. Exploratory thematic analysis was applied to understand the employer perspective and develop a conceptual framework. Results: Employers’ perceptions of MDWs were shaped by personal beliefs and experience, stereotypes, and perceived social norms. These perceptions, alongside hiring motivations and policy knowledge and attitudes, influenced employer management of MDWs, which often required flexibility, consideration of privacy and trust, and efforts at employee retention. Employer-employee relationships ranged in closeness, varying by employer family member and workplace arrangements. Conclusions: Employers of MDWs navigate a complex employment relationship that is often viewed both as familial and a formal arrangement. Perceived inadequacy in labor policies leaves employers to rely on personal beliefs and social norms in their hiring and management practices. Promoting clear communication in the workplace is essential in preserving a harmonious working environment and improving employer and MDW well-being.
AB041. Effects of physical versus online mindfulness breathing meditation intervention on state mindfulness and cognitive functions: a randomized controlled trial and mixed methods study
Background: The practice of mindfulness meditation has gained increasing attention to manage stress levels and enhance cognitive functions. Mindfulness meditation has demonstrated enhancement effects in protecting mental health by modulating autonomic nervous system activity and improving attentional control. However, the effectiveness of physical mindfulness breathing meditation (PMBM) and online mindfulness breathing meditation (OMBM) interventions on stress levels, state mindfulness, and cognitive functions has remained largely unexplored. This study aims to examine the effects of PMBM and OMBM interventions, with an active control (AC) group on state mindfulness and cognitive functions (attention and inhibitory control) and using heart rate variability (HRV) as a measurement of stress levels. An interview was conducted to gain participants’ understanding and attitudes toward practicing mindfulness breathing meditation (MBM) on enhancing their mental health. Methods: Forty-eight participants were randomly assigned to either PMBM, OMBM, or AC groups. During the pre-intervention task, the HRV of the participants was measured for 5 minutes during resting state, and then they answered the Toronto Mindfulness Scale (TMS) and performed the Flanker task. Participants underwent a 3-day intervention with 10 minutes of PMBM or OMBM practices, or music therapy (for the AC group). The post-intervention procedure was the same as the pre-intervention. Among the PMBM and OMBM participants, 20 participants were randomly selected to undergo the interview. Results: The findings showed significantly higher curiosity and de-centering scores (P<0.001) in state mindfulness using TMS, and improvement in reaction time (P=0.01) and Flanker effect (P=0.03) using the Flanker task, in both PMBM and OMBM groups compared to the AC group, though no significant improvement in HRV (all P>0.05). The interview findings suggested that MBM intervention, regardless of the delivery mode, offered a feasible, accessible, and beneficial mindfulness modality to the general population, particularly suitable for beginners. Conclusions: This study supports the adaptability and acceptability of MBM intervention across different delivery formats, making it a promising tool for large-scale mental health promotion. However, the null findings of HRV suggested that brief MBM intervention did not induce changes in autonomic function. Future research could explore longer intervention durations and include follow-up assessments to examine sustained effects.
AB040. Early lessons from financial integration in two provinces: advancing universal health coverage in the Philippines
Background: The Philippines’ Universal Health Care (UHC) Law seeks to integrate local health systems for equitable, efficient, and high-quality service delivery. Financial integration, a core UHC dimension, is operationalized through the Special Health Fund (SHF), which pools resources from national agencies, local government units (LGUs), PhilHealth, and development partners. Despite its potential, SHF implementation remains complex, with many LGUs still navigating its pilot phase. This study examines early implementation experiences in two Philippine provinces, focusing on key actors, processes, and factors influencing SHF operationalization. Methods: A qualitative case study approach was used, including document review and key informant interviews with officials from the health, budget, and accounting offices of the LGUs. Data were analyzed thematically to map processes and identify critical actors. Results: Seventeen actors (nine major, eight supporting) were identified across core processes, including the establishment of a Management Support Unit (MSU), opening SHF accounts, pooling of funds, planning for utilization, budget execution, disbursement, and accounting. Enabling factors for successful SHF implementation included a functional Provincial Health Board with active support from local chief executives, LGU commitment to UHC, the use of Department of Health (DOH)-issued SHF manuals and guidelines, dedicated MSU teams collaborating with key actors, and integrated financial planning that improved fund approval. Key challenges included complex and unclear requirements from Department of Budget and Management (DBM), Commission on Audit (COA), DOH, and PhilHealth; capacity gaps in financial management; delays in downloading PhilHealth funds; and weak coordination among internal and external stakeholders. Conclusions: Effective SHF implementation relies on clear governance structures, active coordination, and strengthened technical and administrative capacities. Developing standardized SHF implementation models, enhancing financial management skills, clarifying inter-office roles, and institutionalizing regular financial and performance reviews can support financial integration and accelerate UHC implementation at the local level.
AB039. Disparities in adolescent mental toughness: roles of sociodemographics, lifestyle, and health literacy
Background: Adolescent mental health problems are rising globally, with growing recognition of mental toughness as a protective factor. However, significant disparities in mental toughness persist across sociodemographic and lifestyle groups, yet the drivers of these inequities remain poorly understood. This study examines how mental toughness is associated with sociodemographic factors, lifestyle behaviors, and health literacy, aiming to identify populations at greatest risk and inform targeted interventions. Methods: This population-based study involved 1,423 participants and was conducted across 20 secondary schools. Mental toughness was assessed using the validated Mental Toughness Scale for Adolescents (MTS-A). Univariable and multivariable linear regression analyses were performed to examine the associations between mental toughness and key disparity-linked factors, including sociodemographic characteristics, lifestyle behaviors, and health literacy. The Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong approved the study (approval No. SBRE-24-0029). Results: For the total score of MTS-A, results showed positive association between male [β=3.59; 95% confidence interval (CI): 2.79, 4.38; P<0.001], daily breakfast consumption (β=1.31; 95% CI: 0.53, 2.10; P=0.001), sufficient physical activity (β=2.06; 95% CI: 0.90, 3.22; P=0.001), sufficient sleep (β=0.92; 95% CI: 0.13, 1.71; P=0.02), and higher-level of health literacy (β=4.32; 95% CI: 3.55, 5.10; P<0.001) and mental toughness adolescent, whiles older age, excessive screen time on video, and self-perceived obesity were negatively associated with the level of overall mental toughness. For MTS-A domains, health literacy emerged as the most consistent and substantial factor, showing significant positive associations with all six domains (β=0.52 to 4.32; all P<0.001). Conclusions: These findings reveal uneven distributions of mental toughness, with clear gaps tied to gender, age, and lifestyle. Health literacy may help mitigate disparities, but systemic efforts—such as school-based health education, screen time regulations, and stigma reduction programs—are needed to ensure equitable resilience-building. Policymakers and educators should prioritize tailored, multi-level strategies to address these inequities and promote adolescent mental health.
AB038. Digital health equity in action: evaluating an AI chatbot for HIV prevention in Malaysian men who have sex with men (MSM)
Background: In Malaysia, human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is rapidly increasing, fueled by persistent stigma, discrimination, and limited access to nonjudgmental healthcare. Leveraging artificial intelligence (AI) chatbots may offer innovative, scalable solutions to promote HIV prevention services in these hard-to-reach populations. This study aimed to evaluate the usability of a web-based AI chatbot embedded within the MYHIV365.com platform to promote HIV testing and related services among MSM in Malaysia. Methods: An observational study was conducted from August 2023 to March 2024 among 334 MSM, recruited through community outreach and social networking apps. The AI chatbot provided information on HIV testing, pre-exposure prophylaxis (PrEP), mental health, and MSM-friendly clinics, and facilitated the ordering of HIV self-testing kits. Usability was assessed using predefined metrics, including interaction time, speech bubble count, topic selection, satisfaction score, and unanswered queries. Data were analyzed using descriptive statistics in R software. Results: The chatbot recorded 393 interactions. Most users (91%) interacted once, with interaction times ranging from under 1 to 31 minutes. The chatbot facilitated 260 HIV self-test kit orders and provided clinic details in 93 interactions. Satisfaction was high (mean score =1.3/1.1; 92.5% thumbs-up), and the mean recommendation score was 8.0/10. While the chatbot successfully answered 92% of queries, 8% remained unaddressed due to algorithm limitations. Conclusions: The AI chatbot demonstrated high usability and potential to complement HIV prevention efforts in Malaysia. To maximize its impact, future iterations must integrate more sophisticated AI models for personalized responses and build trust through stronger privacy protections. Linking the chatbot with health systems is essential for reducing stigma and increasing healthcare access for MSM.
AB037. Digital health education for food literacy: developing content creation guidelines for promoting healthy food choices among youth in Sri Lanka
Background: Youth are connected through digital platforms and exposed to a vast amount of information. Poor food literacy may influence their dietary habits, contributing to non-communicable diseases and obesity. Traditional health promotion efforts do not effectively reach the youth. The content presentation through digital platforms is necessary to reach them effectively and promote healthy eating. The objective of this study is to develop a guideline for content creators to use digital platforms accurately and effectively to promote healthy food choices among youth. Methods: Mixed-methods research informed by the Diffusion of Innovation theory was conducted to formulate the guideline. A rapid review was performed to identify strategies utilized by content creators on digital platforms. A cross-sectional study was used to analyze usage and perceptions of online healthy food content among youth (n=382) in Sri Lanka. The evidence gathered was used in the focus group discussion to develop the guideline. The guideline was validated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Results: Thirty-two articles were selected from 380 retrieved for the rapid review. Strategies to reach and engage youth were categorized into digital platforms, messaging, and self- monitoring. The cross-sectional study revealed that youth predominantly use handheld devices and personal data/Wi-Fi to access social media daily (72.9%) and video-sharing platforms (62.1%). They favor concise, visually appealing content (53.1%) in video (74.7%) or image (62.1%) formats with positive emotions. Testimonials and success stories, especially for females (P=0.039), motivate healthy eating habits. The guideline, developed after the focus group discussion, was validated using the AGREE II tool. It scored highly in scope, purpose, stakeholder involvement, and rigor of development. Conclusions: A validated guideline for content creators backed by evidence to create concise, visually appealing video and image content on digital platforms effectively engages youth and contributes to improving food literacy.
AB036. Development of continuing education programs for novice public health nurses who work on small islands
Background: Okinawa Prefecture is one of Japan’s 47 prefectures. It consists of 37 inhabited islands. Public health nurses (PHNs) working on those islands face challenges in accessing decent training and role models in their jobs due to low staffing and high turnover rates (Chinen, 2020). Continuing education programs specialized in island PHN are needed to prevent resignations and promote career development. This study aims to develop the Island Public Health Nurses’ Continuing Education (IPCE) program. Methods: A continuing education workgroup, comprising the island PHN, Okinawa Prefecture PHNs, and other stakeholders, was established. First, the workgroup verified education needs from a previous study in which the researcher interviewed island PHNs. The workgroup organized the last training program, which included guidelines for novice training by the Japan Nursing Association, as well as the career ladder of PHNs in Japan. It clarified the educational content and goals for novice needs. Finally, we conducted a questionnaire survey for the island municipalities about the contents of this continuing education program. Results: The IPCE program, which focuses on novices, consists of on-the-job training (OJT), off-the-job training (OFF-JT), and self-learning. The contents of the OJT adhere fundamentally to the previous program, but it also incorporates self-management and networking with other island PHNs. OFF-JT contents reinforce OJT. The contents are community assessment, self-management skills, case studies by island expert PHNs, and others. Furthermore, the island PHNs foster networking by attending the programs. Participants can access these programs not only face-to-face but also via Zoom and on-demand video. Approximately half of the island’s municipalities in Okinawa responded to the questionnaire about the IPCE program. While all responding municipalities supported the IPCE program, some had challenges implementing it. Conclusions: We developed the IPCE program. Among the contents, self-management and the island PHNs’ fostering of networking are unprecedented.
AB035. Determinants of cost savings through pooled procurement: evidence from Malaysia’s public sector medicines pricing initiative
Background: Escalating pharmaceutical costs strain public health budgets, particularly in low- and middle-income countries, necessitating effective cost-containment strategies. As a means of reducing procurement fragmentation, addressing inequities, and optimising pharmaceutical spending, Malaysia implemented inter-ministerial pooled procurement (PP) in 2020 across the Ministry of Health (MOH), Ministry of Defence (MOD), and Ministry of Higher Education (MOHE). Following its implementation, a study was conducted to evaluate the impact of inter-ministerial PP on medicine prices and to identify the key determinants influencing cost savings in Malaysia. Methods: A cross-sectional study analyzed procurement data from 82 medicines, comparing two-year periods before [2018–2020] and after [2020–2022] PP implementation. Estimated savings, price differentials, and dissavings were calculated. Multiple linear regression assessed determinants of cost savings, including inter-ministerial collaboration, brand substitution, supplier characteristics, number of bidders, negotiation, and procurement volume. Results: PP generated ringgit Malaysia (RM)179.6 million (17.7%) in overall savings from an expenditure of RM1.01 billion. Inter-ministerial collaboration significantly increased savings (β = RM1.2 million; P<0.001), underscoring the benefits of joint bargaining. The most influential determinant was switching from innovator to generic medicines, resulting in an average additional savings of RM2.0 million (P<0.001). Conversely, switching to innovator products tended to increase costs. Other factors, such as procurement volume, supplier concentration, and number of bidders, were not statistically significant in multivariable analysis, although they influenced outcomes descriptively. Conclusions: Malaysia’s PP demonstrates that generic substitution and cross-ministerial pooling are the strongest drivers of efficiency, delivering fiscal savings and more equitable access to medicines. Strengthening these approaches, supported by digitalisation and improved demand forecasting, can further optimise collaborative strategies to ensure sustainability and responsiveness to evolving healthcare needs amid social and environmental change.
AB034. Adapting to e-Health systems: a descriptive qualitative study on nurses’ experiences in the outpatient department of a private hospital in the Philippines
Background: The increasing shift from paper-based documentation to electronic health record (EHR) systems in healthcare has significantly impacted clinical workflows, especially in outpatient departments. In the Philippines, limited studies have explored the learning curve and real-time adaptation experiences of nurses in these settings. This study was conducted to address this gap by understanding how nurses navigate the challenges of EHR implementation while maintaining quality patient care. Methods: A descriptive qualitative research design was employed. Five registered nurses from a private hospital’s outpatient department were selected using criterion sampling. The inclusion criteria required that participants had at least 6 months of experience using the EHR system to ensure sufficient exposure to the adaptation process. Semi-structured interviews were conducted, transcribed, and analyzed using thematic analysis to identify patterns in adaptation experiences. Four major themes were identified: integrating digital tools into workflow, user efficiency, integrity and accessibility of records, and the role of healthcare professionals in EHR implementation. Results: Four major themes emerged: (I) adapting and integrating digital tools within the clinical workflow; (II) exploring user efficiency and system proficiency in EHR use; (III) maintaining integrity and accessibility of electronic health records; and (IV) understanding the work of healthcare professionals in EHR implementation. Nurses highlighted both the benefits of digital systems such as faster documentation and improved coordination, and persistent challenges, including technical glitches, inadequate training, and digital literacy gaps, particularly among older staff. Informal support systems and self-initiated learning were crucial for overcoming these hurdles. Conclusions: EHR implementation in outpatient nursing practice presents both promise and complexity. Successful adaptation depends not only on system infrastructure but also on human factors such as user training, peer support, and management responsiveness. These findings underscore the need for user-centered implementation strategies, continuous training programs, and institutional policies to improve EHR integration and support quality care.
AB033. A rapid global review of climate action statements and activities across the clinical specialties
Background: Climate change is increasingly recognized as one of the greatest threats to global health in the 21st century. While healthcare systems are both vulnerable to and significant contributors to climate change, the roles and responses from clinical specialty societies remain largely under-recognized. Understanding how these societies engage with climate action is critical to strengthening the health sector’s role in climate mitigation and adaptation. This study aimed to assess the extent and nature of climate-related statements, declarations, and initiatives issued by international clinical specialty societies, with a focus on their roles in promoting climate mitigation and adaptation within healthcare. Methods: A rapid review was conducted to identify climate-related actions from major international specialty societies between January 2019 and December 2024. Using the Association of American Medical Colleges (AAMC) classification, societies were systematically reviewed through their official websites. Identified materials were categorized by thematic focus (education, advocacy, research, clinical care, and operations) and by their alignment with mitigation and/or adaptation strategies. Results: The findings, summarized in structured tables and a chronological figure, reveal uneven but growing engagement from clinical specialties. While general practice and public health societies demonstrated strong advocacy, fewer concrete actions were observed among specialty fields. Some societies addressed mitigation through low-carbon healthcare initiatives, while others focused on adaptation, including health system resilience and climate-informed clinical guidance. Conclusions: Despite growing awareness, significant gaps remain in the integration of climate action into clinical practice across specialties. Stronger implementation, interdisciplinary collaboration, and integration of climate education into medical training are urgently needed. As the climate crisis intensifies, transforming climate action from a voluntary commitment into a professional obligation is essential to safeguarding human and planetary health.
AB032. Determinant factors associated with antenatal care visits at Public Health Center in Padang City, Indonesia: a cross-sectional study
Background: One of the efforts to reduce maternal mortality is the implementation of antenatal care (ANC) visits during pregnancy. Routine ANC visits are crucial for monitoring the health of pregnant women and their fetuses. However, data from the past five years show that the number of ANC visits has not met targets in several regions of Indonesia, including Padang City, West Sumatra Province. This study aims to assess the status of ANC visits of pregnant women and associated factors. Methods: A cross-sectional study was conducted among 142 third-semester pregnant women in Padang City, West Sumatra Province, Indonesia. A validated questionnaire was used to obtain information about the respondents’ characteristics, ANC visits, and associated factors. The data were analyzed using a Chi-squared test and multivariate logistic regression. Results: Most pregnant women have completed all ANC visits (63.4%), but knowledge remains lacking (66.2%), and attitudes toward prenatal visits are largely negative (54.2%). The logistic regression results show that only the respondent’s knowledge variables significantly affect the completeness of ANC visits [P=0.005; odds ratio (OR) =3.253; 95% confidence interval (CI): 1.433–7.386]. However, attitudes, age, parity, education level, working status, economic status, access to healthcare services, family support, and health worker support were not significantly associated (P=0.06, 0.39, 0.69, 0.59, 0.70, >0.99, 0.10, >0.99, 0.36, respectively). Conclusions: Efforts are needed to increase pregnant women’s knowledge about ANC by optimizing the role of health workers and cadres in promoting ANC more extensively, both directly and through social media, and by increasing maternal literacy through reading the Mother and Child Health handbook. A government policy is needed to ensure that pregnant women complete their ANC visits, not solely for the purpose of claiming delivery costs.
AB031. Design of a community-based intervention to the eradication of female genital mutilation in rural Tanzania: a narrative review and evidence-informed framework
Background: Female genital mutilation (FGM) persists in several rural regions of Tanzania, despite a gradual decline in its national prevalence. National surveys report an average prevalence of 10%, but this figure masks significant regional inequalities: in Manyara (57.7%) and Arusha (41%), the practice remains common. Recognized as a human rights violation and a serious public health problem, FGM is reinforced by deep-rooted cultural, economic, and gender norms. This paper presents a proposal for a community intervention based on a narrative review of evidence, aiming to inform the development and future implementation of strategies adapted to the sociocultural context of rural Tanzania. Methods: A narrative review of scientific literature and reports was conducted to identify effective community-based interventions in reducing FGM in sub-Saharan Africa. The findings were classified thematically and used to build the Malaika model, which integrates community participation, trauma-focused psychosocial care, gender-transformative education, and economic empowerment. Results: The most effective interventions combine education, active participation of women, religious leaders, and men, safe spaces, and sustained community work. The Malaika model integrates these components through a multidisciplinary and culturally adapted approach. It includes the implementation of a Safe House for at-risk girls offering psychological support, vocational training, sexual and reproductive health education, and community workshops. Financial sustainability is ensured by integrating Malaika as the social impact arm of Hakuna Rise, a purpose-driven social enterprise and tourism agency. All the income generated by volunteer programs linked to Malaika is reinvested in the Safe House; other programs contribute a proportional percentage. Conclusions: Malaika represents a scalable, financially sustainable, and evidence-based model for addressing FGM in rural Tanzania. Founded on the principles of equity, local leadership, and planetary health ethics, it offers a community-based alternative that connects global solidarity with grassroots action.
AB030. Dengue fever: awareness, knowledge, attitudes, and practices of urban communities in the City of Santa Rosa, Laguna, Philippines
Background: Dengue fever remains a pressing global health concern, particularly in tropical and subtropical regions, where urban and semi-urban communities face recurring outbreaks. In the Philippines, dengue is endemic and continues to pose significant threats to public health, particularly in densely populated areas like Santa Rosa, Laguna. This study assessed the awareness, knowledge, attitudes, and practices (AKAP) of adult residents in the City of Santa Rosa regarding dengue fever. It aimed to identify gaps in community understanding and behaviors to inform targeted, community-based interventions for sustainable dengue control. Methods: An analytic cross-sectional study was conducted in 2023 in two high-incidence barangays—Tagapo and Dita. A total of 230 adult residents were selected through cluster sampling. Data were collected via a structured, pretested, interviewer-guided questionnaire translated into the local language. Variables such as AKAP were measured using validated scales. Data were encoded in Excel, cleaned in SPSS, and analyzed using descriptive statistics and Chi-squared tests, with significance set at P≤0.05. Results: The majority of respondents demonstrated high awareness (43.48%), high knowledge (60.43%), positive attitudes (85.22%), and adequate dengue prevention practices (93.04%). However, disparities in knowledge were noted across gender, education, and income levels. A weak but statistically significant correlation was found between knowledge and practices (r=0.189, P=0.04), suggesting that information alone may not sufficiently drive behavior change. Conclusions: Despite high overall AKAP scores, socioeconomic and educational disparities present significant barriers to equitable dengue prevention. As global urbanization intensifies and climate change expands mosquito habitats, localized risk communication strategies rooted in community engagement are critical. This study underscores the urgent need for inclusive public health interventions that address both informational and structural inequities to prevent future outbreaks—not just in Santa Rosa, but in vulnerable communities worldwide.
AB029. Decision-making for children’s participation in research: perspectives of Malaysian children and their parents
Background: Research involving children presents unique ethical challenges, requiring a delicate balance between parental authority and respect for the evolving autonomy of the child. This study aims to explore the perspectives of Malaysian children and their parents regarding decision-making for children’s participation in research. Methods: Children under 18 years and their parents visiting outpatient clinics (as patients or visitors) at two tertiary hospitals in the Klang Valley, Kuala Lumpur, were recruited between April and May 2021. A qualitative study was conducted using semi-structured, in-depth interviews focusing on four domains: (I) children’s involvement in decision-making; (II) commonly requested information; (III) appropriate minimum age for assent; and (IV) preferred sequence of approach during recruitment. Interviews were audio-recorded, transcribed verbatim, and analyzed manually using both deductive and inductive thematic approaches. Results: Ten children and eight parents participated. Four key themes emerged: (I) decision-maker; (II) consent and assent processes; (III) decision age; and (IV) person-approach sequence. While parental consent was considered necessary, most participants supported a shared decision-making model that incorporates the child’s voice. Participants suggested 17–24 years as the appropriate age for independent consent. Notably, both groups preferred researchers to first seek the child’s assent before approaching parents. Influencing factors included the research topic, perceived risks and benefits, prior findings, child interest, time commitment, cost, and data confidentiality. Conclusions: Although parents play a pivotal role in decision-making, children wish to be actively involved in decisions regarding their research participation. These findings underscore the need to review and strengthen current research ethics guidelines, particularly by formalizing the assent process and encouraging shared decision-making.
AB028. Critical analysis on the impact of algorithm-driven nutrition content on global youth health and wellness
Background: With the rapid rise of short-form video platforms like TikTok, Instagram Reels, and YouTube Shorts, social media has become a dominant source of health and nutrition information, particularly among adolescents and young adults. These platforms use engagement-based algorithms to amplify content, often prioritizing viral appeal over scientific accuracy. This critical analysis examines the global health implications of algorithm-driven nutrition content, specifically its impact on the behaviors, beliefs, and wellness outcomes of young people. The study evaluates both harmful and beneficial trends, with a focus on widely circulated content, such as “What I Eat in a Day”, “Girl Dinner”, and influencer-led dietary advice, including carnivore, keto, and detox diets. Methods: A qualitative content analysis was conducted on high-engagement videos, assessing nutritional accuracy, cultural framing, and target demographics. Results: Findings reveal that misleading or restrictive diet content disproportionately targets young women, normalizes disordered eating behaviors, and distorts public understanding of evidence-based nutrition. However, social media also serves as a platform for positive trends, including cultural food revival, affordable meal-preparation education, and accessible gut-health promotion. Conclusions: This duality underscores the need for public health interventions to enhance youth media literacy, promote culturally relevant health messaging, and advocate for greater algorithmic transparency. By addressing the risks and amplifying the benefits of digital nutrition environments, global health practitioners can more effectively engage with youth populations and promote healthier, more informed dietary behaviors across diverse cultural and socioeconomic contexts.
AB027. Community-based thyroid screening program: a primary care experience in Pampanga, Philippines
Background: Thyroid diseases, such as hypothyroidism and hyperthyroidism, are prevalent endocrine disorders with serious health implications, yet they remain widely underdiagnosed in the Philippines. Recent reports indicate that thyroid disease has emerged as a significant public health challenge in the Asia-Pacific region, with an estimated prevalence of 11%, significantly higher than the global prevalence of 2–4%. These conditions often present with vague symptoms and are frequently missed until advanced. Thyroid-stimulating hormone (TSH) is the gold standard for screening. Despite the availability of effective treatment, outdated national prevalence data—such as the 8.9% rate previously reported in the Philippine Thyroid Diseases Study (PhilTiDeS)—and limited community-based surveillance hinder early diagnosis, especially among high-risk populations including women, the elderly, and those with metabolic conditions. Methods: From December 2024 to March 2025, community-based screening was implemented using a mobile-based thyroid screening initiative in Pampanga. Adults aged ≥18 years were screened using point-of-care TSH tests. Pre-screening was based on the presence of signs and symptoms of thyroid disease, history of thyroid nodules or surgery, pregnancy, miscarriage, primary infertility, autoimmune disease, dyslipidemia, body mass index (BMI) ≥30 kg/m2, elderly status, type 2 diabetes, family history, or being part of an indigenous population. Individuals with abnormal TSH were referred for further testing and care. Results: A total of 2,137 individuals were tested—1,772 (83.2%) females and 358 (16.8%) males. The most common reasons for testing were family history, elderly status, and BMI ≥30 kg/m2. Thyroid dysfunction was found in 239 individuals (11.2%): subclinical hypothyroidism (5.82%), true hyperthyroidism (2.96%), true hypothyroidism (1.27%), and subclinical hyperthyroidism (1.17%). Women had a higher prevalence than men. Symptomatic presentation was the strongest predictor across all categories. Conclusions: This initiative highlights the value of targeted screening among high-risk groups using mobile outreach. The findings support prioritizing women, elderly individuals, and those with metabolic risk factors. Community-based thyroid screening, paired with education and referral, offers a scalable and impactful approach to early detection, especially in resource-limited settings. Policy support for updated surveillance and sustained implementation is urgently needed.
AB026. Climate change and health: emerging consensus at the WHO and the UNFCCC-COP
Background: Since the resolution “Climate Change and Health” was adopted at the 61st World Health Assembly in 2008, adaptation measures have been discussed at the World Health Organization (WHO). On the other hand, at the conferences of the parties (COP) convened under the United Nations Framework Convention on Climate Change (UNFCCC), serious discussion on health started only at the COP26 in Glasgow in 2021. At the COP28 in Dubai, the first joint meeting of environment ministers and health ministers was held, in which the “COP28 UAE Declaration on Climate and Health” was adopted. First, the historical process leading to the “UAE Declaration on Climate and Health” has been reviewed. Second, WHO’s priority areas have been identified. Third, reasons why health was highlighted at the COP26 have been explored. Methods: Policy analysis was conducted, reviewing documents issued at the WHO, UNFCCC-COP, and other relevant global conferences, such as the United Nations (UN) High-Level Forum on Sustainable Development. Results: First, at the COP26, the UK Government and the WHO promoted a health program. Second, the WHO supports the member states to conduct climate change and health vulnerability and adaptation assessment (V&A). The Alliance on Transformative Action on Climate and Health (ATACH) was also launched. Third, particularly since the COP21 in 2015, in which the Paris Agreement was adopted, mitigation measures have been the focus. Conclusions: The mitigation measure to reduce greenhouse gas (GHG) will attract more attention in the health and medical sector.
AB025. Challenges in assessing malnutrition and anemia among Orang Asli children under five in rural peninsular Malaysia
Background: Malnutrition and anaemia remain pressing public health concerns among indigenous Orang Asli children, particularly in rural and remote settlements with limited healthcare access. Conducting research with indigenous Orang Asli children in rural Malaysia presents unique challenges and requires navigating complex logistical, ethical, cultural, linguistic barriers, and historical mistrust of external researchers. This paper reflects on the unforeseen challenges encountered during a study on malnutrition and anaemia among Orang Asli children under five in Malaysia’s most remote settlements, in which these indigenous population often excluded from conventional surveys due to geographic and systemic barriers. Methods: A cross-sectional study was conducted in four rural districts in Peninsular Malaysia, involving 700 Orang Asli children. Interviews were conducted, anthropometric measurements were taken, and anemia was assessed using point-of-care photometry. Results: This research presented with unexpected hurdles that challenged every aspect of our study. From logistical nightmares to cultural complexities and methodological dilemmas, each step revealed critical gaps in conventional research approaches. These obstacles ultimately transformed into valuable lessons about what truly works, and what doesn’t, when studying vulnerable indigenous populations. The experience taught us that successful research in these communities requires more than scientific rigor, and it demands flexible approaches, deep cultural sensitivity, and meaningful collaboration. Conclusions: Research among Orang Asli communities demands flexibility, humility, and adaptive methodologies. Therefore, by sharing these challenges, we hope to prepare future teams for the realities of Indigenous health fieldwork, where ideal protocols often collide with on-ground realities, yet the need for equitable data remains urgent.
AB024. Sacred aging: exploring the lived experiences of elderly Catholic nuns
Background: Aging presents multidimensional challenges that affect physical, psychological, social, and spiritual well-being. Elderly Catholic nuns experience aging within a unique religious environment characterized by lifelong service, communal living, and strong spiritual commitments. This study aimed to explore and describe the lived experiences of elderly Catholic nuns in Baguio City and to identify the factors that contribute to their resilience and holistic well-being during aging. Methods: A qualitative phenomenological approach was employed to gain an in-depth understanding of the participants’ lived experiences. Semi-structured interviews were conducted with purposely selected Catholic nuns aged 60 years and above from selected religious congregations in Baguio City. Data were analyzed using thematic analysis. Ethical principles, including informed consent, voluntary participation, confidentiality, and anonymity, were strictly observed throughout the study. Results: Six major themes emerged: (I) sacred routines, highlighting daily practices that nurture physical and spiritual well-being; (II) embracing fragility, reflecting acceptance of age-related physical decline through faith; (III) emotional resilience, demonstrating the use of spirituality to cope with emotional and interpersonal challenges; (IV) lifelong learning, emphasizing continuous personal and spiritual growth; (V) acceptance, illustrating the role of spiritual guidance in adapting to the aging process; and (VI) communal strength, underscoring the importance of faith-based community support in reducing loneliness and fostering a sense of belonging. Findings revealed that spirituality, community support, and disciplined routines bolster holistic well-being and resilience among elderly Catholic nuns. Conclusions: Elderly Catholic nuns navigate aging through a combination of spiritual devotion, personal acceptance, disciplined routines, and strong communal support. These interconnected factors contribute significantly to their resilience and overall well-being. The findings provide valuable insights for healthcare professionals, caregivers, religious organizations, and policymakers in developing holistic elder care programs that address the physical, emotional, social, and spiritual dimensions of aging.
AB023. Carbon and economic savings from reducing low-value care: case of appendicitis in Thailand
Background: Health sector is responsible for around 5–10% of the global greenhouse gas (GHG) emissions. World Health Organization (WHO) estimates 20–40% of current medical care is low value. Reducing such care can result in health, economic, and environmental co-benefits. The objective of this study is to estimate carbon and economic savings from reducing low-value appendicitis treatment in Thailand. Methods: Data on potentially low-value appendicitis treatments in Thailand were extracted from our previous study across three periods: pre-pandemic (March–June 2019), lockdown (March–June 2020), and post-lockdown (March–June 2021). Carbon emissions related to appendicitis treatment were extracted from published literature: computed tomography (CT) scans [9.2 kg carbon dioxide equivalent (CO2e)], ultrasound (0.5 kg CO2e), open surgery (22.7 kg CO2e), and laparoscopic surgery (27.4 kg CO2e). Economic impact was estimated using the social cost of carbon at $0.185 per kg CO2e. Results: Appendicitis cases dropped by 13.4% and 16.4% during lockdown and post-lockdown, respectively. As a result, carbon emissions decreased by 11.6% during lockdown and 13.9% by 2021. However, CT scan use increased by 71.8% by 2021, creating 18.4 times more emissions than ultrasound. While treatment costs per case increased by 14.2% in 2021, total healthcare costs fell by 4.5% due to reduced appendicitis cases. Economic savings from averted social cost of carbon were estimated to be 458,921 Thai baht (THB) (~$13,000) from 2019 to 2021. Conclusions: Reducing low-value appendicitis care can save money and reduce carbon emissions. Effective use of the updated World Society of Emergency Surgery (WSES) Jerusalem guidelines can help optimize diagnosis and treatment of appendicitis.
AB022. Capacitating local government units for improved health outcomes: a tri-sectoral collaboration model for health leadership development in the Philippines
Background: The Philippine health system operates under a devolved structure created by the 1991 Local Government Code, where local government units (LGUs) lead primary healthcare delivery while the Department of Health (DOH) maintains stewardship. Persistent inequities, fragmented governance, and limited multisectoral coordination highlight the need to strengthen the leadership competencies of local chief executives (LCEs) and municipal health officers (MHOs). To address these gaps, the Zuellig Family Foundation (ZFF) advanced leadership development through the Health Change Model anchored in the Bridging Leadership Framework, which led to the establishment of the national Health Leadership and Governance Program (HLGP) and the Municipal Leadership and Governance Program (MLGP) in partnership with academic institutions and the DOH. The objective of this study is to review published literature on the implementation of health leadership and governance programs designed to strengthen the competencies of local chief executives and municipal health officers in the Philippines. It specifically evaluates how tri-sectoral collaboration among government, academic partners, and non-government organizations facilitates the implementation and institutionalization of these health leadership interventions to improve health outcomes. Methods: This study employed a qualitative documentary analysis of published literature on the HLGP-MLGP. Peer-reviewed studies were examined to explore leadership competency development, governance transformations, and community-engaged leadership processes shaped by Bridging Leadership. The Triple Helix Model guided the analysis, emphasizing the tri-sectoral collaboration among government, academe, and ZFF that enabled program implementation and institutionalization. Results: Findings showed paradigm shifts among LCEs, including the prioritization of health in governance, adoption of evidence-informed decision making, and strengthened multisectoral collaboration. These led to more robust municipal health roadmaps, increased stakeholder participation, and local innovations in service delivery. Tripartite collaboration sustained leadership transformation through technical inputs, coaching, and monitoring. Evidence also showed that the program created structured spaces for community-engaged leadership, enabling co-production of health solutions and embedding accountability. Conclusions: As the Philippines advances Universal Health Care, evidence from the HLGP-MLGP demonstrates that tri-sectoral collaboration effectively empowers local leaders and strengthens health systems. Scaling up the model requires further capacitation in knowledge management to help LGUs sustain leadership gains and health system improvements.
AB021. Building better youth programs through evidence: the YPAR-DMS innovation
Background: The Sangguniang Kabataan (SK) Reform Act of 2015 requires each of the Katipunan ng Kabataan to maintain a youth registry to support evidence-based policymaking and program design. However, most SK units still rely on manual lists with limited demographic data, hindering the ability to assess youth participation meaningfully. This initiative aimed to enhance youth profiling and improve program targeting by developing a system that measures youth engagement across nine centers of participation: health, education, economic empowerment, social inclusion and equity, peacebuilding and security, governance, active citizenship, environment, and global mobility. Methods: To address these gaps, the Zuellig Family Foundation (ZFF), with United Nations Population Fund (UNFPA) support, created the Youth Participation Action Record (YPAR) tool. It was later digitized as the YPAR Data Management System (YPAR-DMS) in response to coronavirus disease 2019 (COVID-19) restrictions. The pilot was conducted in seven local government units (LGUs) in Sarangani Province. Using KoBoToolbox, the digital survey captured detailed data from SK officials, youth leaders, and youth in the community. Local youth development officers and information and communication technology (ICT) staff were engaged to ensure usability and contextual fit. The YPAR-DMS produced real-time analytics and visual reports for local decision-makers Results: The system significantly improved youth profiling and program responsiveness. In one LGU, data revealed high rates of depression and suicidal ideation among youth, leading to the immediate launch of mental health interventions. The platform fostered collaboration among LGUs, youth groups, and ICT teams, highlighting its adaptability for broader use. Conclusions: The YPAR-DMS demonstrated strong potential for scaling up youth data systems. It enabled timely, evidence-based interventions and promoted intersectoral collaboration. Continued refinement, training, and policy integration will be key to its sustainable implementation nationwide.
AB020. Bridging vertical gaps: integrating deworming and micronutrient powders to tackle childhood anemia in Bangladesh
Background: Anaemia and soil-transmitted helminth (STH) infections are major public health challenges among children in low- and middle-income countries. In Bangladesh, anaemia affects 61% of children under two, while STH prevalence remains significant. Although micronutrient powder (MNP) supplementation and deworming interventions are implemented separately, integrating them through community-based platforms may enhance health outcomes and program efficiency. The objective of this study is to assess the acceptability of integrating periodic deworming into an existing MNP program for children aged 6–59 months delivered by Bangladesh Rural Advancement Committee (BRAC)’s community health workers (CHWs). Methods: A qualitative study was conducted in Comilla and Feni districts using the Theoretical Framework of Acceptability (TFA). We collected data through 16 in-depth interviews with caregivers, four focus group discussions with 33 CHWs, and four key informant interviews with BRAC program managers. Data were analysed thematically using a combination of deductive (TFA-based) and inductive approaches. Results: The integrated intervention was generally perceived as acceptable, practical, and beneficial for child health. CHWs and caregivers welcomed the potential for improved outcomes but highlighted challenges including caregiver affordability, community misconceptions, and the need for CHW refresher training. CHWs also raised concerns over increased workload without compensation, which blurred the lines between perceived burden and opportunity cost. No significant ethical or cultural objections were reported. Conclusions: Integrating deworming with MNP delivery through CHWs is feasible and acceptable in Bangladesh. To ensure successful scale-up, implementers must address community awareness, CHW support, and financial accessibility. These findings offer actionable insights for designing integrated child health interventions in resource-constrained settings.
AB019. Bridging the gap: enhancing drug allergy knowledge and management confidence in non-allergist physicians with ADAPT-2—a multinational, AI-assisted, educational initiative
Background: Mislabeled drug allergy (DA) is a global public health challenge associated with emerging antimicrobial resistance, necessitating not only efforts from allergists but also multidisciplinary collaborations with non-allergist physicians. A randomized crossover trial, Advances in Drug Allergy & Penicillin Testing (ADAPT; NCT06399601), was first conducted in late 2023 and demonstrated promising outcomes in improving non-allergist physicians’ DA knowledge and confidence through an intensive educational programme. Following ADAPT’s success, we commenced a multinational phase in 2024—the ADAPT-2. This report aims to report the effectiveness of this initiative on improving participants’ DA knowledge and management confidence. Methods: Non-allergist physicians were recruited from four localities, namely Australia, Hong Kong, mainland China, and Sri Lanka, and received a 1-day intensive training in DA. The training programme in mainland China was translated into Mandarin with artificial intelligence (AI) assistance. Participants’ DA knowledge, confidence, and practice were evaluated by structured surveys (scored on a 0–100 scale) before and after the course. Subgroup analysis was performed between physicians from advanced economies (AEs) and emerging economies (EEs). Results: A total of 181 physicians [13 (7.2%) from Australia, 25 (13.8%) from Hong Kong, 98 (54.1%) from mainland China, and 45 (24.9%) from Sri Lanka] were included. At baseline, physicians’ knowledge and confidence level for DA were unsatisfactory (53.5±17.2 and 47.5±22.7, respectively). In particular, physicians from EEs (mainland China and Sri Lanka) showed significantly lower scores than those from AEs (Australia and Hong Kong) in DA knowledge (49.1±15.5 vs. 70.1±12.7, P<0.001), but not in confidence (46.8±23.2 vs. 50.2±20.9, P=0.41). After ADAPT-2, there were significant improvements in DA knowledge (53.5±17.2 to 72.5±16.0, P<0.001) and confidence (47.5±22.7 to 71.2±17.6, P<0.001). AI-assisted translation was non-inferior to the native programme in effectiveness (P=0.65) and had high satisfaction (98% somewhat clear or better). Conclusions: Lack of DA knowledge among non-specialists remains ubiquitous with significant disparities between AEs and EEs. An intensive, structured, AI-assisted training is effective to significantly enhance participants’ knowledge levels.
AB018. Diagnostic reliability of adsorption elution technique in detecting ABO antigens in saliva
Background: Saliva is increasingly recognized for its diagnostic potential in determining secretor or non-secretor phenotypes. Analyzing secretor antigens in saliva presents a compelling non-invasive option for blood typing, contributing to personalized medicine. This study investigated the relationship between secretor antigens found in saliva and blood, addressing the increasing interest in non-invasive diagnostics, minimizing patient discomfort while maintaining sensitivity and specificity in clinical settings. Methods: This study used a quantitative comparative design with non-proportional quota sampling and analyzed saliva and blood samples in a controlled laboratory setting. The forward and reverse tube methods was used for blood, while the absorption-elution method was used for saliva. For the results, binary testing categorized the presence or absence of agglutination (positive or negative) to identify secretor antigen status. The study’s diagnostic accuracy was assessed by measuring sensitivity and specificity. Results: Among 40 participants, traditional methods showed type O as the most common (47.5%) and type AB as the least common (12.5%). Using the adsorption-elution method on saliva (supernatant, eluate, and supernatant eluate), individuals were classified as secretors or non-secretors based on anti-H antigen presence. Overall, 65–75% were secretors, 15% non-secretors, and 10% had inconsistent results. Receiver operating characteristic (ROC) analysis indicated excellent diagnostic accuracy for saliva testing, with the supernatant anti-H sample showing excellent performance [area under the curve (AUC) =0.897] and eluate and supernatant eluate samples showing acceptable reliability (AUCs =0.752 and 0.719). These results support the potential of saliva-based blood typing as a reliable option in non-invasive settings. Conclusions: The adsorption-elution method shows good sensitivity and specificity for detecting blood group antigens in saliva, with moderate to excellent AUC values. It offers a good option; however, it should not replace standard blood typing methods. Inconsistencies highlight the need for further research to improve its reliability and consistency across various populations and ethnicities.
AB017. Beyond the workday: exploring mental health and wellbeing among Indonesian migrant domestic workers in older adult care roles
Background: Indonesian migrant domestic workers (IMDWs) play a vital role in the care of older adults across Asia, yet they are subject to extended working hours, restricted autonomy, and social isolation. These challenges have been shown to have a detrimental effect on their mental health and wellbeing. However, the extent of this impact remains underexplored, thus highlighting the need for further research in order to inform the provision of more effective support and policies. The present study aims to examine the mental health and wellbeing of IMDWs who care for older adults in Asian countries, as their contribution is rarely recognized. Methods: An online cross-sectional survey was conducted with 872 IMDWs in Malaysia, Singapore, Hong Kong, Macau, and Taiwan (August–December 2022). The survey examined the caregiving impact, depressive and anxiety symptoms, loneliness, perceived social support, perceived control and autonomy, caring self-efficacy, and resiliency among participants. Descriptive analyses were performed in addition to inferential tests in order to examine the association between variables. Results: The average participant age was 36.8 years, with a mean workday of 14.2 hours—half spent on elderly care. Most (96%) lived in their employers’ homes, but only 59% had private bedrooms. The majority reported a medium caregiving impact. Between 60.2% and 78.6% experienced varying levels of depressive and anxiety symptoms. Participants also reported moderate levels of perceived loneliness, social support, control, autonomy, and caregiving self-efficacy. Overall, the findings suggest that while participants face significant mental health challenges, they maintain moderate resilience and coping abilities in their caregiving roles. Conclusions: This study highlights the challenges faced by IMDWs in delivering care to older adults in Asia. This underscores the necessity of identifying and addressing these issues to promote optimal outcomes.
AB016. Behavioral nudges to enhance mental health help-seeking behavior among secondary school students—a randomized controlled trial protocol
Background: Adolescents often face barriers in seeking mental health support due to stigma, lack of awareness, and limited help-seeking skills. Despite growing mental health needs among secondary school students in Malaysia, many remain reluctant to access available services. Behavioral insights approaches, such as nudging and boosting, may reduce stigma and increase help-seeking intentions cost-effectively. This study applies an integrative behavioral science framework, drawing on the Social Ecological Model (SEM), the Capability, Opportunity, Motivation, and Behavior (COM-B) model, and Plans, Responses, Impulses, Motives, and Evaluations (PRIME) theory, to design and test a multilevel intervention addressing individual, social, and contextual drivers of secondary school students’ help-seeking behavior. This study aims to evaluate the effectiveness of combined nudging and boosting interventions in improving mental health help-seeking behaviors and related competencies among secondary school students. Methods: A three-arm randomized controlled pilot trial was conducted in selected Malaysian secondary schools with students aged 13–16 years. Participants were randomly allocated to one of three groups: (I) control—no exposure to behavioral nudges; (II) basic nudge—exposure to strategically placed visual and educational posters for 4 weeks; or (III) enhanced nudge—exposure to the same posters plus an additional interactive skill-building session designed to strengthen mental health communication skills and self- efficacy. Guided by SEM, COM-B model, and PRIME theory, outcomes were analyzed using a validated self-administered questionnaire (Cronbach’s α=0.89), with descriptive and comparative analyses conducted in SPSS. Ethical approval has been obtained from the Medical Review & Ethics Committee [No. NMRR ID-25-02340-U1L (IIR)] and Educational Research Application System by Ministry of Education. Results: Expected to show that behaviorally informed nudges and boosting strategies can significantly improve students’ help-seeking intentions, awareness of mental health resources, and confidence while reducing internal stigma. Findings will generate empirical evidence for scalable, school-based interventions and inform future strategies to strengthen adolescent mental health support systems. Conclusions: By integrating SEM, COM-B model, and PRIME theory, the study is positioned to assess implementation practicality, intervention acceptability, and outcome responsiveness across behavioral domains. The findings will inform refinement of intervention components, measurement strategies, and sample size estimation, supporting the design of a robust, fully powered trial and scalable school-based mental health interventions.
AB015. Associations between globalization index and cancer burden: a global analysis
Background: Globalization is a multifaceted phenomenon with potential implications for global cancer patterns, both by disseminating lifestyle risk factors and by enabling the transfer of medical knowledge and technology. This study aimed to investigate the associations between the KOF Globalisation Index and key national-level cancer metrics. Methods: We conducted an ecological study using country-level data. Cancer incidence and mortality rates were obtained from the World Health Organization (WHO) Global Cancer Observatory (GLOBOCAN), and the mortality-to-incidence ratio (MIR) was calculated. The KOF Globalisation Index, socioeconomic data [Gross Domestic Product (GDP), Human Development Index (HDI)], and risk factor prevalence (smoking, alcohol, obesity, etc.) were sourced from international databases. Uni- and multi-variable linear regression analyses were performed to examine these relationships. Results: A higher KOF Globalisation Index was significantly associated with increased cancer incidence (adjusted β=1.529, P<0.001) in models controlling for major risk factors. However, it was also independently associated with a more favorable MIR (adjusted β=−0.002, P<0.001), suggesting better survival outcomes. Behavioral risk factors, smoking and alcohol consumption, demonstrated strong, independent associations with both higher incidence and mortality. Conclusions: This study reveals a dual role of globalization in the cancer landscape. It is associated with an elevated burden of cancer cases, likely through the diffusion of risk factors, but also with markedly improved cancer survival, likely mediated through advanced healthcare infrastructure and services. Public health strategies must therefore focus on curbing the uptake of risk factors while promoting the transfer of cancer control capacities to mitigate the global cancer burden.
AB014. Assessment of the knowledge, attitudes, and practices (KAP) on fascioliasis among farmers in Nueva Ecija
Background: Nueva Ecija, a key agricultural province in the Philippines, heavily depends on farming and carabao (water buffalo) husbandry to sustain its rural economy. However, fascioliasis—a neglected zoonotic parasitic disease—poses a threat to livestock productivity, agricultural output, and farmer livelihoods. This study assessed the knowledge, attitudes, and practices (KAP) of carabao-owning farmers toward fascioliasis, emphasizing socio-behavioral and environmental factors influencing disease management and control. Methods: A mixed-methods research design was employed. Quantitative data were gathered through a structured KAP survey of 57 purposively and snowball-sampled farmers and caretakers, analyzed using SPSS. Qualitative data were collected via semi-structured interviews with 19 participants and examined thematically. Triangulation integrated both data sets. Results: Analysis of variance (ANOVA) revealed significant differences in knowledge based on marital status (P=0.001) and monthly income (P=0.03), while attitudes (P=0.44) and practices (P=0.61) showed no significant variation across sociodemographic variables. Spearman’s rho indicated no significant correlations among the KAP domains (P=0.65, P=0.12, and P=0.09). Four themes emerged from qualitative analysis: (I) foundational knowledge and information sources; (II) belief systems guiding prevention; (III) practical disease management strategies; and (IV) experiences with carabao morbidity and mortality. The integration of findings led to the development of the Snail Shell Model of Fascioliasis Control, identifying key points for effective intervention in the community. Conclusions: Farmers demonstrated low knowledge but moderately positive attitudes and practices regarding fascioliasis control. Sociodemographic factors influenced knowledge but not the relationships among KAP elements. Strengthening community-based education and engagement initiatives is recommended to enhance disease control and protect both animal and public health, leading towards a One Health approach.
AB013. Assessment of one health core competencies among the Malaysian One Health workforce
Background: The Competency Framework and Evaluation Toolkit, developed under the One Health Workforce-Next Generation (OHW-NG) initiative, supports cross-sectoral, skill-based training and evaluation. This study assessed core One Health (OH) competencies among Malaysia’s workforce. Identifying competency gaps is vital for evidence-based human resource development. Methods: A One Health Core Competency (OHCC) assessment questionnaire was developed based on the Competency Framework and Evaluation Toolkit. The tool was adapted for local relevance, incorporating six priority domains identified by experts from both government and academia. The questionnaire was administered to participants of the 2023 and 2024 Malaysia One Health University Network (MyOHUN) Field Epidemiology Training and Tabletop Simulation Exercise Programme. Participants self-assessed their proficiency using a five-point scale, ranging from 0 (“not relevant”) to 4 (“proficient”). Data were analyzed using SPSS version 26. Results: A total of 123 participants completed the survey. Most were female (68%), aged 30–39 years (62%), and had no prior OH experience (64%). Respondents were primarily from human health (62%), followed by animal health (26%), environmental health (8%), and others (4%). Limited or no knowledge was reported in OH risk analysis (72%), principles and concepts (62%), and epidemiology (60%). The remaining three domains also showed over 50% reporting limited or no knowledge. Age was negatively correlated with OH principles and concepts (r2=−0.194, P=0.032). While years of OH experience were positively correlated with OH epidemiology (r2=−0.182, P=0.044) and OH risk analysis (r2=0.193, P=0.032). The assessment found substantial gaps in OH competencies, especially in risk analysis, epidemiology, and OH concepts. This highlights the value of using competency-based assessments to guide capacity-building efforts. Conclusions: Addressing these gaps will enhance Malaysia’s readiness for health threats and offer a model to strengthen OH workforce capacity in other regions, supporting global health security and sustainability.
AB012. Assessing the knowledge, perception and utilization of adolescents towards Adolescent Friendly Health Services (AFHS) in Malaysia: study protocol
Background: In Malaysia, Adolescent Friendly Health Services (AFHS), known as Perkhidmatan Kesihatan Mesra Remaja (PKMR), were established in 1996 under the Family Health Development Division of the Ministry of Health and provide standardized care across five domains, sexual and reproductive health, nutrition, mental health, high-risk behaviors, and physical health, through 1,087 clinics. Although AFHS play a vital role in addressing adolescents’ health needs, their utilization remains low compared with mainstream health services. Late adolescents aged 18–19 years represent a distinct developmental stage, yet no Malaysian study has comprehensively examined their knowledge, perception, and utilization of AFHS, particularly among those who have never accessed these services in public primary healthcare settings. This study aims to develop and validate a questionnaire to assess the knowledge, perceptions, and utilization of AFHS among late adolescents in Malaysia. Methods: This study employs a quantitative approach. The tool will be adapted from existing international instruments and refined with input from subject matter experts to ensure contextual relevance and content validity. Respondent eligibility criteria are embedded within the tool. Data collection will be conducted through online distribution via social media platforms and in partnership with non-governmental organizations to enhance reach and participation. Results: This study will help to determine the proportion of adolescents who are knowledgeable about AFHS, as well as their perceptions and patterns of utilization. These findings are anticipated to provide valuable insights into improving adolescents’ awareness towards the AFHS and identify strategies to strengthen their engagement with the AFHS. In addition, it also helps as a foundational reference to the development of a comprehensive interview guide for the subsequent qualitative phase, grounded in the selected framework. Conclusions: This study will help to determine the proportion of adolescents who are knowledgeable about AFHS, as well as their perceptions and patterns of utilization. These findings are anticipated to provide valuable insights into improving adolescents’ awareness towards the AFHS and identify the strategies to strengthen their engagement with AFHS. In addition, it also helps as a foundational reference to the development of a comprehensive interview guide for the subsequent qualitative phase, grounded in the selected framework.
AB011. Assessing hospital executive’s awareness of climate change and proposing sustainable strategies: survey-based approaches
Background: Climate change presents significant threats to human health and is exacerbated by the healthcare sector, which contributes 5–10% of global carbon emissions. Despite its critical role in safeguarding health, the sector remains a substantial emitter, accounting for 9.58% of Thailand’s total emissions. Hospital executives, as key decision-makers, are positioned to lead mitigation efforts. The objective of this study is to understand the perspectives and awareness of Thai hospital executive about the nexus of climate change and healthcare. Methods: An online self-administered cross-sectional survey (in Thai) was conducted among 60 healthcare executives across 12 area health regions in Thailand between May and June 2023. The questionnaire, informed by a literature review, assessed their knowledge, attitudes, and strategies for adaptation and mitigation of climate change. Data were analyzed using Microsoft Excel and R version 4.4.2. Results: Fifty-five healthcare executives (56.4% directors and 43.6% deputy directors) responded. Among them, 83.6% showed strong concern about climate change, and 54.6% believed cross-sectoral policies need more cohesion. Over half reported lacking electricity usage records, indicating no baseline for greenhouse gas emissions. Key emission sources included electricity, transportation, waste, and lab testing. Support for climate action was strong—54.5% for the Ministry of Health’s leadership and 100% for hospitals’ role. Proposed solutions included solar power, electric vehicles, waste management, and telemedicine, though budget and implementation barriers remain. Conclusions: Our findings indicate strong awareness and readiness among Thai hospital executives to adopt sustainable practices. Coherent cross-sectoral policies with adequate funding and support are crucial. Hospitals must also establish reliable baseline data on energy use and emissions to effectively track and guide climate actions. Future research can inform strategic plans and cost-effective interventions to help hospitals achieve net zero goals.
AB010. Are people living with diabetes using more outpatient healthcare?—insights from Malaysia
Background: Diabetes mellitus is highly prevalent in Malaysia and places a substantial burden on outpatient care in the country’s mixed public-private system. Outpatient healthcare utilization (OPHCU) is higher among individuals with diabetes than those without, reflecting complex disease management and frequent comorbidities, consistent with Andersen’s behavioral model in which diabetes functions as a need factor for care. Population-level estimates of outpatient utilization by provider sector and across socio-demographic, socio-economic, and comorbidity strata, however, remain limited, and this study addresses these gaps using nationally representative survey data. Methods: A cross-sectional study was conducted using data from 18,616 Malaysian adults aged 18–90 years, drawn from the 2015 National Health and Morbidity Survey. Diabetes was identified through self-report, laboratory results, or medication use. OPHCU was defined as visits to non-hospital outpatient care providers within the past 2 weeks. Sociodemographic and clinical variables (age, sex, ethnicity, income, marital status, education, comorbidities) were analyzed. Multivariable logistic and multinomial regression examined associations and effect modification. Results: Diabetics use more OPHCU with [adjusted odds ratio (aOR) =1.23; 95% confidence interval (CI): 1.05–1.43; P=0.008] compared to non-diabetics. Greater utilization was observed in Malay ethnicity (aOR =1.28), lower income [< ringgit Malaysia (RM)1,500; aOR =1.25], unmarried status (aOR =1.34), and absence of hypercholesterolemia (aOR =1.73). Age, sex, and education did not have a significant effect. Relative risk analysis confirmed that people living with diabetes were 1.44 times more likely to use public OPHCU compared to non-diabetics. Conclusions: People living with diabetes utilized outpatient healthcare more than non-diabetics, with disparities by ethnicity, income, and marital status. Public-sector OPHCU predominated. Addressing utilization disparities through integrated policies is key to optimizing diabetes management in Malaysia.
AB009. Antibiotic resistance pattern of Escherichia coli from selected water sources: a preliminary study in Upper Sitio Pintor, Rodriguez, Rizal
Background: Rodriguez, Rizal, now the relocation site of the former Payatas landfill, faces environmental and public health challenges due to the presence of an unregulated open dumpsite near residential areas in Upper Sitio Pintor. Communities in this area rely on untreated water sources, including groundwater, which may harbor harmful bacteria such as Escherichia coli (E. coli). A known fecal coliform, E. coli, has the potential to develop antibiotic resistance in aquatic environments. This study aimed to detect the occurrence of E. coli in leachate, groundwater, and tap water near the dumpsite, describe the resistance profiles of antibiotic-resistant isolates, and compare resistance patterns across different antibiotic classes and water sources. Methods: A total of 58 water samples were collected in duplicates from 29 sampling sites: 13 from leachate, 13 from groundwater, and 3 from tap water. All samples were cultured for E. coli and subjected to antibiotic susceptibility testing using the Kirby-Bauer disk diffusion method. Descriptive statistics and repeated measures analysis of variance (ANOVA) were conducted using SPSS to compare resistance patterns across water sources. A P<0.05 was considered statistically significant. Results: E. coli was detected in 69.2% of leachate and 61.5% of groundwater samples, while all tap water samples tested negative. Leachate isolates showed the highest resistance to penicillin (100%) and aztreonam (44.4%), while groundwater isolates showed the highest resistance to penicillin (87.5%) and nitrofurantoin (68.8%). Significant differences in resistance were observed for ceftriaxone (P=0.006) and nitrofurantoin (P=0.003) across sources. Conclusions: This preliminary study highlights the presence of antibiotic-resistant E. coli in water sources near an open dumpsite. Results emphasize the need for improved water monitoring and waste management. Findings may guide future research and public health interventions on antibiotic resistance.
AB008. Advancing health equity through institutional health screening: a university-based approach to metabolic syndrome prevention in Indonesia
Background: University communities represent a critical setting for advancing population health and addressing rising non-communicable disease (NCD) burdens. In Indonesia, the Health Promoting University (HPU) framework has guided institutional efforts to embed health into university systems, policies, and culture. This study explores how a university-based annual Medical Check-Up (MCU) program contributes to health equity and chronic disease prevention among academic staff, with a focus on early detection and management of metabolic syndrome (MetS). Methods: A qualitative descriptive design was employed, drawing on the Context, Input, Process, and Product (CIPP) evaluation model. Data were gathered from two MCU providers at a major Indonesian public university through in-depth interviews with key informants (n=4), document analysis, and reflective journals. Thematic analysis was used to examine the program’s development and institutional alignment with HPU principles. This study received ethical approval from the Medical and Health Research Ethics Committee, Universitas Gadjah Mada (KE/FK/0057/EC/2025). Results: The MCU program has evolved over time, demonstrating improvements in inputs—such as expanded interprofessional teams (e.g., nutritionists, lab personnel), enhanced infrastructure (e.g., mobile units, on-site labs), and updated MetS screening parameters. The coronavirus disease 2019 (COVID-19) pandemic accelerated innovation, prompting mobile service delivery and safety-driven layouts. Key enablers included institutional leadership, policy integration, and sustainable financing. Nonetheless, gaps in documentation, health communication, and participation persist, particularly among younger staff. Conclusions: Embedding preventive health screening within a university’s ecosystem fosters equitable access to NCD risk assessment and supports institutional health literacy. The findings underscore the role of HPUs in promoting long-term health outcomes and system resilience, aligning with global health goals and regional commitments to equity and prevention.
AB007. Adolescent elopement in child marriage contexts: counter-narratives of resistance, relief, and risk from Rohingya refugee youth in Malaysia
Background: Child marriage and early unions (CMEU) affect around 640 million girls worldwide. Global health narratives often frame CMEU as gender-based violence—family-driven and inherently harmful—linked to risky pregnancies, school dropout, and domestic violence. However, these discourses frequently overlook how adolescents assess their circumstances and exercise agency, particularly among forcibly displaced populations. This study, co-produced with stateless Rohingya refugee and asylum-seeking adolescents, examines how they use elopement to navigate adversity within a context of precarious legal status and restricted access to education and livelihoods in Malaysia. Methods: This qualitative study aimed to investigate the drivers, trajectories, and outcomes of elopement among Rohingya boys and girls (10–19 years) in Malaysia. Collaborating with refugee-led organizations and 13 Rohingya youth advisors, we conducted semi-structured interviews and focus groups with 32 participants. Fifty-eight accounts of elopement, child marriage, and dating were compiled and analyzed thematically. Results: Common reasons adolescents elope include: (I) pursuit of love against contested social norms; and (II) responses to adversity (e.g., poverty, family restrictions, forced marriage, or intimate partner violence from a first spouse). Elopement unfolded in three stages: (I) secret partnership formation, often facilitated by online interactions in early adolescence; (II) rapid progression to elopement; and (III) post-elopement outcomes, with many unions dissolving due to severe financial hardship, marital strain, abuse, and family estrangement—leaving adolescents viewing elopement as a “mistake”. Conclusions: This study broadens understandings of CMEU by highlighting the significant but structurally constrained role of adolescent agency. Rohingya adolescents use elopement to seek autonomy, love, safety, and relief from financial hardship, yet such choices often heighten vulnerability and introduce new protection risks. Findings suggest that interventions should build on adolescents’ strong preference for education. Policies expanding refugees’ right to stay, work, and study could reduce pressures to enter premature and precarious unions by creating viable alternatives.
AB006. Acculturation, social support, and outpatient care use among Indonesian migrant workers in Malaysia: a cross-sectional study
Background: Equitable access to healthcare is a fundamental human right. However, for many migrant workers, this right remains unattainable due to persistent legal, economic, and social barriers. While socio-environmental determinants of health are increasingly acknowledged, there is limited evidence on how acculturation and social support influence migrant workers’ access to healthcare in low- and middle-income countries. This study examined how acculturation (language proficiency and social interaction) and social support (from family, friends, and third parties) are associated with outpatient care use among Indonesian migrant workers in Malaysia. It also explored whether social support mediates the relationship between acculturation and healthcare access. Methods: A cross-sectional survey was conducted with 322 Indonesian migrant workers in the Klang Valley region of Peninsular Malaysia from October 2024 to February 2025. Participants were recruited through convenience and snowball sampling methods, with support from community organizations. Analysis involved descriptive statistics and partial least squares structural equation modelling (PLS-SEM). Results: Most participants were middle-aged, Javanese, Muslim, and had completed secondary education. The majority were documented workers employed in the services sector, with about 8 years of work experience and a monthly income of ringgit Malaysia (RM)1,700. Acculturation and social support showed limited influence on outpatient care use. Better language proficiency was significantly associated with greater support from friends (β=0.198, P=0.02), but it was not linked to support from family or third parties, nor did it predict outpatient care use. No significant mediation effects of social support were observed. However, greater social interaction (β=−0.165, P=0.02) and undocumented status (β=−0.143, P=0.005) were significantly associated with lower use of outpatient care services. Conclusions: These findings highlight the complex pathways through which socio-environmental factors influence healthcare access for migrant workers. Ensuring equitable healthcare access for migrant workers requires inclusive, affordable health services and culturally responsive policies to build trust and encourage engagement with formal healthcare systems.
AB005. Acceptability of medication for early vascular ageing (EVA) in Malaysia: a focus group study
Background: There has been extensive recent effort to identify potential drug candidates targeting cellular senescence to treat ageing-related comorbidities. In Malaysia, where cardiovascular diseases (CVDs) remain a major public health concern, such interventions may be especially valuable. Despite the growing relevance of early vascular ageing (EVA) in clinical research, little is known about how Malaysians perceive this concept or their views on the acceptability of related preventative medications. This qualitative study aimed to explore Malaysian young adults’ understanding of the concept of EVA, as well as their attitudes and acceptance of medication for EVA. Methods: Six online focus group discussions (FGDs) were conducted with 31 Malaysian adults (aged 18–50 years) of diverse backgrounds between January and May 2024. Transcripts were analyzed thematically to explore perceptions, concerns, and acceptance of EVA medication. Results: The awareness about EVA was low, although some participants had heard of known of premature death from sudden heart attacks among their friends or relatives. In general, older participants expressed higher perceived risk of EVA than the younger. Participants expressed concern over safety profile, long-term side effects, and efficiency of the medication. The acceptance of medication for EVA was moderate among younger participants and high among older participants. Some conditions that increase their acceptance were the physicians’ recommendation, convenient administration route, and affordable pricing. Conclusions: Findings provide insights into the need to raise awareness about EVA, particularly among younger adults in Malaysia. Addressing concerns about medication safety and effectiveness, alongside clear guidance from healthcare providers, may enhance public acceptance. Interventions to reduce negative perceptions of new therapies and improve awareness about EVA may enhance acceptance of medication.
AB004. A study on urban resilience building under the context of climate change: integrating the indicator frameworks of the Sustainable Development Goals and ISO 37123
Background: Climate change is increasingly impacting urban environments, posing significant risks to public health, infrastructure, and social equity. Urban areas, due to their population density, complex systems, and vulnerability to heat island effects, are at the front line of these challenges. In response, this study proposes an urban resilience indicator framework that integrates the United Nations Sustainable Development Goals (SDGs) with International Organization for Standardization (ISO) 37123: indicators for resilient cities, aiming to guide local governments in enhancing resilience under climate stress. Methods: This study adopts literature analysis and the Fuzzy Delphi Method (FDM) to construct an urban resilience indicator framework. Drawing from SDG 11 (sustainable cities and communities), SDG 13 (climate action), SDG 3 (good health and well-being), and SDG 16 (peace, justice, and strong institutions), the research maps relevant indicators from ISO 37123 to initially develop three key dimensions—environmental, social, and governance (ESG)—comprising 12 primary indicators and 36 sub-indicators. Subsequently, the study engaged nine experts from the fields of urban planning, disaster governance, and public health. Through a questionnaire survey, the Fuzzy Consensus Value (FCV) was calculated to identify indicators that reflect both expert consensus and policy relevance. Results: The Fuzzy Delphi results show that experts ultimately selected 19 sub-indicators. The strongest agreement centers on climate risk management (e.g., climate-disaster monitoring platforms), post-disaster health response capacity (e.g., 24-hour access to medical resources and efficiency of integrated emergency medical systems), and public safety and social stability (e.g., efficiency and coverage of warning systems). Experts emphasize that urban resilience should go beyond engineering and physical infrastructure, integrating health systems and governance mechanisms to safeguard personal security and community stability under climate risks. The framework was preliminarily applied to Taipei’s West District Gateway Project by mapping the ESG resilience indicators to the project’s policies and objectives to assess planning and governance applicability. Environmentally, rainwater detention, permeable pavements, and green infrastructure reduce runoff and heat risks, supported by smart-city monitoring. Socially, proximity to National Taiwan University Hospital improves medical accessibility, while city-wide programs and renewal enhance community resilience. Governance-wise, public participation, resilience budgeting, and open data strengthen transparency and collaboration. Overall, 15 of the 19 indicators are applicable, indicating strong policy alignment and adaptive capacity. Conclusions: This study contributes to the evolving discourse on planetary health by offering a structured tool for cities to adapt to climate change while promoting health and sustainability.
AB003. A quantitative study of the prevalence of hepatitis B among garbage collectors in Baguio City, Philippines
Background: Hepatitis B virus (HBV) remains a pressing occupational health issue, especially among waste collectors who are often overlooked despite high exposure to biohazards. In Baguio City, the lack of personal protective equipment (PPE), limited access to healthcare, and minimal vaccination coverage suggest increased vulnerability, yet data on this population remain scarce. This study aimed to determine the prevalence of HBV among garbage collectors and to identify whether occupational exposure, knowledge about HBV, and workplace conditions are associated with HBsAg positivity. Methods: A quantitative correlational design was used among 59 registered male garbage collectors under the Baguio City General Services Office. Data collection included a structured questionnaire and rapid hepatitis B antigen (HBsAg) testing. Chi-squared analysis determined associations between variables. Ethical clearance was secured through institutional approval, and informed consent was obtained. Results: The study found a 3.4% HBV prevalence rate. While knowledge and exposure levels were not statistically associated with infection, poor workplace conditions showed significant correlation (χ2=6.65, P=0.01). Results emphasize the need for structural interventions like PPE provision, vaccination drives, and routine screening. Conclusions: This study concludes that hepatitis B prevalence among garbage collectors in Baguio City is relatively low at 3.4%; however, workplace conditions play a significant role in influencing infection status. While occupational exposure and knowledge did not show statistically significant associations, inadequate workplace safety measures were strongly linked to hepatitis B occurrence. These findings highlight the need for improved occupational health standards, consistent provision of protective equipment, and regular health monitoring. Strengthening nursing and public health advocacy is essential to promote safer working environments and reduce infection risks among garbage collectors.
AB002. A personalized air quality monitoring approach to support asthma control in an environment affected by air pollution
Background: Exposure to particulate matter ≤2.5 µm (PM2.5) is linked to more frequent and severe asthma exacerbations, especially in children. Around 10% of children in Asia have asthma, and short-term spikes in PM2.5 can raise exacerbation risk within three days. While public air quality monitoring networks exist, localized PM2.5 levels may vary significantly from central monitoring data, limiting the ability of individuals to make timely personalized health decisions. This highlights the urgent need for real-time, localized air quality monitoring to support personalized asthma management in an environment affected by air pollution. Methods: A health innovation project was undertaken to design, develop, and evaluate a portable, user-centered air quality monitoring device aimed at supporting asthma management among children living in pollution-affected environments. The design process started with problem identification, algorithm creation, and feature selection. Next, the development process included low-fidelity prototype creation and preliminary early-adopter user interaction components to support symptom tracking and potential early medication adjustments. Results: The design process identified several key stakeholders, including children as primary users, along with parents and healthcare providers who play important roles in the deployment of the device. The design of the dashboard required a short and succinct pop-up message with colorful buttons that increase users’ interaction. The first version of the prototype demonstrated technical feasibility in collecting and transmitting PM2.5 data. The prototype will enable personalized monitoring, which may help increase symptom awareness and support timely behavioral changes. This could inform earlier adjustments to asthma management plans and improve disease control under fluctuating air quality conditions. Conclusions: Personalized monitoring tools may offer a complementary approach to existing public air quality systems by providing more individualized exposure insights. Such innovations may help vulnerable populations, in this case children, to better manage pollution-related health risks, advance planetary health equity, and support adaptation strategies to mitigate the health impacts of climate change.
AB001. A correlational study on psychological adaptation among parents of children with asthma and chronic cardiovascular diseases
Background: Among the most common pediatric chronic conditions are asthma and chronic cardiovascular diseases (CVDs), each presenting unique management challenges. The study aimed to analyze and understand the correlation of six Family Management Measure (FaMM) key subscales: (I) child’s daily life and view of condition impact; (II) condition management ability and condition management effort; and (III) parental mutuality and family life difficulty, among parents of children with asthma and those of children with CVD at the University of the East Ramon Magsaysay Memorial Medical Center. Methods: With a quantitative descriptive correlational design, the study gathered data using the FaMM, a validated tool assessing six domains of family management of chronic illness, from 64 parents (32 from each group) who met the criteria from the outpatient clinic. Results: Significant correlations were found among parents of children with asthma across all tested relationships. Condition management effort was moderately negatively correlated with the child’s daily life (r=−0.483, P=0.005). Condition management ability showed a strong negative correlation with view of condition impact (r=−0.754, P<0.001). Condition management effort was also negatively correlated with parental mutuality (r=−0.411, P=0.04), while condition management ability demonstrated a strong negative correlation with family life difficulty (r=−0.746, P<0.001). In contrast, among parents of children with chronic CVD, no statistically significant correlations were observed across the tested relationships, with all P values ≥0.05. Conclusions: These findings suggest that psychological adaptation among asthma parents is closely related to their perceived caregiving competence and family management dynamics. Conversely, the absence of similar correlations in the CVD parents indicated the potential need for more specialized psychosocial interventions due to more complex stressors. This highlights the importance of caregiver psychological support into pediatric chronic care and suggests that condition-specific approaches may enhance caregiver well-being and improve health outcomes for families affected by the chronic illnesses.