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Dearie C, Linhart C, Figueroa C, Saumaka V, Dobbins T, Morrell S, Taylor R. Adult mortality from non-communicable diseases in Fiji's major ethnic groups 2013-17. GLOBAL EPIDEMIOLOGY 2024; 8:100157. [PMID: 39161916 PMCID: PMC11332792 DOI: 10.1016/j.gloepi.2024.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024] Open
Abstract
Background Sustainable Development Goal 3.4.1 (SDG3.4.1) targets a one-third reduction in non-communicable disease (NCD) mortality in ages 30-69-years by 2030 (relative to 2015). Directing interventions to achieve this aim requires reliable estimates of underlying cause of death (UCoD). This may be problematic when both cardiovascular diseases (CVD) and diabetes are present due to a lack of consistency in certification of such deaths. We estimate empirically 2013-17 NCD mortality in Fiji, by sex and ethnicity, from CVD, diabetes, cancer, and chronic lower respiratory diseases (CRD), and aggregated as NCD4. Methods UCoD was determined from Medical Certificates of Cause-of-Death (MCCD) from the Fiji Ministry of Health after pre-processing of mortality data where diabetes and/or hypertension were present in order to generate internationally comparable UCoD. If no potentially fatal complications from diabetes or hypertension accompanied these causes in Part I (direct cause) of the MCCD, these conditions were re-assigned to Part II (contributory cause). The probability of a 30-year-old dying before reaching age 70-years (PoD30-70), by cause, was calculated. Findings The PoD30-70 from NCD4 over 2013-17 differed by sex and ethnicity: in women, it was 36% (95%CI 35-37%) in i-Taukei and 27% (26-28%) in Fijians of Indian descent (FID); in men, it was 41% (40-42%) in both i-Taukei and FID.PoD30-70 from CVD, diabetes, cancer and CRD in women was: 18%, 10%, 13% and 1·0% in i-Taukei; 13%, 10%, 5·6% and 1·1% in FID; in men was: 28%, 8.4%, 7·6% and 2·2% in i-Taukei; 31%, 8.3%, 3.5% and 3·1% in FID. Interpretation To achieve SDG3.4.1 goals in Fiji by 2030, effective population wide and ethnic-specific interventions targeting multiple NCDs are required to reduce PoD30-70 from NCD4: from 36% to 24% in i-Taukei, and 27% to 18% in FID women; and from 41% to 27% in i-Taukei and FID men. Funding Not applicable.
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Affiliation(s)
- Catherine Dearie
- School of Population Health, University of New South Wales, Samuels Building, Botany St, Randwick, NSW 2052, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Carah Figueroa
- School of Health & Social Development, Deakin University, Burwood, Victoria, Australia
| | | | - Timothy Dobbins
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Stephen Morrell
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, Australia
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Rich AM, Hussaini HM, Nizar MAM, Gavidi RO, Tauati-Williams E, Yakin M, Seo B. Diagnosis of oral potentially malignant disorders: Overview and experience in Oceania. FRONTIERS IN ORAL HEALTH 2023; 4:1122497. [PMID: 37089445 PMCID: PMC10117992 DOI: 10.3389/froh.2023.1122497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
The diagnosis and management of oral potentially malignant disorders (OPMD) should be the same the world over, but there are important nuances in incidence, aetiological factors, and management opportunities that may lead to differences based on ethnogeography. In this review, we update and discuss current international trends in the classification and diagnosis of OPMD with reference to our experience in various regions in Oceania. Oceania includes the islands of Australia, Melanesia (including Papua New Guinea, Fiji, Solomon Islands, Micronesia and Polynesia (including New Zealand, Samoa, Tonga) and hence has diverse populations with very different cultures and a range from well-resourced high-population density cities to remote villages.
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Affiliation(s)
- Alison M. Rich
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
- Correspondence: Alison M. Rich
| | | | | | - Ratu Osea Gavidi
- School of Dentistry & Oral Health, Fiji National University, Suva, Fiji
| | | | - Muhammed Yakin
- Adelaide Dental School, University of Adelaide, Adelaide, SA, Australia
| | - Benedict Seo
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Mohammadnezhad M, Kengganpanich M. Factors affecting smoking initiation and cessation among adult smokers in Fiji: A qualitative study. Tob Induc Dis 2021; 19:92. [PMID: 34949974 PMCID: PMC8647017 DOI: 10.18332/tid/143027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Smoking as a public health challenge is globally considered the main risk factor of many non-communicable diseases (NCDs). Knowing factors contributing to smoking commencement and cessation is the necessary step to develop prevention strategies to combat this issue. To date, no study has been conducted in Fiji, therefore this study aimed to explore the reasons adult smokers initiate smoking and cessation in Fiji. METHODS A qualitative study was conducted among 35 current smokers who were interviewed between 1 May and 31 July 2020 in Suva, Fiji. Three health centers were chosen randomly to collect data and purposive sampling was applied to reach study participants. A semi-structured, open-ended questionnaire was used to guide the interviews. The content of in-depth interviews was transcribed and data were analyzed using content and thematic analysis. RESULTS The results of this study showed that most of the participants were male (57%), I-taukei (77%), single (54%), had attained tertiary education level (69%), were of Christian religion (77%), and unemployed (63%). Two main themes were identified including: ‘factors affecting smoking initiation’ and ‘factors affecting smoking cessation’. ‘Peer pressure’, ‘smoking myth’, ‘smoking as a fun’, ‘unpleasant event in life’ and ‘smoking establishes friendships’ were factors affecting initiation of smoking; while ‘knowledge on smoking harms’, ‘financial constraints’, ‘desire to improve health’, ‘constant request from family members’, ‘desire to save time’, ‘religious factors’ and ‘cultural factors’, were factors affecting smoking cessation among smokers. CONCLUSIONS This study highlights the main factors affecting smoking among adult smokers in Fiji. Considering these factors in future health planning will help policy makers and decision makers to develop tailored interventions to combat this health issue.
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Affiliation(s)
| | - Mondha Kengganpanich
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Dearie C, Linhart C, Rafai E, Nand D, Morrell S, Taylor R. Trends in mortality and life expectancy in Fiji over 20 years. BMC Public Health 2021; 21:1185. [PMID: 34158012 PMCID: PMC8218490 DOI: 10.1186/s12889-021-11186-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fiji, a Pacific Island nation of 884,887 (2017 census), has experienced a prolonged epidemiological transition. This study examines trends in mortality and life expectancy (LE) in Fiji by sex and ethnicity over 1996-2017, with comparisons to published estimates. METHODS Trends in infant mortality rates (IMR), under-5 mortality (U5M), adult mortality (probability of dying), LE (at birth) and directly age-standardised death rates (DASRs) by sex and ethnicity, are calculated (with 95% confidence limits) using unit death records from the Fiji Ministry of Health and Medical Services. The LE gap between populations, or within populations over time, is examined using decomposition by age. Period trends are assessed for statistical significance using linear regression. RESULTS Over 1996-98 to 2014-17: IMR and U5M for i-Taukei and Fijians of Indian descent declined; U5M decline for i-Taukei (24.6 to 20.1/1000 live births) was significant (p = 0.016). Mortality (15-59 years) for i-Taukei males was unchanged at 27% but declined for Indians 33 to 30% (p = 0.101). Mortality for i-Taukei females increased 22 to 24% (p = 0.011) but declined for Indians 20 to 18% (p = 0.240). DASRs 1996-2017 were lower for i-Taukei (9.3 to 8.2/1000 population) than Indian males (10.6 to 9.8/1000). DASRs declined for i-Taukei (both sexes, p < 0.05), and for Indians (both sexes, p > 0.05). Over 22 years, LE at birth increased by 1 year or less (p = 0.030 in male i-Taukei). In 2014-17, LE (years) for males was: i-Taukei 64.9, Indians 63.5; and females: i-Taukei 67.0 and Indians 68.2. Mortality changes in most 5-year age groups increased or decreased the LE gap less than 10 weeks over 22 years. Compared to international agency reports, 2014-17 empirical LE estimates (males 64.7, females 67.8) were lower, as was IMR. CONCLUSIONS Based on empirical data, LE in Fiji has minimally improved over 1996-2017, and is lower than some international agencies report. Adult mortality was higher in Indian than i-Taukei men, and higher in i-Taukei than Indian women. Exclusion of stillbirths resulted in IMRs lower than previously reported. Differing mortality trends in subgroups highlight the need to collect census and health data by ethnicity and sex, to monitor health outcomes and inform resource allocation.
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Affiliation(s)
- Catherine Dearie
- School of Population Health, University of New South Wales, Samuels Building, Botany St, UNSW Sydney, NSW, 2052, Australia.
| | - Christine Linhart
- School of Population Health, University of New South Wales, Samuels Building, Botany St, UNSW Sydney, NSW, 2052, Australia
| | - Eric Rafai
- Ministry of Health and Medical Services (MoHMS), Government of Fiji, Suva, Fiji
| | - Devina Nand
- Ministry of Health and Medical Services (MoHMS), Government of Fiji, Suva, Fiji
| | - Stephen Morrell
- School of Population Health, University of New South Wales, Samuels Building, Botany St, UNSW Sydney, NSW, 2052, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Samuels Building, Botany St, UNSW Sydney, NSW, 2052, Australia
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Morrell S, Taylor R, Nand D, Rao C. Changes in proportional mortality from diabetes and circulatory disease in Mauritius and Fiji: possible effects of coding and certification. BMC Public Health 2019; 19:481. [PMID: 31046741 PMCID: PMC6498492 DOI: 10.1186/s12889-019-6748-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/18/2023] Open
Abstract
Background Many developing countries are experiencing the epidemiological transition, with the majority of deaths attributed to cardiovascular disease, cancer, Type 2 diabetes (T2DM) and others. In some countries, large proportional mortality attributed to diabetes is evident in official mortality statistics, with Mauritius and Fiji rated as the highest in the world. Methods This study investigates trends in recorded diabetes and cardiovascular disease mortality in Mauritius and Fiji under coding from the International Classification of Diseases (ICD) versions 9 and 10, using mortality data reported from these countries to the World Health Organization (WHO). Results In Mauritius over 1981–2004, T2DM proportional mortality varied between 4% and 7% in males (M) and 5% and 9% in females (F). In 2005 there was a sudden increase to M 20% and F 25%, which continued to M 25% and F 30% by 2012. Over 1981–2004 the proportion of circulatory disease mortality rose from 44% to 49% in males, and from 46% to 57% in females. In 2005, circulatory disease mortality proportions fell precipitously to 34% in males and 37% in females, and declined to 31% and 34% by 2013. ICD–10 coding was introduced in 2005. In Fiji, sharp rises in proportional T2DM mortality from 3% in both sexes in 2001 to M 15% and F 20% in 2002 were followed by more gradual trend increases to M 20% and F 26% by 2012–13. Circulatory disease proportions fell steeply from M 57% and F 53% in 2001 to M 44% and M 38% by 2004, with subsequent less steep declines to M 39% and F 30% by 2012. ICD–10 coding was introduced in 2001. Conclusions Large, abrupt changes in diabetes and circulatory disease proportional mortality in Fiji and Mauritius coincided with the local introduction of ICD–10 coding in different years. There is also evidence for diabetes-related misclassification of underlying cause of death in Australia and the USA. These artefacts can undermine accurate monitoring of cause of death for evaluation of effectiveness of prevention and control, especially of circulatory disease mortality which is demonstrably reversible in populations.
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Affiliation(s)
- Stephen Morrell
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine University of New South Wales (UNSW), Sydney, Australia.
| | - Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine University of New South Wales (UNSW), Sydney, Australia
| | | | - Chalapati Rao
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Gartner C, Waa AM, Walker N, Hao’uli S, Bonevski B. Introducing the SRNT Oceania Chapter. Nicotine Tob Res 2018; 20:1289-1291. [DOI: 10.1093/ntr/nty118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Morehu Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Wiseman V, Lagarde M, Batura N, Lin S, Irava W, Roberts G. Measuring inequalities in the distribution of the Fiji Health Workforce. Int J Equity Health 2017; 16:115. [PMID: 28666460 PMCID: PMC5493125 DOI: 10.1186/s12939-017-0575-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the centrality of health personnel to the health of the population, the planning, production and management of human resources for health remains underdeveloped in many low- and middle-income countries (LMICs). In addition to the general shortage of health workers, there are significant inequalities in the distribution of health workers within LMICs. This is especially true for countries like Fiji, which face major challenges in distributing its health workforce across many inhabited islands. METHODS In this study, we describe and measure health worker distributional inequalities in Fiji, using data from the 2007 Population Census, and Ministry of Health records of crude death rates and health workforce personnel. We adopt methods from the economics literature including the Lorenz Curve/Gini Coefficient and Theil Index to measure the extent and drivers of inequality in the distribution of health workers at the sub-national level in Fiji for three categories of health workers: doctors, nurses, and all health workers (doctors, nurses, dentists and health support staff). Population size and crude death rates are used as proxies for health care needs. RESULTS There are greater inequalities in the densities of health workers at the provincial level, compared to the divisional level in Fiji - six of the 15 provinces fall short of the recommended threshold of 2.3 health workers per 1,000 people. The estimated decile ratios, Gini co-efficient and Thiel index point to inequalities at the provincial level in Fiji, mainly with respect to the distribution of doctors; however these inequalities are relatively small. CONCLUSION While populations with lower mortality tend to have a slightly greater share of health workers, the overall distribution of health workers on the basis of need is more equitable in Fiji than for many other LMICs. The overall shortage of health workers could be addressed by creating new cadres of health workers; employing increasing numbers of foreign doctors, including specialists; and increasing funding for health worker training, as already demonstrated by the Fiji government. Close monitoring of the equitable distribution of additional health workers in the future is critical.
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Affiliation(s)
- Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2033 Australia
| | - Mylene Lagarde
- London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Neha Batura
- Institute for Global Health, University College London, Gower St, Kings Cross, London, WC1E 6BT UK
| | - Sophia Lin
- School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2033 Australia
| | - Wayne Irava
- Centre for Health Information Policy & Systems Research, College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Graham Roberts
- Human Resources for Development Alliance, PO Box 10570, Laucala Beach Suva, Fiji
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Gamlath L, Nandasena S, Hennadige Padmal de Silva S, Linhart C, Ngo A, Morrell S, Nathan S, Sharpe A, Taylor R. Differentials in Cardiovascular Risk Factors and Diabetes by Socioeconomic Status and Sex in Kalutara, Sri Lanka. Asia Pac J Public Health 2017; 29:401-410. [DOI: 10.1177/1010539517709028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Anh Ngo
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
- Department of Student Health, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen Morrell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Sally Nathan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Albie Sharpe
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Richard Taylor
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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