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Heinsberg LW, Niu S, Arslanian KJ, Chen R, Bedi M, Unasa-Apelu F, Fidow UT, Soti-Ulberg C, Conley YP, Weeks DE, Ng CA, Hawley NL. Characterization of per- and polyfluoroalkyl substances (PFAS) concentrations in a community-based sample of infants from Samoa. Chemosphere 2024; 353:141527. [PMID: 38401869 PMCID: PMC10997188 DOI: 10.1016/j.chemosphere.2024.141527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are persistent contaminants with documented harmful health effects. Despite increasing research, little attention has been given to studying PFAS contamination in low- and middle-income countries, including Samoa. Using data and biosamples collected through the Foafoaga o le Ola ("Beginning of Life") Study, which recruited a sample of mothers and infants from Samoa, we conducted an exploratory study to describe concentrations of 40 PFAS analytes in infant cord blood collected at birth (n = 66) and infant dried blood spots (DBS) collected at 4 months post-birth (n = 50). Of the 40 PFAS analytes tested, 19 were detected in cord blood, with 10 detected in >50% of samples (PFBA, PFPeA, PFOA, PFNA, PFDA, PFUnA, PFTrDA, PFHxS, PFOS, and 9Cl-PF3ONS); and 12 analytes were detected in DBS, with 3 detected in >50% of samples (PFBA, PFHxS, and PFOS). PFAS concentrations were generally lower than those reported in existing literature, with the exception of PFHxS, which was detected at higher concentrations. In cord blood, we noted suggestive (p < 0.05) or significant (p < 0.006) associations between higher PFHxS and male sex; higher PFPeA and residence in Northwest 'Upolu (NWU) compared to the Apia Urban Area (AUA); lower PFUnA and 9Cl-PF3ONS and greater socioeconomic resources; lower PFOA and higher parity; higher PFDA and higher maternal age; and lower PFUnA, PFTrDA, and 9Cl-PF3ONS and higher maternal BMI. In DBS, we found suggestive (p < 0.05) or significant (p < 0.025) associations between lower PFBA and residence in NWU versus AUA; lower PFBA and PFHxS and higher maternal age; and higher PFBA and higher maternal BMI. Finally, we observed associations between nutrition source at 4 months and DBS PFBA and PFHxS, with formula- or mixed-fed infants having higher concentrations compared to exclusively breastfed infants. This study represents the first characterization of PFAS contamination in Samoa. Additional work in larger samples is needed to identify potentially modifiable determinants of PFAS concentrations, information that is critical for informing environmental and health policy measures.
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Affiliation(s)
- Lacey W Heinsberg
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Shan Niu
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Kendall J Arslanian
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
| | - Ruiwen Chen
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Megha Bedi
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Folla Unasa-Apelu
- Obesity, Lifestyle and Genetic Adaptations Study Group, Apia, Samoa.
| | | | | | - Yvette P Conley
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Daniel E Weeks
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Carla A Ng
- Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, USA.
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Baffsky R, Koshiba C, Muna EL, Maua RF, Ivers R, Peden AE. Assessing violence and injury prevention plans, strategies and indicators in eighteen Pacific Islands countries: an environmental scan. Lancet Reg Health West Pac 2024; 44:100985. [PMID: 38226330 PMCID: PMC10788529 DOI: 10.1016/j.lanwpc.2023.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/17/2024]
Abstract
Background Similar to many other resource poor settings, due to competing priorities, injury is often neglected in the Pacific Islands despite being a prevalent cause of death and disability. This study identifies, and synthesises existing plans and strategies, and assesses progress against indicators for the prevention of violence and injury in 18 Pacific Islands nations to identify gaps and highlight opportunities. Methods An environmental scan of known government repositories and Google Advanced was conducted to identify publicly available documents describing/evaluating national-level injury prevention strategies and plans in the Pacific Islands. Data were extracted on the strategy/plan, country, government department responsible, indicators and related progress. Findings We identified 44 relevant documents. Most were published in more resourced countries (e.g., Fiji, Cook Islands) and described strategies/plans relating to traffic injury, injury from natural disaster and/or intimate partner violence. No strategies/plans to prevent injury mechanisms of drowning, falls, suffocation, burns, or electrocution were identified. Progress against only one indicator was reported for road traffic injury in the Commonwealth of the Northern Mariana Islands. Interpretation This study suggests that there would be benefit in Pacific Islands nations to develop more robust data systems to assess progress against indicators of existing strategies and plans for traffic-injury, natural disaster and intimate partner violence. Development of strategies and implementation plans to address neglected injury areas such as drowning and falls which account for a significant burden of injury in the Pacific Islands is also recommended. Funding This work was funded by the World Health Organization Regional Office for the Western Pacific (RG 221962).
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Affiliation(s)
- Rachel Baffsky
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | - Candace Koshiba
- Prevention Unit, Division of Behavioural Health, Ministry of Health and Health Services, Palau
| | - Esther L. Muna
- Commonwealth Healthcare Corporation, Saipan, MP, Northern Mariana Islands
| | | | - Rebecca Ivers
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
| | - Amy E. Peden
- School of Population Health, UNSW Sydney, Samuels Building, F25, Samuel Terry Ave, Kensington, NSW, Australia
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Kharwadkar S, Herath N. Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2521. [PMID: 38340071 DOI: 10.1002/rmv.2521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Dengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, haemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalisation and mortality rates in dengue were 9.90% (95% CI 7.67-12.37) and 0.23% (95% CI 0.16-0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72-3.63) of reported cases and 23.23% (95% CI 13.58-34.53) of hospitalised patients. Complications associated with Zika virus included Guillain-Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71-16.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30-4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06-2.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreaks.
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Affiliation(s)
- Sahil Kharwadkar
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nipun Herath
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Roland HB. External vulnerability, local resilience, and urban-rural heterogeneity in the Marshall Islands. Environ Sci Policy 2024; 152:103643. [PMID: 38390316 PMCID: PMC10883475 DOI: 10.1016/j.envsci.2023.103643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Popular media often positions the Marshall Islands as especially vulnerable to environmental shocks and shifts. This framing overlooks sources of vulnerability, local resilience, and within country differences. To better understand relationships between social, economic, and cultural shifts and vulnerability and resilience in the Marshall Islands, this study draws on interviews with internal migrants and members of government and civil society to investigate perceptions of vulnerability and resilience in outer islands and Majuro. Findings reveal sharp perceived differences. Participants largely tied vulnerability on outer islands to increasingly variable environmental conditions affecting natural resource-dependent livelihoods and vulnerability on Majuro to the cash economy. In both urban core and rural outer islands, participants linked vulnerability to interdependencies far beyond the Marshall Islands. By evaluating historical and external influences and spatial heterogeneity, this study supports a nuanced understanding of vulnerability and resilience within archipelagic countries critical to policy development.
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Affiliation(s)
- Hugh B Roland
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 220 Ryals Public Health Building, 1665 University Blvd, Birmingham, AL 35233, United States
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Kuek T. Type 2 Diabetes Prevalence, Control and Management within Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A Scoping Review with a Systematic Approach. Curr Diabetes Rev 2024; 20:CDR-EPUB-137615. [PMID: 38258764 DOI: 10.2174/0115733998260306231025151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.
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Affiliation(s)
- Timothy Kuek
- Interplast Australia and New Zealand, 250/290 Spring St, East Melbourne VIC, 3002, Australia
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Phillips G, Kendino M, Brolan CE, Herron LM, Kὃrver S, Motofaga S, Cox M. Women on the frontline: exploring the gendered experience for Pacific healthcare workers during the COVID-19 pandemic. Lancet Reg Health West Pac 2024; 42:100961. [PMID: 38022711 PMCID: PMC10658397 DOI: 10.1016/j.lanwpc.2023.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/24/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
Background Women comprise 90% of patient-facing global healthcare workers (HCWs), yet remain underpaid, undervalued, and under-represented in leadership and decision-making positions, particularly across the Pacific region. The COVID-19 pandemic has exacerbated these health workplace inequalities. We sought to understand Pacific women HCWs experience from the COVID-19 frontline to contribute to policies aimed at addressing gendered gaps in regional health systems. Methods Our interpretative phenomenological study used critical feminist and social theory, and a gendered health systems analytical framework. Data were collected using online focus groups and in-depth interviews with 36 Pacific regional participants between March 2020 and July 2021. Gender-specific content and women's voices were privileged for inductive analysis by Pacific and Australian women researchers with COVID-19 frontline lived experience. Findings Pacific women HCWs have authority and responsibility resulting from their familial, biological, and cultural status, but are often subordinate to men. They were emancipatory leaders during COVID-19, and as HCWs demonstrated compassion, situational awareness, and concern for staff welfare. Pacific women HCWs also faced ethical challenges to prioritise family or work responsibilities, safely negotiate childbearing, and maintain economic security. Interpretation Despite enhanced gendered power differentials during COVID-19, Pacific women HCWs used their symbolic capital to positively influence health system performance. Gender-transformative policies are urgently required to address disproportionate clinical and community care burdens and to protect and support the Pacific female health workforce. Funding Epidemic Ethics/World Health Organization (WHO), Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.
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Affiliation(s)
- Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | - Claire E. Brolan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Kὃrver
- TB Elimination, and Implementation Science, Burnet Institute, Papua New Guinea and Australia
| | - Silina Motofaga
- Clinical Services Program, Public Health Division, Pacific Community, Suva, Fiji
| | - Megan Cox
- Faculty of Medicine and Health, The University of Sydney, Australia
- The Sutherland Hospital, NSW, Australia
- NSW Ambulance, Sydney, Australia
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Burry K, Beek K, Worth H, Vallely L, Haire B. Framings of abortion in Pacific Island print media: qualitative analysis of articles, opinion pieces, and letters to the editor. Sex Reprod Health Matters 2023; 31:2228113. [PMID: 37436430 DOI: 10.1080/26410397.2023.2228113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Abortion is significantly restricted by law in most Pacific Island countries, and this has profound implications for the lives and health of women from this region. There are limited data on how abortion is framed in the Pacific Islands: that is, interpreted, discussed, and made meaningful as an issue in public forums. How abortion is framed can have implications for how it is treated in public and political debate and policy, abortion stigmatisation, and inform advocacy strategies. We undertook a thematic analysis of 246 articles, opinion pieces, and letters to the editor that covered the topic of abortion in mainstream print media. We found three dominant framings. Abortion was often positioned in opposition to gender ideology and national identity, with gender and national identity constructed by many commentators according to socially conservative, Christian doctrine. Abortion was also constructed as the killing of the "unborn," with the fetus positioned as the key social subject. Alternatively, abortion was framed as often unsafe and a response to teenage pregnancy, with various solutions suggested in this context. Few commentators constructed women who experienced unwanted pregnancies and abortions as making decisions about their pregnancies in response to complex gendered and socio-economic conditions. Dominant framings of abortion as opposed to gender ideals, nationalism, and the killing of the "unborn" complicate simplified appeals to "choice" in advocacy efforts. Focusing on health and broader injustice experienced by women offer alternative framings.
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Affiliation(s)
- Kate Burry
- PhD Candidate, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kristen Beek
- Lecturer, School of Population Health, University of New South Wales, Sydney, Australia
| | - Heather Worth
- Director, Te Puna Vai Marama, University of the South Pacific, Rarotonga, Cook Islands
| | - Lisa Vallely
- Senior Research Fellow, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Bridget Haire
- Senior Research Fellow, The Kirby Institute, University of New South Wales, Sydney, Australia
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Dela Cruz R, Novotny R, Wilkens LR, Shvetsov YB, Yamanaka A, Butel J, Aflague TF, Coleman P, Shallcross L, Fleming T, Deenik J, Lee R. Mapa V, Boushey CJ. Diet Quality of Young Children in the US-Affiliated Pacific's Children's Healthy Living (CHL) Program. J Acad Nutr Diet 2023; 123:1781-1792. [PMID: 37562772 PMCID: PMC10840861 DOI: 10.1016/j.jand.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/16/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Childhood diet can impact health outcomes over the life course. Few studies have assessed dietary quality among infants and children in the US-Affiliated Pacific (USAP) region. OBJECTIVE The aim of this study was to examine the differences in diet quality among Pacific children in the Children's Healthy Living (CHL) program by Pacific jurisdiction and by their World Bank Income Group (WBIG) level. DESIGN This cross-sectional study used dietary records collected from 2012 to 2015. PARTICIPANTS/SETTING Data were collected on 2- to 8-year-old children (n = 3,529) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, conducted in the USAP jurisdictions of Alaska, Hawai'i, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM islands include Chuuk, Kosrae, Pohnpei, Yap), Republic of the Marshall Islands (RMI), and Republic of Palau. MAIN OUTCOME MEASURE Diet quality was assessed using the Healthy Eating Index-2005 (HEI-2005). This HEI version was commensurate with the time of dietary data collection for the CHL project and previous studies, thus allowing cross-study comparisons. STATISTICAL ANALYSIS PERFORMED Means of total HEI-2005 scores between jurisdictions and their WBIG level were compared using linear models, with and without adjustment for age, sex, and dietary energy. RESULTS Differences in mean HEI-2005 scores among children were found between jurisdictions and their WBIG level. Alaska had the highest adjusted mean score (63.3). RMI had the lowest adjusted mean score (50.1). By WBIG, lower-middle income jurisdictions had the lowest adjusted mean HEI-2005 score (56.0), whereas high income jurisdictions had the highest adjusted mean HEI-2005 score (60.5). CONCLUSIONS Variation in children's diet quality was found between USAP jurisdictions, notably between jurisdictions of different WBIG levels. Future research is needed to deepen understanding of these differences in diet quality by WBIG level, such as whether differences may be attributable to the jurisdictions' varying food systems, and possibly explained by the nutrition transition. Understanding childhood diet quality in this region can inform approaches for nutrition programs in the Pacific region.
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Affiliation(s)
| | | | - Lynne R. Wilkens
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
| | - Yurii B. Shvetsov
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
| | | | - Jean Butel
- University of Hawai’i at Mānoa, Honolulu, HI
| | | | | | | | - Travis Fleming
- American Samoa Community College, Pago Pago, American Samoa
| | | | | | - Carol J. Boushey
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
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Kaspar A, Newall J, Pifeleti S, Hunkin G. High Levels of Satisfaction Among Hearing Aid Users in a Pilot Study for Sustainable Low-Cost Auditory Rehabilitation Services in Samoa. Health Serv Insights 2023; 16:11786329231212122. [PMID: 38028121 PMCID: PMC10655641 DOI: 10.1177/11786329231212122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
The provision of locally sustainable hearing aid device services is desirable in the Pacific Islands. The aim of the present study was (1) To assess the suitability of low-cost pre-programmable hearing aids in Samoa, a Polynesian nation of the Pacific Islands, and (2) To develop translations of established auditory rehabilitation questionnaires into the FaaSamoan language for clinical, public health, and research applications. A cross-over trial of 2 low-cost pre-programmable hearing aids among 20 adults in Samoa was conducted as part of a larger UN-funded global audiology study. The International Outcome Inventory for Hearing Aids, the International Outcome Inventory for Hearing Aids for Significant Others, and the Revised Hearing Handicap Inventory questionnaires were translated into the FaaSamoan language to assess the self-reported outcomes of study participants. Overall, high scores were measured for the self-reported outcome measures, suggesting good levels of use and satisfaction with the hearing aid devices. Overall, results found that once a hearing aid was fitted that 67.6% of participants reported no hearing handicap, 32.4% reported a mild to moderate hearing handicap, and no participant reported a significant hearing handicap.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Moto’otua, Samoa
| | - John Newall
- Linguistics Department, Macquarie University, Sydney, NSW, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Moto’otua, Samoa
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Chen TX, Hamachi A, Soon R, Natavio M. Roots, Leaves, and Flowers: A Narrative Review of Herbs and Botanicals Used for Self-Managed Abortion in Asia and the Pacific. J Midwifery Womens Health 2023; 68:710-718. [PMID: 37668006 DOI: 10.1111/jmwh.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Abortion has existed throughout history, often outside of formal health care systems. This type of care, now called self-managed abortion, has historically been achieved in part through botanicals and traditional medicines. Their use continues into the modern day, especially in Asia, Hawai'i, and other Pacific Islands, where indigenous medicine traditions practice alongside allopathic medicine. Many of these botanicals, such as papaya leaves, hibiscus flowers, and young kī, and traditional medicines, such as tianhuafen, yuanhua, and Shenghua Decoction, have undergone scientific and clinical investigation of their potential abortifacient and antifertility action. The incidence of self-managed abortion with such abortifacients in countries with severe abortion restrictions are only estimates, leading to the possibility that legal rulings and societal pressures may cause underreporting. The Asian American, Native Hawaiian, and Pacific Islander communities in the United States also suffer from a lack of abortion access in addition to unique health disparities and barriers to reproductive health care. As difficulties in abortion access increases due to the Supreme Court decision in Dobbs v. Jackson Women's Health Organization, some may seek or even prefer self-managed abortion through traditional methods that have been passed down in their communities. Midwives and other health care providers may then be contacted during this process. This narrative review provides an overview of the literature on the use of botanicals, herbs, and traditional medicines used for self-managed abortion, specifically in Asia, Hawai‧i, and other Pacific Islands. Their implications for practice for providers in the United States and further opportunities for research are also presented.
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Affiliation(s)
- Tracy X Chen
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - April Hamachi
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Reni Soon
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Melissa Natavio
- Division of Complex Family Planning, Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Li Y, Li H, Jiang Y. Analysis of the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. BMC Public Health 2023; 23:2064. [PMID: 37865756 PMCID: PMC10590040 DOI: 10.1186/s12889-023-16894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Communicable diseases contribute substantially to morbidity and death rates worldwide, particularly in low-and middle-income countries. Pacific Island countries face unique challenges in addressing these diseases due to their remote locations and limited resources. Understanding the burden and trends of these diseases in this region is crucial for developing effective public health interventions. OBJECTIVE This study aimed to analyze the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. METHODS We utilized data from the 2019 Global Burden of Disease (GBD) study to analyze indicators including incidence, death, and disability-adjusted life years (DALYs). Excel 2016, R 4.2.1, and GraphPad Prism 9 were used to analyze and visualize the data. Joinpoint regression models were used for trend analysis, and the average annual percent change (AAPC) was calculated. RESULTS From 1990 to 2019, the standardized incidence rate of communicable diseases in Pacific Island countries showed an upward trend (AAPC = 0.198%, 95% CI = 0.0174 ~ 0.221), while the standardized death rate (AAPC = -1.098%, 95% CI = -1.34 ~ 0.86) and standardized DALY rate (AAPC = -1.008%, 95% CI = -1.187 ~ -0.828) showed downward trends. In 2019, the standardized incidence, death, and DALY rates of communicable diseases were higher among males than among females, but the standardized death and DALY rates among males decreased faster than those among females from 1990 to 2019. There were significant differences in the disease burden among different Pacific Island countries. The Solomon Islands had the highest standardized death rate (363.73/100,000), and Guam had the lowest (50.42/100,000). Papua New Guinea had the highest standardized DALY rate (16,041.14/100,000), and the Cook Islands had the lowest (2,740.13/100,000). In 2019, the main attributable risk factors for communicable disease deaths in Pacific Island countries were child and maternal malnutrition (28.32%), followed by unsafe water, sanitation, and handwashing (27.14%), air pollution (16.11%), and unsafe sex (14.96%). There were considerable geographical variations in risk factors. CONCLUSION The burden of communicable diseases in Pacific Island countries remains high, despite improvements in mortality and disability-adjusted life-year rates over the past few decades. This study provides valuable insights into the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. The findings reveal several important insights and highlight the need for targeted public health interventions in the region.
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Affiliation(s)
- Yan Li
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Hao Li
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- School of Public Health, Chongqing Medical University, Chongqing, China.
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12
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Kaspar A, Swanepoel DW, Pifeleti S. The PEN Fa'aSamoa Initiative: An Integrated Platform for Hearing and Vision Screening in Samoa. Glob Pediatr Health 2023; 10:2333794X231203504. [PMID: 37822475 PMCID: PMC10563456 DOI: 10.1177/2333794x231203504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Annette Kaspar
- Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
- Ministry of Education, Sports, and Culture, Apia, Samoa
| | | | - Sione Pifeleti
- Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
- Ministry of Education, Sports, and Culture, Apia, Samoa
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13
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Iusitini L, Tautolo ES, Plank LD, Rush E. Pacific Islands Families Study: Household Food Security during Pregnancy and Secondary School Educational Achievement. Nutrients 2023; 15:4131. [PMID: 37836415 PMCID: PMC10574222 DOI: 10.3390/nu15194131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between nutrition in early life and academic achievement in adolescence. The birth cohort of the Pacific Islands Families (PIF) study was born in the year 2000. When their child was six weeks old, mothers were asked questions concerning food security over the past year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). In 2020, records of academic achievement from the National Certificate of Educational Achievement (NCEA) for 649 (317 female, 332 male) cohort members showed progressive achievement at levels 1, 2, and 3 of NCEA and allowed University Entrance (UE) to be assessed. The prevalence of food insecurity was not different for sex but high at 29% and 42% using the PIF and MOH definitions of food insecurity, respectively. More females (27%) than males (18%) achieved UE as their highest qualification, and more males (40%) than females (31%) achieved NCEA levels 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food-secure households and 17% from food-insecure households. Logistic regression demonstrated that the odds of achieving UE were 1.8-fold (95% CI 1.2, 2.6, p = 0.003) higher in females than males and, independently, 1.6-fold (95% CI 1.1, 2.5 p = 0.026) higher if the household was food secure. This work emphasises the importance of maternal and early-life food security for subsequent academic achievement and the well-being of future generations.
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Affiliation(s)
- Leon Iusitini
- New Zealand Work Research Institute, Faculty of Business, Economics and Law, Auckland University of Technology, Auckland 1142, New Zealand;
| | - El-Shadan Tautolo
- School of Public Health & Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand;
| | - Lindsay D. Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand;
| | - Elaine Rush
- School of Sport and Recreation, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand
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14
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Craig AT, Leong RNF, Donoghoe MW, Muscatello D, Mojica VJC, Octavo CJM. Comparison of statistical methods for the early detection of disease outbreaks in small population settings. IJID Reg 2023; 8:157-163. [PMID: 37694222 PMCID: PMC10482728 DOI: 10.1016/j.ijregi.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023]
Abstract
Objectives This study examines the performance of 6 aberration detection algorithms for the early detection of disease outbreaks in small population settings using syndrome-based early warning surveillance data collected by the Pacific Syndromic Surveillance System (PSSS). Although previous studies have proposed statistical methods for detecting aberrations in larger datasets, there is limited knowledge about how these perform in the presence of small numbers of background cases. Methods To address this gap a simulation model was developed to test and compare the performance of the 6 algorithms in detecting outbreaks of different magnitudes, durations, and case distributions. Results The study found that while the Early Aberration Reporting System-C1 algorithm developed by Hutwagner et al. outperformed others, no single approach provided reliable monitoring across all outbreak types. Furthermore, aberration detection approaches could only detect very large and acute outbreaks with any reliability. Conclusion The findings of this study suggest that algorithm-based approaches to outbreak signal detection perform poorly when applied to settings with small numbers of background cases and should not be relied upon in these contexts. This highlights the need for alternative approaches for accurate and timely outbreak detection in small population settings, particularly those that are resource-constrained.
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Affiliation(s)
- Adam T. Craig
- School of Public Health, The University of Queensland, Herston, Australia
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Robert Neil F. Leong
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Mark W. Donoghoe
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Kensington, Australia
| | - David Muscatello
- School of Population Health, University of New South Wales, Sydney, Kensington, Australia
| | - Vio Jianu C. Mojica
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, Philippines
| | - Christine Joy M. Octavo
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, Philippines
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15
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Earl E, Johnson F, Marshall L, Sanderson D. A critical review of Natural Flood Management application and spatial prioritisation approaches in tropical island catchments. Sci Total Environ 2023; 878:162776. [PMID: 36931514 DOI: 10.1016/j.scitotenv.2023.162776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 05/13/2023]
Abstract
Tropical island communities face substantial hydrometrological threats, including flood inundation. Flood risk is increasing, driven by climate change but also other factors including urbanisation, land-cover and land-use (LCLU) change, making flood management challenging to address in practice. Protecting, restoring, and emulating the natural functions of catchments to reduce flood risk, also known as Natural Flood Management (NFM), is a promising method for improving flood management. Global NFM research is in its infancy and NFM research in tropical island states has tended to focus on individual catchment projects. Therefore, overall trends, challenges, and opportunities for NFM in tropical island catchments are poorly understood and, until now, have not been reviewed across these geographies. A particular gap in NFM understanding in tropical island catchments is how NFM options can be best implemented within any particular catchment - specifically where NFM should be located, how modelling can support these decisions and the influence of different catchment characteristics on these decisions. This literature review aims to explore what, where and how NFM has been used in catchments in tropical island states, with a specific focus on catchment characteristics and spatial modelling. This paper draws on research and interconnections between multiple environmental science spheres, by reviewing both academic and grey literature to better understand how NFM has been applied in tropical island states, with a primary focus on Pacific Island Countries and Territories (PICTs). The research highlights that some islands have greater potential for exploiting NFM due to their physical catchment characteristics and data availability. NFM spatial modelling approaches need to be further developed and adapted to specific tropical island community requirements to improve inland flood resilience at the pace needed and to ensure resources are directed optimally.
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Affiliation(s)
- Eleanor Earl
- Water Research Centre, School of Civil Environmental Engineering, The University of New South Wales, High Street Kensington, Sydney, NSW 2052 Australia.
| | - Fiona Johnson
- Water Research Centre, School of Civil Environmental Engineering, The University of New South Wales, High Street Kensington, Sydney, NSW 2052 Australia.
| | - Lucy Marshall
- Water Research Centre, School of Civil Environmental Engineering, The University of New South Wales, High Street Kensington, Sydney, NSW 2052 Australia; Faculty of Science and Engineering, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia.
| | - David Sanderson
- School of Built Environment, Faculty of Arts, Design & Architecture, University of New South Wales, Sydney 2052, NSW, Australia.
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16
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Martin E, Snowdon W, Moadsiri A, Volavola S, Bell C. Pacific Healthy Islands Vision: success factors and challenges faced by health promotion programs. Health Promot Int 2023; 38:daac002. [PMID: 35700446 PMCID: PMC10269115 DOI: 10.1093/heapro/daac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization's (WHO) Western Pacific Regional Office developed the biennial Healthy Islands Recognition Awards (HIA) in 2009 to reinforce the Healthy Islands vision and encourage countries to continue to innovate and demonstrate effective and efficient ways of promoting and protecting population health. This research aimed to identify characteristics of and challenges for successful health promotion in the Pacific. The research was undertaken to develop practical guidance for other groups in the Pacific Islands interested in supporting Healthy Islands. We used a qualitative case study to review 2013 and 2015 HIA awardees from eight Pacific Island countries and territories using a set of questions drawn from the HIA application criteria. In 2015-2016, 35 key informant interviews and a review of program documents were undertaken. This was followed by a workshop with representatives from three HIA awardees to further develop recommendations. We reviewed eight programs targeting healthy eating, physical activity, healthy settings and sanitation. Using evidence, careful planning, building capacity, developing partnerships, strengthening and reorientating networks, ensuring accountability and conducting evaluation were keys to the success of healthy islands projects. Considering the local setting and community was perhaps the most crucial theme amongst the programs examined. Challenges included funding and capacity constraints, maintaining commitment and prioritisation, maintaining communication and coordination and technical challenges. Success factors, challenges and recommendations aligned well with mainstream health promotion literature, although some important distinctions exist. Further research is needed to guide successful health promotion practice in the Pacific.
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Affiliation(s)
- Erik Martin
- School of Medicine, Deakin University, Geelong, Australia
| | - Wendy Snowdon
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Ada Moadsiri
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Saula Volavola
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Colin Bell
- School of Medicine, Deakin University, Geelong, Australia
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17
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Leong-Nowell TA, Tamani L, Kaspar A. Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa. Int J Emerg Med 2023; 16:32. [PMID: 37158839 PMCID: PMC10165277 DOI: 10.1186/s12245-023-00512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Access block and overcrowding are known to adversely impact on patient outcomes, service delivery, and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or overcrowding from the Pacific Islands. The aim of the present study is to provide preliminary data on access block and overcrowding in the ED of the national tertiary hospital of Samoa. METHODS Mixed methods study design. Data collection was performed in March 2020. The quantitative strand calculated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access block and overcrowding with ED medical and nursing staff members. RESULTS On the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20 patients who were admitted into ED, 80% were triaged as 'see without delay' (CAT1), 'emergency' (CAT2) or 'urgent' (CAT3). For patients requiring admission to hospital wards, 100% waited 4 + h in ED, and 100% waited 8 + h, suggesting the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staff focus groups and individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards ED staff members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recommendations to improve patient flow through the ED, i.e., improved collaboration between ED, outpatient services, and the hospital wards. CONCLUSIONS Preliminary evidence suggested the presence of access block and overcrowding in the ED of the national tertiary hospital of Samoa. ED staff interviews provided insight into the ED frontline challenges and offered practical recommendations for ED health service improvement.
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Affiliation(s)
- Tamara Ah Leong-Nowell
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
- Samoa Medical Association, Apia, Samoa
| | - Ledua Tamani
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
| | - Annette Kaspar
- Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa.
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18
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Horne JB, Frey A, Gaos AR, Martin S, Dutton PH. Non-random mating within an Island rookery of Hawaiian hawksbill turtles: demographic discontinuity at a small coastline scale. R Soc Open Sci 2023; 10:221547. [PMID: 37206959 PMCID: PMC10189603 DOI: 10.1098/rsos.221547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023]
Abstract
Hawksbill sea turtles (Eretmochelys imbricata) from the Hawaiian archipelago form a small and genetically isolated population, consisting of only a few tens of individuals breeding annually. Most females nest on the island of Hawai'i, but little is known about the demographics of this rookery. This study used genetic relatedness, inferred from 135 microhaplotype markers, to determine breeding sex-ratios, estimate female nesting frequency and assess relationships between individuals nesting on different beaches. Samples were collected during the 2017 nesting season and final data included 13 nesting females and 1002 unhatched embryos, salvaged from 41 nests, of which 13 had no observed mother. Results show that most females used a single nesting beach laying 1-5 nests each. From female and offspring alleles, the paternal genotypes of 12 breeding males were reconstructed and many showed high relatedness to their mates. Pairwise relatedness of offspring revealed one instance of polygyny but otherwise suggested a 1 : 1 breeding-sex ratio. Relatedness analysis and spatial-autocorrelation of genotypes indicate that turtles from different nesting areas do not regularly interbreed, suggesting that strong natal homing tendencies in both sexes result in non-random mating across the study area. Complexes of nearby nesting beaches also showed unique patterns of inbreeding across loci, further indicating that Hawaiian hawksbill turtles have demographically discontinuous nesting populations separated by only tens of km.
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Affiliation(s)
- John B. Horne
- Southwest Fisheries Science Center, NOAA-Fisheries, La Jolla, CA, USA
| | - Amy Frey
- Southwest Fisheries Science Center, NOAA-Fisheries, La Jolla, CA, USA
| | - Alexander R. Gaos
- Pacific Islands Fisheries Science Center, NOAA-Fisheries, Honolulu, HI, USA
| | - Summer Martin
- Pacific Islands Fisheries Science Center, NOAA-Fisheries, Honolulu, HI, USA
| | - Peter H. Dutton
- Southwest Fisheries Science Center, NOAA-Fisheries, La Jolla, CA, USA
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19
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Langridge FC, 'Ofanoa M, Hamm L, Fakakovikaetau T, Wilkinson-Meyers L, Percival T, Grant CC. Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands. J Paediatr Child Health 2023. [PMID: 37126435 DOI: 10.1111/jpc.16417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
Globally, the child health focus has been on reducing under-5-year mortality, with large populations in low-resource regions prioritised. Children in older age groups, particularly in less populated regions such as the Pacific, have received limited attention. Child health research in the Pacific region has been lacking, and research approaches for the region have historically been from Western biomedical paradigms. We completed the study of primary school children's health over a period of 5 years. Firstly, we conducted a literature review, then we completed an audit of hospital admissions of primary school children, then we completed a two-round Delphi process and finally, we piloted the survey in three primary schools. Our results found there were high levels of oral health problems, ear health, obesity and exposure to violence and poverty impacting on the quality of health of primary school-age children. Identifying these indicators was made possible by the partnerships and trust established by the study team and provides specific and measurable targets for future work to improve the quality of child health outcomes. This paper describes key field work lessons learnt for research in the Pacific region. It must: (i) be on the platform of relationship, cultural safety and local ownership; (ii) include consideration of holistic Pacific paradigms of health; (iii) be adaptive to the context and environment; and (iv) be committed to long-term partnership and work.
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Affiliation(s)
- Fiona C Langridge
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Malakai 'Ofanoa
- Department of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | | | | | - Teuila Percival
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Cameron C Grant
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
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20
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Kaspar A, Figao F, Driscoll C, Pifeleti S. Knowledge and attitudes of female caregivers in Samoa to childhood hearing loss and hearing services. Int J Pediatr Otorhinolaryngol 2023; 169:111557. [PMID: 37088037 DOI: 10.1016/j.ijporl.2023.111557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES To assess the knowledge and attitudes of 150 female caregivers in Samoa to childhood hearing loss and hearing services, and to compare findings between urban (n = 100) and rural-dwelling (n = 50) caregivers. METHODS A semi-structured interview using a 26-item questionnaire was administered to participants in the Samoan language. Participants were required to respond "yes", "no", or "unsure". RESULTS Highest awareness of aetiology of childhood hearing loss was found for otitis media (88.7%), followed by noise exposure (64.7%) and family history (38%). Highest awareness of public health measures that may prevent/reduce otitis media was found for routine childhood immunizations (74.7%) and breast-feeding for first 6 months of life (69.3%). Overall, 40% of Samoan caregivers agreed that curses may cause childhood hearing loss. There was overwhelming support for community-based hearing services for newborns/infants (98%) and school students (97.3%). CONCLUSIONS There is positive support for community-based hearing health services for children among female caregivers of Samoa. There was high awareness of otitis media as a major cause of childhood hearing loss, as well as good knowledge of public health measures that reduce/minimise the risk of otitis media.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa; Hearing Research Unit for Children, University of Queensland, Brisbane, Australia.
| | - Ferila Figao
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
| | - Carlie Driscoll
- Hearing Research Unit for Children, University of Queensland, Brisbane, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
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21
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Hingle M, Short E, Aflague T, Boushey C, Butel J, Coleman P, Deenik J, Fleming T, Olfert M, Shallcross L, Wilkens LR, Novotny R. Food Security is Associated with Higher Diet Quality Among Children of the US-Affiliated Pacific Region. J Nutr 2023; 153:848-856. [PMID: 36775673 DOI: 10.1016/j.tjnut.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The prevalence of food insecurity and its relationship to diet quality are factors impacting the health of persons living across the United States-affiliated Pacific region (USAP). OBJECTIVES The aim of this study was to describe characterize the relationship between household food security status and diet quality of 2- to 8-y-old children across jurisdictions in the USAP. METHODS Baseline data from 2- to 8-y-olds (n = 3099) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, an obesity prevention study conducted in communities across Alaska, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, and Hawaii, and a concomitant prevalence study in communities across the Freely Associated States (FAS) (the Federated States of Micronesia: Kosrae, Pohnpei, Chuuk, Yap; Republic of Marshall Islands; Republic of Palau) were collected in 2012. Caregivers self-reported sociodemographic data and food insecurity. Assisted by their caregiver, children completed two dietary records on nonconsecutive, randomly assigned days. The Healthy Eating Index 2005 (HEI-2005) was used to assess the diet quality. Data were summarized overall and by jurisdiction. Differences in HEI-2005 and HEI component scores among jurisdictions and by household food security status were tested using 1-factor ANOVA. RESULTS Half or more of participants from American Samoa, Guam, CNMI, and FAS reported household food insecurity (n = 295, 59.7%; n = 292, 49.9%; n = 267, 54.6%; n = 572, 69.0%, respectively). HEI-2005 scores varied by jurisdiction (P < 0.001) and were significantly lower among FAS participants (54.7 ± 1.2) than among all other jurisdictions (P < 0.05). Total diet quality scores did not differ by food security status (59.9 ± 0.8 food secure compared with 58.3 ± 1.1 food insecure, P = 0.07); however, most diet quality adequacy component scores were significantly higher and moderation component scores significantly lower among participants in food secure households than those in food insecure households. CONCLUSIONS Significant differences in children's diet quality and household food security existed across USAP jurisdictions.
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Affiliation(s)
- Melanie Hingle
- School of Nutritional Sciences and Wellness, College of Agriculture and Life Sciences, The University of Arizona, Tucson, Arizona, USA.
| | - Eliza Short
- School of Nutritional Sciences and Wellness, College of Agriculture and Life Sciences, The University of Arizona, Tucson, Arizona, USA
| | - Tanisha Aflague
- Cooperative Extension and Outreach, University of Guam, Mangilao, Guam
| | - Carol Boushey
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA; Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawaii, USA
| | - Jean Butel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Patricia Coleman
- Nutrition and Health Programs, Northern Marianas College, Saipan, Northern Mariana Islands
| | - Jonathan Deenik
- Department of Tropical Plant and Soil Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Travis Fleming
- Community and Natural Resources Division (Land Grant Program), American Samoa Community College, Pago Pago, American Samoa
| | - Melissa Olfert
- Department of Human Nutrition and Foods, West Virginia University, Morgantown, West Virginia, USA
| | - Leslie Shallcross
- Health, Home and Family Development, Institute of Agriculture, Natural Resources and Extension, University of Alaska, Fairbanks, Alaska, USA
| | - Lynne R Wilkens
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA; Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawaii, USA
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
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22
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Pineda E, Benavente R, Gimmen MY, DeVille NV, Taparra K. Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region. Cancers (Basel) 2023; 15. [PMID: 36900185 DOI: 10.3390/cancers15051392] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.
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Kaspar A, Samuelu-Matthes M, Driscoll C, Pifeleti S. Awareness and Perceptions of University Nursing Students in Samoa Towards Childhood Hearing Impairment and Hearing Healthcare: A Cross-Sectional Study. SAGE Open Nurs 2023; 9:23779608231216163. [PMID: 38020322 PMCID: PMC10666687 DOI: 10.1177/23779608231216163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Pacific Islands have among the highest prevalence of pediatric hearing impairment in the world. Given the limited availability of ear and hearing specialists in the Pacific region, the broader health professional community plays a vital role in the prevention of avoidable pediatric hearing impairment. Nurses emerge as one of the ideal candidates for task-sharing in the administration of ear and hearing care at the public and primary healthcare levels. Objectives The aim of this study is to evaluate the awareness and perceptions of university nursing students in Samoa to pediatric hearing impairment and hearing healthcare. Methods This study employed a cross-sectional study design. A 10-item questionnaire was administered to university nursing students in Samoa (N = 100). The statements aimed to evaluate perceptions towards childhood hearing impairment, as well as awareness of causal factors of permanent childhood hearing loss and available hearing healthcare. Participants were required to provide a response based on the five-point Likert scale "Strongly Agree," "Agree," "Neutral/Don't know," "Disagree," and "Strongly Disagree." Results Overall, 79% of participants responded "Disagree/Strongly Disagree" to the item "Hearing loss is not that important because it does not kill." Overall, 52% of respondents were aware of hearing impairment as a public health concern in Samoa. Early identification and intervention services for newborns with hearing impairment are nonexistent in Samoa, and awareness was low for the importance of early detection (62%) and amplification suitability for babies (49%). Overall, awareness was also low for causal factors of permanent sensorineural hearing loss. Conclusions A borderline neutral/positive perception was found among our future nursing professionals to engage with pediatric hearing impairment in Samoa. Awareness regarding the causes of permanent childhood hearing impairment, as well as early identification and intervention services, could be integrated in the university curriculum.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
- Hearing Research Unit for Children, University of Queensland, Brisbane, Australia
| | | | - Carlie Driscoll
- Hearing Research Unit for Children, University of Queensland, Brisbane, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
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Curtis SJ, Shah AW, Ratu A, Wilson DJ, Hill PC, Hulcome P, Gaylard C, Faktaufon D, Cabemaiwai T, Rabukawaqa I, Qoriniasi T, Narayan A, Nakalevu S, Romakin P, Tudravu J, Fong J, Walsh N. Rapid SARS-CoV-2 Seroprevalence Survey in Central and Western Divisions of Fiji, 2021. Emerg Infect Dis 2023; 29:226-228. [PMID: 36573643 PMCID: PMC9796197 DOI: 10.3201/eid2901.221514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During November-December 2021, we performed a SARS-CoV-2 seroprevalence survey in Central and Western Divisions of Fiji. A total of 539 participants 8-70 years of age were 95.5% (95% CI 93.4%-97.1%) seropositive, indicating high community levels of immunity. Seroprevalence studies can inform public health responses to emerging SARS-CoV-2 variants.
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25
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Young K, Bulosan H, Baksa J, Jeong Y, Buenconsejo-Lum LE, Birkeland AC. Oral Cancer Disparities in the Outer US-affiliated Pacific Islands. Laryngoscope 2022. [PMID: 36165583 PMCID: PMC10040458 DOI: 10.1002/lary.30419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS Oral cancers in the US-affiliated Pacific Islands are poorly described despite disproportionately higher incidences in certain jurisdictions. This study attempts to better characterize the incidence, staging, and management of oral cancers in this region. STUDY DESIGN Retrospective Epidemiological Study. METHODS A retrospective review was conducted across the US-affiliated Pacific Islands between 2007 and 2019. Patient data were obtained for individuals with primary head and neck cancers from the Pacific Regional Central Cancer Registry database. All cohorts were age-adjusted to the 2000 US Standard Population. Further analysis was performed on oral cavity cancers due to their clear predominance within the sample. RESULTS A total of 585 patients with primary head and neck cancers were included. The average age was 54.5 ± 12.9 years, and most patients were male (76.8%). Oral cancer subsite analysis revealed the proportional incidence of buccal mucosa was higher in 5 of 9 jurisdictions when compared with the United States (p < 0.001). Tongue and lip cancers were not found to have significantly higher incidence proportions. Patients in the Pacific Islander group were less likely to be detected at earlier stages for cancers of the cheek and other mouth (p < 0.001), tongue (p < 0.001), and lips (p < 0.001) compared with the United States. CONCLUSIONS Many Pacific Island populations are burdened with higher incidences of oral cancer with later staging. Further investigation is recommended to evaluate oral cancer-related outcomes and mortality in this region. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Kurtis Young
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Hannah Bulosan
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Janos Baksa
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Youngju Jeong
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Lee E Buenconsejo-Lum
- Department of Surgery, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, Hawai, USA
| | - Andrew C Birkeland
- Division of Otolaryngology, University of California Davis Medical Center, Sacramento, California, USA
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26
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Dela Cruz R, Wolfe E, Yonemori KM, Fialkowski MK, Wilkens LR, Coleman P, Lameko-Mua S, Johnson E, Gilmatam D, Sigrah C, Shomour M, Remengesau S, Alfred J, Acosta M, Ettienne R, Deenik J, Tanisha A, Salazar KA, Novotny R, Boushey CJ. Exploring Foods of the Pacific: Cultural Food Identity in the US Affiliated Pacific Region. Hawaii J Health Soc Welf 2022; 81:247-252. [PMID: 36118154 PMCID: PMC9460762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Indigenous peoples of the Pacific have seen major shifts in dietary patterns due to foreign colonization, which introduced an array of new foods. Today, foods considered traditional and acculturated are consumed in various extents. However, the definitions and identity of traditional versus acculturated foods has become unclear as many introduced foods have been incorporated into Pacific cultures. The purpose of this study was to capture culturally relevant definitions of traditional, acculturated, and locally grown foods among 10 jurisdictions of the US-Affiliated Pacific (USAP) region with a focus on fruits and vegetables. Questionnaires were used to capture definitions of these terms, and to identify a list of foods (n=121) as traditional, acculturated, and/or locally grown in addition to classify them into food groups (ie, fruit, vegetable, starch, and/or grain). For the most part, definitions of traditional, acculturated, and locally grown were agreed upon by participating USAP jurisdictions, with some supplementary caveats presented by different jurisdictions. More foods were identified as acculturated (n=75) than traditional (n=37). Fruits (n=55) were the most frequent designation and about a third were vegetables (n=44). The majority of the jurisdictions reported growing at least half of the food items. This is the first study to identify and classify foods of the Pacific from the perspective of those indigenous to the USAP region. Understanding these similarities and differences in how food is classified and identified, through the lens of those from the Pacific, is crucial for nutrition education, and understanding what foods are locally grown is important for future sustainability.
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Affiliation(s)
- Rica Dela Cruz
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Eric Wolfe
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Kim M. Yonemori
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Marie K. Fialkowski
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | - Lynne R. Wilkens
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Patricia Coleman
- Northern Marianas College, Saipan, Northern Mariana Islands (PC)
| | | | - Emihner Johnson
- Island Food Community of Pohnpei, Pohnpei, Federated States of Micronesia (EJ)
| | - Daisy Gilmatam
- Yap Health Services, Yap, Federated States of Micronesia (DG)
| | - Cecilia Sigrah
- Kosrae Community Health Center, Kosrae, Federated States of Micronesia (CS)
| | - Moria Shomour
- Chuuk State Division of Public Health, Federated States of Micronesia (MS)
| | | | - Julia Alfred
- Ministry of Health, Majuro, Republic of the Marshall Islands (JA)
| | | | | | - Jonathan Deenik
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | | | | | - Rachel Novotny
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | - Carol J. Boushey
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
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Reeve E, Lamichhane P, McKenzie B, Waqa G, Webster J, Snowdon W, Bell C. The tide of dietary risks for noncommunicable diseases in Pacific Islands: an analysis of population NCD surveys. BMC Public Health 2022; 22:1521. [PMID: 35948900 PMCID: PMC9364577 DOI: 10.1186/s12889-022-13808-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To describe changes over time in dietary risk factor prevalence and non-communicable disease in Pacific Island Countries (PICTs). Methods Secondary analysis of data from 21,433 adults aged 25–69, who participated in nationally representative World Health Organization STEPs surveys in 8 Pacific Island Countries and Territories between 2002 and 2019. Outcomes of interest were changes in consumption of fruit and vegetables, hypertension, overweight and obesity, and hypercholesterolaemia over time. Also, salt intake and sugar sweetened beverage consumption for those countries that measured these. Results Over time, the proportion of adults consuming less than five serves of fruit and vegetables per day decreased in five countries, notably Tonga. From the most recent surveys, average daily intake of sugary drinks was high in Kiribati (3.7 serves), Nauru (4.1) and Tokelau (4.0) and low in the Solomon Islands (0.4). Average daily salt intake was twice that recommended by WHO in Tokelau (10.1 g) and Wallis and Futuna (10.2 g). Prevalence of overweight/obesity did not change over time in most countries but increased in Fiji and Tokelau. Hypertension prevalence increased in 6 of 8 countries. The prevalence of hypercholesterolaemia decreased in the Cook Islands and Kiribati and increased in the Solomon Islands and Tokelau. Conclusions While some Pacific countries experienced reductions in diet related NCD risk factors over time, most did not. Most Pacific adults (88%) do not consume enough fruit and vegetables, 82% live with overweight or obesity, 33% live with hypertension and 40% live with hypercholesterolaemia. Population-wide approaches to promote fruit and vegetable consumption and reduce sugar, salt and fat intake need strengthening. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13808-3.
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Affiliation(s)
- Erica Reeve
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Prabhat Lamichhane
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Briar McKenzie
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Gade Waqa
- Pacific Research Centre for Prevention of Obesity and Non-Communicable Disease (C-POND), Fiji National University, Suva, Fiji
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, UNSW, 1 King St, Newtown, Sydney, Australia
| | - Wendy Snowdon
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Colin Bell
- School of Medicine, Faculty of Health, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
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28
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Ahn H. Advancing the Health and Nursing Knowledge of Asian and Pacific Islander People Through the Asian/Pacific Island Nursing Journal. Asian Pac Isl Nurs J 2022; 6:e41486. [PMID: 36648283 PMCID: PMC9969877 DOI: 10.2196/41486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 01/19/2023] Open
Affiliation(s)
- Hyochol Ahn
- College of Nursing, Florida State University, Tallahassee, FL, United States
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Phillips G, Kendino M, Brolan CE, Mitchell R, Herron LM, Kὃrver S, Sharma D, O'Reilly G, Poloniati P, Kafoa B, Cox M. Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region. Lancet Reg Health West Pac 2022; 25:100518. [PMID: 35818573 PMCID: PMC9259208 DOI: 10.1016/j.lanwpc.2022.100518] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Background Universal access to safe, effective emergency care (EC) during the COVID-19 pandemic has illustrated its centrality to healthcare systems. The 'Leadership and Governance' building block provides policy, accountability and stewardship to health systems, and is essential to determining effectiveness of pandemic response. This study aimed to explore the experience of leadership and governance during the COVID-19 pandemic from frontline clinicians and stakeholders across the Pacific region. Methods Australian and Pacific researchers collaborated to conduct this large, qualitative research project in three phases between March 2020 and July 2021. Data was gathered from 116 Pacific regional participants through online support forums, in-depth interviews and focus groups. A phenomenological approach shaped inductive and deductive data analysis, within a previously identified Pacific EC systems building block framework. Findings Politics profoundly influenced pandemic response effectiveness, even at the clinical coalface. Experienced clinicians spoke authoritatively to decision-makers; focusing on safety, quality and service duty. Rapid adaptability, past surge event experience, team-focus and systems-thinking enabled EC leadership. Transparent communication, collaboration, mutual respect and trust created unity between frontline clinicians and 'top-level' administrators. Pacific cultural assets of relationship-building and community cohesion strengthened responses. Interpretation Effective governance occurs when political, administrative and clinical actors work collaboratively in relationships characterised by trust, transparency, altruism and evidence. Trained, supported EC leadership will enhance frontline service provision, health security preparedness and future Universal Health Coverage goals. Funding Epidemic Ethics/World Health Organization (WHO), Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.
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Affiliation(s)
- Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | - Claire E. Brolan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Policy Futures, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Australia
| | - Rob Mitchell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Health, Australia
| | - Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Kὃrver
- Australasian College for Emergency Medicine, Melbourne, Australia
| | - Deepak Sharma
- Emergency Department, Colonial War Memorial Hospital, Suva, Fiji
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Health, Australia
| | | | - Berlin Kafoa
- Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Megan Cox
- Faculty of Medicine and Health, The University of Sydney, Australia
- The Sutherland Hospital, NSW, Australia
- NSW Ambulance, Sydney, Australia
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Mitchell R, O'Reilly G, Herron LM, Phillips G, Sharma D, Brolan CE, Körver S, Kendino M, Poloniati P, Kafoa B, Cox M. Lessons from the frontline: The value of emergency care processes and data to pandemic responses across the Pacific region. Lancet Reg Health West Pac 2022; 25:100515. [PMID: 35818576 PMCID: PMC9259010 DOI: 10.1016/j.lanwpc.2022.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Emergency care (EC) addresses the needs of patients with acute illness and injury, and has fulfilled a critical function during the COVID-19 pandemic. 'Processes' (e.g. triage) and 'data' (e.g. surveillance) have been nominated as essential building blocks for EC systems. This qualitative research sought to explore the impact of the pandemic on EC clinicians across the Pacific region, including the contribution of EC building blocks to effective responses. Methods The study was conducted in three phases, with data obtained from online support forums, key informant interviews and focus group discussions. There were 116 participants from more than 14 Pacific Island Countries and Territories. A phenomenological approach was adopted, incorporating inductive and deductive methods. The deductive thematic analysis utilised previously identified building blocks for Pacific EC. This paper summarises findings for the building blocks of 'processes' and 'data'. Findings Establishing triage and screening capacity, aimed at assessing urgency and transmission risk respectively, were priorities for EC clinicians. Enablers included support from senior hospital leaders, previous disaster experience and consistent guidelines. The introduction of efficient patient flow processes, such as streaming, proved valuable to emergency departments, and checklists and simulation were useful implementation strategies. Some response measures impacted negatively on non-COVID patients, and proactive approaches were required to maintain 'business as usual'. The pandemic also highlighted the value of surveillance and performance data. Interpretation Developing effective processes for triage, screening and streaming, among other areas, was critical to an effective EC response. Beyond the pandemic, strengthening processes and data management capacity will build resilience in EC systems. Funding Phases 1 and 2A of this study were part of an Epidemic Ethics/World Health Organization (WHO) initiative, supported by Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding for this research was received from the Australasian College for Emergency Medicine Foundation via an International Development Fund Grant.
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Affiliation(s)
- Rob Mitchell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - Lisa-Maree Herron
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Deepak Sharma
- Emergency Department, Colonial War Memorial Hospital, Suva, Fiji
| | - Claire E. Brolan
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Policy Futures, Faculty of Humanities and Social Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah Körver
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mangu Kendino
- Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | | | - Berlin Kafoa
- Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Megan Cox
- Faculty of Medicine and Health, The University of Sydney; NSW, Australia
- The Sutherland Hospital, NSW, Australia
- NSW Ambulance, Sydney, Australia
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Dela Cruz R, Wolfe E, Yonemori KM, Fialkowski MK, Wilkens LR, Coleman P, Lameko-Mua S, Johnson E, Gilmatam D, Sigrah C, Shomour M, Remengesau S, Alfred J, Acosta M, Ettienne R, Deenik J, Aflague TF, Nelson R, Salazar KA, Novotny R, Boushey CJ. Consumption of Traditional Fruits and Vegetables among Children in the US-Affiliated Pacific Region. Curr Dev Nutr 2022; 6:nzac101. [PMID: 35854938 PMCID: PMC9283104 DOI: 10.1093/cdn/nzac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/24/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Traditional Pacific diets have many health benefits, including maintenance of a healthy weight and prevention of various diseases. Few studies have evaluated the frequency at which traditional diets are consumed in the Pacific, especially among children. Objectives This study examined the frequency of traditional and acculturated fruit and vegetable (F&V) intake among children in the US-affiliated Pacific (USAP) region. Methods Diet records of 3319 children ages 2 to 8 y old were analyzed for frequency of traditional or acculturated F&V intake within USAP jurisdictions of American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM; FSM island states include Chuuk, Kosrae, Pohnpei, and Yap), Guam, Hawaii, Republic of the Marshall Islands (RMI), and Republic of Palau. Results Of the 95,304 food items recorded among participating children in the USAP jurisdictions, 15.2% were F&Vs. Of the 10 jurisdictions, children in the islands of Chuuk, Kosrae, Yap, and Pohnpei recorded the highest frequencies of traditional F&V intake relative to their total F&V intake (67.8%, 64.8%, 56.7%, and 52.5%, respectively). American Samoa and RMI recorded moderate frequency of traditional F&V intake (38.9% and 46.4%, respectively), whereas children in Hawaii, Guam, and CNMI recorded the lowest frequencies of traditional F&V intake relative to their total F&V intake (10.4%, 12.4%, and 15.3%, respectively). Children in Hawaii, Guam, Palau, and CNMI recorded high frequencies of acculturated F&V intake (37.8%, 31.2%, 34.5%, and 27.9%, respectively). Conclusions Overall, children in the USAP jurisdictions participating in this study recorded a low frequency of F&V intake. The differences in traditional F&V intake found between the USAP islands may be due to variation in economic income level and external influences on social and cultural norms among the island populations and variations of cost, accessibility, and convenience of each category of food to each island's population.
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Affiliation(s)
| | - Eric Wolfe
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Marie K Fialkowski
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
| | | | | | | | - Emihner Johnson
- Island Food Community of Pohnpei, Pohnpei, Federated States of Micronesia
| | - Daisy Gilmatam
- Yap Health Services, Yap, Federated States of Micronesia
| | - Cecilia Sigrah
- Kosrae Community Health Center, Kosrae, Federated States of Micronesia
| | - Moria Shomour
- Chuuk State Division of Public Health, Federated States of Micronesia
| | | | - Julia Alfred
- Ministry of Health, Majuro, Republic of the Marshall Islands
| | | | | | - Jonathan Deenik
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
| | | | - Randall Nelson
- Northern Marianas College, Saipan, Northern Mariana Islands
| | | | - Rachel Novotny
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
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Crameri NJ, Ellison JC. Atoll inland and coastal mangrove climate change vulnerability assessment. Wetl Ecol Manag 2022; 30:527-546. [PMID: 35571150 PMCID: PMC9091136 DOI: 10.1007/s11273-022-09878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/09/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Climate change threatens global mangroves, which are already among the world's most impacted ecosystems. Vulnerability components of exposure, sensitivity and adaptive capacity were evaluated on mangroves of atoll settings on Jaluit Atoll, in the Marshall Islands, assessing spatial changes of mangrove cover 1945-2018/19, sea-level trends 1968-2019, and reviewing available information. Inland mangrove depressions occur on Jaluit, as well as coastal lagoon margin mangroves, and both were assessed using the same methods. Spatial analysis results showed both inland and coastal mangroves have increased in area. Inland mangroves on eight of Jaluit's islands mostly expanded after 1976 from 40 to 50 hectares, with progradation and tidal creek infill closing lagoon connections. Shoreline mangroves showed 88-100% of transects prograding 0.1-0.51 m year-1 and 0-11.5% of transects eroding 0-0.18 m year-1. Assessment of a combination of aerial/satellite images, literature and on-the-ground photos indicated that the mangroves are in healthy condition. Vulnerability assessment results showed both inland and coastal mangroves to have similar strengths and weaknesses in resilience, with intrinsic areas of vulnerability persisting during increased future sea level rise, limited sediment supply and extremely low elevations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11273-022-09878-0.
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Affiliation(s)
- Nicholas J. Crameri
- School of Geography, Planning and Spatial Sciences, University of Tasmania, Launceston, TAS 7250 Australia
| | - Joanna C. Ellison
- School of Geography, Planning and Spatial Sciences, University of Tasmania, Launceston, TAS 7250 Australia
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Akbar H, Radclyffe CJT, Santos D, Mopio-Jane M, Gallegos D. "Food Is Our Love Language": Using Talanoa to Conceptualize Food Security for the Māori and Pasifika Diaspora in South-East Queensland, Australia. Nutrients 2022; 14:nu14102020. [PMID: 35631160 PMCID: PMC9143296 DOI: 10.3390/nu14102020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
Queensland is home to the largest diaspora of Māori and Pasifika peoples in Australia. They form an understudied population concerning experiences and challenges of food insecurity. This community co-designed research aims to explore the conceptualization of household food security by Māori and Pasifika peoples living in south-east Queensland. Participatory action research and talanoa were used to collect and analyse forty interviews with leaders representing 22 Māori and Pasifika cultural identities in south-east Queensland. Eight key themes emerged that conceptualise food security as an integral part of the culture and holistic health. These themes included: spirituality, identity, hospitality and reciprocity, stigma and shame, expectations and obligations, physical and mental health and barriers and solutions. Addressing food insecurity for collectivist cultures such as Māori and Pasifika peoples requires embracing food sovereignty approaches for improved food security through the co-design of practical solutions that impact social determinants and strengthen existing networks to produce and distribute affordable and nutritious food.
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Affiliation(s)
- Heena Akbar
- Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology, South Brisbane 4101, Australia; (H.A.); (C.J.T.R.)
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Charles J. T. Radclyffe
- Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology, South Brisbane 4101, Australia; (H.A.); (C.J.T.R.)
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
- Pasifika Young Peoples Well-Being Network (PYPWN), School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Daphne Santos
- Good Start Program, Child and Youth Community Health Services, Children’s Health Queensland, South Brisbane 4101, Australia;
| | | | - Danielle Gallegos
- Woolworths Centre for Childhood Nutrition Research, Queensland University of Technology, South Brisbane 4101, Australia; (H.A.); (C.J.T.R.)
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
- Correspondence:
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Langridge FC, 'Ofanoa M, Fakakovikaetau T, Wilkinson-Meyers L, Percival T, Riley AW, Grant CC. Surviving versus thriving: The wellbeing of primary school aged children in Tonga. J Paediatr Child Health 2022; 58:880-886. [PMID: 34964988 DOI: 10.1111/jpc.15869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 11/27/2022]
Abstract
AIM To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This study aimed to investigate the wellbeing of children from three primary schools in Tonga. METHODS A cross-sectional survey was completed in three primary schools in Nuku'alofa with children aged 5-15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile - Child Edition, CHIP-CE (Version 1.0). RESULTS On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P < 0.001). Children aged 5-7 versus 8-15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P = 0.002), resilience (3.34 vs. 3.56, P = 0.016) and achievement (3.25 vs. 3.62, P = 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P = 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P = 0.01). Overall CHIP-CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented. CONCLUSIONS Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.
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Affiliation(s)
- Fiona C Langridge
- Department of Pacific Health, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Malakai 'Ofanoa
- Department of Pacific Health, The University of Auckland, Auckland, New Zealand
| | | | | | - Teuila Percival
- Department of Pacific Health, The University of Auckland, Auckland, New Zealand
| | - Anne W Riley
- Population, Family and Reproductive Health, John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cameron C Grant
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
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Westoby R, Clissold R, McNamara KE, Latai-Niusulu A, Chandra A. Cascading loss and loss risk multipliers amid a changing climate in the Pacific Islands. Ambio 2022; 51:1239-1246. [PMID: 34669169 PMCID: PMC8527965 DOI: 10.1007/s13280-021-01640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
Human society has experienced, and will continue to experience, extensive loss and damage from worsening anthropogenic climate change. Despite our natural tendencies to categorise and organise, it can be unhelpful to delineate clean boundaries and linear understandings for complex and messy concepts such as loss and damage. Drawing on the perspectives of 42 local and regional Pacific Islander stakeholders, an underexplored resource for understanding loss and damage, we explore the complexity and interconnectedness of non-economic loss and damage (NELD). According to participants, Pacific Islander worldviews, knowledge systems and cosmologies often make it difficult to separate and evaluate NELD independently, challenging the nomenclature of NELD categories developed through international mechanisms. Instead, NELD understandings are often centred on the interdependencies between losses, including the cascading flow-on effects that can occur and the nature of some losses as risk multipliers (i.e. one loss creating the risk for further losses). Most notably, losses to biodiversity, ecosystem services and land are critically linked to, and have cascading effects on, livelihoods, knowledge, ways of life, wellbeing, and culture and heritage. We argue that loss and damage is not always absolute, and that there are NELD that are arguably reparable. Concerning, however, is that biodiversity loss, as a risk multiplier, was considered the least reparable by participants. We put forward that NELD understandings must consider interconnectivity, and that biodiversity and ecosystem conservation and restoration must be the focus for interventions to prevent irreparable and cascading losses from climate change in the Pacific Islands.
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Affiliation(s)
- Ross Westoby
- Griffith Institute for Tourism, Griffith University, Nathan, Brisbane, Australia
| | - Rachel Clissold
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | - Karen E. McNamara
- School of Earth and Environmental Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| | | | - Alvin Chandra
- United Nations Environment Programme, Nairobi, Kenya
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Burry K, Beek K, Vallely L, Worth H, Haire B. Illegal abortion and reproductive injustice in the Pacific Islands: A qualitative analysis of court data. Dev World Bioeth 2022. [PMID: 35467067 DOI: 10.1111/dewb.12352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
The Oceania region is home to some of the world's most restrictive abortion laws, and there is evidence of Pacific Island women's reproductive oppression across several aspects of their reproductive lives, including in relation to contraceptive decision-making, birthing, and fertility. In this paper we analyse documents from court cases in the Pacific Islands regarding the illegal procurement of abortion. We undertook inductive thematic analysis of documents from eighteen illegal abortion court cases from Pacific Island countries. Using the lens of reproductive justice, we discuss the methods of abortion, the reported context of these abortions, and the ways in which these women and abortion were constructed in judges' summing up, judgements, or sentencing. Our analysis of these cases reveals layers of sexual and reproductive oppression experienced by these women that are related to colonialism, women's socioeconomic disadvantage, gendered violence, limited reproductive control, and the punitive consequences related to not performing gender appropriately.
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Thorne T, Smith M, Dever G. The Current Status of Telehealth and Distance Learning in Palau. Hawaii J Health Soc Welf 2022; 81:87-93. [PMID: 35415614 PMCID: PMC8995860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In 2017 the Republic of Palau installed fiber optic cables, allowing access to high speed internet for the first time and the capacity for growth in telehealth. Given Palau's poor access to specialists and resources, telehealth has the potential to radically change health care delivery. Currently, the status of telehealth in Palau is unknown. This study describes telehealth resources utilized at the Ministry of Health in Palau and potential future directions for telehealth. Thirty-four people, mostly health professionals at the Belau National Hospital in Palau were interviewed, including physicians, information technology personnel, public health department staff, department managers of allied health, and telehealth experts in the Pacific. Standardized questions and surveys were conducted in-person during July 2019. All departments utilized some form of telehealth. Common needs for the advancement of telehealth included: a telehealth champion, a resource facilitator, successful distance learning for auxiliary staff, dedicated telehealth space, technological help, and better telehealth communication with rural clinics. Survey respondents indicated that they would like to use some sort of distance learning, most commonly for professional betterment (86%) and upskilling of staff (86%). There are numerous distance learning and telehealth opportunities available, yet recurrent barriers to these opportunities were noted across all departments. The barriers identified in the current study and recommendations to overcome them may be applicable to other Pacific nations who face similar challenges.
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Affiliation(s)
- Tyler Thorne
- John A Burns School of Medicine, University of Hawai`i, Honolulu, HI (TT, MS)
| | - Maiya Smith
- John A Burns School of Medicine, University of Hawai`i, Honolulu, HI (TT, MS)
| | - Gregory Dever
- Palau Area Health Education Center, Koror, Palau (GD)
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Craig AT, Beek K, Gilbert K, Soakai TS, Liaw ST, Hall JJ. Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020. Int J Environ Res Public Health 2022; 19:4108. [PMID: 35409794 DOI: 10.3390/ijerph19074108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/05/2023]
Abstract
In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as ‘a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.’ Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015–2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.
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Movono A, Scheyvens R, Auckram S. Silver linings around dark clouds: Tourism, Covid-19 and a return to traditional values, villages and the vanua. Asia Pac Viewp 2022; 63:APV12340. [PMID: 35601079 PMCID: PMC9111196 DOI: 10.1111/apv.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/08/2021] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
The global pandemic has adversely affected tourism globally, particularly in small island states heavily dependent on tourism. The closure of borders to regular flights for over a year in places such as Fiji, Samoa, Cook Islands and Vanuatu, where this research was undertaken, has resulted in massive job losses. Many tourism employees have left the once-bustling tourist hubs, returning to villages and family settlements. Such clear urban to rural migration behaviours do not dominate movement patterns in the Pacific, but are an important and enduring strategy when shocks strike. In the case of the pandemic-induced migration to villages, former tourism workers have had to engage in a complicated process of adapting to the communal setting, employing new - as well as traditional - strategies to sustain a livelihood. Thus, this paper will discuss how the pandemic has influenced return migration patterns in the Pacific, and the implications of this shift. Findings suggest that, despite their financial struggles, people have adapted to life in their ancestral homes by rekindling their relationships with kin and increasing their engagement on their customary land. They have relearned about traditional Indigenous knowledge, diversified their skills and reconnected with their social and ecological systems. This spiritual homecoming observed in the Pacific ultimately shows that there can be silver linings to the dark clouds of the current disorder.
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Affiliation(s)
- Apisalome Movono
- Institute of Development StudiesMassey UniversityPrivate Bag 11222, Palmerston North4442New Zealand
| | - Regina Scheyvens
- Institute of Development StudiesMassey UniversityPrivate Bag 11222, Palmerston North4442New Zealand
| | - Sophie Auckram
- Political ScienceGothenburg University405 30 GothenburgSweden
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Richards J, Sherry E, Tamala F, Schuster S, Schulenkorf N, Keane L. Netball Shoots for Physical and Mental Wellbeing in Samoa: A Natural Experiment. Int J Environ Res Public Health 2022; 19:ijerph19052663. [PMID: 35270356 PMCID: PMC8910206 DOI: 10.3390/ijerph19052663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022]
Abstract
Sport-for-development programs claim to address key determinants of recreational physical activity participation and subsequent development outcomes in low-income settings. We conducted a natural experiment with pre–post measures taken from women in the 12 villages in Samoa, some of which voluntarily participated in the sport-for-development intervention. The intervention comprised a six-week netball league delivered by local volunteers who attended coaching workshops, received ongoing support from the national governing body and were provided with infrastructure and equipment to conduct local training sessions. Changes in netball participation, recreational physical activity, body composition, mental wellbeing and socio-ecological determinants of physical activity were compared between intervention and comparison villages using a univariate ANOVA. The intervention reached women who participated in little recreational physical activity and had poor physical and mental wellbeing. Program uptake was higher in villages with the strongest social support for netball participation. Local social support and capacity to independently organize netball activities increased. There were concurrent improvements in netball participation, physical activity levels, mental wellbeing and body weight in the intervention villages. Our findings support scaling-up of the intervention in similar settings but preceding this with formative evaluation to identify low active communities that are “primed” to participate in the proposed activity.
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Affiliation(s)
- Justin Richards
- Faculty of Health, Victoria University Wellington, Kelburn, Wellington 6012, New Zealand
- Correspondence:
| | - Emma Sherry
- Department of Management & Marketing, Swinburne University of Technology, Melbourne, VIC 3122, Australia;
| | | | - Suzie Schuster
- Faculty of Education, National University of Samoa, Apia, Upolu, Samoa;
| | - Nico Schulenkorf
- Business School, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Lewis Keane
- School of Public Health & Charles Perkins Centre, University of Sydney, Camperdown, NSW 2050, Australia;
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Pifeleti S, Hansell D, Kaspar A. Sensitivity and specificity of the Alvarado Score for the timely differential diagnosis of acute appendicitis for a case series in Samoa. Ann Med Surg (Lond) 2022; 73:103219. [PMID: 35079363 DOI: 10.1016/j.amsu.2021.103219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background Timely diagnosis of acute appendicitis (AA) is essential for optimal management of abdominal pain emergency presentations. Improved diagnostic procedures should minimise progression to complicated appendicitis, as well as reduce the number of unwanted surgical interventions. The Alvarado Score is an important tool to assist with the management of AA based on clinically predictive values. The aim of the present study was to evaluate the sensitivity and specificity of the Alvarado Score as an instrument for the diagnosis of AA in our low-resourced context of Samoa. Materials and methods The lead investigator performed a retrospective clinical data review design of all patients admitted to the Tupua Tamasese Meaole Hospital Surgical Unit for AA from January 2015 to December 2016. Exclusion criteria were appendiceal abscess and/or mass, and final diagnosis ‘not acute appendicitis’. Age, sex, village, Alvarado Score, Ultrasound Scan Result, surgical management, and histopathology result were the main variables entered into the SPSS statistical software package for analysis. Results Of the 225 patients (2–86 years) admitted for AA, 67.1% (N = 151) underwent appendicectomy, and the remaining 32.9% (N = 74) were treated with antibiotics. An Alvarado Score (≥5) showed 91.7% sensitivity and 50% specificity for AA. There was a significant relationship between the Alvarado Score and the Ultrasound Scan for AA (p < 0.05). Histology results showed complicated AA in 68.6% (N = 94) of cases. The negative appendicectomy rate was 2.6%. Conclusions The Alvarado Score is an effective tool for the timely differential diagnosis of AA in our Samoan context. The high rate of complicated acute appendicitis warrants investigation to further improve the management of AA in the Pacific Island setting. Effective instrument required for the timely diagnosis of appendicitis in low-resource contexts Alvarado Score is an effective tool for the differential diagnosis of acute appendicitis High specificity demonstrated for use of Alvarado Score in the emergency department of Samoa Histology results showed high rate of complicated acute appendicitis in Samoa Surgical outcomes showed low negative appendicectomy rate
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Paris A, Kwaoga A, Hewavitharane C. An assessment of floating marine debris within the breakwaters of the University of the South Pacific, Marine Studies Campus at Laucala Bay. Mar Pollut Bull 2022; 174:113290. [PMID: 35090275 DOI: 10.1016/j.marpolbul.2021.113290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Contributions of Pacific Islands countries to marine plastic debris are disproportionate to the effects on people's connections to the ocean. Plastic waste management initiatives face challenges in containing waste and consequently plastics plague coastal environments. The Seabin, a floating trash skimmer, presents a novel and replicable approach to collecting and cataloguing marine plastics. The objectives of the study were to conduct an audit of marine plastic debris within the breakwaters of the University of the South Pacific, Marine Campus at Laucala Bay while simultaneously gauging the effectiveness of the Seabin and providing recommendations to enhance its utility. Inorganic debris was comprised entirely of plastics while the majority of debris collected was organic. This study provides the first assessment of floating marine plastic debris in an inshore environment of a Pacific Island country. Plastic debris assessments have the potential to inform policy and pivot management efforts to mitigate plastic waste pollution.
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Affiliation(s)
- Andrew Paris
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences, The University of the South Pacific, Suva, Fiji.
| | - Alex Kwaoga
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences, The University of the South Pacific, Suva, Fiji
| | - Chinthaka Hewavitharane
- School of Agriculture, Geography, Environment, Ocean and Natural Sciences, The University of the South Pacific, Suva, Fiji
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Kaspar A, Pifeleti S, Lifeng A, Driscoll C. A preliminary report of the pattern of ear disease among students attending a school for people with disabilities in Samoa. SAGE Open Med 2021; 9:20503121211060182. [PMID: 34881042 PMCID: PMC8646189 DOI: 10.1177/20503121211060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The Ear, Nose, and Throat Department of Samoa is developing a school outreach service, and the aim of this study is to determine the pattern of ear disease among students attending a school for people with disabilities in Samoa. Methods The study design is a prospective study of a 2-day outreach visit to a school for people with disabilities by the Samoan Ear, Nose, and Throat team who recorded their clinical findings (N = 28). Two Ear, Nose, and Throat Specialists performed ear examinations for each student and recorded their diagnosis and recommendations as per routine Ear, Nose, and Throat Clinic protocols on a purposefully designed form based on the World Health Organization Ear and Hearing Survey. This information was entered into an Excel spreadsheet for descriptive statistical analysis. Results Results showed that 39% (n = 11) of students passed their initial ear examination, while 61% (n = 17) of students presented with at least one ear condition requiring Ear, Nose, and Throat intervention. The most common pathology was impacted wax (n = 15 ears). Following the Ear, Nose, and Throat Clinic outreach visit, 21 students (75%) no longer required Ear, Nose, and Throat or medical services, five students (18%) required a medical prescription for the treatment of ear disease, and two students (7%) were referred to the Ear, Nose, and Throat Department for further review. Conclusion Students attending schools for people with disabilities are a priority population for the Ear, Nose, and Throat Clinical service outreach programme.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa.,Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
| | - An Lifeng
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa.,ENT Department, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Di Michiel J, Gawthorne J, Shivam A, Maruno K, Cohn S, Lemon C, Liu Z, Byrne A. Lung Health in the Solomon Islands: A Mixed Methods Study. Int J Chron Obstruct Pulmon Dis 2021; 16:3093-3103. [PMID: 34795480 PMCID: PMC8594620 DOI: 10.2147/copd.s331734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Despite a population of 600,000 people from 900 islands, there is little published data on the prevalence of lung disease in the Solomon Islands. We sought to 1) estimate the prevalence of obstructive lung disease (OLD) in Gizo, Solomon Islands, 2) identify risk factors for respiratory disease in this population and 3) review current management practices for respiratory disease through an audit of local emergency department (ED) presentations. Methods A two-part mixed methods study was performed between March and May 2019; the first was a population-based, cross-sectional study conducted in Gizo, Solomon Islands, with a random sample undergoing questionnaires and spirometry. The second was an audit of Gizo Hospital ED records to assess presentation numbers, diagnoses and outcomes. Results A total of 104 patients were randomly selected for spirometry. The mean age was 46.9 years. Current smoking rates were high (24.0% overall, 43.3% age < 40, 16.2% age ≥ 40) as was regular (>10h/week) exposure to indoor/enclosed wood fire ovens (51.5%). The prevalence of COPD was 3.2% overall. A further 9.7% of participants demonstrated significant bronchodilator responsiveness suggestive of possible asthma. Most patients seen in ED presented with a respiratory condition or fever/viral illness, but spirometry was not available. Only four outpatients were prescribed salbutamol and two patients inhaled corticosteroid. Conclusion There appears to be a high burden of obstructive lung disease in the Solomon Islands with high smoking rates, indoor smoke exposure and bronchodilator responsiveness. Respiratory symptoms are common amongst hospital ED presentations; however, inhaled asthma treatments are infrequently prescribed to outpatients.
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Affiliation(s)
- James Di Michiel
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, 2010, Australia
| | - Julie Gawthorne
- Department of Emergency Medicine, St Vincent's Hospital, Sydney, NSW, 2010, Australia
| | - Aruna Shivam
- Department of Emergency Medicine, St Vincent's Hospital, Sydney, NSW, 2010, Australia
| | - Kevin Maruno
- Department of Emergency Medicine, St Vincent's Hospital, Sydney, NSW, 2010, Australia.,University of New South Wales, St Vincent's Medical School, Sydney, NSW, 2010, Australia.,University of Notre Dame, St Vincent's Medical School, Sydney, NSW, 2010, Australia
| | - Sarah Cohn
- University of New South Wales, St Vincent's Medical School, Sydney, NSW, 2010, Australia.,Department of Psychiatry, Prince of Wales Hospital, Sydney, NSW, 2031, Australia
| | - Christopher Lemon
- University of New South Wales, St Vincent's Medical School, Sydney, NSW, 2010, Australia.,Department of Psychiatry, St Vincent's Hospital, Sydney, NSW, 2010, Australia
| | - Zhixin Liu
- Mark Wainwright Analytical Centre, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Anthony Byrne
- Department of Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, 2010, Australia.,University of New South Wales, St Vincent's Medical School, Sydney, NSW, 2010, Australia
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Phillips G, Shailin S, Lee D, O'Reilly G, Cameron P. 'You can make change happen': Experiences of emergency medicine leadership in the Pacific. Emerg Med Australas 2021; 34:398-410. [PMID: 34796662 DOI: 10.1111/1742-6723.13905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to explore the activities, responsibilities and experience of leadership from Pacific emergency medicine (EM) doctors. Additionally, we explored knowledge, attitudes, leadership gaps and training insights for individual clinicians, and from a Pacific regional perspective. METHODS This was a qualitative study using in-depth, semi-structured interviews of invited Pacific EM doctors occupying a leadership role in their countries. Data were recorded, transcribed and triangulated with written field notes. Whole interviews and responses per topic were analysed using data-platform-based and manual methods. Inductive and deductive coding and thematic content analysis was performed in partnership with Pacific co-researchers to determine overall meaning. Monash University granted ethics approval. RESULTS Twelve doctors participated (11 verbal, one written response), representing six different Pacific Island countries. Four key themes were identified which reflected both the individual agency of the Pacific EM doctors and how their experience was constituted by others; professional identity and style; nurturing relationships and building solidarity; growth through experience, education and challenge; and progress and precarity. Pacific EM leaders perform clinical, management, advocacy and education tasks, and build their capacity and resilience through leadership training. They have a strong desire for regional solidarity and networking. CONCLUSIONS Pacific EM doctors embrace leadership in their home countries and collaborate to drive positive change, build teams and gain recognition. As pioneers and advocates for EM, they bear high responsibility and risk burnout. These findings can inform future targeted leadership training and contribute to building Pacific regional networks for career sustainability and specialty advancement.
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Affiliation(s)
- Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency Department, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Shivani Shailin
- Emergency Department, Colonial War Memorial Hospital, Suva, Fiji
| | - Dennis Lee
- School of Medical Science, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
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Mathieu S, de Leo D, Koo YW, Leske S, Goodfellow B, Kõlves K. Suicide and suicide attempts in the Pacific Islands: A Systematic Literature Review. Lancet Reg Health West Pac 2021; 17:100283. [PMID: 34734201 PMCID: PMC8495100 DOI: 10.1016/j.lanwpc.2021.100283] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/19/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Background The Pacific Islands have some of the highest rates of suicide in the Western Pacific region. The purpose of this study was to systematically review the literature on suicidal behaviour in the Pacific Islands. Methods A comprehensive search of Web of Science, PubMed, PsycINFO, Cochrane, CINAHL and Embase databases was conducted for all articles published until 1st February 2021. Inclusion criteria included papers that referred to a pre-specified list of Pacific Islands. Papers referring exclusively to other countries were excluded. Other exclusion criteria included not being about suicide or suicide attempts or not presenting original research. Narrative synthesis was applied without meta-analysis. The review followed PRISMA guidelines. Findings A total of 36 papers were included for review. Of the Pacific Islands, Kiribati has the highest age-standardised rate of suicide mortality. Key risk groups across the Islands included youth, people of Indian ethnicity in Fiji (a prominent ethnic group in Fiji), and Indigenous peoples across other Islands. Prominent methods were self-poisoning and hanging. A distinct lack of intervention studies was found. Interpretation Overall, the Pacific Islands appear to have relatively high rates of suicide and suicide attempts compared to other countries in the region. This was particularly striking among youth. This review provides important directions for future suicide prevention activities, including means restriction, sensitive media/community coverage, enhanced surveillance, and the development and evaluation of interventions tailored to the needs of young people and other cultural groups. Funding None.
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Affiliation(s)
- Sharna Mathieu
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Diego de Leo
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yu Wen Koo
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Stuart Leske
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Benjamin Goodfellow
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
- Centre Hospitalsier Spécialisé Albert Bousquet, Nouméa, New Caledonia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
- Correspondence: Associate Professor Kairi Kõlves; Level 1, Building M24 Psychology, 176 Messines Ridge Road, Mt Gravatt Campus, Griffith University, QLD, Australia, 4222.
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Tudor DT, Williams AT. The effectiveness of legislative and voluntary strategies to prevent ocean plastic pollution: Lessons from the UK and South Pacific. Mar Pollut Bull 2021; 172:112778. [PMID: 34371341 DOI: 10.1016/j.marpolbul.2021.112778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
The islands of the South Pacific contribute a fraction of the mis-managed plastics in the world's ocean, yet the region is one of the main recipients of its impacts. Based on expert interviews and a review of current strategies to prevent marine plastic pollution in six countries (Australia, New Zealand, Fiji, Tonga, Vanuatu, United Kingdom), this paper identifies several interventions - legislative, financial, voluntary - which governments, organisations and individuals can learn from. Both voluntary and statutory consumer-based behaviour change campaigns are well developed and somewhat successful in several countries. While sub-national policies do not inhibit progress, they are not optimal. Harmonisation across the territories of federal and devolved systems is beneficial, such as container return schemes, levies, and bans. Vanuatu has displayed high ambition, and the challenges in achieving this serve as a case study. A coordinated global strategy with associated legislation aimed at tackling plastic pollution is critical.
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Affiliation(s)
- David T Tudor
- Winston Churchill Fellow, Pelagos, 50 Belmont Road, Bristol, UK; University of the West of England, Faculty of Environment and Technology, Bristol, UK.
| | - Allan T Williams
- Winston Churchill Fellow, Dept. of Architecture, Computing and Engineering, Trinity St David, University of Wales, Swansea, UK
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48
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Beek K, Drysdale R, Kusen M, Dawson A. Preparing for and responding to sexual and reproductive health in disaster settings: evidence from Fiji and Tonga. Reprod Health 2021; 18:185. [PMID: 34544448 PMCID: PMC8451166 DOI: 10.1186/s12978-021-01236-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pacific Island countries are vulnerable to disasters, including cyclones and earthquakes. Disaster preparedness is key to a well-coordinated response to preventing sexual violence and assisting survivors, reducing the transmission of HIV and other STIs, and preventing excess maternal and neonatal mortality and morbidity. This study aimed to identify the capacity development activities undertaken as part of the SPRINT program in Fiji and Tonga and how these enabled the sexual and reproductive health (SRH) response to Tropical Cyclones Winston and Gita. METHODS This descriptive qualitative study was informed by a framework designed to assess public health emergency response capacity across various levels (systems, organisational, and individual) and two phases of the disaster management cycle (preparedness and response). Eight key informants were recruited purposively to include diverse individuals from relevant organisations and interviewed by telephone, Zoom, Skype and email. Template analysis was used to examine the data. FINDINGS Differences in the country contexts were highlighted. The existing program of training in Tonga, investment from the International Planned Parenthood Federation (IPPF) Humanitarian Hub, the status of the Tonga Family Health Association as the key player in the delivery of SRH, together with its long experience of delivering contract work in short time-frames and strong relationship with the Ministry of Health (MoH) facilitated a relatively smooth and rapid response. In contrast, there had been limited capacity development work in Fiji prior to Winston, requiring training to be rapidly delivered during the immediate response to the cyclone with the support of surge staff from IPPF. In Fiji, the response was initially hampered by a lack of clarity concerning stakeholder roles and coordination, but linkages were quickly built to enable a response. Participants highlighted the importance of personal relationships, individuals' and organisations' motivation to respond, and strong rapport with the community to deliver SRH. DISCUSSION This study highlights the need for comprehensive activities at multiple levels within a country and across the Pacific region to build capacity for a SRH response. While the SPRINT initiative has been implemented across several regions to improve organisational and national capacity preparedness, training for communities can be strengthened. This research outlines the importance of formalising partnerships and regular meetings and training to ensure the currency of coordination efforts in readiness for activation. However, work is needed to further institutionalise SRH in emergencies in national policy and accountability mechanisms.
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Affiliation(s)
- Kristen Beek
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Robyn Drysdale
- Humanitarian Programme, International Planned Parenthood Federation (IPPF), Suva, Fiji
| | | | - Angela Dawson
- Centre for Australian Public and Population Health Research, Faculty of Health, University of Technology Sydney, Level 8, Room 225, 235 Jones St, PO Box 123, Sydney, NSW 2007 Australia
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Dodd R, Shanthosh J, Lung T, Robaigau A, Perman ML, Rafai E, Poulos R, Zwi AB, John R, Palagyi A. Gender, health and ageing in Fiji: a mixed methods analysis. Int J Equity Health 2021; 20:205. [PMID: 34521430 DOI: 10.1186/s12939-021-01529-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women are disadvantaged by ageing: older women are more likely than older men to suffer from ill-health, have less access to health care and suffer discrimination within the health care system. Globally, there is a dearth of health research on gender and ageing with substantial knowledge gaps in low and middle-income country contexts. Part of a wider investigation on health and ageing in Fiji, our objective was to identify and describe gendered differences in healthy ageing in this Pacific Island context. We believe this to be the first such study in the Pacific region. METHODS Applying a health systems lens, we used a mixed-methods approach, encompassing analysis of cause of death data; focus group discussion to gather community and family attitudes to health services; and policy analysis, and then used data triangulation techniques to draw out key themes and insights. RESULTS We found that gender affects health outcomes among older persons, attitudes towards and experience of healthy ageing, and an older person's access to and use of health services. We also found that while Fiji's policy response to ageing has recognised the importance of gender, to-date there has been limited action to address gender differences. Gender (as oppose to sex differences) has direct and indirect implications for the health of older Fijians, while gendered inequalities and patriarchal norms appear to affect both men and women's experience of ageing and the health system response. Further, gender and age discrimination may be intersecting, intensifying their separate effects. CONCLUSION This study demonstrates the feasibility and importance of applying a gender lens to the study of healthy ageing. Our findings from Fiji may be relevant to other island nations in the south Pacific which share similar challenges of population ageing, a constrained health budget and geographically-dispersed populations. The data triangulation methodology may be considered an efficient and insightful way to examine gendered responses to healthy ageing elsewhere.
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Kaspar A, Pifeleti S, Driscoll C. Knowledge and attitudes of schoolteachers in the Pacific Islands to childhood hearing loss and hearing services: A national survey protocol for Samoa. SAGE Open Med 2021; 9:20503121211041518. [PMID: 34484787 PMCID: PMC8411643 DOI: 10.1177/20503121211041518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The Pacific Island region is estimated to have among the highest rates of
childhood ear disease and hearing loss in the world. The adverse effects of
childhood hearing loss include delayed speech/language development, learning
difficulties, and reduced social-emotional well-being. Schoolteachers and
early childhood educators are among the first professionals who may suspect
hearing loss in their young students, and they are well-placed to initiate
referrals to appropriate health services. Given the current efforts to
implement Inclusive Education in the Pacific Islands, teachers are also
uniquely positioned to positively influence, support, and advocate for a
child with hearing loss in their classroom. There are no previous studies on
this topic from the Pacific Island region. Methods: The study will use a national survey and convenience sampling design.
Teachers attending the Annual Teachers Conference in Samoa will be invited
to independently and anonymously completed a 23-item questionnaire on
childhood hearing loss and hearing services. Questions are in English, with
a Samoan translation provided. The participating teachers will be required
to respond with “yes,” “no,” or “unsure,” and to mark their response on the
questionnaire. The questions assess knowledge of biomedical etiology of
hearing impairment, knowledge of the adverse impacts of hearing loss on
childhood development, knowledge of hearing loss identification and
intervention, and attitudes toward children with a hearing impairment. Results: Not applicable for a study protocol. Conclusion: We publish these protocols to facilitate similar studies in other low- and
middle-income countries, and especially among our Pacific Island
neighbors.
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Affiliation(s)
- Annette Kaspar
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa.,Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Sione Pifeleti
- ENT Department, Tupua Tamasese Meaole Hospital, Ministry of Health, Apia, Samoa
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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