Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program

OBJECTIVE

To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program.

DESIGN

Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Food (n = 426) and PA (n = 552) Outlets.

MAIN OUTCOME MEASURES

Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively.

ANALYSIS

Descriptive statistics are presented as means ± SD or percentages.

RESULTS

High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions.

CONCLUSIONS AND IMPLICATIONS

The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.

Improving maternal and newborn health and reducing stillbirths in the Western Pacific Region - current situation and the way forward

Despite positive trends in many indicators, there remains an unacceptable burden of preventable maternal, newborn deaths and stillbirths every year. This paper provides an overview of the maternal and perinatal outcomes across 22 Pacific Island Countries and Territories, including Papua New Guinea. We highlight some unique challenges and provide examples of initiatives in three of the larger countries to contribute to safer childbirth. There are high maternal and perinatal morbidity and mortality rates in many of the countries, although reliable data are limited. There are currently no data relating to the burden of intrapartum-related maternal and perinatal morbidity or stillbirth or the quality of intrapartum care. Varying definitions across countries for perinatal indicators mean that meaningful comparisons are difficult and unreliable. There is need for midwives and other maternal and newborn health providers to improve maternal and newborn indicators as countries advance towards the 2030 Sustainable Development Goals.

Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific

Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.

Lessons from the frontline: Leadership and governance experiences in the COVID-19 pandemic response across the Pacific region

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.

Lessons from the frontline: The value of emergency care processes and data to pandemic responses across the Pacific region

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.

Lessons from the frontline: The COVID-19 pandemic emergency care experience from a human resource perspective in the Pacific region

Background

This study explores emergency care (EC) and other frontline healthcare worker (HCW) experiences responding to the COVID-19 pandemic in the Pacific region. The crisis has reinforced the crucial role well-trained, resourced, and supported EC providers play in supporting vital health systems and services in all global regions not only during 'business as usual' periods, but in times of tremendous stress and surge.

Methods

Qualitative data were collected from EC providers and relevant stakeholders in three research phases in 2020 and 2021. Data on the World Health Organization's (WHO) Human Resources Building Block, adapted for the Pacific EC context, was thematically analysed. Key findings were further analysed to identify enablers and barriers to effective EC pandemic management.

Findings

116 participants from across the Pacific region participated in this study. Five themes emerged: (1) EC providers performed multiple pandemic roles; (2) Importance of authorities' valuing frontline HCWs; (3) HCW mental health and exhaustion; (4) HCW tension managing stigma, personal/professional expectations, and chronic health needs; and (5) Building health and human resource capacity.

Interpretation

This study significantly contributes to the limited scientific literature on HCW experiences responding to COVID-19 across the Pacific. Recommendations arising out of this research align with consensus priorities and standards that were identified pre-pandemic by health stakeholders across the Pacific for enhancing EC system development. With limited HCWs available for many Pacific nations, it is imperative the dignity and welfare of local HCWs is genuinely prioritised.

Funding

Epidemic Ethics/WHO, Foreign, Commonwealth and Development Office/Wellcome Grant 214711/Z/18/Z. Co-funding: Australasian College for Emergency Medicine Foundation, International Development Fund Grant.

Prevalence and Factors Associated With Men's Perpetration of Intimate Partner Violence in South Tarawa, Kiribati

In the Republic of Kiribati, two-thirds of women report experiencing intimate partner violence (IPV) during their lifetime. Less is known about men's perpetration of IPV, or associated risk factors, in this high-prevalence setting. We conducted a cross-sectional study with 429 currently partnered men aged 15 to 49 in South Tarawa, Kiribati, to estimate the prevalence of, and risk factors associated with, currently married men's perpetration of physical and sexual IPV against female partners. Two-thirds (63%) of currently partnered men reported past year physical and/or sexual IPV. Modifiable risk factors associated with men's perpetration of physical and/or sexual IPV included child physical abuse (adjusted odds ratio [aOR]: 2.31, P = .01), gender inequitable attitudes (aOR: 1.12, P = .02), and antisocial behaviors, including gang involvement (aOR: 3.36, P = .01) and involvement in fights with weapons (aOR: 3.54, P = .004). Intimate partner violence prevention approaches in Kiribati should prioritize efforts to prevent child maltreatment, promote gender equitable norms and practices, and reduce community violence.

Proximate Composition, Antioxidant Properties, and Hepatoprotective Activity of Three Species of Shellfish of the Pacific Coast of Russia

The objective of the present study was to investigate the proximate composition, antiradical properties and hepatoprotective activity of three species of shellfish, Corbicula japonica, Spisula sachalinensis, and Anadara broughtonii, from the coastal areas of Far East Russia. Biologically active peptides such as taurine (3.74 g/100 g protein) and ornithine (2.12 g/100 g protein) have been found in the tissues of A. broughtonii. C. japonica contains a high amount of ornithine (5.57 g/100 g protein) and taurine (0.85 g/100 g protein). The maximum DPPH and ABTS radical scavenging activity (36.0 µg ascorbic acid/g protein and 0.68 µmol/Trolox equiv/g protein, respectively) was determined for the tissue of C. japonica. The protein and peptide molecular weight distribution of the shellfish tissue water extracts was investigated using HPLC. It was found that the amount of low molecular weight proteins and peptides were significantly and positively correlated with radical scavenging activity (Pearson’s correlation coefficient = 0.96), while the amount of high molecular weight proteins negatively correlated with radical scavenging activity (Pearson’s correlation coefficient = −0.86). Hepatoprotective activity, measured by the survival rate of HepG2 hepatocytes after cotreatment with t-BHP, was detected for C. japonica. The highest protection (95.3 ± 2.4%) was achieved by the cold water extract of C. japonica at the concentration of 200 mg/mL. Moreover, oral administration of hot water extract of C. japonica to rats before the treatment with CCl₄ exhibited a markedly protective effect by lowering serum levels of ALT and AST, inhibiting the changes in biochemical parameters of functional state of rat liver, including MDA, SOD, GSH and GST.

The tropical Pacific Oceanscape: Current issues, solutions and future possibilities

Marine ecosystems across the world's largest ocean - the Pacific Ocean - are being increasingly affected by stressors such as pollution, overfishing, ocean acidification, coastal development and warming events coupled with rising sea levels and increasing frequency of extreme weather. These anthropogenic-driven stressors, which operate cumulatively at varying spatial and temporal scales, are leading to ongoing and pervasive degradation of many marine ecosystems in the Pacific Island region. The effects of global warming and ocean acidification threaten much of the region and impact on the socio-cultural, environmental, economic and human health components of many Pacific Island nations. Simultaneously, resilience to climate change is being reduced as systems are overburdened by other stressors, such as marine and land-based pollution and unsustainable fishing. Consequently, it is important to understand the vulnerability of this region to future environmental scenarios and determine to what extent management actions can help protect, and rebuild ecosystem resilience and maintain ecosystem service provision. This Special Issue of papers explores many of these pressures through case studies across the Pacific Island region, and the impacts of individual and cumulative pressures on the condition, resilience and survival of ecosystems and the communities that depend on them. The papers represent original work from across the tropical Pacific oceanscape, an area that includes 22 Pacific Island countries and territories plus Hawaii and the Philippines. The 39 papers within provide insights on anthropogenic pressures and habitat responses at local, national, and regional scales. The themes range from coastal water quality and human health, assessment of status and trends for marine habitats (e.g. seagrass and coral reefs), and the interaction of local pressures (pollution, overfishing) with increasing temperatures and climate variability. Studies within the Special Issue highlight how local actions, monitoring, tourism values, management, policy and incentives can encourage adaptation to anthropogenic impacts. Conclusions identify possible solutions to support sustainable and harmonious environment and social systems in the unique Pacific Island oceanscape.

Beliefs about cancer causation in Samoa: results from an awareness campaign recall survey

INTRODUCTION

Cancer is a leading cause of death in Samoa. Cultural beliefs shape attitudes towards disease and disease prevention in Pacific countries, and are a barrier to engaging in cancer screening services.

METHODS

A survey of 205 Samoan adults conducted as part of the evaluation of the first cancer awareness campaign implemented in Samoa explored beliefs about cancer causation.

RESULTS

Lifestyle factors associated with a departure from fa'aSamoa (traditional lifestyle) were most commonly cited as causing cancer. Cancer was also attributed to pathogens and person-to-person transmission, and, to a lesser extent, cultural beliefs including supernatural agency (spirits, God).

CONCLUSION

Addressing misconceptions while integrating certain aspects of fa'aSamoa into cancer control strategies could support greater engagement in health promotion practices and screening initiatives.

Role of social ecological model level on young Pacific children's sugar-sweetened beverage and water intakes: Children's Healthy Living intervention

OBJECTIVE

To examine children's sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial.

DESIGN

Children's Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013-2015). Baseline and 24-month cross-sectional data were analysed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organisation, community and policy). Child SSB and water intakes were assessed by caregiver-completed 2-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level.

SETTING

US-Affiliated Pacific region.

PARTICIPANTS

Children aged 2-8 years (baseline: n 1343; 24 months: n 1158).

RESULTS

On average (± sd), communities implemented 74 ± 39 SSB and 72 ± 40 water activities. More than 90 % of activities targeted both beverages together. Community-level activities (e.g. social marketing campaign) were most common (61 % of total activities), and child-level activities (e.g. sugar counting game) were least common (4 %). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0·62 ml/d/activity; 95 % CI: 0·09, 1·15) and water-for-SSB substitution (operationalised as SSB minus water: -0·88 ml/d/activity; 95 % CI: -1·72, -0·03). Activities implemented at the organization level (e.g. strengthening preschool wellness guidelines) and policy level (e.g. SSB tax advocacy) also suggested greater water-for-SSB substitution (P < 0·10).

CONCLUSIONS

Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.

Coronavirus: COVID-19 Transmission in Pacific Small Island Developing States

Background: Pacific Small Island Developing States (SIDS) have health care systems with a limited capacity to deal with pandemics, making them especially vulnerable to the economic and social impacts of the coronavirus (COVID-19). This paper examines the introduction, transmission, and incidence of COVID-19 into Pacific SIDS. Methods: Calculate the rate of transmission (the average number of new cases per day between the first recorded case and the most recent day) and connectivity (daily direct flights to the leading airport in each selected island group) using flight history and COVID-19 transmission data. Results: Correlational analyses show that connectivity is positively related with (a) first-case dates and (b) spread rate in Pacific SIDS. Conclusion: Connectivity plays a central role in the spread of COVID-19 in Pacific SIDS. The continued entry of people was a significant factor for spread within countries. Efforts to prevent transmission by closing borders reduced transmission but also created significant economic hardship because many Pacific SIDS rely heavily on tourism and international exchange. The findings highlight the importance of exploring the possibility that the COVID-19 spread rate may be higher than official figures indicate, and present pathways to mitigate socio-economic impacts. The practical implications of the findings reveal the vulnerability of Pacific SIDS to pandemics and the key role of connectivity in the spread of COVID-19 in the Pacific region.

Potential distribution of main malaria vector species in the endemic Colombian Pacific region

OBJECTIVE

To assess the existing fundamental niche, potential distribution and degree of niche overlap for the three main Colombian malaria vectors Anopheles albimanus, Anopheles darlingi and Anopheles nuneztovari in the major malaria endemic Pacific region.

METHODS

We used models based on presence records and Normalised Difference Vegetation Index (NDVI) data, created using the maximum entropy algorithm.

RESULTS

The three vector species occupied heterogeneous environments, and their NDVI values differed. Anopheles albimanus had the largest niche amplitude and was distributed mainly on coastal areas. Environmentally suitable areas for An. albimanus and An. nuneztovari were the dry forest of inter-Andean Valleys in south-western Colombia, as confirmed for An. albimanus during model validation. There was a slight degree of niche overlap between An. darlingi and An. nuneztovari, and the species co-occurred in humid forests, predominantly in riparian zones of the San Juan and Atrato rivers.

CONCLUSION

The information obtained may be used for the implementation of vector control interventions in selected priority areas to reduce malaria risk in this region while optimising resources.

Introduction of the Anopheles bancroftii Mosquito, a Malaria Vector, into New Caledonia

In June 2017, an Anopheles mosquito species was detected in New Caledonia. Morphologic identification and genomic sequencing revealed that the specimens tested belong to An. bancroftii genotype A1. This introduction underscores the risk for local malaria transmission and the vulnerability of New Caledonia to vector introduction.

Dengue-1 virus and vector competence of Aedes aegypti (Diptera: Culicidae) populations from New Caledonia

Background

Dengue virus (DENV) is the arbovirus with the highest incidence in New Caledonia and in the South Pacific region. In 2012–2014, a major DENV-1 outbreak occurred in New Caledonia. The only known vector of DENV in New Caledonia is Aedes aegypti but no study has yet evaluated the competence of New Caledonia Ae. aegypti populations to transmit DENV. This study compared the ability of field-collected Ae. aegypti from different locations in New Caledonia to transmit the DENV-1 responsible for the 2012–2014 outbreak. This study also aimed to compare the New Caledonia results with the vector competence of Ae. aegypti from French Polynesia as these two French countries have close links, including arbovirus circulation.

Methods

Three wild Ae. aegypti populations were collected in New Caledonia and one in French Polynesia. Female mosquitoes were orally exposed to DENV-1 (10⁶ FFU/ml). Mosquito bodies (thorax and abdomen), heads and saliva were analyzed to measure infection, dissemination, transmission rates and transmission efficiency, at 7, 14 and 21 days post-infection (dpi), respectively.

Results

DENV-1 infection rates were heterogeneous, but dissemination rates were high and homogenous among the three Ae. aegypti populations from New Caledonia. Despite this high DENV-1 dissemination rate, the transmission rate, and therefore the transmission efficiency, observed were low. Aedes aegypti population from New Caledonia was less susceptible to infection and had lower ability to transmit DENV-1 than Ae. aegypti populations from French Polynesia.

Conclusion

This study suggests that even if susceptible to infection, the New Caledonian Ae. aegypti populations were moderately competent vectors for DENV-1 strain from the 2012–2014 outbreak. These results strongly suggest that other factors might have contributed to the spread of this DENV-1 strain in New Caledonia and in the Pacific region.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-017-2319-x) contains supplementary material, which is available to authorized users.

A qualitative evaluation of leadership development workshops for mental health workers from four Pacific Island Countries

OBJECTIVE

This paper provides a qualitative evaluation of a series of leadership development workshops held at the New South Wales Institute of Psychiatry (NSWIOP) for mental health workers from Papua New Guinea, Federated States of Micronesia, Republic of Marshall Islands, and Palau.

METHOD

Fourteen mental health workers attended the week-long training focused on project management and partnership development skills. In-depth interviews were conducted with participants at the commencement and conclusion of the training, and questionnaires were completed. A focus group was conducted with the NSWIOP organisers. The data was analysed using qualitative techniques to identify emergent themes for both participants and NSWIOP project team.

FINDINGS

All Pacific Island participants responded positively to the training. All reported greater confidence in taking on formal or informal leadership roles in the workplace, developing project planning skills and interpersonal skills such as networking and partnerships. The NSWIOP organisers identified strengths and weaknesses in the delivery of this training.

CONCLUSIONS

The strong partnerships developed between NSWIOP and the Ministry of Health in all four countries contributed to the success of the training. Leadership Development Programs are an important aspect of building capacity in the mental health services of Pacific Island Countries.

Taxonomic review of the genus Tambinia Stål (Hemiptera, Fulgoromorpha, Tropiduchidae) with descriptions of four new species from the Pacific region

Four new species of Tambinia Stål (Hemiptera: Fulgoromorpha: Tropiduchidae), Tambinia conussp. n. (Papua New Guinea), Tambinia maculasp. n. (Malaysia: Borneo), Tambinia robustocarinasp. n. (Malaysia: Sabah) and Tambinia sexmaculatasp. n. (Australia: Kuranda) are described and illustrated from the Pacific region. The diagnostic characters of this genus are redefined. A checklist and a key to the known species of Tambinia are provided.