FNU-CMNHS FIPHR Institutional Research Repository
Not a member yet
4038 research outputs found
Sort by
Sugar, power and policy: The political economy of a health and economic ‘win–win’ in Fiji’s sugar-sweetened beverage tax
No full textAbstract
Background In 2006, the Fiji Government introduced a 0.05FJ$ (0.03USD) per litre excise tax on domestically produced sugar-sweetened beverages (SSBs). Since then, the tax has been abandoned, reintroduced, or adjusted at least
ten times, while tariffs on imported SSBs have also undergone reform. These rapid iterations of Fiji’s SSB tax raise questions about which interests and motivations underpin the tax, what instigated the multiple adjustments, and implications for its impact on health versus economic and political considerations.
Methods Using case study methodology, this study maps the history of SSB tax adjustments in Fiji and examines
the political economy forces that have shaped, and continually re-shaped, this policy landscape. We used policy
analysis and theories of power to analyse the intersection of ideas, interests and institutions, drawing on policy documents (n=304), key informant interviews (n=32) and direct observations of socio-political events (n=7) as data
sources.
Results Findings from this study indicate that the introduction of the SSB tax and subsequent adjustments were motivated more by economic, than health, imperatives. The relationship of mutual dependence between the Fiji Government and domestic SSB industry actors led policymakers to make multiple adjustments, seesawing in an attempt to balance the immediate need for revenue and long-term economic development through strengthened local
industries. Early SSB tax lobbying from health actors alone had minimal impact. However, a subsequent alliance between government health actors and politically savvy and well-positioned civil society actors proved persuasive in both increasing the tax rate and ensuring a health and rights focus, arguably achieving a health and economic ‘win–win’.
Conclusion: Global adoption of SSB taxes is increasing. Examining the protracted history of Fiji’s SSB tax reveals the political ebbs and fows that alter how prospective population health ‘wins’ are weighed up against other policy imperatives. For health-interested actors, these insights point to important strategic inroads around the explicit use of political economy analysis to complement technical policy insights. Building and maintaining coalitions that extend beyond government and into civil society also proved pivotal. Health system leadership that champions political thinking and cross-sectoral partnerships holds great promise for enhancing health actors’ engagement with SSB tax-specific policy making and other multisectoral reform in Fiji and elsewhere.
Keywords Fiji, Noncommunicable diseases, Pacific, Policy, Sugar-sweetened beverages, T
PM2.5 and PM10 concentrations in urban and peri-urban environments of two Pacific Island Countries
No full textAir quality monitoring in most Pacific Island Countries, Territories, and States (PICTS) is minimal, with notable exceptions in Hawai’i and New Caledonia. However, air quality issues are increasingly significant in the region. Existing data on air quality, particularly regarding PM2.5 and PM10, are limited, with studies focusing on Fiji and New Caledonia. Our research provides the first continuous and comparative air quality monitoring in urban and peri-urban areas of Fiji and the Solomon Islands, and it is the first assessment since the introduction of the 2021 World Health Organization (WHO) Air Quality Guidelines (AQG). This study assesses health risks and air pollution trends to inform governmental recommendations. We collected PM2.5, PM10, and weather data from Honiara, Solomon Islands (February 2020–August 2023), and Suva, Fiji (April 2021–August 2023). In Honiara, PM2.5 levels exceeded WHO AQG on 75% of days in urban areas and 51% in peri-urban areas, while PM10 levels
surpassed guidelines on 2% of days in both areas. In Suva, urban areas had a 10% exceedance of PM2.5 guidelines, compared to 13% in peri-urban areas. Annual PM2.5 averages exceeded WHO guidelines every year, with levels in Suva and Honiara exceeding guidelines by 2–4 times. PM10 levels were 1.5 times higher than WHO AQG in urban Honiara and 1.2 times higher in peri-urban areas. These findings highlight the urgent need for governmental action to establish robust air quality standards and long-term monitoring programs in Fiji and the Solomon Islands to mitigate health risks from poor air quality
Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji
No full textBackground: Clinical practice guidelines (CPGs) improve patient care by standardizing medical practice. However, little is known about their applicability in low-resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice.
Aims: We describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low-resource setting in the Pacific.
Methods: A mixed-methods design included a survey and focus groups. All 178 doctors
in five departments at Fiji’s largest tertiary hospital were invited to participate.
Subsequently, two focus group interviews explored clinicians’ perspectives in more.
detail. Analysis included data description, multi-variable logistic, multinomial regression and manifest content analyses.
Results: The response rate was 74%. Most doctors agreed that CPGs were good for
patient management (100%), doctors continuing medical education (CME) (96%),
patient education (73%), supported by systematic reviews (91%) and consistent with
existing norms/values (83%). Ninety-five per cent stated that CPGs increased the quality of care, and 80% stated that CPGs increased physician satisfaction. Approximately
two-thirds stated that CPGs decreased medical-legal problems (63%) and malpractice.
suits (68%). Sixty to 90% of doctors disagreed that CPGs were oversimplified/cookbook.
medicine (60%), too rigid to apply individually (65%), challenged physician autonomy.
(60%) or were ambiguous/unclear (86%) or not practical (89%). The preferred method of dissemination was CME, and quick reference guides were best for implementation. No formal CPG monitoring existed in any department.
Conclusion: Most physicians found CPGs to be valuable for improving the consistency
of care. In low-resource settings, dissemination of guidelines should be paired with
CME to improve their uptake. Increased monitoring of guideline use appears necessary
Clinical practice guidelines: Their utility, dissemination and monitoring at Colonial War Memorial Hospital: A mixed methods study from Fiji
No full textBackground: Clinical practice guidelines (CPGs) improve patient care by standardizing medical practice. However, little is known about their applicability in low resource settings. Since 2010, Fiji has introduced guidelines to increase the application of evidence-based practice.
Aims: We describe the dissemination, utility and monitoring of guideline implementation in Fiji, a low-resource setting in the Pacific.
Methods: A mixed-methods design included a survey and focus groups. All 178 doctors in five departments at Fiji’s largest tertiary hospital were invited to participate.
Subsequently, two focus group interviews explored clinicians’ perspectives in more detail. Analysis included data description, multi-variable logistic, multinomial regression and manifest content analyses.
Results: The response rate was 74%. Most doctors agreed that CPGs were good for patient management (100%), doctors continuing medical education (CME) (96%), patient education (73%), supported by systematic reviews (91%) and consistent with
existing norms/values (83%). Ninety-five per cent stated that CPGs increased the quality of care, and 80% stated that CPGs increased physician satisfaction. Approximately
two-thirds stated that CPGs decreased medical-legal problems (63%) and malpractice suits (68%). Sixty to 90% of doctors disagreed that CPGs were oversimplified/cookbook medicine (60%), too rigid to apply individually (65%), challenged physician autonomy (60%) or were ambiguous/unclear (86%) or not practical (89%). The preferred method of dissemination was CME, and quick reference guides were best for implementation. No formal CPG monitoring existed in any department.
Conclusion: Most physicians found CPGs to be valuable for improving the consistency of care. In low-resource settings, dissemination of guidelines should be paired with CME to improve their uptake. Increased monitoring of guideline use appears necessary
When one size does not fit all: aid and health system strengthening for Small Island Developing States.
No full textHealth System strengthening is high on the agenda of the global health community. We review some of the specific challenges faced by Small Island Developing States in the development of their health systems. We propose a list of action points for aid actors willing to adapt their health programs and interventions
Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines
No full textIntroduction: Limited data on 24-hour movement behaviors of children aged 5–8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region.
Methods: Cross-sectional representative data from 1192 children aged 5–8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012–2014 Children’s Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables.
Results: Twenty-seven percent (95% confidence interval, 24.6–30.0) of children met integrated guidelines; 98% (96.2–98.0) met
PA, 78% (75.4–80.0) met sleep, and 35% (32.6–38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence
interval, 1.03–1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49–3.54]) were more likely to meet ST
guidelines. Overweight children (0.62 [0.40–0.96]), those aged 8 years (0.39 [0.22–0.69]), and children with caregivers of an
education level of high school or beyond (0.44 [0.29–0.68]) were less likely to achieve ST guidelines. Children from midrange
annual household incomes were less likely to meet combined guidelines (0.60 [0.39–0.92]). Conclusions: Three-quarters of
children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed
Molecular epidemiology of the HIV-1 epidemic in Fiji
No full textVery little is known about the HIV-1 epidemic in Fiji, nor the wider South Pacific region more generally, yet new reported HIV-1
infections are on the rise. As of 2023, there are an estimated 2000 cases of HIV-1 in Fiji with heterosexual contact the primary route of transmission. In this study, we used a molecular epidemiological approach to better understand the genetic diversity of the HIV-1 epidemic in Fiji and reveal patterns of viral transmission. Between 2020 and 2021, venous blood samples were collected from people who had previously been diagnosed with HIV-1. We generated molecular data from 53 infections, representing ~2–3% of reported cases, to identify HIV-1 subtypes and determine the outbreak’s trajectory. Among the 53 HIV-1 cases, we used Bayesian inference to estimate six separate introductions with at least two of these introductions leading to sustained transmission forming large, nation-wide clusters of HIV-1 subtype C. We found that since the introduction of public health interventions circa 2014, the effective reproductive number, Re, decreased among the major clusters identified from an average of 2.4 to just below 1. Molecular epidemiological analysis suggested that public health efforts aimed at decreasing the spread of the disease were at least somewhat
effective. Nevertheless, with a recent rise in reported HIV-1 cases, this study demonstrates the utility of molecular data to inform a more targeted public health approach for controlling its spread
Prevalence and trends of cervical cancer screening among women in Fiji from 2014 to 2018
No full textIntroduction: Cervical cancer is the third most common cancer in women both in developed and developing countries. This study aimed to determine the prevalence of cervical cancer and the
trends of cervical cancer screening among women who had cervical cancer screening in Suva, Fiji between 2014 and 2018.
Materials and method: This study applied a 5-year retrospective electronic chart review of data from all women attending the Women’s Wellness Clinic (WWC) in Suva, Fiji. The women who
were selected for this study and screened for cervical cancer were Fijian citizens above 18 years of age and were registered in 2014–2018. A data collection form was used to collect data. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 24; p <0.05 % was considered as the level of significance.
Results: Among the 39,579 women who attended WWC for other family planning services, 12,074
women screened for cervical cancer with a prevalence of 30.5 %. The overall mean age for women screened for cervical cancer was 37.6 (SD ± 11.2). Two-thirds (76.4 %) of the women screened
for cervical cancer were less than 46 years of age and 53.9 % were I-taukei. The number of women who came for Pap smear increased in 2015, however, a slight decline was observed in 2016 which was later improved to 35.1 % in 2018. Malignancy was more common in the age range of 42–49 respectively. In this study, women of 46 years and above had an OR of 0.51 (95 % CI: 0.36, 0.72), other ethnicity OR was 1.73 (95 % CI: 1.27, 2.35), and the Muslim religion OR recorded was 1.44 (95 % CI: 1.03, 2.01) which was comparatively considered a high-risk group. Women who are
widowed 1.57 (95 % CI: 0.798, 3.11), single 1.29 (95 % CI: 0.87, 1.92) or divorced 1.08 (95 % CI: 0.59, 1.99), employed 1.01 (95 % CI: 0.83, 1.24) and are living in rural areas 1.19 (95 % CI: 0.82, 1.73) are also associated with higher odds of having abnormal results.
Conclusion: Cervical cancer is listed as the first and most common type of cancer in women which is noticeably increasing in Fiji. Even though cervical cancer screening has improved over the years, adequate surveillance systems and ongoing programs should be designed and implemented to increase awareness and monitor the trend of cervical cancer screening in order to reduce
cervical cancer prevalence and mortality rates
Research about eye health and eye health services in Pacific Island Countries and Territories: a scoping review
No full textBackground: We aimed to summarise the extent and nature of published research about eye health and eye health
services in Pacific Island Countries and Territories since 1980.
Methods We searched Medline, EMBASE, Global Health and Cochrane Library to identify publications about eye health and eye health services in 22 Pacific Island Countries and Territories from 1 January 1980 to 26 January 2024. Study selection and data extraction were conducted by two reviewers independently.
Findings Of the 1610 publications identified, 180 were included. This research was most commonly conducted in Papua New Guinea (n = 52) or Fiji (n = 33) and focused on diabetic retinopathy (n = 29) or trachoma (n = 18), with few focused on cataract or refractive error. While eye health services research was common in the past, recent research focused on trachoma. The included research was largely undertaken and funded by people and organizations from Australia, Aotearoa New Zealand and the USA, though authors with Pacific affiliations is increasing.
Interpretation Few countries have up-to-date estimates of the prevalence of vision impairment or service coverage to enable evidence-informed planning. Increased effort is required to strengthen research capability to ensure research priorities in eye health are set by Pacific People
An assessment of latrine front‑end characteristics and associated surface E. coli indicated faecal contamination in rural Fiji
No full textIn Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug–Dec 2019), endline (n = 262) (Jun–Sep 2022) and an in-depth front-end study (n = 12) (Oct–Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use