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Burns injury characteristics and outcomes at Lautoka Hospital, Fiji
No full textBackground: Burns injury are a global public health problem and one of the leading causes of morbidity and mortality. However, there is no published literature available from Lautoka Hospital in Fiji that assessed the characteristics and outcomes of burn patients.
Objective: The aim of this study was to explore sociodemographic and clinical characteristics, medical care and outcomes of burn injury patient at Lautoka Hospital in order to gain deeper insights into burns related issues and improve burns care at the hospital.
Method: A retrospective cross-sectional study was conducted between January 1st 2020 and June 30th 2024 at Lautoka Hospital in Fiji. Data were analysed using SPSS version 25. The association between independent variables and outcomes was assessed using Chi-square test.
Results: Study population included 267 patients predominately male (57 %). Majority of the patients (59 %) were aged below 10 years. Most of the burns occurred at home (92 %). A significant proportion of patients (64 %) had burns affecting multiple regions with the lower extremities being the most commonly affected area. Partial
thickness burns were observed in 87.5 % of patients. The majority of patients (55 %) had a total body surface area (TBSA) < 10 % affected by burns. Normal saline (39 %) and Paracetamol (93 %) were most commonly used intravenous fluid and analgesic respectively. Most patients (93.5 %) underwent daily hydrotherapy while 26 % required surgical interventions. The median length of hospitalisation was 7.4 days. Wound infection occurred in 25 % of patients and the mortality rate was 10 %.
Conclusion: This study provides deeper insights into burn related issues in order to reduce the incidence and morbidity of burn injury, and improve care. This study is single-centred and conducted retrospectively thus limiting exploration of additional associations. A multicentred prospective study is recommende
Redesigning Prehospital Care: Fiji’s Response to the COVID-19 Pandemic
No full textAbstract
The benefits of emergency care systems in low- and middle-income countries are well�described. Passed in the wake of the coronavirus disease 2019 (COVID-19) pandemic,
the World Health Assembly (WHA) Resolution 76.2 emphasizes the importance of
communication, transportation and referral mechanisms, and the linkages between
communities, primary care, and hospital care. Literature describing prehospital care and
ambulance system development is scarce, with little data on the effectiveness and cost
effectiveness of different options. Prehospital care systems in Pacific Island countries are
under-developed. In Fiji, out-of-hospital care is fragmented with an uncoordinated
patchwork of ambulance providers. There is no scope of practice or training requirement for
providers and no patient care records. There are no data relating to demand, access, and
utilization of ambulance services.
In response to a surge of COVID-19 cases in 2021, the Fiji government created a
Prehospital Emergency Care Coordination Center (PHECCC) in the capital Suva, which
was operational from July-October 2021. Access was via a toll-free number, whereby the
public could receive a medical consultation followed by phone advice or dispatch of an ambulance for a home assessment, followed by transportation to hospital, if required. The PHECCC also provided coordination of inter-facility transport and retrieval of the critically ill. The system that was created met many of the prehospital care standards set by emergency care leaders in the region and created the first dataset relating to ambulance demand and utilization. This is the first article to document prehospital system development in the Pacific regio
Measuring what matters: Context-specific indicators for assessing immunisation performance in Pacific Island Countries and Areas
No full textIncreasing countries’ access to data can improve immunisation coverage through evidence-based decision-making. However, data collection and reporting is resource-intensive, so needs to be pragmatic, especially in low-and-middle-income countries. We aimed to identify which indicators are most important for measuring, and improving, national immunisation performance in Pacific Island Countries (PICs). We conducted an expert elicitation study, asking 13 experts involved in delivering immunisation programs, decision-makers, health information specialists, and global development partners across PICs to rate 41 indicators based on their knowledge of the feasibility and relevance of each indicator. We also asked experts their preferences for indicators to be retained or removed from a list of indicators for PICs. Experts participated in two rating rounds, with a discussion on the reasons for ratings before the second round. We calculated mean scores for feasibility and relevance, and ranked indicators based on experts’ preferences and mean scores. We used framework analysis to identify reasons for selecting indicators. Experts agreed that certain indicators were essential to measure (e.g. data use in program planning and measles vaccination coverage), but preferences varied for most indicators. Preferences to include indicators in a set of indicators for PICs moderately correlated with scores for relevance (r = 0.68) and feasibility (r = 0.56). In discussions, experts highlighted usefulness for decision-making and ease of data collection, reporting and interpretation as the main reasons driving indicator selection. Country-specific factors such as health system factors, roles and influence of various immunisation actors, and macro-level factors (namely population size, distribution and mobility) affected relevance and feasibility, leading us to conclude that a single set of indicators for all PICs is inappropriate. Rather than having a strict set of indicators that all countries must measure and report against, performance indicators should be flexible, country-specific, and selected in consultation with immunisation actors who collect and use the data
Clinical Symptoms and Complications of Dengue, Zika and Chikungunya Infections in Pacific Island Countries: A Systematic Review and Meta-Analysis
No full textBackground: Dengue fever (DENV), Zika virus (ZIKV) and chikungunya (CHIKV) pose a significant public health risk to Pacific Island countries. However, there is limited existing research that compares the clinical manifestations of these arboviruses.
Methods: We searched PubMed, Embase and Scopus for epidemiological studies that presented quantitative data for symptoms or complications of DENV, ZIKV or CHIKV in a Pacific Island country. Risk of bias assessment was conducted using the Newcastle-Ottawa Scale (NOS). For each arbovirus, we used descriptive statistics and performed random-effects meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals. Heterogeneity was assessed using the I2 statistic and was further investigated through subgroup analysis. Publication bias was assessed via Egger’s test.
Findings: We found that fever, headache, arthralgia, myalgia, rash and gastrointestinal symptoms were common in all three arboviruses. Complications for ZIKV included Guillain-Barré syndrome (GBS) (0.5%) and microcephaly (56%), and for CHIKV, were shock or organ failure (3%), liver disease (1%), myocarditis (0.1%) and neurological complications (1%). Through meta-analysis, we estimated the rates of hospitalisation (12.45% [7.88-17.87]), mortality (0.25% [0.05-0.54]) and severe dengue (4.47% [0.97-10.17]) in DENV. Subgroup analysis revealed clinical heterogeneity based on age, geographical location, study design and whether studies only examined hospitalised patients. Publication bias was also detected for studies assessing complications of DENV.
Interpretation: We identified overlapping symptoms as well as clinical features that were specific to each arbovirus: For DENV, haemorrhagic symptoms, flushed face and taste alteration; and for ZIKV, limb oedema, Guillain-Barré syndrome and microcephaly. Despite CHIKV being recognised as a classically mild disease, we also identified the potential for severe complications such as myocarditis, encephalitis and shock or organ failure. We proposed updated clinical criteria for DENV, ZIKV and CHIKV to guide clinicians in Pacific Island countries. Our review was limited by lack of data availability and consequently we advocate for efforts to improve the transparency and consistency of disease reporting systems in the region. Overall, our research will assist healthcare providers in Pacific Island countries to better understand these clinically challenging arboviruses
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
Transforming place-based management within watersheds in Fiji: The watershed interventions for systems health project
No full textWatersheds offer opportunities for place-based interventions to transform systems health via preventative versus reactive approaches to management that achieve multiple co-benefits for public and environmental health. The Watershed Interventions for Systems Health in Fiji (WISH Fiji) project embraced participatory knowledge co-production and action-oriented research to identify risks to public and ecosystem health, prioritize interventions to address risks, and monitor responses of the system to interventions. We used screening filters and local knowledge to collaboratively identify five watersheds for action with high prior incidence of water-related diseases (Fiji’s “three plagues” of leptospirosis, typhoid and dengue) and high risk to downstream environmental health. We reviewed literature to identify disease risk factors, evaluated overlaps with risks for downstream environmental impact, and
designed 13 instruments to collect information about baseline risk. Following consultations
to obtain free, prior and informed consent, we enrolled 311 households across 29 communities. We synthesized data to identify key risks at the household, community, and landscape
level, which were communicated to community water and resource management committees and government leaders as part of developing water and sanitation safety plans for each community. Local committees identified 339 priority risk reduction actions across nine main categories: animal management; drainage; health systems surveillance; hygiene; integrated planning; land use management; sanitation systems; waste management; and water systems. As of October 2022, 154 interventions were implemented in the five watersheds
across different risk categories and scales. While we can track changes to factors that reduce risk of water-related disease and improve environmental health, direct evaluation of impacts to public health is limited due to poor geolocation of case records. The WISH Fiji project is a model of cross-sectoral coordination that efficiently progresses multiple Sustainable Development Goals, but scaling requires sustained investment in interventions to realized full benefits, particularly for nature-based solutions that exhibit lagged responses
Perception of Type 2 Diabetes Mellitus (T2DM) patients on diabetes self-care management in Fiji
No full textThe prevalence of diabetes has increased globally where Type 2 Diabetes Mellitus (T2DM) is more common than any other type of diabetes. Self- care management education of diabetes provides skills and information for diabetic patients to effectively perform their own self diabetic self-care for optimum glycemic index control. As T2DM is a growing health issue in Fiji, promoting diabetes self manages among patients is a need, however there is lack of evidence in this regard. Therefore, the aim of this study is to explore the perception of T2DM patients on diabetic self-care management.
Method
This study used a qualitative method among T2DM patients regarding diabetic self-care management in Central Division, Fiji in 2022. This study was conducted in SOPD (Special Outpatient Department) clinics in the three chosen governmental health centers in the central division of Fiji. The study sample inclusion criteria were only T2DM patients, and no other types of diabetes, patients who are 18years and above, patients who are attending
clinic at least for more than 6 months, self-identified as Fijian participants of any ethnicity or gender. The study settings were also purposively selected but the study sample was selected using purposive sampling. In depth interview using semi-structured open-ended questionnaires was used to collect data. Thematic analysis was done, followed by reviewing themes, defining and naming them.
Results
Thirty patients participated in this study. Five major themes emerged from the in-depth interview including patient factors that affect diabetes self-care management, behavior and attitude towards T2DM self-care management, health services delivery, challenges and barriers faced by patients to perform diabetes self-care management, and recommendations to improve patient self-care management. Patients in this study have good knowledge about T2DM and the self-care management they have to perform. It is the patients’ attitude and behavior towards T2DM self-care management that affects patients to perform self-care management. The study also showed patients have gained good knowledge from Health Care Workers (HCW). Socio-economic and psychological status also played a vital part in patients’ self-care management. Apart from challenges, there were opportunities to
learn the difficulties patients face in order to perform self-care management.
Conclusion
The results of this study revealed a combination of individual, cultural, and health systematic related factors as the mots influencer of diabetes self-management among patients in Fiji.
Patients have to take ownership of their own health in order to improve their blood sugar reading and reduce complication of diabetes. Tailored interventions that consider patients’
belief and address potential challenges would be useful. A lot is needed in terms of upgrading facilities for the comfort of patients and need to collaborate more with other multidisciplinary team and stakeholders
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
The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019–2022
No full textBackground There is a paucity of data on antimicrobial resistance in Fiji. The aim of this study was to determine the
antimicrobial susceptibility profile of bacterial isolates from clinical samples at Colonial War Memorial Hospital
in Fiji.
Methods This retrospective study reviewed four-year of data from January 1, 2019, through December 31, 2022.
Laboratory testing was carried out using locally approved protocols. Selective antimicrobial susceptibility testing
was performed whereby only isolates resistant to first line antimicrobials were tested against second line
antimicrobials. Only the first isolate of a given species per patient in a single year were included in the analysis.
WHONET software and Microsoft Excel were used for analysis.
Findings A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria.
K. pneumoniae was the most common (n = 5363), followed by E. coli (n = 4321). Extended spectrum beta
lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst K. pneumoniae, and 10%–23%
in E coli. There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were A.
baumannii, 15% (n = 110) E. coli and 14% (n = 101) P. aeruginosa. Amongst the E. coli isolates tested,
susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of
methicillin resistance amongst Staphylococcus aureus was steady, remaining between 11% and 13%.
Interpretation This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL
producing K. pneumoniae and E. coli and carbapenem-resistant A. baumannii. The emergence and rapid spread of
carbapenemase producing E. coli in Fiji’s largest hospital is of particular concern. There is an urgent need to
allocate resources to improve existing capacity and to develop effective multimodal strategies to detect, manage
and control the spread of MDR organisms
Climate change and gastroenterology: from the frontline
No full textDespite contributing minimally to global greenhouse gas emissions,
1. Pacific Island nations are at the frontline of climate
change impacts.
2. Their heightened vulnerability stems from their geographical dispersal across the expansive Pacific Ocean, which leaves them encircled by vast bodies of water. This unique geological position subjects these island communities to climate-related threats, including rising sea levels, coastline erosion, ocean acidification, loss of biodiversity, food and water insecurities and extreme weather events, jeopardizing their existence and way of lif