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Fiji’s policy response to COVID-19 and the integration of Indigenous voices
No full textIndigenous Peoples, such as Pacific Islanders have been identified as particularly vulnerable to the impacts of
COVID-19. Past research has focused on Indigenous Peoples as minority populations with less known about
countries like Fiji where the Indigenous population (iTaukei) are the majority. In this study we sought to assess
the inclusion of the Indigeneity (i.e., culture, traditions, Indigenous knowledge, worldview, and values) of iTaukei in
COVID-19 policies through the following steps:
1) identify key policy responses to COVID-19 in Fiji,
2) document
how these policies evolved over the pandemic, and
3) assess if and how iTaukei were considered in these responses and the impact of these policies on their lives.
Drawing on an analysis of policy documents (n = 74),
interviews (n = 11), and a focus group (n = 22), we characterized 11 key policy responses by the Government of
Fiji:
i) containment measures,
ii) economic support,
iii) prevention measures,
iv) vaccinations, v) medical
assistance,
vi) food security,
vii) COVID-19 testing,
viii) education,
ix) worker safety,
x) disaster management,
and xi) enforcement.
The nature of these responses altered in response to positive case numbers and vaccinations. There is no evidence the dimensions of iTaukei Indigeneity were included in the policy process highlighting the need to examine underlying political and power structures that may be silencing the voices of iTaukei
Molecular and clinical epidemiology of carbapenem resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales in Fiji: a multicentre prospective observational study
No full textLessons for strengthening policymaking for obesity and diet-related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region
No full textSummary: Obesity and diet-related noncommunicable diseases (NCDs) have a profound impact on individuals, households, health care systems, and economies in low- and middle- income countries (LMICs), with the Western Pacific Region experiencing some of the highest impacts. Governments have committed to improving population diets; however, implementation challenges limit effective policy action. We undertook meta-narrative synthesis of the academic literature and used theories of policymaking and implementation to synthesize current knowledge of issues affecting the adoption and implementation of policies to prevent obesity and diet-related NCDs in LMICs in the Western Pacific Region. We found that political leadership and management of food and nutrition policies often diluted following policy adoption, and that nutrition and health advocates find it difficult to enforce policy compliance from actors outside their sectors. Opportunities for strengthening implementation of food and nutrition policies in the Western Pacific include (1) improved and earlier engagement between health policymakers and implementing agencies; (2) focusing on the need for increased accountability from governments, including through effective engagement and organization of actor networks, knowledge sharing, and in highlighting where stronger action is required; and (3) identifying and building the strategic capacities of policy actors in framing, advocacy, coalition-building, knowledge translation, and leadershi
Practice and perception of dental practitioners in the Suva-Nausori area, Fiji on management of paediatric patients with dental anxiety.
No full textDental anxiety in children has been associated with poor oral health outcomes.
Behaviour management and psychological interventions have been recognized as
effective methods of reducing anxiety in children with positive long-term effects.
So far, no information is available on how this issue is managed in the Fijian
population. The aim is to investigate the practice and perception of dental practitioners
in Suva-Nausori when managing paediatric patients with dental anxiety. A cross�sectional descriptive study was conducted using a questionnaire distributed to dental
practitioners in Suva-Nausori area, Fiji. The questionnaire focused on assessment
methods for identifying anxious paediatric patients, management approaches, and
challenges faced by practitioners. The response rate was 80% (n = 40), with almost
an equal distribution between private and public practitioners of 47% and 53%
respectively. Observation-based assessment was reported as the most commonly used
method for identifying dental anxiety by 79% of participants. Behaviour management
techniques, particularly communication and Tell-Show-Do, were widely used by 83%
of practitioners. Additionally, 17% utilised both behavioural and pharmacological
techniques, with oral sedation being the most common pharmacological method (71%).
Local anaesthesia was identified as the most challenging procedure for anxious children.
These findings indicate that dental practitioners in the Suva-Nausori area primarily
utilise behaviour management techniques and oral sedation to manage dentally anxious
children, indicating a limited range of techniques. There is a need for further education
and training to ensure that anxious patients receive optimal management, including
options such as conscious sedation tailored to individual needs.
Keywords
Behaviour management; Dental anxiety; Paediatric patients; Dental practitioner
Adult mortality from non-communicable diseases in Fiji's major ethnic groups 2013–17
No full textAbstract
Background
Sustainable Development Goal 3.4.1 (SDG3.4.1) targets a one-third reduction in non-communicable disease (NCD) mortality in ages 30–69-years by 2030 (relative to 2015). Directing interventions to achieve this aim requires reliable estimates of underlying cause of death (UCoD). This may be problematic when both cardiovascular diseases (CVD) and diabetes are present due to a lack of consistency in certification of such deaths. We estimate empirically 2013–17 NCD mortality in Fiji, by sex and ethnicity, from CVD, diabetes, cancer, and chronic lower respiratory diseases (CRD), and aggregated as NCD4.
Methods
UCoD was determined from Medical Certificates of Cause-of-Death (MCCD) from the Fiji Ministry of Health after pre-processing of mortality data where diabetes and/or hypertension were present in order to generate internationally comparable UCoD. If no potentially fatal complications from diabetes or hypertension accompanied these causes in Part I (direct cause) of the MCCD, these conditions were re-assigned to Part II (contributory cause). The probability of a 30-year-old dying before reaching age 70-years (PoD30–70), by cause, was calculated.
Findings
The PoD30–70 from NCD4 over 2013–17 differed by sex and ethnicity: in women, it was 36% (95%CI 35–37%) in i-Taukei and 27% (26–28%) in Fijians of Indian descent (FID); in men, it was 41% (40–42%) in both i-Taukei and FID.
PoD30–70 from CVD, diabetes, cancer and CRD in women was: 18%, 10%, 13% and 1·0% in i-Taukei; 13%, 10%, 5·6% and 1·1% in FID; in men was: 28%, 8.4%, 7·6% and 2·2% in i-Taukei; 31%, 8.3%, 3.5% and 3·1% in FID.
Interpretation
To achieve SDG3.4.1 goals in Fiji by 2030, effective population wide and ethnic-specific interventions targeting multiple NCDs are required to reduce PoD30–70 from NCD4: from 36% to 24% in i-Taukei, and 27% to 18% in FID women; and from 41% to 27% in i-Taukei and FID men
Characteristics and predictors of pain among women who underwent cesarean section in Fiji
No full textAim: To identify the characteristics and predictors of post cesarean section (CS) pain among women.
Materials & methods: This quantitative study was conducted at Labasa hospital in Fiji over a 6-month period. A total of 312 mothers who received spinal, epidural and general anesthesia were included. Their pain score was assessed using the visual analogue scale 24 h postoperatively.
Results:70.8% women had either moderate or severe pain on the visual analogue scale. About 41.3%women expressed dissatisfaction with their pain management and 70.5% women had difficulties in performing activities due to pain. Lower parity was noted to be a positive predictor of pain among women undergoing CS. Conclusion: Adequate pain management for post-CS patient at Labasa hospital is lacking. Plain language summary: Pain & pain control methods after surgical birth in Labasa, Fiji What is the study about?: This study looked at what affects pain in women after delivering a baby through surgery, also known as surgical birth or cesarean section (CS), at Labasa Hospital in Fiji. Over6 months, 312 mothers who had surgical births with different types of pain-reducing medicines tookpart in this study. Their pain was checked 24 h after surgery using a pain scale.What were the results?: The results showed that 70.8% of women felt moderate to severe painafter their surgical birth. In addition, 41.3% of the women were not happy with their pain control, and 70.5% had difficulties doing their daily activities because of the pain. The study also found that first-time mothers were more likely to feel more pain after their surgical birth. What do the results mean? The key point of the study is that many women at Labasa Hospital are not getting enough pain relief after their surgical birth, especially first-time mothers. This shows there is a need to improve pain control methods for these patients. A better pain control could help these mothers get better more comfortably and feel more satisfied with their car
The Lived Experiences of Fijian Male Student Nurses - School of Nursing - Fiji National University: A Mixed Method Study
No full textIntroduction: Globally there are fewer male student nurses than their female counterparts apparently making it a female-oriented profession; while there is an increase in recruitment of males it is not sufficient to create a gender balance. This study explored the lived teaching and learning experiences of Fijian male student nurses including perceptions of families and communities.
Method: A mix-method design was involved where the Inventory of Male Friendliness in Nursing Programs (IMFNP-S) was used to collect data from third year male student nurses at the Fiji School of Nursing. In addition, Focus Groups were used to gain depth of insight about their lived experience.
Results: All male student nurses were invited to participate (n=30) and the response rate was 93% and the male friendliness in the nursing program was at a moderate level (x̄ = 37.39/68); while thematic analysis elicited the following: ‘being single out’ ‘societal and cultural image of male student nurses’ and ‘educational environment and content’
Conclusion: Male student nurses reported experiencing negative portrayals, being ridiculed for being a male in nursing, harassment and discrimination culminating in them feeling singled out. Educators should have strategies to recruit and to acclimatize male student into nursing education
A tuberculosis elimination-focused geospatial approach to optimizing access to diagnostic GeneXpert machines in Fiji
No full textAbstract
Objectives: Fiji could be the first country to eliminate tuberculosis. To inform this strategy, we aimed to identify how many GeneXpert® machines are required to enable over 90% of Fijians to be within one-hour easy access.
Methods: We used Geographic Information System (Quantum GIS; QGIS), OpenStreetMap and population data (Kontur) to map possible facilities in relation to QGIS generated 60-min drive-time isochrones, with correction for missing road data. For outer islands, we calculated a distance to nearest hub operation.
Results: The solution comprised 24 GeneXpert® machines, allocating 7 GeneXpert® to Viti Levu, 6 GeneXpert® to Vanua Levu and 11 to other islands. This resulted in 827,810 people, 93.6% of Fiji’s population, being within 1 h of a machine. Twenty-one thousand four hundred seventy-nine people on outer islands were an average of 43 km by water from the nearest facility.
Conclusions: We conclude that over 90% of Fijians could be within an hour of a GeneXpert® machine with placement of 24 machines. KEYWORDS access, allocation, diagnosis, elimination, GeneXpert, tuberculosi
Hepatitis B virus infection on Kwajalein Atoll, Marshall Islands: a seroprevalence, knowledge and attitudes study
No full textObjective: A study was conducted to determine the seroprevalence of chronic hepatitis B (HBV) infection among children and their mothers on Kwajalein Atoll in the Marshall Islands two decades after routine vaccination was introduced in the 1990s. Mothers’ knowledge and attitudes towards HBV disease and vaccination were also assessed.
Methods: Results of a national seroprevalence survey conducted in 2016–2017 and antenatal records were used to determine the prevalence of HBV seropositivity in children aged 6–8 years and their biological mothers. The associations between demographic, social, and vaccination-related factors and seropositivity were explored using Fisher’s exact tests.
Results: HBV seroprevalence was 0.3% in children and 6.8% in their mothers (during pregnancy). Coverage of timely
HBV vaccination was 90.3% for the birth dose and was significantly associated with factors related to place of residence
(P < 0.001), place of birth (P < 0.001) and number of antenatal visits (P < 0.001). Maternal attitudes towards infant vaccination and antenatal screening were largely positive (95.8% and 96.7%, respectively) despite low vaccination rates (20.9%) among mothers. Knowledge levels were low for disease complications, treatment, and transmission.
Discussion: The prevalence of HBV in children and mothers residing on Kwajalein Atoll in 2016–2017 was lower than the national average for the Marshall Islands. Timely birth dose administration appears to have been effective in preventing mother-to-child transmission of HBV in this setting. It should be promoted in remote settings where antiviral therapy is not available. The provision of out-of-cold-chain HBV vaccines should be considered to improve access in remote settings
A Comparison of the Enamel Remineralisation Potential of Self-Assembling Peptides
No full textBackground
The aim of this research was to compare the efficacy of the remineralising potential of self-assembling peptides (SAPs): Curodont Repair (P11-4), P26, and leucine-rich amelogenin peptides (LRAP) with the standard 5% NaF varnish (Duraphat) on early enamel caries lesions (EECLs).
Methods
A demineralising solution (DS) was used to create artificial EECLs in human dental enamel specimens, which were randomly allocated to treatment groups: P11-4; P26 solution; LRAP solution; 5% NaF varnish; and deionised water (DIW). Each specimen was subjected to 8 days of pH cycling. Specimens from each test group were subjected to microcomputed tomography (micro-CT) and nanomechanical testing to assess mineral density (MD), hardness (H), and elastic modulus (EM) properties of sound, demineralised, and treated enamel.
Results
The mean MD percentage gain was highest in the P26 and P11-4 groups, followed by the LRAP, 5% NaF varnish, and DIW groups. There were statistically significant differences amongst groups. In the outer layer of EECLs, the EM and H were highest in P26 and P11-4 groups, followed by the LRAP and 5% NaF varnish. In the inner layer of EECLs, the EM and H were highest in P11-4 and P26 groups, indicative of enhanced penetration and remineralisation of the deeper parts of the artificial EECLs