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Barriers and facilitators to the introduction of import duties designed to prevent noncommunicable disease in Tonga: a case study
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Background: In Tonga, import duties were lowered on tinned fish and seafood in 2013 and raised on soft drinks,dripping and other animal fats. Additional import duties were applied to soft drinks and dripping and other fats in 2016 and duties were also applied to high fat meats, mutton flaps and turkey tails. The objective of this study was to describe barriers to and facilitators of these import duties from a policy-maker perspective.
Methods: A case study was conducted to analyse implementation of policies originally modelled by the Pacific Obesity Prevention in Communities project to reduce mortality in the Kingdom of Tonga. Policymakers (n = 15) from the Ministries of Revenue, Health, Finance and Labour and Commerce involved in the development and implementation of Tonga’s food-related policies participated in key-informant interviews.
Results: The main facilitator of import duties were strong leadership and management, cross-sector collaboration,
awareness raising and advocacy, nature of the policy, and the effective use of data to model policy impacts and inform the general public. The absence of clear lines of responsibility and a decline in collaboration over time were identified as barriers to implementation of the import duties.
Conclusion: In a small Island state implementing import duties to prevent non-communicable disease can be straight forward providing policymakers and the community have a shared understanding of the health and economic costs of NCDs
A preliminary report of the pattern of ear disease among students attending a school for people with disabilities in Samoa
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The Role of Hemoglobin A1C in Diabetes Screening and Diabetic Retinopathy
Get PDFAbstract: Hemoglobin A1C (A1C) is used in various settings. Its performance has not been evaluated
systemically. We compared A1C in diagnosis of diabetes with fasting plasma glucose (FPG) and 2-h
postchallenged plasma glucose (2hPG) parameters in a cross-sectional cohort in the United Stated.
Adult subjects (≥20 years) were identified from the National Health and Nutrition Examination
Survey 2005–2016 without a history of diabetes who had BMI, A1C, FPG, and 2hPG (n = 10,416). For
comparisons, we calculated the sample weighted prevalence, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with subgroup analyses. For the retinopathy
study, diabetic subjects with established diabetes who responded to the question of diabetic retinopathy were evaluated (n = 3907). Compared to the FPG/2hPG criteria, A1C ≥ 48 mmol/mol (6.5%) had
a low sensitivity at 25.90%, with specificity 99.70%, PPV 84.70%, and NPV 95.70%. Subgroup analyses
revealed a lower sensitivity in males (24.52%); the lowest in non-Hispanic White (21.35%), in the
third decade (14.32%), and in the BMI < 22.50 kg/m2 group (7.21%). The prevalence of self-reported
diabetic retinopathy increased drastically with an inflection point at A1C 48 mmol/mol (6.5%) from
11.52% to 18.32% (p < 0.0001). A1C ≥ 48 mmol/mol (6.5%) should be cautiously used to diagnose
diabetes in certain subgroups due to very low sensitivity in certain groups. With the confirmation of
the association of increasing self-reported diabetic retinopathy with A1C ≥ 48 mmol/mol (6.5%),
the current A1C cutoff is an acceptable value with the understanding of especially low sensitivity in
certain subgroups.
Keywords: diabetes mellitus; diagnosis; sensitivity; specificity; retinopath
Mainstreaming Climate Adaptation Planning and Action into Health Systems in Fiji, Ghana, and Benin
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