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Analysis of the burden and trends of communicable diseases in Pacifc Island countries from 1990 to 2019
No full textAbstract
Background Communicable diseases contribute substantially to morbidity and death rates worldwide, particularly
in low-and middle-income countries. Pacific Island countries face unique challenges in addressing these diseases due
to their remote locations and limited resources. Understanding the burden and trends of these diseases in this region
is crucial for developing effective public health interventions.
Objective This study aimed to analyze the burden and trends of communicable diseases in Pacific Island countries
from 1990 to 2019.
Methods We utilized data from the 2019 Global Burden of Disease (GBD) study to analyze indicators including incidence, death, and disability-adjusted life years (DALYs). Excel 2016, R 4.2.1, and GraphPad Prism 9 were used to analyze
and visualize the data. Join point regression models were used for trend analysis, and the average annual percent
change (AAPC) was calculated.
Results From 1990 to 2019, the standardized incidence rate of communicable diseases in Pacific Island countries showed an upward trend (AAPC=0.198%, 95% CI=0.0174~0.221), while the standardized death rate
(AAPC=-1.098%, 95% CI=–1.34~0.86) and standardized DALY rate (AAPC=-1.008%, 95% CI=-1.187~-0.828) showed
downward trends. In 2019, the standardized incidence, death, and DALY rates of communicable diseases were higher
among males than among females, but the standardized death and DALY rates among males decreased faster
than those among females from 1990 to 2019. There were significant differences in the disease burden among different Pacific Island countries. The Solomon Islands had the highest standardized death rate (363.73/100,000), and Guam
had the lowest (50.42/100,000). Papua New Guinea had the highest standardized DALY rate (16,041.14/100,000),
and the Cook Islands had the lowest (2,740.13/100,000). In 2019, the main attributable risk factors for communicable
disease deaths in Pacific Island countries were child and maternal malnutrition (28.32%), followed by unsafe water,
sanitation, and handwashing (27.14%), air pollution (16.11%), and unsafe sex (14.96%). There were considerable geographical variations in risk factors.
Conclusion The burden of communicable diseases in Pacific Island countries remains high, despite improvements
in mortality and disability-adjusted life-year rates over the past few decades. This study provides valuable insights
into the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. The findings reveal several important insights and highlight the need for targeted public health interventions in the regio
Access block and overcrowding at the emergency department at Tupua Tamasese Meaole Hospital in Samoa
No full textAbstract
Background Access block and overcrowding are known to adversely impact on patient outcomes, service delivery,
and patient experiences within emergency departments (ED) worldwide. There are no studies on access block or
overcrowding from the Pacifc Islands. The aim of the present study is to provide preliminary data on access block and
overcrowding in the ED of the national tertiary hospital of Samoa.
Methods Mixed methods study design. Data collection was performed in March 2020. The quantitative strand calcu‑
lated (1) the point prevalence of patients impacted by access block in the ED, and (2) the ED bed occupancy rate to
assess for overcrowding. The qualitative strand used thematic analysis of two focus group interviews exploring access
block and overcrowding with ED medical and nursing staf members.
Results On the day of data collection, a total of 60 patients presented through the ED triage system. Of the 20
patients who were admitted into ED, 80% were triaged as ‘see without delay’ (CAT1), ‘emergency’ (CAT2) or ‘urgent’
(CAT3). For patients requiring admission to hospital wards, 100% waited 4+h in ED, and 100% waited 8+h, suggest‑
ing the presence of access block. Overcrowding in the ED setting was also evident, with an ED bed occupancy rate
of 0.95, and an adjusted bed occupancy rate of 1.43. The major themes emerging from the ED staf focus groups and
individual in-depth interviews were (1) the adverse impacts of access block and overcrowding, i.e., violence towards
ED staf members, (2) the preventable contributing factors, i.e., lack of physical beds in the ED, and (3) practical recom‑
mendations to improve patient fow through the ED, i.e., improved collaboration between ED, outpatient services,
and the hospital wards.
Conclusions Preliminary evidence suggested the presence of access block and overcrowding in the ED of the
national tertiary hospital of Samoa. ED staf interviews provided insight into the ED frontline challenges and ofered
practical recommendations for ED health service improvement
A qualitative exploration of food choice motives of urban indigenous food gatekeepers in Fiji: Implications for the use of the Food choice Questionnaire
No full textNurses Voices: Factors Affecting Qualifications Upgrading- A Qualitative Study of I-Taukei Nurses-Suva
No full text
Systematic scoping review of the implementation, adoption, use, and effectiveness of digital contact tracing interventions for COVID-19 in the Western Pacific Region
No full textA systematic scoping review of digital contact tracing (DCT) interventions for COVID-19 was conducted to describe the implementation, adoption, use and effectiveness of DCT interventions implemented as part of the COVID-19 response in the Western Pacific Region (WPR). A systematic search identified 341 studies and 128 grey literature sources, of which 18 studies and 41 grey literature sources were included. 17 (46%) WPR countries and areas implemented DCT interventions. Adoption ranged from 14.6% to 92.7% in different adult populations and epidemiological contexts. Trust in authorities, and privacy concerns and beliefs, were the most frequent determinants of adoption and use. Only two studies analyzed DCT effectiveness, which showed limited to no effectiveness of DCT interventions in low transmission settings. Overall, there is limited evidence available to evaluate the contribution of DCT to mitigating COVID-19 in the WPR. Preparedness for future health emergencies should include developing robust frameworks for DCT effectiveness evaluations
Assessing the potential impact of COVID-19 booster doses and oral antivirals: A mathematical modelling study of selected middle-income countries in the Indo-Pacific
No full textContinued efforts to reduce the burden of COVID-19 require the consideration of additional booster doses and emerging oral antivirals. This study explored the individual- and population-level impacts of booster dose and oral antivirals in Indonesia, Fiji, Papua New Guinea, and Timor-Leste. Our mathematical model included age structure, vaccine coverage, prevalence of comorbidities, and immunity from prior infection fit to incidence data from our study settings. We explored a range of eligibility criteria and found that boosters had the largest impact per dose when prioritized to high-risk adults and adults who had not previously received a booster. Antivirals were most effective in settings with low vaccine-derived immunity. In general, fewer antivirals than booster doses were required to prevent a hospitalization or death. Only in settings with very high vaccine uptake was the impact per dose of providing booster doses to high-risk adults comparable to providing oral antivirals to high-risk adults. Together, booster doses and oral antivirals could prevent 80%, 64%, 49%, and 65% of deaths, and 38%,
37%, 16%, and 34% of hospitalizations in Fiji, Indonesia, Papua New Guinea, and Timor-Leste respectively. Therefore, our findings support the continued provision of COVID-19 booster doses to high-risk adults in 2023, and advocate for increased access to oral antivirals, especially in settings with low vaccine coverage such as Papua New Guinea. Future work should consider the threshold at which self-financing of COVID-19 oral antivirals would be viable for middle-income countries in South-East Asia and the Pacific
Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta‐analysis
No full textDengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta‐ analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, hemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalizations and mortality rates in dengue were 9.90% (95% CI 7.67–12.37) and 0.23% (95% CI 0.16–0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72–3.63) of reported cases and 23.23% (95% CI 13.58–34.53) of hospitalized
patients. Complications associated with Zika virus included Guillain‐Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71–16.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first
trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30–4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06–2.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreak
Population-based assessment of cardiovascular complications of rheumatic heart disease in Fiji: a record linkage analysis
No full textABSTRACT
Objective To determine population-based rates of non�fatal complications of rheumatic heart disease (RHD).
Design Retrospective cohort study based on multiple
sources of routine clinical and administrative data
amalgamated by probabilistic record-linkage.
Setting Fiji, an upper-middle-income country, where
most of the population has access to government-funded
healthcare services.
Participants National cohort of 2116 patients with
clinically apparent RHD aged 5–69 years during 2008 and
2012.
Primary and secondary outcome measures The
primary outcome was hospitalisation for any of
heart failure, atrial fibrillation, ischaemic stroke and
infective endocarditis. Secondary outcomes were first
hospitalisation for each of the complications individually
in the national cohort as well as in hospital (n=1300) and
maternity (n=210) subsets. Information on outcomes was
obtained from discharge diagnoses coded in the hospital
patient information system. Population-based rates were
obtained using relative survival methods with census data
as the denominator.
Results Among 2116 patients in the national cohort
(median age, 23.3 years; 57.7% women), 546 (25.8%)
were hospitalised for an RHD complication, a substantial
proportion of all cardiovascular admissions in the country
during this period in those aged 0–40 years (heart failure,
210/454, 46.3%; ischaemic stroke 31/134, 23.1%).
Absolute numbers of RHD complications peaked during
the third decade of life with higher population-based rates
in women compared with men (incidence rate ratio 1.4,
95%CI 1.3 to 1.6, p<0.001). Hospitalisation for any RHD
complication was associated with substantially increased
risk of death (HR 5.4, 95%CI 3.4 to 8.8, p<0.001),
especially after the onset of heart failure (HR 6.6, 95%CI
4.8 to 9.1, p<0.001).
Conclusions Our study defines the burden of RHD�attributable morbidity in the general population of Fiji,
potentially reflecting the situation in low-income and
middle-income countries worldwide. Hospitalisation for an
RHD complication is associated with markedly increased
risk of death, re-emphasising the importance of effective
early preventio