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Hon KY, McMillan N, Fitridge RA. Gap analysis of diabetes-related foot disease management systems in Pacific Islands Countries and Territories. BMC Health Serv Res 2024; 24:324. [PMID: 38468255 PMCID: PMC10929083 DOI: 10.1186/s12913-024-10768-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Pacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region. METHODS A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks. RESULTS Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development. CONCLUSION Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.
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Affiliation(s)
- Kay Y Hon
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia.
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia.
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
| | - Neil McMillan
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Robert A Fitridge
- Discipline of Surgical Specialties, The University of Adelaide, Adelaide, SA, Australia
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, 1 Port Road, Adelaide, SA, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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Elliott LM, Taylor J. Community Perceptions of the Determinants of Diabetes in Peri-Urban Vanuatu. Asia Pac J Public Health 2021; 33:734-739. [PMID: 33797296 DOI: 10.1177/10105395211005924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health promotion is a core component of the Pacific region's response to noncommunicable diseases (NCDs) prevention and control. However, while health promotion should build on and be informed by contextually specific norms and social discourse, there remains a paucity in research that seeks to understand how people in the Pacific region comprehend chronic conditions and their determinants. Based in peri-urban Vanuatu, this codesigned study utilized an open-ended survey to investigate community perceptions of factors contributing to the development of type 2 diabetes. Results demonstrate a complex picture of diabetes-specific health literacy, with 22 distinct causes identified by 308 respondents. Dietary factors were commonly acknowledged; however, dietary complexity was not well understood. Limited recognition of the role of tobacco and alcohol consumption in disease development was also noted. Overall, findings demonstrate mixed successes in NCD-related health promotion. Moving away from more universalized approaches commonly advocated by donors, this research identifies the need for locally designed and driven health promotion that focuses on more nuanced, culturally sensitive, and contextually grounded messaging.
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Affiliation(s)
- Lana M Elliott
- Queensland University of Technology, Brisbane, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - John Taylor
- La Trobe University, Melbourne, Victoria, Australia
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'Ofanoa M, Aitip B, Ram K, Dalmia P, Pal M, Nosa V, Goodyear-Smith F. A qualitative study of patient perspectives of diabetes and diabetic retinopathy services in Vanuatu. Health Promot J Austr 2021; 33:289-296. [PMID: 33743544 DOI: 10.1002/hpja.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/14/2021] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Diabetes mellitus is an increasing global health problem, particularly in Vanuatu, where it poses a major health burden. There is paucity of information on how patients in Vanuatu perceive diabetes, diabetic retinopathy, access to services and management, health promotion and intervention services to alleviate the issues. This study aimed to explore the perceptions of diabetic patients in Vanuatu on these issues, to help inform the design of health promotion materials and community activities to empower people to self-manage and shape diabetic services that are integrated and people-centred. METHODS Qualitative Talanga and Kakala Pacific research methodologies were applied. Participants were diabetic patients from both urban locations and rural villages in Vanuatu. Data were collected from four (two male, two female) focus group interviews and thematically analysed. RESULTS There were 26 participants. System failures became apparent, including the inability of the health care services to meet the complex needs of patients with diabetes. The protective factors to reduce the risk and increasing incidence of diabetes and diabetic retinopathy included comprehensive village-based health promotion and community development programmes at the primary prevention level. CONCLUSION This study described patients' experiences of their diabetic care and identified key barriers and facilitators of service delivery pathways. SO WHAT?: Vanuatu needs to expand nationwide health promotion and education programmes on nutrition and exercise, food insecurity and access through trade agreements and provide well-trained nursing and medical specialists for early diagnosis and adequate management of diabetes that all people can access and afford.
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Affiliation(s)
- Malakai 'Ofanoa
- Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Basil Aitip
- Ministry of Health, Norsup Hospital, Norsup, Malekula, Vanuatu
| | - Komal Ram
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | | | - Moneeta Pal
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Vili Nosa
- Pacific Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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Figueroa C, Linhart C, Fusimalohi L, Kupu S, Mathenge G, Morrell S, Taylor R. Mortality in Tonga over three triennia, 2010-2018. BMC Public Health 2021; 21:36. [PMID: 33407295 PMCID: PMC7789386 DOI: 10.1186/s12889-020-10023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tonga is a South Pacific Island country with a population of 100,651 (2016 Census). This study examines Tongan infant mortality rates (IMR), under-five mortality rates (U5MR), adult mortality and life expectancy (LE) at birth from 2010 to 2018 using a recent collation of empirical mortality data over the past decade for comparison with other previously published mortality estimates. METHODS Routinely collected mortality data for 2010-2018 from the Ministry of Health, national (Vaiola) hospital, community nursing reports, and the Civil Registry, were consolidated by deterministic and probabilistic linkage of individual death records. Completeness of empirical mortality reporting was assessed by capture-recapture analysis. The reconciled data were aggregated into triennia to reduce stochastic variation, and used to estimate IMR and U5MR (per 1000 live births), adult mortality (15-59, 15-34, 35-59, and 15-64 years), and LE at birth, employing the hypothetical cohort method (with statistical testing). Mortality trends and differences were assessed by Poisson regression. Mortality findings were compared with published national and international agency estimates. RESULTS Over the three triennia in 2010-2018, levels varied minimally for IMR (12-14) and U5MR (15-19) per 1000 births (both ns, p > 0.05), and also for male LE at birth of 64-65 years, and female LE at birth 69-70 years. Cumulated risks of adult mortality were significantly higher in men than women; period mortality increases in 15-59-year women from 18 to 21% were significant (p < 0.05). Estimated completeness of the reconciled data was > 95%. International agencies reported generally comparable estimates of IMR and U5MR, with varying uncertainty intervals; but they reported significantly lower adult mortality and higher LE than the empirical estimates from this study. CONCLUSIONS Life expectancy in Tonga over 2010-2018 has remained relatively low and static, with low IMR and U5MR, indicating the substantial impact from premature adult mortality. This analysis of empirical data (> 95% complete) indicates lower LE and higher premature adult mortality than previously reported by international agencies using indirect and modelled methods. Continued integration of mortality recording and data systems in Tonga is important for improving the completeness and accuracy of mortality estimation for local health monitoring and planning.
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Affiliation(s)
- Carah Figueroa
- School of Population Health, University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, UNSW Sydney, Sydney, Australia
| | | | | | - Gloria Mathenge
- Statistics for Development Division, Pacific Community, Nouméa, New Caledonia
| | - Stephen Morrell
- School of Population Health, University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, UNSW Sydney, Sydney, Australia.
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Savage A, Bambrick H, Gallegos D. From garden to store: local perspectives of changing food and nutrition security in a Pacific Island country. Food Secur 2020. [DOI: 10.1007/s12571-020-01053-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kitur U, Adair T, Riley I, Lopez AD. Estimating the pattern of causes of death in Papua New Guinea. BMC Public Health 2019; 19:1322. [PMID: 31640631 PMCID: PMC6805633 DOI: 10.1186/s12889-019-7620-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/13/2019] [Indexed: 01/21/2023] Open
Abstract
Background Papua New Guinea (PNG) is a diverse country with high mortality and evidence of increased prevalence of non-communicable diseases (NCDs), but there is no reliable cause of death (COD) data because civil registration is insufficient and routine health data comprise only a small proportion of deaths. This study aims to estimate cause-specific mortality fractions (CSMFs) for five broad groups of causes (endemic infections, emerging infections, endemic NCDs, emerging NCDs and injuries), by sex for each of PNG’s provinces. Methods CSMFs are calculated as the average of estimates obtained from: (1) Empirical cause method: Utilising available Verbal Autopsy (VA) data and Discharge Health Information System (DHIS) data, and applying statistical models of community versus facility CODs; and (2) Expected cause patterns method: Utilising existing estimates of mortality levels in each province and statistical models of the relationship between all-cause and cause-specific mortality using Global Burden of Disease (GBD) data. Results An estimated 41% of male and 49% of female deaths in PNG are due to infectious, maternal (female only), neonatal and nutritional causes. Furthermore, 45% of male and 42% of female deaths arise from NCDs. Infectious diseases, maternal, neonatal and nutritional conditions account for more than half the deaths in a number of provinces, including lower socioeconomic status provinces of Gulf and Sandaun, while provinces with higher CSMFs from emerging NCDs (e.g. ischemic heart disease, stroke) tend to be those where socioeconomic status is comparatively high (e.g. National Capital District, Western Highlands Province, Manus Province, New Ireland Province and East New Britain Province). Provinces with the highest estimated proportion of deaths from emerging infectious diseases are readily accessible by road and have the highest rates of sexually transmitted infections (STIs), while provinces with the highest CSMFs from endemic infectious, maternal, neonatal and nutritional causes are geographically isolated, have high malaria and high all-cause mortality. Conclusions Infectious, maternal, neonatal and nutritional causes continue to be an important COD in PNG, and are likely to be higher than what is estimated by the GBD. Nonetheless, there is evidence of the emergence of NCDs in provinces with higher socioeconomic status. The introduction of routine VA for non-facility deaths should improve COD data quality to support health policy and planning to control both infectious and NCDs.
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Affiliation(s)
- Urarang Kitur
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Carlton, Victoria, Australia. .,National Department of Health, P.O. Box 807, Waigani, National Capital District, Papua New Guinea.
| | - Tim Adair
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Carlton, Victoria, Australia
| | - Ian Riley
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Carlton, Victoria, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Carlton, Victoria, Australia
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Tervonen H, Foliaki S, Bray F, Roder D. Cancer epidemiology in the small nations of Pacific Islands. Cancer Epidemiol 2017; 50:184-192. [PMID: 29120824 DOI: 10.1016/j.canep.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pacific island countries and territories (PICTs) comprise 20,000-30,000 islands in the Pacific Ocean. PICTs face challenges in relation to small population sizes, geographic dispersion, increasing adoption of unhealthy life-styles and the burden of both communicable and non-communicable diseases, including cancer. This study reviews data on cancer incidence and mortality in the PICTs, with special focus on indigenous populations. METHODS PICTs with populations of <1.5 million ('small nations') were included in this study. Information on cancer incidence and mortality was extracted from the GLOBOCAN 2012 database. Scientific and grey literature was narratively reviewed for publications published after 2000. RESULTS Of the 21 PICTs, seven countries were included in the GLOBOCAN 2012 (Fiji, French Polynesia, Guam, New Caledonia, Samoa, Solomon Islands, Vanuatu). The highest cancer incidence and mortality rates were reported in New Caledonia (age-standardized incidence and mortality rates 297.9 and 127.3 per 100.000) and French Polynesia (age-standardized incidence and mortality rates 255.0 and 134.4 per 100.000), with relatively low rates in other countries. Literature indicated that cancer was among the leading causes of deaths in most PICTs; thus they now experience a double burden of cancers linked to infections and life-style and reproductive factors. Further, ethnic differences in cancer incidence and mortality have been reported in some PICTs, including Fiji, Guam, New Caledonia and Northern Mariana Islands. CONCLUSION Cancer incidence in the PICTs was recorded to be relatively low, with New Caledonia and French Polynesia being exceptions. Low recorded incidence is likely to be explained by incomplete cancer registration as cancer had an important contribution to mortality. Further endeavors are needed to develop and strengthen cancer registration infrastructure and practices and to improve data quality and registration coverage in the PICTs.
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Affiliation(s)
- Hanna Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University, Wellington Campus, PO Box 756, Wellington 6140, New Zealand
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, 69372 Lyon Cedex 08, France
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, 5000, Australia
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Pollaers K, Kujan O, Johnson NW, Farah CS. Oral and oropharyngeal cancer in Oceania. TRANSLATIONAL RESEARCH IN ORAL ONCOLOGY 2017. [DOI: 10.1177/2057178x17726455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Katherine Pollaers
- UWA Dental School, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Omar Kujan
- UWA Dental School, the University of Western Australia, Nedlands, Western Australia, Australia
| | - Newell W Johnson
- Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia
| | - Camile S Farah
- UWA Dental School, the University of Western Australia, Nedlands, Western Australia, Australia
- Australian Centre for Oral Oncology Research and Education, Perth, Western Australia, Australia
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Dixson BJW, Little AC, Dixson HGW, Brooks RC. Do prevailing environmental factors influence human preferences for facial morphology? Behav Ecol 2017. [DOI: 10.1093/beheco/arx067] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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10
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Gopalani SV, Samo M, Soaz S, David WJ, Mori S, Luther XN, Carter KL. Premature Mortality From Noncommunicable Diseases in the Federated States of Micronesia, 2003-2012. Asia Pac J Public Health 2017; 29:171-179. [PMID: 28434247 DOI: 10.1177/1010539517696555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was conducted to assess status, and understand burden, of premature and leading causes of deaths from noncommunicable diseases (NCDs) in the Federated States of Micronesia (FSM). From 2003 to 2012, ICD-10 coded mortality data from the national Health Information System were analyzed. Proportional mortality was calculated and a ranking list of the leading causes of premature death was produced. Of the 2349 premature deaths reported, 1970 (83.9%) were due to NCDs, and 1680 (71.5%) were from 4 main NCD groups-cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. Diabetes (19.5%), ischemic heart diseases (13.2%), and cerebrovascular diseases (7.1%) were the leading causes of premature deaths. The findings indicate that the burden of premature NCD deaths in FSM is higher than global levels, and existing efforts need to be strengthened to alter their course.
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Affiliation(s)
- Sameer Vali Gopalani
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - Marcus Samo
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - Siocy Soaz
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - Wincener J David
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - Scott Mori
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - X-Ner Luther
- 1 Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
| | - Karen L Carter
- 2 Statistics for Development Division, Pacific Community, Nouméa, New Caledonia
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Tervonen HE, Bray F, Foliaki S, Roder D. Cancer registration challenges in low- and middle-income countries-the case of the Pacific Islands. Eur J Cancer Care (Engl) 2017; 26:e12650. [PMID: 28111858 DOI: 10.1111/ecc.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/06/2016] [Indexed: 12/29/2022]
Affiliation(s)
- H E Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
- Cancer Institute NSW, Alexandria, Sydney, NSW, Australia
| | - F Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon Cedex 08, France
| | - S Foliaki
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - D Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, Australia
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