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Durand AM, Cash HL, Reichhardt ML, Taulung L, Tolenoa NM. The Protection Gap - Diagnosis, Treatment Status, and Disease Control for People with Diabetes and Hypertension in the US-Affiliated Pacific Islands. Hawaii J Health Soc Welf 2023; 82:66-71. [PMID: 36908647 PMCID: PMC9995153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Hypertension and diabetes are major causes of disability and mortality in the US-Affiliated Pacific Islands (USAPI). Control of these conditions has the potential to avert much of the burden of non-communicable diseases in the region. To realize this potential, people living with hypertension and diabetes must be identified and receive treatment of sufficient intensity to control their blood pressure and blood glucose. Data from recent cross-sectional surveys conducted in 5 jurisdictions-Pohnpei, Palau, Kosrae, Marshall Islands and American Samoa-were used to estimate the adult prevalence of hypertension and diabetes as well as diagnosis awareness, treatment, and control status of the adults with these conditions. In addition to traditional prevalence indicators, the authors provide a novel presentation of non-communicable disease (NCD) data, using the concept of "protection gaps", defined as the number of people living in a community who have an NCD for which effective control is not attained. The protection gap is determined by applying survey-derived population prevalence estimates to the community's population size using census data. The protection gap is further divided into 3 groups: (1) case-finding gap-those who are unaware of their conditions; (2) tracking and outreach gap-those who are aware of their condition but not receiving treatment; and (3) treatment efficacy gap-those who are receiving treatment but whose disease is not under control. The findings show a large protection gap, with a majority of adults living with hypertension (80.8%) and diabetes (91.6%) not having their condition under control. The case-finding gap accounts for more than half of these, followed by treatment efficacy, and tracking and outreach gaps. These findings can guide public health strategies and monitoring for control of hypertension and diabetes in the USAPI region.
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Affiliation(s)
- A. Mark Durand
- Pacific Islands Health Officers Association, Honolulu, HI (AMD, HLC)
| | - Haley L. Cash
- Pacific Islands Health Officers Association, Honolulu, HI (AMD, HLC)
| | | | - Livinson Taulung
- Department of Health and Social Affairs, Federated States of Micronesia (LT)
| | - Nena M. Tolenoa
- Pacific Islands Primary Care Association, Honolulu, HI (NMT)
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Durand AM, Hancock WT, Cash HL, Rouse I, Chutaro E, Taulung L, Patel M. Innovations to maximise impact of a data for decision-making training programme in the Federated States of Micronesia. BMJ Glob Health 2021; 6:bmjgh-2021-005855. [PMID: 34635551 PMCID: PMC8506883 DOI: 10.1136/bmjgh-2021-005855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/06/2021] [Indexed: 11/03/2022] Open
Abstract
Accurate and timely health information is an essential foundation for strengthening health systems. Data for decision making (DDM) is a training curriculum designed to enhance capacity of health department staff to capture and use high-quality data to address priority health issues. In 2013, the Pacific Public Health Surveillance Network adapted and piloted the DDM curriculum as an 'at work, from work, for work' field epidemiology training programme component for low-income and middle-income Pacific Island jurisdictions. Based on lessons learned from the pilot, we made several innovations, including delivery on-site at each district (rather than bringing trainees to a central location), conducting pre-DDM consultations and ongoing contact with health leaders across the programme, taking more care in selecting trainees and enrolling a larger cohort of students from within each health department. The decentralised programme was delivered in-country at four sites (both at national and state levels) in the Federated States of Micronesia. Following delivery, we performed an external evaluation of the programme to assess student outcomes, benefits to the health department and general programme effectiveness. Of the 48 trainees who completed all four classroom modules, 40 trainees participated in the evaluation. Thirty-two of these trainees completed the programme's capstone field project. Eighteen of these projects directly contributed to changes in legislation, revised programme budgets, changes in programme strategy to augment outreach and to target disease and risk factor 'hot spots'.
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Affiliation(s)
- A Mark Durand
- Pacific Islands Health Officers Association, Honolulu, Hawaii, USA
| | - W Thane Hancock
- US Centers for Disease Control and Prevention, Hagatna, Guam, USA
| | - Haley L Cash
- Pacific Islands Health Officers Association, Honolulu, Hawaii, USA
| | - Ian Rouse
- Pacific Islands Health Officers Association, Leederville, Western Australia, Australia
| | - Emi Chutaro
- Pacific Islands Health Officers Association, Honolulu, Hawaii, USA
| | - Livinson Taulung
- Federated States of Micronesia Department of Health and Social Affairs, Palikir, Micronesia
| | - Mahomed Patel
- Australian National University, Canberra, Australian Capital Territory, Australia
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Palafox NA, Reichhardt M, Taitano JR, Nitta M, Garstang H, Riklon S, Taulung L, Buenconsejo-Lum LE. A Socio-Ecological Framework for Cancer Control in the Pacific: A Community Case Study of the US Affiliated Pacific Island Jurisdictions 1997-2017. Front Public Health 2018; 6:313. [PMID: 30483488 PMCID: PMC6243120 DOI: 10.3389/fpubh.2018.00313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
The United States Affiliated Pacific Island Jurisdictions (USAPIJ) are politically associated to the United States (US) as US Territories (Guam, American Samoa), a US Commonwealth (Commonwealth of the Northern Mariana Islands), and as sovereign nations linked to the US through Compacts of Free Association [Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Republic of Palau (ROP)]. Cervical cancer incidence in the RMI is the highest in the world, mammography services are not available in the FSM and only Guam has on-island oncology services. Cancer risk factors such as obesity, tobacco, and Hepatitis B are prevalent. Twelve years of nuclear testing in the RMI adds to the cancer burden. A community-based, multi-national coalition with multi-system external partners the Pacific Regional Cancer Control Partnership (PRCP) was developed to address cancer prevention and control in the USAPIJ. Through the PRCP, local cancer coalitions, a regional cancer registry, 12 years of regional cancer control plans, and cancer prevention programs and research has been implemented. Methods: The PRCP is the subject of this community case study. The PRCP is analyzed through a socio-ecological theoretical framework to contextualize its typology, building blocks, and management. The respective roles and work of each partner and organization will be described and aligned with the levels of the socio-ecological framework. Results: The USAPIJs evolved a community-focused internal and external regional cancer prevention and control network over 20 years. The function and structure of the PRCP fits within a socio-ecological framework for cancer control. An adaptive management strategy has been used within the PRCP to manage its multi-national, multi-level, and multi-system partners. Conclusion: The PRCP has been able to advance cancer prevention and control programs with a community-centric model that functions in a multi-national, multi-cultural, low-resource, geographically dispersed environment over the last 20 years. The PRCP operates with a structure and management style that is consistent with a socio-ecological framework for cancer control. This case study provides a blueprint for the PRCP organizational structure and a mechanism for its function. The PRCP concept, a community-centric model for cancer control in multi-national resource-limited environments, may be scaled to other global environments.
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Affiliation(s)
- Neal A. Palafox
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | | | - John Ray Taitano
- Cancer Council of the Pacific Islands, Tamuning, GU, United States
| | - Mavis Nitta
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Helentina Garstang
- Republic of the Marshall Islands Ministry of Health, Majuro, Marshall Islands
| | - Sheldon Riklon
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, United States
| | | | - Lee E. Buenconsejo-Lum
- Department of Family Medicine and Community Health, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
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Gopalani SV, Helgenberger L, Apaisam C, Donre S, Takiri K, Charley J, Yomai A, Judicpa P, Nakazono N, Johnson E, Setik E, Taulung L, Elias A, Barrow-Kohler L. Measles outbreak response vaccination in the Federated States of Micronesia. Int J Epidemiol 2016; 45:1394-1400. [DOI: 10.1093/ije/dyw111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 11/13/2022] Open
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Noda S, Yamamoto S, Toma T, Taulung L. Distribution of mosquito larvae on kosrae island, kosrae state, the federated States of micronesia. Trop Med Health 2013; 41:157-61. [PMID: 24478593 PMCID: PMC3880869 DOI: 10.2149/tmh.2013-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/24/2013] [Indexed: 11/11/2022] Open
Abstract
Surveys of mosquito larvae were carried out in six areas of Kosrae Island, Kosrae State, the Federated States of Micronesia in December 2009 and June 2012. A total of 962 larvae of six species were collected from 106 natural and artificial habitats. They were identified as Aedes aegypti, Ae. albopictus, Ae. marshallensis, Culex quinquefasciatus, Cx. annulirostris, and Cx. kusaiensis. This is the first report from Kosrae Island for three of these species-Ae. marshallensis, Cx. quinquefasciatus, and Cx. annulirostris. The most abundant species was Ae. albopictus, followed by Ae. marshallensis, and these two species were found in all areas. Relatively large numbers of Cx. quinquefasciatus and Cx. kusaiensis were found in five areas. Fewer Cx. annulirostris were found, and only in three areas. Aedes aegypti larvae were collected from a single habitat at Tafunsak in 2009. To prevent the outbreak of dengue fever, environmental management should focus on the destruction, alteration, disposal and recycling of containers that produce larger numbers of adult Aedes mosquitoes.
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Affiliation(s)
- Shinichi Noda
- Kagoshima University Research Center for the Pacific Islands, Kagoshima, Japan
| | - Sota Yamamoto
- Kagoshima University Research Center for the Pacific Islands, Kagoshima, Japan
| | - Takako Toma
- School of Health, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Livinson Taulung
- Department of Health Services, Kosrae State Government, Kosrae, Federated States of Micronesia
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Ichiho HM, Tolenoa N, Taulung L, Mongkeya M, Lippwe K, Aitaoto N. An assessment of non-communicable diseases, diabetes, and related risk factors in the Federated States of Micronesia, State of Kosrae: a systems perspective. Hawaii J Med Public Health 2013; 72:39-48. [PMID: 23900387 PMCID: PMC3689452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State.
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Shehata C, Kroon E, Skilling VA, Taulung L. Cancer in Kosrae State, Federated States of Micronesia. Pac Health Dialog 2004; 11:37-43. [PMID: 16281676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Little is known about the impact of cancer and the extent of cancer-related services in Kosrae. The purpose of this study, funded by the National Cancer Institute, was to document the state of cancer awareness and services in Kosrae and to begin to identify cancer-care needs. Findings suggest that cancer is the eighth-leading cause of death in Kosrae, although a number of factors contribute to a possible undercount of cancer cases. Cancer-related services are limited. A number of needs were identified, and an action plan was developed based on three priority areas: 1) establishing a cancer registry; 2) increasing public awareness about cancer risk, prevention, and detection; and 3) expanding cancer screening and detection programs.
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Affiliation(s)
- Cherie Shehata
- John A. Burns School of Medicine, University of Hawai'i, USA
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