Smile dynamics: A comparative study of Fijians and NZ Europeans

BACKGROUND

The Fijian 'Bula Smile' is often described as the world's friendliest; however, its description remains anecdotal.

OBJECTIVE

This study aimed to describe and compare the dynamics of Fijians' smiles with those of New Zealand Europeans.

METHODS

An observational study was conducted on two ethnic groups, Fijians (FJ; N = 23) and New Zealand Europeans (NZ; N = 23), age- and gender-matched. All participants were asked to watch amusing videos, and their reactions were video recorded. The videos were analysed by software to assess the frequency, duration, intensity and genuineness of smiling episodes. Based on the Facial Action Coding System, Action Unit 6 (AU6-cheek raiser), Action Unit 12 (AU12-lip corner puller) and Action Unit 25 (AU25-lips apart) were assessed. Data were analysed by generalised linear models after adjusting for personality traits.

RESULTS

Fijians smiled longer than New Zealand Europeans (+19.9%; p = .027). Mean intensity of AU6 (+1.0; 95%CIs = 0.6-1.5; p < .001), AU12 (+0.5; 95%CIs = 0.1-0.9; p = .008) and AU25 (+22.3%; 95%CIs = 7.3%-37.3%; p = .005) were significantly higher in FJ group than the NZ group.

CONCLUSION

Smiling features of Fijians and New Zealanders showed objective differences, the most distinctive being a higher activation of the Duchenne's marker (AU6) in the Fijian group, which is regarded as a sign of smile genuineness.

The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019-2022

Background

There is a paucity of data on antimicrobial resistance in Fiji. The aim of this study was to determine the antimicrobial susceptibility profile of bacterial isolates from clinical samples at Colonial War Memorial Hospital in Fiji.

Methods

This retrospective study reviewed four-year of data from January 1, 2019, through December 31, 2022. Laboratory testing was carried out using locally approved protocols. Selective antimicrobial susceptibility testing was performed whereby only isolates resistant to first line antimicrobials were tested against second line antimicrobials. Only the first isolate of a given species per patient in a single year were included in the analysis. WHONET software and Microsoft Excel were used for analysis.

Findings

A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria. K. pneumoniae was the most common (n = 5363), followed by E. coli (n = 4321). Extended spectrum beta lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst K. pneumoniae, and 10%-23% in E coli. There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were A. baumannii, 15% (n = 110) E. coli and 14% (n = 101) P. aeruginosa. Amongst the E. coli isolates tested, susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of methicillin resistance amongst Staphylococcus aureus was steady, remaining between 11% and 13%.

Interpretation

This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL producing K. pneumoniae and E. coli and carbapenem-resistant A. baumannii. The emergence and rapid spread of carbapenemase producing E. coli in Fiji's largest hospital is of particular concern. There is an urgent need to allocate resources to improve existing capacity and to develop effective multimodal strategies to detect, manage and control the spread of MDR organisms.

Funding

This study was supported by the Medical Research Future Fund through the Australian government (grant number APP 1200970).

The epidemiology of enterococci in a tertiary hospital and primary healthcare facilities in Fiji (2019-2022)

OBJECTIVES

We analysed 4 y of laboratory data to characterise the species and determine the antimicrobial susceptibility profiles of enterococci as human pathogens in Fiji. The study also investigated the molecular epidemiology amongst the subset of vancomycin-resistant enterococci (VRE).

METHODS

This retrospective study reviewed bacteriological data from Colonial War Memorial Hospital (CWMH) and other healthcare facilities in the Central and Eastern divisions of Fiji. Phenotypic, antimicrobial susceptibility and vanA and vanB PCR testing were performed using locally approved protocols. The first clinical isolates per patient with antimicrobial susceptibility testing results in a single year were included in the analysis. Data was analysed using WHONET software and Microsoft Excel.

RESULTS

A total of 1817 enterococcal isolates were reported, 1415 from CWMH and 402 from other healthcare facilities. The majority of isolates, 75% (n = 1362) were reported as undifferentiated Enterococcus spp., 17.8% (n = 324) were specifically identified as Enterococcus faecalis and 6.7% (n = 122) as E. faecium. Overall, 10% of the enterococci isolates were from blood cultures. Among isolates from CWMH, <15% of E. faecium were susceptible to ampicillin, and 17.2% were vancomycin resistant. Overall, 874 enterococcal isolates (including the undifferentiated species) were tested against vancomycin, of which 4.8% (n = 42) were resistance. All of the VRE isolates tested (n = 15) expressed vanA genes.

CONCLUSIONS

This study demonstrates the clinical importance of VRE, particularly van A E. faecium in the national referral hospital in Fiji. Enhanced phenotypic and molecular surveillance data are needed to better understand enterococci epidemiology and help guide specific infection prevention and control measures and antibiotic prescribing guidelines.

Understanding Fijian health system challenges in the prevention of mother-to-child transmission of HIV services in the three tertiary hospitals in Fiji

Mother-to-child transmission is the most common route of human immunodeficiency virus transmission in children, which could be prevented with proper treatment and access to care. Health system challenges can impede the effectiveness of prevention of mother-to-child transmission (PMTCT) programmes. We aim to understand the health system challenges to the provision of PMTCT services for pregnant women in three tertiary hospitals in Fiji. Data were collected using in-depth interviews in the three tertiary hospitals and associated health clinics in Fiji between April-May 2013 and February-March 2014. Ethical approvals were obtained. A total of 58 healthcare providers were interviewed including doctors (n = 12), midwives (n = 19), nurses (n = 14), laboratory technicians (n = 5) and counsellors (n = 8). The data were analysed using thematic analysis. We found that the healthcare workers faced a wide range of health system challenges including institutional and human resource challenges. Staff shortage, limited PMTCT training and shortage of supplies were barriers to the quality of PMTCT services. Our findings would be useful in developing strategies to overcome barriers as it would be imperative in improving the quality of PMTCT service provision in Fiji and other similar settings.

Redesigning Prehospital Care: Fiji's Response to the COVID-19 Pandemic

The benefits of emergency care systems in low- and middle-income countries are well-described. Passed in the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Assembly (WHA) Resolution 76.2 emphasizes the importance of communication, transportation and referral mechanisms, and the linkages between communities, primary care, and hospital care. Literature describing prehospital care and ambulance system development is scarce, with little data on the effectiveness and cost effectiveness of different options. Prehospital care systems in Pacific Island countries are under-developed. In Fiji, out-of-hospital care is fragmented with an uncoordinated patchwork of ambulance providers. There is no scope of practice or training requirement for providers and no patient care records. There are no data relating to demand, access, and utilization of ambulance services.In response to a surge of COVID-19 cases in 2021, the Fiji government created a Prehospital Emergency Care Coordination Center (PHECCC) in the capital Suva, which was operational from July-October 2021. Access was via a toll-free number, whereby the public could receive a medical consultation followed by phone advice or dispatch of an ambulance for a home assessment, followed by transportation to hospital, if required. The PHECCC also provided coordination of inter-facility transport and retrieval of the critically ill.The system that was created met many of the prehospital care standards set by emergency care leaders in the region and created the first dataset relating to ambulance demand and utilization. This is the first article to document prehospital system development in the Pacific region.

Type 2 Diabetes Prevalence, Control and Management within Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A Scoping Review with a Systematic Approach

BACKGROUND

Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population.

OBJECTIVES

The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects.

METHODS

This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023.

RESULTS

A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services.

CONCLUSION

The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.

Dietary Patterns of iTaukei (indigenous) Fijians: Preliminary Findings From a Five-Day Dietary Record in Rural Communities

This article presents the preliminary findings from a five-day dietary record of 105 iTaukei (indigenous) Fijians in seven rural communities on remote islands, Fiji. Although the literature on noncommunicable diseases (NCDs) has discussed the potential reasons for the NCD increase in Fiji, research has relied on secondary data on the consumption patterns of limited food items. Hence, this research is one of the first in the country to analyze detailed dietary patterns. A high body mass index rate in the case study communities is observed. We also find that carbohydrate sources dominate the diet of the participants, while the consumption of protein sources (including canned products) and vegetables/fruits is limited. In addition, the diversity of food items is limited. Meanwhile, the major carbohydrate sources are locally produced cassava, although rice and flour products are also consumed. We suggest integrating these factors into the determination of the cause of the NCD increase.

Species-specific coral microbiome assemblages support host bleaching resistance during an extreme marine heatwave

Scleractinian assemblages are threatened by marine heat waves with coral survivorship depending on host genetics and microbiome composition. We documented an extreme marine heat wave in Fiji and the response of corals in two thermally stressed reef flats. Through high-throughput amplicon sequencing of 16S and ITS rDNA phylogenetic markers, we assessed coral microbiomes (Symbiodiniaceae, prokaryotes, fungi, and Apicomplexa) of paired bleached and unbleached colonies of four common coral species representative of dominant genera in the South Pacific. While all coral species exhibited one or more pathways to bleaching resistance, harboring assemblages composed primarily of thermally tolerant photosymbionts did not always result in host bleaching resistance. Montipora and Pocillopora species, which associate with diverse Symbiodiniaceae and vertically transmit their photosymbionts, fared better than Acropora, which acquire their photosymbionts from the environment, and Porites, which associate with a narrow photosymbiont assemblage. Prokaryotic and fungal beta diversity did not differ between bleached and unbleached conspecifics, however, the relative abundance of the fungus Malassezia globosa was significantly greater in unbleached colonies of Montipora digitata. Each coral species harbored distinct assemblages of Symbiodiniaceae, prokaryotes, and Apicomplexa, but not fungi, reiterating the importance of host genetics in structuring components of its microbiome. Terrestrial fungal and prokaryotic taxa were detected at low abundance across coral microbiomes, indicating that allochthonous microbial inputs occur, but that coral microbiomes remain dominated by marine microbial taxa. Our study offers valuable insights into the microbiome assemblages associated with coral tolerance to extreme water temperatures.

Prevalence and associated risk factors for mental health problems among young adults in Fiji Island during COVID-19: a cross-sectional study

Introduction

The COVID-19 pandemic has had a significant impact on mental health globally. To understand the impact of the pandemic on mental health in Fiji, this study aimed to investigate the prevalence of anxiety disorder and depression among the young adults.

Method

An online survey was conducted to assess the prevalence of anxiety disorder and depression among the general population in Suva, Fiji during the COVID-19 pandemic. A total of 1,119 Fiji adults participated in the study. The study was conducted between May 20 to June 30, 2022, using a snowball sampling via social media platforms. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales were used to measure anxiety and depression, respectively. The COVID-19 related stressors was evaluated using the adapted SARS stressors assessment. Univariate and multivariate logistic regression analysis was performed to determine the factors influencing mental health among respondents.

Results

The result shows that a significant portion of individuals experienced each of the stressors, with the highest prevalence seen for hearing information about the severity of COVID-19. The prevalence of anxiety and depression was found to be 45% and 49%, respectively. Being female, having pre-existing illness and COVID-19 stressors were a risk factor to develop anxiety and depression. On the other hand, employed individuals and having high BMI was a protective factor against developing depression during COVID-19 lockdown.

Conclusion

These findings highlight the importance of addressing the mental health needs of the Fijian population during the COVID-19 pandemic and beyond.

Assessing risks for bovine and zoonotic tuberculosis through spatial analysis and a questionnaire survey in Fiji - A pilot study

Mycobacterium bovis causes tuberculosis in cattle and when transmitted to humans typically causes extra-pulmonary tuberculosis (EPTB). Bovine tuberculosis (bTB) has a global distribution and is controlled in most countries to protect animal and public health. Recent studies revealed that bTB is established on dairy farms in Fiji where EPTB cases have been reported in people. The aims of this pilot investigation were to look for putative zoonotic TB (EPTB) cases in people and to evaluate practices that might contribute to the persistence and transmission of M. bovis between cattle and to humans. Existing data sets were shared between the Fiji Ministry of Agriculture and Ministry of Health and a questionnaire-based survey was implemented using One Health principles. Statistically significant co-location and close proximity of EPTB cases and bovine TB affected farms were identified. The bTB infection status of farms was significantly associated with unfenced water sources where cattle grazed. Of 247 households, 65 % shared drinking water sources with cattle and 36 % consumed raw milk without boiling, while 62 % of participants reported backyard slaughter of cattle. Several participants reported current symptoms potentially suggestive of TB (chronic cough) but the impact of smoking and history of previous TB treatment could not be evaluated. Farmers had limited understanding of the practices required to prevent bTB at farm level. Further study is recommended and should include an assessment of lifetime EPTB diagnoses, classification of farms based on more recent bTB test data and molecular typing of mycobacterial isolates from humans, cattle and the environment. A targeted awareness and education approach is required to reduce the future risk of zoonotic TB and to help ensure uptake of recommendations and practices aimed at controlling and preventing bTB.

Drawing time-density curve with Fiji/ImageJ: An alternative approach for parametric coding of cerebral digital subtraction angiography

BACKGROUND

Quantitative spatiotemporal analysis of digital subtraction angiography could support clinical decision making for the management of cerebral vascular disease. However, there is a lack of free and user-friendly applications. The objective of our study is to devise a free and simple solution for parametric coding of digital subtraction angiography.

NEW METHOD

By driving the time-density curves in the region of interest, the digital subtraction angiography images were color-coded and quantitatively analyzed using fully open-source and free software (Fiji/ImageJ). The similarity factor (f2) was used to compare the resolution profiles between time-density curves generated with commercial software on the Siemens workstation (syngo iFlow, Siemens Healthcare, Berlin, Germany) and our method.

RESULTS AND COMPARISON WITH EXISTING METHOD

Sixteen patients diagnosed with acute ischemic stroke resulting from acute occlusion of the distal internal carotid artery or the first segment of the middle cerebral artery were selected for analysis. Angiography images were successfully processed with syngo iFlow and Fiji/ImageJ. The images processed with Fiji/ImageJ provided excellent anatomic and hemodynamic details. In all patients, the similarity factor (f2) values of the time-density curves derived from the same region of interest were 99.90 (range 99.85-99.95).

CONCLUSIONS

The ImageJ/Fiji software provides a user-friendly and free alternative for parametric coding of digital subtraction angiography.

The Journey to Early Identification and Intervention for Children with Disabilities in Fiji

Early identification of developmental delay or disability and access to early intervention improves outcomes for children with disabilities and their families. However, in many low- and middle-income countries, services and systems to enable timely, co-ordinated care and support are lacking. The aim of this research was to explore the experiences of families of children with developmental disabilities in Fiji in accessing services for intervention and support across sectors. This qualitative study involved conducting interviews with caregivers of children with disabilities (n = 12), and relevant key stakeholders from health, education, disability, and social support sectors (n = 17). We used journey maps to identify key stages of the families' journeys, identify key barriers and enablers at each stage, and provide multi-sectoral recommendations for each stage. Enablers include proactive help seeking behaviours, the use of informal support networks and an increasingly supportive policy environment. Barriers to identification include a lack of awareness of developmental disabilities and the benefits of early intervention among service providers and the community. A lack of service availability and capacity, workforce issues, family financial constraints and a lack of collaboration between sectors were barriers to intervention once needs were identified, resulting in significant unmet needs and impacting inclusion and participation for children with disabilities. Overcoming these challenges requires a multi-sectoral approach.

The challenges in protecting public health interests in multisectoral governance in the context of small island developing states: the case of tobacco control in Fiji and Vanuatu

BACKGROUND

The commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, protecting public health interests can be challenging amidst industry interference and conflicting policy priorities, particularly in low and middle-income countries (LMICs) where the need for rapid economic development is pronounced. Small island developing states (SIDS) face even more challenges in regulating CDoH because their unique socioeconomic, political, and geographic vulnerabilities may weaken institutional conditions that could aid health sector actors in protecting health interests. This study aims to explore the institutional conditions that shape health sector actors' capability to protect public health interests in tobacco governance in Fiji and Vanuatu.

METHODS

We employed a qualitative, exploratory case study design. We applied the administrative process theory to inform data collection and analysis. Seventy interviews were completed in Fiji and Vanuatu from 2018 to 2019.

RESULTS

The findings show that the protection of health interests in tobacco governance were not supported by the institutional conditions in Fiji and Vanuatu. While the policy processes formally ensured a level playing field between actors, policies were often developed through informal mechanisms, and the safeguards to protect public interests from vested private interests were not implemented adequately. SIDS vulnerabilities and weak regulation of political parties contributed to the politicisation of government in both states, resulting in high-level government officials' questionable commitment to protect public health interests. The system of checks and balances usually embedded into democratic governments appeared to be muted, and policymakers had limited bureaucratic autonomy to elevate health interests in multisectoral policymaking amidst high-level government officials' frequent rotation. Finally, capacity constraints aggravated by SIDS vulnerabilities negatively impacted health sector actors' capability to analyse policy alternatives.

CONCLUSIONS

Health sector actors in Fiji and Vanuatu were not supported by institutional conditions that could help them protect public health interests in multisectoral governance to regulate CDoH originating from the tobacco industry. Institutional conditions in these states were shaped by SIDS vulnerabilities but could be improved by targeted capacity building, governance and political system strengthening.

Use of the HESPER Web to assess perceived needs immediately after multiple disaster events in Fiji

OBJECTIVE

In January 2022, Fiji was hit by multiple natural disasters including a cyclone causing flooding, an underwater volcanic eruption and tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters.

METHODS

A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data.

RESULTS

In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD 3). The top three most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public.

CONCLUSIONS

The top three needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters, and may require more attention from responding actors. The HESPER Web was be considered as a usable tool for needs assessment in a sudden onset disaster.

Socio-ecological challenges and food security in the 'salad bowl' of Fiji, Sigatoka Valley

This article examines food security in the Sigatoka Valley, one of the most productive food regions in Fiji, in the context of recent socio-ecological challenges through a case study of Narewa village. Data were collected using semi-structured interviews (n = 25), a fixed question food insecurity experience survey (n = 25), and a free listing exercise about preferred and consumed foods (n = 24). Results revealed that while most households had access to sufficient food, the increased frequency and intensity of droughts, tropical cyclones, and flooding caused almost half to worry about meeting their future food needs. To date, a culture of sharing within the village has helped most households access food but this will likely be inadequate to meet future needs as climate change is projected to impact food production. Given that the foundation of food production in Narewa, like other villages in the valley, relies on the long-term viability of agricultural systems, better focus needs to be placed on the natural resources that form the backbone of these systems such as water availability, soil health, and slope stability and their resilience to anthropogenic and natural stressors. Efforts that focus on protecting and enhancing local ecosystems in light of expected future climate change, combined with greater attention on food storage and the use of resilient crops, and enhancing social cohesion and sharing networks are needed to avoid breaching tipping points in the food system.

Fast4DReg - fast registration of 4D microscopy datasets

Unwanted sample drift is a common issue that plagues microscopy experiments, preventing accurate temporal visualization and quantification of biological processes. Although multiple methods and tools exist to correct images post acquisition, performing drift correction of three-dimensional (3D) videos using open-source solutions remains challenging and time consuming. Here, we present a new tool developed for ImageJ or Fiji called Fast4DReg that can quickly correct axial and lateral drift in 3D video-microscopy datasets. Fast4DReg works by creating intensity projections along multiple axes and estimating the drift between frames using two-dimensional cross-correlations. Using synthetic and acquired datasets, we demonstrate that Fast4DReg can perform better than other state-of-the-art open-source drift-correction tools and significantly outperforms them in speed. We also demonstrate that Fast4DReg can be used to register misaligned channels in 3D using either calibration slides or misaligned images directly. Altogether, Fast4DReg provides a quick and easy-to-use method to correct 3D imaging data before further visualization and analysis.

Predictors of Knowledge, Attitude, and Practice (KAP) Towards Family Planning (FP) Among Pregnant Women in Fiji

OBJECTIVE

This study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women.

METHODS

A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP.

RESULTS

240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015).

CONCLUSION

This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies.

Physicians' perceptions on their roles in cardiovascular diseases risk reduction and management in Fiji

BACKGROUND

Primary health care (PHC) physicians' perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians' perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji.

METHODS

This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months' experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done.

RESULTS

This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians' roles and perceptions of patients' expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs.

CONCLUSIONS

Physicians' perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.

Mapping the Localization of Proteins Within Filopodia Using FiloMap

Filopodia are fingerlike membrane protrusions extended by cells to sense their environment. Filopodia are widely used by migrating cells in vivo and directly contribute to several physiological processes and diseases. Due to the essential roles of filopodia in sensing the extracellular environment, there is a need to characterize their composition and ultrastructure further. This chapter highlights FiloMap, an image analysis pipeline that utilizes Fiji and R to map the localization of proteins within filopodia from microscopy images. I provide step-by-step protocols on (a) setting up FiloMap in Fiji and R, (b) extracting line intensity profiles from filopodia stainings in Fiji, (c) further analyzing line intensity profiles in R, and (d) creating filopodia maps to compare the localization of multiple proteins within filopodia. Notably, while FiloMap was written to analyze filopodia, the analysis pipeline described here can also analyze and compile any line intensity profiles.

Synaptonemal & CO analyzer: A tool for synaptonemal complex and crossover analysis in immunofluorescence images

During the formation of ova and sperm, homologous chromosomes get physically attached through the synaptonemal complex and exchange DNA at crossover sites by a process known as meiotic recombination. Chromosomes that do not recombine or have anomalous crossover distributions often separate poorly during the subsequent cell division and end up in abnormal numbers in ova or sperm, which can lead to miscarriage or developmental defects. Crossover numbers and distribution along the synaptonemal complex can be visualized by immunofluorescent microscopy. However, manual analysis of large numbers of cells is very time-consuming and a major bottleneck for recombination studies. Some image analysis tools have been created to overcome this situation, but they are not readily available, do not provide synaptonemal complex data, or do not tackle common experimental difficulties, such as overlapping chromosomes. To overcome these limitations, we have created and validated an open-source ImageJ macro routine that facilitates and speeds up the crossover and synaptonemal complex analyses in mouse chromosome spreads, as well as in other vertebrate species. It is free, easy to use and fulfills the recommendations for enhancing rigor and reproducibility in biomedical studies.

Climate change and coastal resiliency of Suva, Fiji: a holistic approach for measuring climate risk using the climate and ocean risk vulnerability index (CORVI)

Coastal cities are under severe threat from the impacts of climate change, such as sea-level rise, extreme weather events, coastal inundation, and ecosystem degradation. It is well known that the ocean, and in particular coastal environments, have been changing at an unprecedented rate, which poses increasing risks to people in small island developing states, such as Fiji. The Greater Suva Urban Area, the capital and largest metropolitan area of Fiji, is expected to be largely impacted by climate-related risks to its socio-economic, cultural, and political positions. In the face of these threats, creating a resilient city that can withstand and adapt to the impacts of climate change and promote sustainable development should be guided by a holistic approach, encompassing stakeholders from the government, the private sector, civil society organizations, and international institutions. This study assesses the risk profile of Suva city using an innovative risk information tool, the climate and ocean risk vulnerability index (CORVI), which applies structured expert judgment to quantify climate-related risks in data-sparse environments. Through comparative quantification of diverse risk factors and narrative analysis, this study identifies three priority areas for Suva's future climate-resilient actions: development of climate risk-informed urban planning, harmonized urban development and natural restoration, and enhancing the climate resilience to the tourism sector.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11027-022-10043-4.

Rapid SARS-CoV-2 Seroprevalence Survey in Central and Western Divisions of Fiji, 2021

During November-December 2021, we performed a SARS-CoV-2 seroprevalence survey in Central and Western Divisions of Fiji. A total of 539 participants 8-70 years of age were 95.5% (95% CI 93.4%-97.1%) seropositive, indicating high community levels of immunity. Seroprevalence studies can inform public health responses to emerging SARS-CoV-2 variants.

Glia Cell Morphology Analysis Using the Fiji GliaMorph Toolkit

Glial cells are the support cells of the nervous system. Glial cells typically have elaborate morphologies that facilitate close contacts with neighboring neurons, synapses, and the vasculature. In the retina, Müller glia (MG) are the principal glial cell type that supports neuronal function by providing a myriad of supportive functions via intricate cell morphologies and precise contacts. Thus, complex glial morphology is critical for glial function, but remains challenging to resolve at a sub-cellular level or reproducibly quantify in complex tissues. To address this issue, we developed GliaMorph as a Fiji-based macro toolkit that allows 3D glial cell morphology analysis in the developing and mature retina. As GliaMorph is implemented in a modular fashion, here we present guides to (a) setup of GliaMorph, (b) data understanding in 3D, including z-axis intensity decay and signal-to-noise ratio, (c) pre-processing data to enhance image quality, (d) performing and examining image segmentation, and (e) 3D quantification of MG features, including apicobasal texture analysis. To allow easier application, GliaMorph tools are supported with graphical user interfaces where appropriate, and example data are publicly available to facilitate adoption. Further, GliaMorph can be modified to meet users' morphological analysis needs for other glial or neuronal shapes. Finally, this article provides users with an in-depth understanding of data requirements and the workflow of GliaMorph. © 2023 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Download and installation of GliaMorph components including example data Basic Protocol 2: Understanding data properties and quality 3D-essential for subsequent analysis and capturing data property issues early Basic Protocol 3: Pre-processing AiryScan microscopy data for analysis Alternate Protocol: Pre-processing confocal microscopy data for analysis Basic Protocol 4: Segmentation of glial cells Basic Protocol 5: 3D quantification of glial cell morphology.

Isolation, antibacterial screening, and identification of bioactive cave dwelling bacteria in Fiji

Bacteria are well known producers of bioactive secondary metabolites, including some of the most effective antibiotics in use today. While the caves of Oceania are still largely under-explored, they form oligotrophic and extreme environments that are a promising source for identifying novel species of bacteria with biologically active compounds. By using selective media that mimicked a cave environment, and pretreatments that suppressed the growth of fast-growing bacteria, we have cultured genetically diverse bacteria from a limestone cave in Fiji. Partial 16S rRNA gene sequences from isolates were determined and compared with 16S rRNA gene sequences in EzBioCloud and SILVA data bases. Fifty-five isolates purified from culture had Actinomycete-like morphologies and these were investigated for antibacterial activity. Initial screening using a cross streak test with pathogenic bacteria indicated that 34 of the isolates had antibacterial properties. The best matches for the isolates are bacteria with potential uses in the manufacture of antibiotics and pesticides, in bioremediation of toxic waste, in biomining, in producing bioplastics, and in plant growth promotion. Nineteen bacteria were confirmed as Actinomycetes. Thirteen were from the genus Streptomyces and six from genera considered to be rare Actinomycetes from Pseudonocardia, Kocuria, Micromonospora, Nonomuraea. Ten isolates were Firmicutes from the genera Bacillus, Lysinbacillus, Psychrobacillus and Fontibacillus. Two were Proteobacteria from the genera Mesorhizobium and Cupriavidus. Our findings identify a potentially rich source of microbes for applications in biotechnologies.

Perceptions of public health nursing Team Leaders (TLs) and Team Supervisors (TSs) on nurse's development in Fiji

BACKGROUND

Nurse team leaders are responsible for contributing to managing the quality of service delivery and facility output of their nurses to ensure there is a high quality of care delivered by the health system. This study aimed to explore the perceptions of public health nursing Team Leaders (TLs) and public health nursing Team Supervisors (TSs) on nurses' development in Fiji.

METHODS

A qualitative study was used to gather information using in-depth phone interviews among TLs and TSs comprising Chief Midwifery Nursing Officer (CMNO), Director of Nursing (DON), Sub-divisional Nursing Managers (SDNMs), acting SDNMs and Nursing Manager (NM) at Central health division in Fiji. The data was collected through semi-structured open-ended questionnaires and were audio recorded. The data was analyzed using manual thematic analysis process.

RESULTS

The study comprised of 26 participants, which included 10 TSs and 16 TLs. Four themes were identified for the results amongst TSs and TLs: ethical development; professional development; psychological development; and recommendations. However, nine sub- themes were identified for TSs and eight sub-themes were identified for the result amongst TLs.

CONCLUSION

This study highlighted that TLs and TSs elaborated on the need for the ethical, professional, psychological development, nursing development and also on the importance of policies and guidelines. Professional ethics should be integrated into the Continuous Profession Development (CPD) points that are used to renew yearly nursing licenses as well as exposing the need for having competencies on professional ethics in nurses' logbooks. Further research is needed to determine the in-depth barriers.

The ridge-to-reef approach on Cicia Island, Fiji

Many Pacific countries and territories embrace an officially recognized 'ridge-to-reef' approach to environmental management. This is the case of Fiji, where the Lau Seascape Strategy 2018-2030, led by Conservation International, aims for integrated natural resource management across 335 895 km². This area includes Cicia Island, which deserves particular attention since, years before the design of the Lau Seascape Strategy, its population developed its own informal ridge-to-reef scheme, involving a combination of certified organic agriculture and locally managed marine closures. Based on 1 month of ethnographic fieldwork, this paper presents this scheme and highlights local perception and conceptualization of its positive effects on both the land and the sea. These reflect the iTaukei (Indigenous Fijian) concept of vanua, which intrinsically connects the health of the land, the sea, and their (human and non-human) dwellers, while stressing the importance of addressing land-sea processes and management efforts beyond an ecological perspective, i.e. through an engagement with the iTaukei relational ontology.

Marine resources and their value in Kadavu, Fiji

Recognition of the multiple types of value of marine resources is crucial to help design locally meaningful and sustainable management approaches for marine and coastal habitats. There is a lack of information on the amount of living marine resources harvested by coastal communities in many Pacific Island Countries and Territories (PICTs), as well as on their economic and non-economic value. This paper explores the monetary, subsistence, and sociocultural value of selected marine resources (finfish and invertebrates) in Kadavu province, Fiji, based on a household survey and semi-structured interviews conducted in 2019 within one specific district. The paper provides estimates of the annual catch and monetary value of marine resources harvested by local communities at both the district and provincial levels, derived from catch and effort information collected from fishers and gleaners in situ. It also highlights the importance of integrating the sociocultural significance of marine resources into future value assessments.

Gender roles, generational changes and environmental challenges: an intersectional interpretation of perceptions on healthy diets among iTaukei women and men in Fiji

OBJECTIVE

To investigate perceptions of iTaukei Fijian women and men around diet and the ability to consume a healthy diet.

DESIGN

Six focus groups were conducted with women and men separately. Six to ten women and men participated in each group. Discussions were recorded, transcribed, translated and thematically analysed. Themes were mapped to an intersectionality framework to aid interpretation.

SETTING

Four villages in Viti Levu, Fiji.

PARTICIPANTS

Twenty-two women and twenty-four men.

RESULTS

Seven overarching themes were identified, including generational changes in food behaviour, strong-gendered beliefs around food and food provision, cultural and religious obligations around food, the impact of environmental change on the ability to consume a healthy diet, perceptions of the importance of food, food preferences and knowledge. Participants across focus groups identified that it was the 'duty' of women to prepare food for their families. However, some women reflected on this responsibility being unbalanced with many women now in the formal workforce. Changes between generations in food preferences and practices were highlighted, with a perception that previous generations were healthier. Power dynamics and external factors, such as environmental changes, were identified by women and men as crucial influences on their ability to eat a healthy diet.

CONCLUSION

Embedded traditional perceptions of gendered roles related to nutrition were misaligned with other societal and environmental changes. Given factors other than gender, such as broader power dynamics and environmental factors were identified as influencing diet, viewing nutrition-related issues through an intersectional lens is important to inform equitable food policy in Fiji.

Perceptions of dental health professionals (DHPs) on job satisfaction in Fiji: a qualitative study

Background:

Reviewing job satisfaction is crucial as it has an impact on a person’s physical and mental wellbeing, as well as leading to a better organizational commitment of employees that enhances the organizations succession and progress as well as better staff retention. This study aimed to explore the perceptions of job satisfaction amongst Dental Health Professionals (DHPs) in Fiji and associated factors.

Methods:

This study used a phenomenological qualitative method approach commencing from August to November, 2021. The target group for this study were the DHPs who provide prosthetic services. This study was conducted among DHPs from 4 purposively selected clinics in Fiji. A semi- structured open-ended questionnaire was used to collect data. Thematic analysis was used to transcribe and analyze the audio qualitative data collected from the interviews.

Results:

Twenty-nine DHPs took part in the in-depth interview and the responses were grouped into three themes. The findings from the study indicate that DHPs are most satisfied with their teamwork and the relationship they have with their colleagues and co-workers, followed by the nature of the work and the supervision they received. The participants indicated that they were less satisfied with professional development opportunities and least satisfied with their pay and organizational support they receive.

Conclusion:

The results of this study have identified gaps and areas for improvement of job satisfaction for DHPs who provide prosthetic services in Fiji such as need for more career and professional development pathways, improved infrastructure to support prosthetic service delivery in Fiji and improve remuneration for DHPs. Understanding the factors that affect satisfaction levels and being able to act accordingly are likely to lead to positive outcomes both for DHPs and their organization.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08620-z.

Incorporating a gender lens into nutrition and health-related policies in Fiji: analysis of policies and stakeholder perspectives

Background

Gender equality, zero hunger and healthy lives and well-being for all, are three of the Sustainable Development Goals (SDGs) that underpin Fiji’s National Development Plan. Work towards each of these goals contributes to the reduction of non-communicable diseases (NCDs). There are gender differences in NCD burden in Fiji. It is, however, unclear whether a gender lens could be more effectively included in nutrition and health-related policies.

Methods

This study consisted of three components: (i) a policy content analysis of gender inclusion in nutrition and health-related policies (n = 11); (ii) policy analysis using the WHO Gender Analysis tool to identify opportunities for strengthening future policy; and (iii) informant interviews (n = 18), to understand perceptions of the prospects for gender considerations in future policies.

Results

Gender equality was a goal in seven policies (64%); however, most focused on women of reproductive age. One of the policies was ranked as gender responsive. Main themes from key informant interviews were: 1) a needs-based approach for the focus on specific population groups in policies; 2) gender-related roles and responsibilities around nutrition and health; 3) what is considered “equitable” when it comes to gender, nutrition, and health; 4) current considerations of gender in policies and ideas for further gender inclusion; and 5) barriers and enablers to the inclusion of gender considerations in policies. Informants acknowledged gender differences in the burden of nutrition-related NCDs, yet most did not identify a need for stronger inclusion of gender considerations within policies.

Conclusions

There is considerable scope for greater inclusion of gender in nutrition and health-related policies in Fiji. This could be done by: 1) framing gender considerations in ways that are actionable and inclusive of a range of gender identities; 2) undertaking advocacy through actor networks to highlight the need for gender-responsive nutrition and health-related policies for key stakeholder groups; 3) ensuring that data collected to monitor policy implementation is disaggregated by sex and genders; and 4) promoting equitable participation in nutrition related issues in communities and governance processes. Action on these four areas are likely critical enablers to more gender equitable NCD reduction in Fiji.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01745-x.

A Novel Quantitative Evaluation of Bone Formation After Opening Wedge High Tibial Osteotomy Using Tomosynthesis

This study aimed to establish and validate a novel evaluation method using digital tomosynthesis to quantify bone formation in the gap after opening wedge high tibial osteotomy (OW-HTO). We retrospectively analyzed bone formation in the gap in 22 patients who underwent OW-HTO using digital tomosynthesis at 1, 2, 3, 6, 9, and 12 months postoperatively. Bone formation was semi-quantitatively assessed using the modified van Hemert's score and density measurements on digital tomosynthesis images. The gap filling value (GFV) was calculated as the ratio of the intensities of the opening gap and the tibial shaft. In addition, the relationship between the modified van Hemert's score and GFV was evaluated. The reproducibility of GFV had an interclass correlation coefficient (ICC [1,2]) of 0.958 for intraobserver reliability and an ICC (2,1) of 0.975 for interobserver reliability. The GFV increased in a time-dependent manner and was moderately correlated with the modified van Hemert's score (r = 0.630, p < 0.001). The GFV plateaued at 6 months postoperatively. In addition, the GFV was higher in patients with a modified van Hemert's score of 2 than in patients with a modified van Hemert's score of 3 (p = 0.008). The GFVs obtained using digital tomosynthesis can be used to assess postoperative bone formation in the opening gap after OW-HTO with high accuracy and reproducibility.

An automatic method to quantify trichomes in Arabidopsis thaliana

Trichomes are unicellular or multicellular hair-like appendages developed on the aerial plant epidermis of most plant species that act as a protective barrier against natural hazards. For this reason, evaluating the density of trichomes is a valuable approach for elucidating plant defence responses to a continuous challenging environment. However, previous methods for trichome counting, although reliable, require the use of specialised equipment, software or previous manipulation steps of the plant tissue, which poses a complicated hurdle for many laboratories. Here, we propose a new fast, accessible and user-friendly method to quantify trichomes that overcomes all these drawbacks and makes trichome quantification a reachable option for the scientific community. Particularly, this new method is based on the use of machine learning as a reliable tool for quantifying trichomes, following an Ilastik-Fiji tandem approach directly performed on 2D images. Our method shows high reliability and efficacy on trichome quantification in Arabidopsis thaliana by comparing manual and automated results in Arabidopsis accessions with diverse trichome densities. Due to the plasticity that machine learning provides, this method also showed adaptability to other plant species, demonstrating the ability of the method to spread its scope to a greater scientific community.

Frontline Health Care Workers' (HCWs) perception of barriers to managing COVID-19 in Fiji

Background

Health Care Workers (HCWs) are at higher risk of COVID-19 infection with their efforts while protecting the greater community and also exposed to hazards, such as psychological distress, fatigue, and stigma. This study aimed to explore the perception of frontline HCWs on barriers of managing COVID-19 in Fiji.

Methods

A qualitative study method was approached to conduct this study among the HCWs who worked on the frontline during the COVID-19 pandemic based at ten purposively selected health facilities in the Suva subdivision in the Central Division of Fiji. The Colonial War Memorial Hospital (CWMH), the Fiji Centre for Communicable Diseases (Fiji CDC), Twomey hospital laboratory, and CWMH laboratory did the main control and most of the operations of other divisions were monitored from these settings. A semi-structured open-ended questionnaire was used to collect data using in-depth interviews. The participants' responses were audio-recorded and were later transcribed and analyzed using thematic analysis.

Results

A total of twenty-nine HCWs took part in the in-depth interview and the responses were grouped into four themes, which include: workload, poor communication, lack of resources, and hindrance to education. It was also found through this study that some of the HCWs felt tired, frustrated, got rude to patients, and found it difficult to handle situations, which affected them mentally and physically stressed.

Conclusion

Managing the COVID-19 cases has been attributed to the presence of many barriers, such as workload, tiredness, frustration, and sometimes difficult-to-handle situations, and the HCWs were indeed affected mentally and physically. Regular training for HCWs and more awareness programs would help the general public to follow the preventive measures, which reduces the cases and would help the HCWs manage COVID-19 well.

An assessment of transmission dynamics via time-varying reproduction number of the second wave of the COVID-19 epidemic in Fiji

This study involves the estimation of a key epidemiological parameter for evaluating and monitoring the transmissibility of a disease. The time-varying reproduction number is the index for quantifying the transmissibility of infectious diseases. Accurate and timely estimation of the time-varying reproduction number is essential for optimizing non-pharmacological interventions and movement control orders during epidemics. The time-varying reproduction number for the second wave of the pandemic in Fiji is estimated using the popular EpiEstim R package and the publicly available COVID-19 data from 19 April 2021 to 1 December 2021. Our findings show that the non-pharmacological interventions and movement control orders introduced and enforced by the Fijian Government had a significant impact in preventing the spread of COVID-19. Moreover, the results show that many restrictions were either relaxed or eased when the time-varying reproduction number was below the threshold value of 1. The results have provided some information on the second wave of the COVID-19 pandemic that could be used in the future as a guide for public health policymakers in Fiji. Estimation of time-varying reproduction numbers would be helpful for continuous monitoring of the effectiveness of the current public health policies that are being implemented in Fiji.

Dietary Patterns, Food Insecurity, and Their Relationships with Food Sources and Social Determinants in Two Small Island Developing States

Small Island Developing States (SIDS) have high burdens of nutrition-related chronic diseases. This has been associated with lack of access to adequate and affordable nutritious foods and increasing reliance on imported foods. Our aim in this study was to investigate dietary patterns and food insecurity and assess their associations with socio-demographic characteristics and food sources. We recruited individuals aged 15 years and above from rural and urban areas in Fiji (n = 186) and St. Vincent and the Grenadines (SVG) (n = 147). Data collection included a 24 h diet recall, food source questionnaire and the Food Insecurity Experience Scale. We conducted latent class analysis to identify dietary patterns, and multivariable regression to investigate independent associations with dietary patterns. Three dietary patterns were identified: (1) low pulses, and milk and milk products, (2) intermediate pulses, and milk and milk products and (3) most diverse. In both SIDS, dietary pattern 3 was associated with older age, regularly sourcing food from supermarkets and borrowing, exchanging, bartering or gifting (BEB). Prevalence of food insecurity was not statistically different across dietary patterns. In both SIDS, food insecurity was higher in those regularly sourcing food from small shops, and in SVG, lower in those regularly using BEB. These results complement previous findings and provide a basis for further investigation into the determinants of dietary patterns, dietary diversity and food insecurity in these settings.

Perception of mothers about Acute Respiratory Infections (ARIs) and risk factors affecting children Under 5 Years (U5Ys) in Fiji

PURPOSE

To explore the perception of mothers about Acute Respiratory Infections (ARIs) and their risk factors affecting children Under 5 Years (U5Ys) in Fiji.

DESIGN

This was a qualitative study done in the Integrated Management of Childhood Illness (IMCI) Clinic in Ba Hospital, Fiji. Mothers who had brought in their children with ARIs were selected through a purposive sampling method. A semi-structured open-ended questionnaire was used to guide in-depth interviews. The interviews were transcribed and the thematic analysis was done to look at the themes and sub-themes that emerged.

RESULTS

A total of 30 mothers were interviewed. There were five themes that were derived from the interviews including the mothers' perception of ARIs; treatment methods; perceived barriers; services provided by IMCI clinic; and recommendations and suggestions. The mothers were familiar with the causes, risk factors and able to recognize severity of ARIs based on the local context. They mostly relied on traditional and home remedies for ARIs. Most mothers preferred injections for treatment for their child. There were many perceived barriers of ARIs prevention such as traditional norms and poor social support. Most mothers stayed in rural areas which caused poor accessibility to health care services. Few mothers had issues with poor attitude and skills of health care workers.

CONCLUSIONS

There are multiple factors that are barriers in reducing the risks of ARIs. There needs to be policies implemented to support the health of children in the communities as well as social support structures.

PRACTICE IMPLICATIONS

This study provides a clear picture of the perception of the mothers regarding ARIs in children under five years old. With this information at hand, it is easier to answer the question regarding the perceptions of the mothers of ARIs and the risk factors and design tailored interventions to prevent ARIs among children.

Genomic epidemiology of Salmonella Typhi in Central Division, Fiji, 2012 to 2016

BACKGROUND

Typhoid fever is endemic in some Pacific Island Countries including Fiji and Samoa yet genomic surveillance is not routine in such settings. Previous studies suggested imports of the global H58 clade of Salmonella enterica var Typhi (Salmonella Typhi) contribute to disease in these countries which, given the MDR potential of H58, does not auger well for treatment. The objective of the study was to define the genomic epidemiology of Salmonella Typhi in Fiji.

METHODS

Genomic sequencing approaches were implemented to study the distribution of 255 Salmonella Typhi isolates from the Central Division of Fiji. We augmented epidemiological surveillance and Bayesian phylogenomic approaches with a multi-year typhoid case-control study to define geospatial patterns among typhoid cases.

FINDINGS

Genomic analyses showed Salmonella Typhi from Fiji resolved into 2 non-H58 genotypes with isolates from the two dominant ethnic groups, the Indigenous (iTaukei) and non-iTaukei genetically indistinguishable. Low rates of international importation of clones was observed and overall, there were very low levels an antibiotic resistance within the endemic Fijian typhoid genotypes. Genomic epidemiological investigations were able to identify previously unlinked case clusters. Bayesian phylodynamic analyses suggested that genomic variation within the larger endemic Salmonella Typhi genotype expanded at discreet times, then contracted.

INTERPRETATION

Cyclones and flooding drove 'waves' of typhoid outbreaks in Fiji which, through population aggregation, poor sanitation and water safety, and then mobility of the population, spread clones more widely. Minimal international importations of new typhoid clones suggest that targeted local intervention strategies may be useful in controlling endemic typhoid infection. These findings add to our understanding of typhoid transmission networks in an endemic island country with broad implications, particularly across Pacific Island Countries.

FUNDING

This work was supported by the Coalition Against Typhoid through the Bill and Melinda Gates Foundation [grant number OPP1017518], the Victorian Government, the National Health and Medical Research Council Australia, the Australian Research Council, and the Fiji Ministry of Health and Medical Services.

Attributable Mortality and Excess Length of Stay associated with Third-Generation Cephalosporin Resistant Enterobacterales Bloodstream Infections - a prospective cohort study in Suva, Fiji

OBJECTIVES

There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the impact of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji.

METHODS

We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and multistate modelling to estimate the excess length of hospital stay.

RESULTS

From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs, 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio (aHR) 1.13, 95% CI 0.51-2.53) or being discharged alive (aHR 0.99, 95% CI 0.65-1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36-1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31-9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5-2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission.

CONCLUSION

Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.

Challenges faced by edentulous patients (EDPs) during complete denture prostheses (CDP) service delivery in Fiji - a qualitative study

BACKGROUND

Edentulism is a state of having no teeth in the oral cavity, an irreversible condition popularly known as the marker of disease burden on the oral health. For edentulous patients (EDPs) Complete Denture Prostheses (CDP) is a means to improve oral health. Due to limited studies in this area, this research aimed to explore the challenges faced by the EDPs during CDP service delivery in Fiji.

METHODS

A directed descriptive qualitative study was conducted among EDPs attending Dental Prosthetic Clinics (DPCs) at the four centres in Fiji under purposive sampling. A semi-structured questionnaire with open ended questions was used for in-depth interview with EDPs who had worn CDP for 1 year via telephone. Participant responses were recorded, transcribed verbatim and analyzed manually using thematic analysis.

RESULTS

A total of 30 EDPs participated in the study. Six themes were identified as challenges faced by the EDPs during CDP service delivery in Fiji: lack of information, non-compliance, overwhelmed by illness, reduction on quality of life (QoL) financial barriers to CDP treatment care and personal acceptance. 77% of EDPs felt they did not receive adequate information on CDP when attending DPCs which indicated the non-compliance nature irrespective of using and cleaning CDP on a daily basis. The Dental Professionals (DPs) at the DPCs gave their full support in attending to the CDP challenges faced by the EDPs in Fiji during the review clinics.

CONCLUSION

The EDPs expressed a variety of challenges that was faced while seeking appropriate CDP services in Fiji. The findings demonstrate the need to explore approaches to develop patients' engagement practices during CDP service delivery by the Dental professionals (DPs), which leads to effective oral health promotion in Fiji for CDP wearers.

Fijian school students' Fiji English speech sound acquisition

Purpose: The aim of this study was to investigate Fijian students' acquisition of Fiji English speech sounds.Method: Participants were 72 multilingual students (5-10 years) living in Fiji who spoke the Fijian or Fiji Hindi dialects of Fiji English. The students' productions of single words from the Diagnostic Evaluation of Articulation and Phonology (DEAP) were analysed according to dialect using the Children's Independent and Relational Phonological Analysis (CHIRPA).Result: Most English consonants were acquired by 6;0. English consonants that were not in the inventories of Fijian or Fiji Hindi were the last acquired, while those that were common between English and the two languages were some of the earlier acquired consonants. Percentage of consonants correct (PCC) for Fiji English was significantly lower for Grade 1 students (M = 93.01, SD = 0.07) in comparison to Grade 4 students (M = 99.03, SD = 0.01). Plosive and nasal sounds were acquired by 90% of the students earlier than fricative, approximant and affricate sounds, though acquisition of some plosive and fricative sounds varied between Fiji English dialects. All word-initial consonant clusters were acquired by 90% of the students by 9;6, with r-clusters tending to be the latest acquired. The acquisition of word-final consonant clusters was highly variable as students often produced appropriate dialectal variants.Conclusion: Multilingual Fijian children may acquire English specific sounds later than their monolingual English-speaking peers. Consideration of the language environment and analysis of the speech sample with reference to the child's dominant English dialect is imperative for valid identification of speech sound disorder (SSD) in children who speak different dialects of English.

Perceptions of patients on factors affecting diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Fiji: A qualitative study

Introduction

Optimal glycemic control can be achieved when patients are adherent to self-management behaviours such as healthy diet, physical activity, monitoring of blood glucose, reducing the risk factors, ability to solve problems and healthy coping. In light of limited studies conducted, this study aimed to explore patient's perceptions on factors affecting diabetes self-management among Type 2 Diabetes Mellitus (T2DM) patients of Labasa, Fiji.

Materials and methods

A qualitative study was employed to obtain data using semi-structured interviews conducted amongst T2DM patients attending clinics in 3 randomly selected health facilities in Labasa, Fiji from 15^th March to 5^th April 2021. Non probability purposive sampling was used to recruit 30 T2DM patients. The data was collected using semi-structured open ended questionnaires. Thematic analysis was used for data analysis. This was done by closely examining the transcribed data to identify common themes such as ideas, topic and pattern that come up repeatedly, followed by reviewing themes, defining it and naming them.

Result

Five themes emerged including; awareness on diabetes, perceptions towards diabetes mellitus, social support and diabetes self-management, challenges in diabetes self-management, and cultural beliefs and practices. The findings of the study demonstrated lack of knowledge and attitude towards definition of diabetes and its complications. The self-management practices amongst patients were insufficient. There was poor financial support and lack of social support among patients.

Conclusion

The results of this study highlighted various factors such as poor knowledge of diabetes and its complications, inadequate family support, financial burden and strong cultural beliefs and social norms affecting diabetes self-management. This study informs the need to identify the factors affecting diabetes self-management among T2DM patients.

Behavioral Preventative Strategies Undertaken by Dental Clinics in Fiji during COVID-19 Pandemic

Introduction:

COVID-19 has created a significant impact on dentists and oral health professionals. This research aimed to explore the perspective of dental officers (DOs) and dental managers (DMs) on behavioral preventative strategies and recommendations for preventing the virus transmission in the dental clinics in Fiji.

Materials and Methods:

This qualitative study was conducted among DOs and DMs who worked in nine private dental clinics, eight government dental clinics, and one School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji between August 9 and September 12, 2021. The participants were selected using purposive sampling method using the inclusion and exclusion criteria. Self-developed semi-structured open-ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted.

Results:

Thirty DOs and 17 DMs participated in this study. Seven themes emerged from data analysis: Risk perception-COVID-19 versus dentistry; Staff safety, satisfaction, and motivation; Breaking the chain of infection transmission; Adaptability, and acceptance; Shared responsibility; Roles and knowledge; and Importance of good planning. Majority of participants felt that dental professionals are at high risk, and hence, need to take extra precautionary measures. Participants also stated that more care should be provided to patients by accepting the situation and moving forward.

Conclusion:

This study highlighted the importance of dentists in preventing disease transmission in a dental setting. Continuation with the protocols and strategies gave the participants more sense of protection. The importance of good planning, accepting the situation, and moving forward was highlighted. Future research is recommended in other divisions and other health-care professionals can be included.

A Method to Measure the Damage Caused by Cell-Sucking Herbivores

The damage that herbivores inflict on plants is a key component of their interaction. Several methods have been proposed to quantify the damage caused by chewing insects, but such methods are not very successful when the damage is inflicted by a cell-sucking organism. Here, we present a protocol that allows a non-destructive quantification of the damage inflicted by cell-sucking arthropods, robustly filtering out leaf vascular structures that might be mistakenly classified as damage in many plant species. The protocol is set for the laboratory environment and uses Fiji and ilastik, two free software packages.

Characteristics and Predictors of Late Antenatal Booking Among Pregnant Women in Fiji

OBJECTIVE

Antenatal Care (ANC) plays a pivotal role in improving child and maternal health. Even though antenatal coverage in Fiji is more than 95%, the majority of pregnant women fail to initiate ANC within the first trimester. Thus, the research aimed to determine factors that are associated with late antenatal booking among pregnant women who delivered in Ba Mission Hospital (BMH) in Fiji in 2019.

METHODS

Secondary data analysis was done using SPSS version 24 on 340 pregnant women who had delivered in BMH from January 1 to December 31, 2019 and met the eligibility criteria. A data extraction sheet was used to collect information on socio-demographic, obstetric, and medical factors.

RESULTS

The prevalence of late booking in BMH in 2019 was 79.7%. The results of the bivariate analysis showed that being from I-taukei ethnicity (AOR: 2.36; p = 0.003), an unmarried woman (AOR: 2.5; p = 0.004), and women with < eight ANC visits (AOR: 3.7; p < 0.001) during the pregnancy were significant predictors of late antenatal booking. Multivariate analysis showed that only < eight ANC visits were a significant determinant of late antenatal booking (COR: 3.6; p < 0.001).

CONCLUSION

The burden of late antenatal booking in Ba is higher than those of some other developing nations. Efforts are needed to create community awareness on the importance of early ANC booking. The significant factor identified should inform policymakers on how to influence pregnant women to come for an early booking for ANC.

The Fiji Sugar Industry: Sustainability Challenges and the Way Forward

This paper examines the problems facing the sugar industry in Fiji. It expands on the difficulties of world trade and the macro- and micro-problems that affects the sugar industry sternly. It also discusses local challenges associated with sugarcane crop production and sugar manufacturing in the country. Additionally, it provides an overview of some of the specific issues directly facing smallholder sugarcane growers. This study is based on a customised mixed-methods research conducted in the year 2015 in the sugarcane-producing areas on the islands of Viti Levu and Vanua Levu in Fiji. The 33 farmers and members of their households in the study comprised both descendants of the Girmitiya community brought from India under the colonial rule and the native iTaukei sugarcane farmers, who rely primarily on cash incomes derived from the sale of sugarcane and other diversified farm products. This paper demonstrates that the sugar industry in Fiji is currently facing a 'perfect storm'-wave after wave of major difficulties coming all at once-and the country is beginning to tackle these problems only as they reach crisis point.

Displaced by climate and disaster-induced relocations: experiences of cascading displacement in Fiji and the Philippines

Disasters and climate-related risks displace millions of people each year. Planned relocation is one strategy used to address displacement. However, little attention has been paid to the secondary impacts of planned relocations, and how they influence the risk, vulnerability, and well-being of other groups, particularly people who live on the land selected for relocation sites, or in neighbouring areas. This paper explores how current and potential planned relocations in Fiji and the Philippines redistribute vulnerabilities to non-target communities that previously lived on, or alongside, relocation site land. The notion of cascading displacement is introduced to illustrate a serious consequence of planned relocations in which insecurity and displacement are recreated and perpetuated due to a failure to consider the needs of non-target groups that are directly disadvantaged by relocation processes. Insights from this paper may be used to inform future relocation policy and practice to achieve more equitable and sustainable outcomes for all involved.

Five culturally protected water body practices in Fiji: Current status and contemporary displacement challenges

Community-based natural resource management in Oceania has its roots in culturally protected water body (CPWB) practices. However, CPWBs in Fiji have been under-researched regarding what practices exist, and the extent to which they are currently practiced. Archival research and interviews with 201 individuals across Fiji's 189 districts revealed five CPWB types. Conception, Meconium, and Circumcision CPWBs are at risk of practice cessation, while Chiefly investiture and Funerary, have 15% and 42% actively practicing districts, respectively. Primarily serving a ceremonial and food provisioning service, the view that CPWBs do not contribute to biodiversity conservation can be counterproductive to conservation efforts. CPWBs as a place-based practice are eroding due to low awareness by conservation practitioners, and exclusion from community management plans. Knowledge of CPWBs and the practical challenges of implementing them can help conservation practitioners and Indigenous peoples maintain cultural practices, while ensuring food security and conservation into the future.

"Patients would probably be more compliant to therapy if encouraged by those around them": a qualitative study exploring primary care physicians' perceptions on barriers to CVD risk management

Background

Public health prevention strategies have been developed to overcome the disease burden. Despite all the available resources, there have been several challenges in keeping up with the practices in Cardiovascular Diseases (CVD) risk management. The aim of this study is to explore Primary Care Physicians’ (PCP) perceptions on barriers to CVD risk management and strategies to overcome these barriers in Suva, Fiji.

Methods

This is a qualitative study conducted in the Suva Medical area among 7 health centers from August 1st to September 30th, 2021. Purposive sampling was used to recruit participants who provided in-depth and detailed information. From those physicians who worked in the Suva medical area as Primary Health Care (PHC) physicians, those who had at least 6 months experience and those who had some Special Outpatients Department (SOPD) exposure, in-depth interview was conducted using semi-structured questionnaire over the telephone and recorded in a mobile app. The interview content was then transcribed and thematic analysis was done.

Results

This study included 25 PHC physicians. From the thematic analysis, 2 major themes were developed including perceived barriers to CVD risk management and some of the strategies to overcome these barriers. Some of the barriers identified include patient factors such as non-compliance, physician factors such as time-constraints and lack of training, and health system factors such as poor medical records system and lack of basic resource. The strategic support systems include patient expectations, physician’s encouragement, utilization of resources, laws and legislations and continuing evidence-based medicine.

Conclusions

Physicians’ perceptions on the barriers and the strategies to overcome those barriers in CVD risk management plays an important role. The barriers include those of physician factors, patient factors and the health system as a whole. It is suggested to encourage shared-decision making in CVD management, enhance physician support and reinforce policies and research to bring about positive change and improvements in the quality of care.

Psychometric properties of the Child-OIDP and oral health-related quality of life (OHRQoL) in secondary schools in Suva, Fiji

Background

Oral health-related problems are highly prevalent and, like many other diseases, affect Quality of Life. Although most primary schools in Fiji have supervised school brushing programs and have regular screenings these preventive aspects are missing in secondary schools.

Objective

To assess the internal consistency reliability, face and content validity of the Child-OIDP questionnaire and determine the oral health-related quality of life in 15-year-olds in Suva, Fiji.

Methods

A cross-sectional prospective study was carried out on 15-year-old children from four secondary schools in Suva, Fiji from 2014 to 2015. All students enrolled in the 10th and 11th year of studies were included. Multi-stage cluster sampling was used to identify the participants and the sample size of 367 was calculated. The Child Oral Impact on Daily Performance (Child-OIDP) self-administered questionnaire was used to collect data and data was analyzed using Epi-Info (3.5.1).

Results

A total of 281 students (76.6%) responded, of whom 47.0% experienced at least one impact. Cronbach’s alpha for the Child-OIDP frequency items was 0.70 and the corrected item-total correlation ranged from 0.13 to 0.57. The most common performances that were affected were eating (27.8%) and relaxing (12.8%). Performances that were severely and most severely influenced were social contact (23.1%), smiling (16.7%) and relaxing (16.7%). The most common conditions leading to impacts were dental sensitivity (38.4%), dental caries (23.5%) and toothache (21.4%).

Conclusion

The original version of the Child-OIDP is a reliable index with acceptable internal consistency when used directly in the Fiji setting, however, further studies to validate the tool will be useful. Oral impacts were prevalent, but not severe.

Blue carbon storage in Fijian seagrass meadows: First insights into carbon, nitrogen and phosphorus content from a tropical southwest Pacific Island

Seagrasses provide vital ecosystem services which include the accumulation and storage of carbon and nutrients in sediments and biomass. Despite their importance in climate change mitigation and adaptation, seagrass ecosystems have been poorly studied, particularly in the Pacific. Therefore, the present study assessed variability in sedimentary and vegetative C, N and P storage in three monospecific seagrass meadows (Halophila ovalis, Halodule pinifolia and Halodule uninervis), reporting baseline data for the first time. Sediment C_org stocks ranged from 31 to 47 Mg C ha^-1 and varied (p < 0.001) between seagrass meadows, unvegetated areas and locations. Comparison of N and P storage between vegetated meadows and unvegetated areas revealed differences (p < 0.05); implying seagrass meadows function as C, N and P sinks. Differences in species composition and environmental conditions, may play a key role in estimating C, N and P stocks, which are valuable data for conservation and monitoring of seagrass ecosystems.