Infertility in the Pacific: A crucial component of the sexual and reproductive health and rights agenda

Across Pacific Island countries, women and men are disproportionately affected by several risk factors for infertility, including sexually transmissible infections, complications from unsafe abortions, postpartum sepsis, obesity, diabetes, tobacco smoking and excessive alcohol consumption. Despite this, little is known about community awareness of infertility, behavioural risk factors, the lived experiences of infertile couples or the contexts in which they access fertility care. In this opinion piece we discuss the current evidence and gaps in evidence regarding infertility in Pacific Island countries and the importance of locally tailored approaches to preventing infertility and the provision of fertility care.

Midwifery education in Pacific Island countries: A discussion paper

BACKGROUND

The aim for 95% maternal health care coverage and zero-unmet need for family planning in Pacific Island countries by 2030 could be achieved by strengthening the midwifery workforce. To enable health services to provide accessible, locally acceptable, and high-quality care, the midwifery workforce must be regulated and educated to global standards and supported to practice in enabling environments. In 2019, around 64,000 live births occurred in Pacific Island countries, yet information regarding the state the midwifery workforce and midwifery education is limited.

AIM

Using data from recent reports and country case studies, this paper provides an overview of the current midwifery education situation in Pacific Island countries and discusses strategic directions for strengthening quality midwifery education and therefore quality midwifery care provision in Pacific Island countries.

DISCUSSION

Six Pacific Island countries have midwifery curricula, all post-nursing programs, although few offer midwifery education programs on a regular annual basis. Current programs do not meet ICM Global Standards for Midwifery Education. Critical areas for strengthening include making underpinning philosophical frameworks, the vision for midwifery education, and program intended learning outcomes explicit in curricula documents and ensuring integration of these in program implementation. Fortunately, five of six midwifery education programs are under processes of renewal and strengthening against global, regional, and national standards.

CONCLUSION

Strengthening the midwifery workforce in the Pacific to meet maternal and newborn health targets can be achieved through supporting the existing midwifery education programs to meet global standards. Strengthened midwifery education programs in Pacific Island countries offer an opportunity to meet each country's maternal and newborn health targets.

Did imports of sweetened beverages to Pacific Island countries increase between 2000 and 2015?

BACKGROUND

Nutrition-related chronic diseases are the major cause of illness and death in Pacific Island countries. Imports of sweetened beverages (SBs) are likely to be contributing but there is limited analysis of the quantities imported or the source countries of such beverages. The purpose of this study was to describe trends in the amount and types of SBs imported to Pacific Island countries and the impact of SB taxes on imports in Fiji and Tonga.

METHODS

A repository of official international trade statistics was used to collect data on the volume, dollar value and source countries of SBs exported to Pacific Island countries from 2000 to 2015. Corresponding population data was sourced from the Secretariat of the Pacific Community for per capita analyses. We also explored which countries earned the most from exporting SBs to the Pacific. Descriptive and regression analyses were used to describe trends over time for each country and for the region as a whole.

RESULTS

Imports of SBs to Pacific Island Countries from 2000 to 2015 increased by an average of 0.30 kg per person per year (p < 0.001). New Zealand and the USA were the largest income earners from SB exports to the Pacific over this period. The introduction of a tax did not impact the volume of SBs imported to Fiji. More data is needed to assess the impact of SBs tax on imports in Tonga.

CONCLUSIONS

Exports of SBs to Pacific Island countries are increasing. Both importing and exporting countries should consider the health implications of trade in these products.

The COVID-19 Pandemic and Sexual and Reproductive Health and Rights in the Pacific

This short communication explores the challenges and ways forward for the delivery of sexual and reproductive health care in Pacific Island countries during the pandemic and the responses in relation to contraception, the management of unintended pregnancies, and gender-based violence.

Congenital Syphilis in Honiara, Solomon Islands

INTRODUCTION

Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis.

METHODOLOGY

All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated.

RESULTS

Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy.

CONCLUSIONS

In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.

Contribution of fat, sugar and salt to diets in the Pacific Islands: a systematic review

OBJECTIVE

Pacific Island countries are experiencing a high burden of diet-related non-communicable diseases; and consumption of fat, sugar and salt are important modifiable risk factors contributing to this. The present study systematically reviewed and summarized available literature on dietary intakes of fat, sugar and salt in the Pacific Islands.

DESIGN

Electronic databases (PubMed, Scopus, ScienceDirect and GlobalHealth) were searched from 2005 to January 2018. Grey literature was also searched and key stakeholders were consulted for additional information. Study eligibility was assessed by two authors and quality was evaluated using a modified tool for assessing dietary intake studies.

RESULTS

Thirty-one studies were included, twenty-two contained information on fat, seventeen on sugar and fourteen on salt. Dietary assessment methods varied widely and six different outcome measures for fat, sugar and salt intake - absolute intake, household expenditure, percentage contribution to energy intake, sources, availability and dietary behaviours - were used. Absolute intake of fat ranged from 25·4 g/d in Solomon Islands to 98·9 g/d in Guam, while salt intake ranged from 5·6 g/d in Kiribati to 10·3 g/d in Fiji. Only Guam reported on absolute sugar intake (47·3 g/d). Peer-reviewed research studies used higher-quality dietary assessment methods, while reports from national surveys had better participation rates but mostly utilized indirect methods to quantify intake.

CONCLUSIONS

Despite the established and growing crisis of diet-related diseases in the Pacific, there is inadequate evidence about what Pacific Islanders are eating. Pacific Island countries need nutrition monitoring systems to fully understand the changing diets of Pacific Islanders and inform effective policy interventions.

Human immunodeficiency virus status disclosure and education for children and adolescents in Papua New Guinea

AIM

How to provide human immunodeficiency virus (HIV) disclosure and awareness for children and young people has not been studied in Papua New Guinea or Pacific Island countries. We aimed to determine the current practices of HIV disclosure and evaluate whether an incremental disclosure education model, as recommended by World Health Organization (WHO), would increase children's knowledge about their condition and improve adherence to antiretroviral therapy (ART).

METHODS

We enrolled HIV-infected children on ART whose parents consented, and we identified whether they were aware that they were HIV positive or not. An incremental education model was used to teach the children about their illness and to disclose their HIV status if that was the parents' wishes. Knowledge of HIV and adherence to ART before and following education sessions was assessed.

RESULTS

A total of 138 children HIV-positive children were recruited. Only 7% had previously been made aware of their HIV test results; the mean disclosure age was 12.7 years. By 10 years of age, 25 of 34 participants (74%) had not been told they had HIV. The common reasons caregivers gave for not disclosing were that the child was too young and the potential psychosocial impacts on the child and the family. Using an education model of HIV disclosure, children's knowledge of HIV increased significantly, and ART adherence, which was good at 95%, increased to 99% an average of 9 months after education.

CONCLUSION

There is a low rate of disclosure for HIV-infected children in Papua New Guinea. This study underlines the importance and value of incorporating age-appropriate HIV education within HIV services.

Active Community-Based Case Finding for Tuberculosis With Limited Resources

Papua New Guinea is one of the 14 highest-burden countries for tuberculosis (TB) infection, but few community-based studies exist. We evaluated a low-cost method of active community case finding in Kabwum and Wasu in Morobe Province, Papua New Guinea. Over 3 months we visited 26 villages and screened adults and children for symptoms and signs of TB. Sputum samples were examined using smear microscopy. A total of 1700 people had chronic symptoms, of which 267 were suspicious for TB on further examination. Sputum from 230 symptomatic adults yielded 97 samples that were positive for acid-fast bacilli. In addition, 15 cases of extrapulmonary TB in adults and 17 cases of TB in children were identified. One hundred and thirty people were identified with active TB disease among the source population of approximately 17 000, giving an estimated prevalence of 765 per 100 000. One hundred and six (82%) cases were not previously diagnosed. The cost per case identified was US$146. It is feasible to conduct active community-based case finding and treatment initiation for TB with limited resources and in remote areas, and in Papua New Guinea the yield was high. Active case finding and follow-up of treatment in villages is needed to address the hidden burden of TB in Papua New Guinea and other high-burden Asia Pacific countries.

Hospital pharmacy services in the Pacific Island countries

RATIONALE, AIMS AND OBJECTIVES

Non-communicable diseases have become an increasing problem in the Pacific Island countries (PICs). With the medical supply system often attached to hospitals in PICs, the training of hospital pharmacy staff has become increasingly important. This study aimed to explore hospital pharmacy services in the PICs using these validated surveys (BS26-27 and BS28-31 surveys) focusing upon hospital pharmacists' influence on prescribing and quality use of medicines.

METHOD

The BS26-27 and BS28-31 surveys were distributed online to pharmacy directors in hospitals in the PICs in 2011 and 2013, respectively. Surveys were made available in both English and French.

RESULTS

In total, data from 55 hospitals were received (77% of the hospital sample in PICs) for either the BS26-27 or BS28-31 survey. From the responses received, 97% (36/37) of hospitals had a formulary, with 81% (26/32) of hospitals having a Pharmacy and Therapeutics (P&T) committee. Furthermore, 67% (24/36) of respondents stated that they provided some sort of clinical pharmacy service. On average, hospitals had two pharmacists involved in clinical pharmacy services. In BS28-31, over 75% (n=27) of respondents believed having a strong relationship with other health care professionals, having effective communication skills and taking professional responsibility for the medicines prescribed as 'mostly' or 'strongly' facilitating clinical services.

CONCLUSIONS

Hospital pharmacists' participation on P&T committee and clinical services is common in the PICs. Such services enhance medication selection and reduce wastage. Although there are still too few hospital pharmacists in PICs, additional support aimed at enhancing their team building and communication skills will allow them to expand their roles and continue to improve patient health outcomes.