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Pacific Islands
Health
Research
Symposium
SOCIAL DETERMINANTS
OF HEALTH
6th - 7th September 2012
TANOA INTERNATIONAL HOTEL, NADI, FIJI.
Booklet Compiled by:
Edited by:
Formatted by:
Printed in:
Date:
CPOND
Dr Wendy Snowdon, Mabel Taoi
Setita Naqelevuki
Suva, Fiji
August 2012.
Foreword
It is my great pleasure to welcome you all to the 2012 Pacific Islands Health Research
Symposium. The idea of a Health Research Symposium for the Pacific Islands was
initiated last year in response to an overwhelming call for a research conference to be
held locally. With the Pasifika Medical Conference meeting held in Fiji last year it was
seen as an opportune time to trial a research-based conference for the Pacific Islands
Countries and to showcase research undertaken in the Pacific as well as regionally and
internationally.
By any measure, last year’s Symposium was a great success - the venue was a sell-out
and discussion was lively. We foreshadowed the conference in 2012 and I am now
delighted to welcome all presenters and delegates to this meeting. You will hear
an exciting array of papers which address the overall Symposium theme of Social
Determinants of Health. You will also be fortunate to see genuine Pacific Island Health
research in transition from idea to research to presentation and then to publication.
At the Fiji National University we are working hard to encourage presenters at symposia
like this to publish their research in academic journals and ultimately contribute to
better accessibility for much needed Pacific Health literature. For some people the
process of publication comes naturally – and for others it’s a more challenging journey.
But we hope that the positive impact of the research symposium will go a long way
to encourage the creative and questioning minds that are abundant across the Blue
Continent. What I can say is that now, more than ever before, we need to develop
enquiry and quality research if we are to better understand the health challenges we
all face and if we want to work out positive and sustainable ways forward that are
understood by and owned by Pacific Island people.
But for now can I wish everyone who attends a thoroughly enjoyable time and can
I thank all of those who worked tirelessly to put together this 2012 Pacific Islands
Health Research Symposium.
Professor Ian Rouse,
Dean, College of Medicine, Nursing & Health Sciences
Pacific Islands Health Research Symposium 2012
Page 2
Acknowledgement
We would like to extend our sincere thanks to AusAID for providing funding support
for this year’s Pacific Islands Health Research Symposium, through its Strategic
funding to the College of Medicine, Nursing and Health Sciences. The additional
financial support from the Fiji Medical Association is also gratefully acknowledged.
We would also like to acknowledge the support of the Secretariat of the Pacific
Community’s Healthy Pacific Lifestyle Section for its generous provision of travel
grants, which have enabled seven presenters to be funded to participate in the PIHRS.
We must also thank the World Health Organization and George Institute for their
sponsorship of the evening event on the 6th September.
We appreciate the support of our keynote speaker Professor Sharon Friel and our
other invited speakers from WHO and SPC, in generously giving their time to present
at this symposium.
This symposium would not have been possible without the considerable work and
enthusiasm from many members of the College. In particular we owe a huge thankyou to the members of the College Research Committee and the other volunteers who
undertook the challenging task of abstract reviews. Also within the Departments many
staff provided support to students and colleagues in developing abstracts. We would
also particularly like to acknowledge the efforts of Nola Vanualailai and Jyotishna
Mudaliar in co-ordinating the abstract review process and also A/Prof Christian Ezeala
for his additional assistance. Thank-you also to Setita Naqelevuki for her excellent
work on the abstract booklet and assistance in the planning processes, and also to the
other members of the research team for their involvement. We also acknowledge Prof
Ian Rouse and Dr Berlin Kafoa for their ongoing support and assistance.
I’d like to particularly thank the C-POND team for their considerable support for the
symposium, particularly Susana Lolohea for taking the lead in the administrative and
logistical arrangements. Also to Gade Waqa and Astika Raj for their considerable
efforts.
Finally, a big thanks to all the presenters for their willingness to be part of the PIHRS,
and to all the participants for providing your support.
Dr Wendy Snowdon
C-POND Coordinator
Pacific Islands Health Research Symposium 2012
Page 3
Pacific Islands Health Research Symposium
TABLE OF CONTENTS
Session 1:
KEYNOTE PRESENTATION:
No data, no problem, no action: evidence for action on the social determinants
of health and health inequities
Professor Sharon Friel, Australian National University
9
Session 2:
Room 1:
Knowledge, attitudes and practices of people with Type 2 diabetes
and guardians toward diabetes
Rachel Sorumana, Ministry of Health, Solomon Islands
Prevalence of rheumatic heart disease among Primary School
children in Samoa detected by Echocardiographic screening
Dr Satupaitea Viali, Samoa
Oral cancer in Kiribati: Knowledge and screening practices of
health care professionals
Dr Kantara Tiim, University of Melbourne and FNU
Room 2:
HIV, health and prisoners in Fiji
Lanieta Matanatabu, PCSS, Fiji
Forced sex: Sexual quicksand in the Pacific
Avelina Rokoduru, PacS-RHRC, FNU
Barriers to condom and other contraceptive uptake study in Vanuatu
Dr Timaima Tuiketei, CMNHS, FNU
12
13
14
15
16
17
Session 3:
Room 1:
iTaukei mothers’ perceptions of their young children’s diets
Laisa Vereti, C-POND, FNU
Processed foods available in the Pacific Islands
Dr Wendy Snowdon, C-POND, FNU
Sodium in processed foods in the Pacific Islands countries and territories
Astika Raj, C-POND, FNU
Social determinates of behaviours related to salt consumption in
the Cook Islands
Tae Tutai, Ministry of Health, Cook Islands
19
20
21
22
Room 2:
Initial defaulter in new smear PTB: 10 year observational study in Fiji
Sharan Ram, CMNHS, FNU
Patient compliance to hypertension treatment in Tuvalu
Tiemain Angela Kilei, Ministry of Health, Fiji
Patient knowledge and compliance with antibiotic therapy
at Outpatients pharmacy, CWM hospital, Suva
Chaaya Chandra, Ministry of Health, Fiji
Evaluation of laboratory surveillance system for dengue fever causes in Fiji
Aminiasi Tavui, Ministry of Health, Fiji
23
24
25
26
Session 4:
Room 1:
MSM and trans gender in Suva and Lautoka. A tale of two cities
Praneel Maharaj, PacS-RHRC, FNU
Theoretical approaches to explaining domestic violence in Fiji
Akisi Ravono, CMNHS, FNU
Violence against women: a Public health approach
Avelina Rokoduru, PacS-RHRC, FNU
Research in Transgender and Men who have sex with Men in Fiji
Sepesa Rasili, MENFiji
Room 2:
Growing NCD workforce in the Pacific: a brief update
Dr Judith McCool, University of Auckland
Identifying risk of non-communicable diseases:
ethnic and gender differences in the Pacific
Dr Wendy Snowdon, C-POND, FNU
Socio-cultural influences on ‘outside-home’ eating patterns
for adolescents in Fiji
Jillian Wate, C-POND, FNU
Knowledge exchange in Fiji: The Translational Research on
Obesity prevention in Communities project
Gade Waqa, C-POND, FNU
28
29
30
31
32
33
34
35
Session 6:
Room 1:
Determinants of fruit and vegetable consumption among urban residents in Fiji
Emily Morgan, LSHTM
Study on the dietary patterns of Molituva and Vusuya communities - Talievu
Kiti Bulamainaivalu, CMNHS, FNU
Effects of processing on the cyanide content of cassava products in Fiji
Bandna Chand, CEST, FNU
Indo-Fijian mothers’ ideas of their young children’s diet
Astika Prasad, C-POND, FNU
Room 2:
The relationship between climate variables and infectious disease
Dr Lachlan McIver, WHO/Ministry of Health, Fiji
Meningitis in children in Fiji:
etiology, epidemiology and neurological sequelae
Viema Biaukula, CMNHS, FNU
Attitudes towards HIV/AIDS among Pharmacy students at
Fiji National University
Prashant Sarup, Ministry of Health, Fiji
HIV-modelling in the Pacific
Dr Jito Vanualailai, USP, Fiji
37
38
39
40
41
42
43
44
Session 7:
Room 1:
Dental caries and Dietary Pattern of Pre-school children in Honiara,
Solomon Islands
Dr Joji Ralovo, CMNHS, FNU
Ring the recess bells and let the children play
Jeremy Dorovolomo, USP, Fiji
Implications for trade agreements on health outcomes in Samoa
Jacinta Fa’alili-Fidow, University of Auckland
Are children in Fiji less content with life than other children?
A/Prof Marj Moodie, Deakin University
Room 2:
Strengthening church-government partnerships for primary health care
in Papua New Guinea
Margareth Samei, Divine Word University
46
47
48
49
50
Estimates of the prevalence of hearing loss and summary of
hearing services in the Pacific
Dr Michael Sanders, University of Auckland
Stigma and sex-work: Social determinates of health for sex workers
Kate Saxton, PCSS, Fiji
National Health Accounts of Fiji
Nola Vanualailai, CMNHS, FNU
51
52
53
Session 8:
Need and options for strengthening governance and management
of Health Research in the Pacific Islands for improved
efficiency, quality and utilization.
Dr Manju Rani, WHO
APPENDIX - PROGRAMME
55
58
KEYNOTE
PRESENTATION
No data, no problem, no action: evidence for action on the social determinants
of health and health inequities
Professor Sharon Friel
Professor of Health Equity and ARC Future Fellow, National Centre for Epidemiology and Population
Health,The Australian National University
Systematic social differences in health that are judged to be avoidable are unfair and inequitable.
Putting these inequities in health right is a matter of social justice. This was the guiding principle
that underlay the WHO Commission on Social Determinants of Health. Our conclusion was that
health inequities arise because of a toxic combination of poor social policies, unfair economic
arrangements and bad politics. These, in turn, affect the circumstances in which people are
born, grow, live, work, and age. This position – that social circumstances lead to health – was not
just a value but a judgement derived from decades of research.
Can one draw conclusions about causation, and the likely benefits of interventions, from
observational studies? If you think the only evidence worth considering is that from randomised
controlled trials, you can happily save time by not reading further. The social determinants
of health are the circumstances in which people are born, grow, live, work, and age; and the
inequitable distribution of power, money and resources that are drivers of those circumstances
of daily life. It will not take long to assemble all the randomised controlled trials of the health
effects of income redistribution in Fiji; or to conduct a systematic review of the effects on health
equity of social protection mechanisms in Asia; or the effect of trade agreements on type II
diabetes in the Pacific Island Countries.
Many health researchers spend their lives on analytical epidemiological studies isolating causal
effects. Traditionally, case studies, action research, qualitative studies, policy analysis were
seen as not quite up to this purpose. Gathering evidence to address the social determinants of
health and health inequity requires a fit-for-purpose approach to evidence, balancing the use of
different types of evidence, and assessing the degree to which action in social determinants is
shown to be possible and effective. One must also apply chains of reasoning. Take for example
the question: is collective action at the grass roots level good for health? If it can be reasonably
shown that collective action can lead to improved housing for disadvantaged groups, and given
that a wealth of evidence points to the importance of housing for health, it is a reasonable
supposition that collective action to improve housing will be beneficial for health equity.
As researchers we have a responsibility to provide timely and scientifically robust evidence
that demonstrates any inequities in health outcomes, inequities in social determinants, health
care and proximal risk factors, and, importantly, evaluates the impact of public policy and
interventions on health equity. If policy is to address health equity through action on the social
determinants of health, policy-makers must broaden the scope of what constitutes evidence,
and make judgment on evidence compiled on a fitness-for-purpose basis.
No data, no problem, no action.
Pacific Islands Health Research Symposium 2012
Page 9
Biodata: Professor Sharon Friel
Sharon Friel, Professor of Health Equity at the Australian National
University, has been a public health academic since 1992. Between 2005
and 2008 she worked with Sir Michael Marmot as the Head of the
Scientific Secretariat (University College London) of the World Health
Organisation’s landmark global Commission on Social Determinants of
Health. In 2008 she chaired the Rockefeller Foundation global research
network on urban health equity (GRNUHE), which reported in 2010. In
2010 she was awarded an Australian Research Council Future Fellowship
to investigate the interface between health equity, social determinants and
climate change (particularly through food systems and urbanisation), based
at the National Centre for Epidemiology and Population Health, ANU.
Before moving to Australia, she worked for many years in the Department
of Health Promotion, National University of Ireland, Galway.
Prof Friel is interested in complex systems and how they affect health
inequities. Her research and publications, which number over 130 are
policy focussed and in areas of social determinants of health; global
health; climate change; food systems; non-communicable disease
prevention, and urbanisation. She is co-founder of the Global Action for
Health Equity Network (HealthGAEN), a global alliance concerned with
research, training, policy and advocacy related to action in the social and
environmental determinants of health equity, and chairs Asia PacificHeathGAEN.
Pacific Islands Health Research Symposium 2012
Page 10
SESSION 2
11.00am - 12.oopm
Knowledge, Attitude and Practices of people with Type 2 diabetes and
guardians towards diabetes
Rachel Sorumana*, Numa Vera
*Ministry of Health, Solomon Islands.
Background:
Diabetes Mellitus is becoming a growing concern in the Solomon Islands. This study sought to
assess knowledge, attitude, practices of people with Type 2 diabetes and their guardians; to
form strategies and solutions acceptable to people with diabetes, to enable them to improve
their knowledge, attitude and practices.
Methods :
Patients with Type 2 diabetes and their guardians were interviewed using a structured
questionnaire at the National Referral Hospital between June and August 2009. Locations of
interview included: surgical ward, medical ward, diabetes center and the eye clinic.
Results:
Of the 50 participants interviewed, 30 (60%) were admitted >1 month. Thirty-seven (74%)
claimed that nurses educated them about diabetes. Thirty (60%) claimed excellent knowledge
and (48) 96% of the guardians had knowledge about diabetes. Many (43; 86%) had accepted
their conditions when first diagnosed. Many (47; 94%) were aware of the complications. Most
(48; 96%) mentioned the importance of diet control however only (15) 30% monitored their food
intake and (33) 66% did some physical activity. Only (13) 26% were compliant with medication.
All the guardians encouraged proper management and 46% assisted patients to be compliant to
treatment.
Conclusion:
Since participants showed sufficient knowledge of how to manage their condition and sufficient
support from guardians, self-management counseling seems indicated. Health personnel, with
appropriate training about the importance of diabetes management and monitoring, could
provide some support.
Pacific Islands Health Research Symposium 2012
Page 12
Prevalence of Rheumatic Heart Disease among Primary School Children in
Samoa detected by Echocardiographic screening.
Dr Satupaitea Viali*
*Specialist Physician and Cardiologist, Ministry of Health, Samoa. Email: [email protected]
Background:
Early detection of rheumatic heart disease is vitally important to minimize the risk of advanced
valvular heart disease by preventative measures such as secondary penicillin prophylaxis. The
RHD screening program in Samoa utilized echocardiographic examinations. The 2012 World
Heart Federation (WHF) echocardiographic criteria for diagnosing rheumatic heart disease was
used to categorized pathologies on these echocardiographic examinations.
Methods:
As part of our National RHD screening program, we screened 6,930 school children in primary
schools aged 3 to 16 years in Samoa using a portable echocardiographic ultrasound machine
(Cypress) from 2008 to 2011. Those kids who had any abnormalities suggestive of RHD in the first
echocardiographic examination were brought back for a second confirmatory echocardiography.
The pathologies on the second echocardiography were categorized according to the 2012 WHF
RHD criteria and were reported as Definite RHD, Borderline RHD or Normal. All the kids with
Definite and Borderline RHD were started on IM Penicillin prophylaxis.
Results:
The first screening echocardiogram detected abnormalities that may be related to rheumatic
heart diseases (probable RHD) in 308 (4.4%) of 6,930 children. The second and confirmatory
echocardiogram detected 96 (31.2%) of 308 that satisfy the Definite RHD diagnosis. This equates
to a crude prevalence for Definite RHD of 1.39% (96 of 6,930 children). The age-standardized
prevalence rates for Definite RHD in Primary Schools in Samoa of the usual standard age groups
from 5-13 years old, was 14.3 cases per 1,000 (95% CI, 1.14 – 1.73). The age-standardized
prevalence rates for Borderline RHD in Primary Schools in Samoa of the usual standard age
groups from 5-13 years old, was 6.1 cases per 1,000 (95% CI, 0.41– 0.80).
Conclusions:
The prevalence of Definite RHD is high in Samoa.
Pacific Islands Health Research Symposium 2012
Page 13
Oral Cancer in Kiribati: Knowledge and screening practices of health care
professionals
Dr Kantara Tiim*, Michael McCullough
*Department of Oral Health, Fiji National University, Email: [email protected]
Introduction:
There is an increasing rate of oral cancer seen at the Dental Department in Kiribati according
to anecdotal data. With the high proportion of tobacco smokers amongst the Kiribati young
population and tobacco being the main risk factor in the aetiology of oral cancer, we will anticipate
a higher rate of this disease in future. With the lack of specialists and minimal resources, early
detection of this disease is paramount to prevent expensive referral and radical treatment costs.
Knowledge and screening practices of health care professionals in Kiribati in particular nursing
officers could be seen as a target in improving early detection.
Methods:
All medical (MO) and dental officers (DO), general surgeons (S)and a representative number
of nursing officers (NO) were included in the study . MO/DO/S being one group and NO being
another group. 100 self administered questionnaires were distributed to participants in Tarawa
and the outer islands to determine their knowledge and screening practices. Outer islands
questionnaires were delivered and returned via postal mail whereas in the capital personal
delivery and collection was carried out.
Results:
The response rate was 70%, with 48% answering incorrectly regarding treatment choice.
There were 63% who had low knowledge score and 37% with high knowledge score. There
were significantly low knowledge scores and incorrect choices of treatment of nursing officers
compared to MO/DO/S. There was about half of the participants who would screen patients
and the other half who wouldn’t. There were significantly more MO/DO/S reporting to screen
patients for oral cancer compared to NO.
Discussion:
This survey clearly identifies the need to improve knowledge and screening practices for nursing
officers with regards to oral cancer. It identified barriers for screening being the lack of specialists
and inadequate training in medical and nursing school. It also highlighted that there was a
general need for continuing education and improvement of the local referral system with better
screening tools. The bulk of the health workforce in Kiribati is comprised of nursing officers
who are usually the first point of contact for patients in both urban and rural areas. Efforts in
improving current knowledge and screening practices of this particular group, and utilizing them
in this area is crucial considering our limited resources.
Pacific Islands Health Research Symposium 2012
Page 14
HIV, Health & Prisoners in Fiji
Kate Saxton, Lanieta Matanatabu*, Semisi Siga
*Pacific Counseling and Social Services (Transitioning to Empower Pacific), Fiji.
Introduction:
In Fiji, HIV infection has increased steadily since 2001 and the current prevalence is thought to
be underestimated due to low testing rates. A recent situation analysis in Fijian Prisons showed
that prisoners engage in high levels of risk behavior including unprotected sex and unsterile
tattooing, therefore this research aims to estimate the prevalence of HIV and syphilis infection
among a representative sample of prisoners in Fiji.
Methods:
This is a longitudinal study of people leaving prison in Fiji. So far, 71 adult prisoners in Fiji
have been interviewed in the weeks prior to their release from custody; for each prisoner, a
comprehensive health assessment and a non-diagnostic testing for HIV and syphilis using a dried
blood sample was done. After their release, these prisoners were followed up 1 month and 4
months respectively, on their HIV risk behavior, drug use, mental health status and utilization of
health services in their communities.
Results:
So far, 71 inmates have been surveyed and blood samples collected for analysis. Of the 71
participants 69% reported that they have never had an HIV test. Participants were also asked
about their experience of common STI symptoms, the two most common symptoms reported by
the participants were pain or burn when urination, which was about 36% and genital discharge
which was 33%. Out of the 71 participants interviewed so far, 61% reported they never used
condoms with their regular partner, including either husband or wife or boyfriend or girlfriend.
Among the 34 participants who reported at least one casual sex partner, almost half (44%)
reported never using condoms and only 8(23%) reported always using condoms with casual
partners.
With regards to drug and alcohol used; tobacco, alcohol, cannabis and yaqona (kava) use
appears to be prevalent amongst the prisoners. Using the ASSIST scale to assess alcohol and
drug dependency risk, one- third were at high- risk of dependency on alcohol and cannabis and
more than half had a moderate risk of dependency with 88% moderate dependency on tobacco,
64% on alcohol, 62% on cannabis and 75% on yaqona.
Pacific Islands Health Research Symposium 2012
Page 15
Forced Sex – Sexual Quicksand in the Pacific.
Avelina Rokoduru*
*Pacific Sexual and Reproductive Health Research Centre, Research Unit, College of Medicine, Nursing and
Health Sciences, Fiji National University, Fiji Email: [email protected]
Introduction:
Forced sex is defined as any sexual act that is coerced, unwanted or not consensual. Forced sex
is another manifestation of gender inequalities and their related issues within society. Limited
Pacific data show substantial increasing rates of forced sex. An ominous silence pervades all
Pacific HIV Second Generation Surveillance reports and national HIV/STIs strategies regarding
issues and ways to address forced sex.
Method:
Desk review conducted to identify latest Pacific-based studies providing empirical and sexual
health impacts data concerning forced sex and reports linking this phenomenon to HIV/STI
transmissions.
Results:
Recent Pacific SGS and other studies have reported forced sex. 50% of studied sex workers in,
21% of studied MSM in Cook Islands over 25% of antenatal women aged 14-44yrs in Solomon
Islands, 40% of male clients and 60% of FSWs visiting Vanuatu’s STI clinics), and, 9% of antenatal
women and 3% of seafarers in Kiribati have all experienced forced sex. Antenatal women (1.7%)
and youths (3.1%) in Tonga have reported forced sex) including Fiji’s SWs and 3% of Fiji’s antenatal
women. Now, the Solomon Island’s latest SGS identifies persons forcing sex as partners, friends,
relatives, strangers and neighbours.
Discussion:
There is little surveillance data on forced sex and data gaps discussing sexual health impacts
or how forced sex is linked to HIV/STI transmission. No Pacific studies have discussed ways
of addressing forced sex within the HIV/STI discourse. There is need to conduct research on
the causes of and coping mechanisms for forced sex for antenatal women, youths, MSM,
transgender and sex workers. There is the fear that the topic of forced sex might sink into the
sexual quicksand of Pacific cultural taboos and denial.
Pacific Islands Health Research Symposium 2012
Page 16
Barriers to Condom and Other Contraceptive Uptake Study in Vanuatu
Avelina Rokoduru, Dr. Timaima Tuiketei*
*Department of Public Health and Primary Care, College of Medicine, Nursing and Health Sciences, Fiji
National University, Fiji, Email: [email protected]
Introduction:
Previous surveillance reports and studies show that levels of condom use have continuously
decreased over time across the pacific. The 2006 and 2008 SGS conducted in Vanuatu showed
similar levels of decreased knowledge and awareness of HIV and STIs, with limited activities
implemented to increase condom use and address the RH ‘unmet needs’. A qualitative in-depth
interview study to understand the low rates of condom & other contraceptive uptake in Vanuatu
was conducted in 2010. The main objectives were to establish the reasons for the low uptake of
condoms and other contraceptives and to identify barriers to the uptake of condoms and other
contraceptives in Vanuatu.
Methods:
The sample population included 397 respondents in Villa and Santos; focus group discussions
of twenty Ni – Vanuatu university students; and 5 key informants interview of policy makers
and program managers from MOH and WHO Vanuatu. A questionnaire was used and the
interviewees were identified using the WHO 30 cluster sampling technique, in Urban & Rural
Villa; and Lugonville.
Results:
[1] For condom access and use, 93% of the participants agreed that accessing free condom is
not a barrier. Most condom use occurred in urban Vila (45%) compared to rural Vila (31%) and
Santos (24%). 84% of male condom users were youths, 37% females who use condoms were
between 14 – 39 years. 44% had used a condom in the last 4 weeks. [2] In access and barriers
to other Family Planning uptake, the three most common places that supply FP are the MOH
Clinics and Aid posts (24%), pharmacies (21%) & Nakamal (20%). The most common reasons that
will stop participants from using FP are: their spouse do not want them to use FP (30%), high
travelling expenses to collect FP (20%), high cost of FP (14%), religious beliefs (8%), traditional
beliefs & values (7%). 59% of the participants strongly agreed that FP was easily accessible. 10%
use traditional medicines instead of condoms. 29% use herbal and traditional medicines as FP.
Discussion:
This study established that an individual’s power to make a decision whether to access & use a
condom or FP is based on various cultural and socio-economic factors. These factors have placed
the individuals at a disadvantage as their decisions have been subsumed by their sexual partners,
spouses & others. Decisions and personal choices on condoms or FP have been influenced by the
level of education, employment status, gender, and ‘Kastom’ values/practices. The main barriers
to condom and contraceptives uptake identified are socio-cultural factors as social labeling of
women such as ‘solmit’; gender; vulnerable groups; negative attitude of health staff towards
clients accessing condom; short opening hours ofclinics; long waiting time to obtain condoms;
and unavailability of condoms. Based on these findings, a number of recommendations were
also made.
Pacific Islands Health Research Symposium 2012
Page 17
SESSION 3
1.15am - 2.45pm
iTaukei mothers’ perceptions of their young children’s diets
Laisa Vereti*, Dr Helen Mavoa, Gade Waqa, Dr Wendy Snowdon
*C-POND, Fiji National University, Suva, Fiji. Email: [email protected]
Introduction:
The continuing rise in malnutrition and obesity among iTaukei children demands urgent
examination of factors that influence their diets. There is very little evidence on socio-cultural
and socio-economic factors that influence young children’s diets in Fiji during the first few years
of life.
Method:
24 iTaukei mothers whose eldest child was two to three years were purposively recruited from
eight Maternal Health Clinics in and around Suva, and informed consent obtained. A trained
iTaukei interviewer conducted semi-structured interviews at a venue of the mother’s choice.
Interview questions were designed to determine when and why solid food was introduced by
the mothers, and socio-cultural and socio-economic factors influencing their children’s diets.
Interviews were digitally recorded, transcribed and translated where necessary and thematic
analysis undertaken.
Results:
Most mothers stopped breast-feeding when their child was aged between three months and two
years. The main reasons for this cessation was returning to the workforce, a second pregnancy
or that the child graduated to family food, usually between age of one and two years. Finance
played a major role in the selection of milk substitutes, infant diets and when children graduated
to family meals. Participants’ grandmothers drew on traditional knowledge to advice on the
selection and preparation of special infant diets.
Conclusion:
It is important to establish socio-cultural and socio-economic factors that influence the diets of
infants and young children in order to develop evidence-based initiatives that reduce obesity
and malnutrition in this age group.
Pacific Islands Health Research Symposium 2012
Page 19
Processed foods available in the Pacific Islands
Dr Wendy Snowdon*, Katia Cateine, Charlene Guignet, A/Prof Rachael Leon Guerrero,
Astika Raj, Erica Reeve.
*C-POND, Fiji National University, Email: [email protected]
Aim:
Non-communicable diseases are a growing problem in the region, in part due to poor diets. The
use of processed foods within diets is significant, particularly in urban areas, and understanding
their nutritional value is therefore extremely important. This research aimed to collect data on
processed foods sold in the region.
Methods:
Five countries within the Pacific; Fiji, Nauru, Guam, New Caledonia and Samoa, were selected for
data collection, based on their representativeness of the region. Following a standard protocol
from an International Collaborative Group, adapted for use in the Pacific, data was collected in
stores from the food labels of processed foods. Data collected included nutrients, serve size,
country of origin and nutrition-based claims. Following cleaning, datasets were merged to
produce a regionally relevant dataset.
Results:
The overall dataset included 6041 foods, of which 352 had no nutritional labels. Guam had the
largest country dataset (n= 2063) and Nauru the smallest (n=234). There were 57 different country
of origin identified, and multiple labelling formats. Considerable difficulties were experienced
with some labelling formats where nutritional information was only given per serve. Extensive
variations in nutrients were found between similar foods, including canned meats where fat
content ranged from 5 to 29g per 100g and sugar in tomato sauce/ketchup from 3.2 to 30g per
100g.
Conclusions:
The Pacific Island region is exposed to foods from across the world, and labelling styles and
content vary markedly. Consumers can select healthier versions of some products, however
interpreting labels may be challenging.
Pacific Islands Health Research Symposium 2012
Page 20
Sodium in processed foods in the Pacific Island Countries and territories
Astika Raj*, Katia Cateine, Charlene Guignet, A/Prof Rachael Leon Guerrero, Erica Reeve,Dr
Wendy Snowdon.
*C-POND, Fiji National University, Suva, Fiji, Email: [email protected]
Introduction:
Processed foods are now major contributors to high salt intake, which is a significant risk factor
for hypertension and associated non-communicable diseases. Understanding which food
sources are high in sodium is important to assist with targeting of reformulation strategies and
also monitoring progress.
Methods:
Based on the protocol of the International Collaborative Group, five Pacific Island countries;
Fiji, Nauru, Guam, New Caledonia and Samoa, were identified for data collection, as being
representative of the food supply in the region. Nutrient composition data was collected in
larger stores in urban areas, from the labels of all processed foods sold. Results were analysed
by product groupings between countries and with the product-specific targets adopted in the
United Kingdom.
Results:
Nutrient data was collected for 6041 processed food products, of which 5077 provided
sodium data. Analysis showed considerable variations in sodium concentration for similar food
subcategories. In particular, a large range was found in canned meat (280 to 1410mg per 100g)
and chilli sauce (225 to 4800mg per 100g). Within the product categories, mean sodium values
were mainly above the United Kingdom targets.
Conclusions:
This baseline data will be used to monitor progress in reducing sodium content of processed
foods available in Pacific Island countries. The considerable variation in sodium content between
the five countries and within the food categories indicates that reduction in sodium content is
feasible for many products.
Pacific Islands Health Research Symposium 2012
Page 21
Social Determinants of behaviours related to salt consumption in the Cook
Islands
Karen Tairea, Tania Avare, Tae Nootutai*, Mary-Anne Land, Elizabeth Dunford, Dr Helen
Eyles, Dr R Fariu, Dr Temo Waqanivalu, Dr Jacqui Webster
*Ministry of Health, Cook Islands. Email: [email protected]
Introduction:
Salt is bad for health. Attitudes, price and availability of foods affects people’s decisions to
reduce salt consumption. This research collected information on consumer salt knowledge and
attitudes and sodium levels of foods available in the Cook Islands.
Methods:
A survey was conducted amongst 300 participants, 15-65 years, on three islands using a KAB
and food frequency questionnaire. A shops survey was conducted and data on brand, product
name and sodium content (mg/100g) was collected for 900 products. Mean sodium values were
calculated for each food category and compared against sodium levels for equivalent products
in NZ.
Results:
Most people (79%) knew salt was bad for health. Many (63.9%) felt they ate the right amount,
but only 4% knew what the right amount was. Most people added salt when cooking even
though 53.4% said reducing salt was very important. Not adding salt at the table, avoiding
processed foods and using spices were common practices to reduce salt intake. Bread and
sausages were the most frequently consumed products. Bread ranged from 505-870mg/100g
Na and sausages from 620-940mg/100g. There was limited availability of lower salt products
but they were generally not more expensive. Mean sodium values of five categories were higher
than equivalent product categories in NZ.
Discussion:
People know that salt is bad for health but don’t know how much they should be eating. High
salt levels in foods and lack of availability of lower salt options means that it is very difficult
for people to choose a low salt diet. This new information will be invaluable in informing a salt
reduction strategy which includes working with the food suppliers to increase availability of
lower salt foods and raising consumer awareness about how much salt they should be eating.
Pacific Islands Health Research Symposium 2012
Page 22
Initial defaulter in new smear PTB: 10 year observational study in Fiji
Sharan Ram*
*College of Medicine, Nursing and Health Sciences, Fiji National University, Email:[email protected]
Setting:
All TB diagnostic and treatment centres in Fiji.
Objectives:
To report on pre-treatment loss to follow-up rates over a 10 year period (2001-2010) and to
examine if age, sex and geographic origin of patients are associated with this short-coming in
the health service
Methods:
A retrospective review of routine program data reconciling TB laboratory and treatment
registers.
Results:
A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory of whom
579 (84%) were started on anti-TB treatment – an overall pre-treatment loss to follow-up of 111
(16%). Peak loss-to-follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses
were all above the age of 15 years. From the Western Division of Fiji, 33% of sputum positive
patients were declared pre-treatment loss to follow-up and this division had over five times the
risk of such an adverse outcome compared to those from the Central Division (Odds Ratio 5.2,
95% Confidence Interval:3.1-8.9, P <0.0001).
Conclusion:
This study has identified an important shortcoming in programme linkage, communication and
feedback between TB diagnostic and treatment services leading to high pre-treatment loss
to follow-up rates. This negatively influences TB services and ways to rectify this situation are
discussed.
Pacific Islands Health Research Symposium 2012
Page 23
Patient Compliance to Hypertension Treatment in Tuvalu
Tiemain Angela Kilei*, Numa Vera
*Ministry of Health, Fiji.
Aim:
To investigate the level of compliance to Hypertension (HTN) treatment in Tuvalu.
Objectives:
To determine the prevalence of hypertension, to ascertain if patients are compliant to their HTN
treatment and to determine factors that may contribute to non-compliance.
Methods:
A descriptive quantitative study using a questionnaire to interview hypertensive patients.
Seventy eight, (78), participants of 30-83years, hypertensive and on hypertensive medicines and
willing to take part in the study were interviewed. Participants were interviewed about their
medications and factors that may contribute to non-compliance to treatment. Prevalence of
hypertension was determined from the population ≥ 30 years of age.
Results:
There were a total of 350 reported cases of hypertension in 2011, hence the prevalence is 85
per 1000 people. The population interviewed was made up of 57% females and 43% males with
a mean age of 59 years. Of these, 61% were non-compliant to their treatment, 41% females and
20% males. The most common contributing factors to non-compliance included; forgetfulness,
side effects and feeling better.
Conclusion:
There is a high level of non-compliance among hypertensive patients with more women being
non-compliant than men. Forgetfulness was the most common contributing factor to noncompliance.
Pacific Islands Health Research Symposium 2012
Page 24
Patient Knowledge and Compliance with Antibiotic Therapy at Outpatients
Pharmacy, CWM Hospital, Suva.
Chaaya Charlene Chandra*, Numa Vera
*Ministry of Health, Fiji, Email: [email protected]
Objectives:
To quantify patients’ understanding of what an antibiotic is, the different forms of non compliance,
and patients’ knowledge of the consequences of non compliance.
Methods:
A quantitative cross sectional study was conducted on patients aged 21 years and older and
prescribed Flucloxicillin, Amoxicillin or Metronidazole, at Outpatients Pharmacy, CWM Hospital
Suva from June to July 2011, using a standardized interview. Non-probability quota sampling
was used.
Results:
A total of 100 patients were interviewed. Only 24% of these patients correctly defined antibiotics.
80% correctly identified Amoxicillin as an antibiotic; however 51% incorrectly believed that
Panadol was an antibiotic. 27% believed that antibiotics were needed to treat the common cold
and all coughs. 47% agreed that if antibiotics were not taken as prescribed, next time they may
not work properly. 45% admitted to not completing their last course, 69% of whom said it was
because they felt better. 24% and 21% respectively admitted to sharing and obtaining antibiotics
without a prescription. It was determined that an overall 85% had inadequate knowledge about
antibiotics and 64% were not compliant with their antibiotic therapies.
Conclusion:
This indicates poor knowledge and compliance with antibiotics among participants which may
exist in the general public of Fiji. There is a need for large scale surveys on a national level to
determine the full extent of the problem. Further, education/ awareness of the general public on
antibiotic use and antibiotic resistance must be instituted.
Pacific Islands Health Research Symposium 2012
Page 25
Evaluation of laboratory surveillance system for dengue fever cases in Fiji
Aminiasi Tavui*, Dr Erik Rafai
*Environmental Health Department, Ministry of Health, Fiji, Email: [email protected]; tavuiaminiasi@
yahoo.com.au
Introduction:
The Data Decision Making training(DDM) in Field Epidemiology is designed to help field health
personal to carry out surveillance of disease by detecting outbreaks early so that public health
response and intervention is implemented in timely way. This research is an evaluation of
laboratory surveillance system for dengue fever cases in the four main Divisions in Fiji.
Methods:
Secondary data was collected from the Fiji Centre for Communicable Disease Control. Laboratory
data were collected for 2003 -2007 and the national dengue outbreak in 2008-2009. Data
collected were analysed using Microsoft Excel and then projected into pivot tables for making
of graphs.
Results:
Dengue fever outbreaks in the three main divisions have been occurring throughout the years,
with having smaller peaks in medical centres since 2003, major outbreaks happened in 2008 –
2009. Male Fijian within the age group 11-40 years and i-Taukei ethnicity background are mostly
affected by the disease, in Suva in the Central Division, Labasa in the Northern Division and
Lautoka in the Western Division
Discussion:
Data Analysis and Interpretation is the key to early intervention and a key component in an
outbreak to assess the magnitude and scale of an outbreak. Also a vital tool to predict the
future trends of any particular disease. It is simply letting the figures talk to you in a descriptive
epidemiology way.
Pacific Islands Health Research Symposium 2012
Page 26
SESSION 4
3.25pm - 5.00pm
MSM and transgender in Suva and Lautoka, Fiji: A Tale of Two Cities
Patrick Rawstorne, Sepesa Rasili, Isikeli Vulavou, Avelina Rokoduru, Praneel Maharaj*, Prof.
Heather Worth
*Pacific Sexual and Reproductive Health Research Centre, Research Unit, Fiji National University, Email:
[email protected]
Background:
Prior to the IBBS in 2010/2011 there was a paucity of data on MSM and transgender in Fiji. Due
to stigma and discrimination, these populations have been relatively hidden, yet at risk of HIV
transmission. This paper provides a description of, and contrasts, MSM and transgender in two
cities: Suva and Lautoka.
Methods:
The IBBS utilised respondent driven sampling (RDS) to recruit 459 MSM and transgender in Suva
(n=212) and Lautoka (n=247). Participants completed a behavioural questionnaire administered
through PDAs (personal digital assistants).
Results:
Participants in Suva compared with Lautoka were less likely to identify as transsexual (6% vs.
17%), with no differences in gay/homosexual (61%vs.56%), heterosexual (8%vs.11%), or bisexual
(27%vs.28%) identity. Suva participants were more likely to be urban living (84%vs.66%), Fijian
(85%vs.69%), not Indo-Fijian (6%vs.24%) and higher educated (47%vs.22%). Suva participants
were more likely to know someone with HIV (67%vs.51%), have participated in HIV peer
education (54%vs.42%), had an HIV test (47%vs.36%), have more accurate HIV knowledge, and
easier access to health services.
Conclusions:
Findings reflect the relative involvement and success of NGOs and health services in the
respective cities. Suva is larger and better resourced; health services and NGOs appear to be
reaching MSM and transgender more effectively in Suva.
Pacific Islands Health Research Symposium 2012
Page 28
Theoretical approaches to explaining domestic violence in Fiji
Akisi Ravono*
*School of Nursing, College of Medicine, Nursing and Health Sciences, Fiji National University, Email:akisi.
[email protected]
Introduction:
This paper explains the influences of theoretical explanations on the occurrences of human
violence in society. Based from a study conducted within an urban area within the municipality
of Suva on the main island of Viti Levu, the Republic of Fiji, seven different theories including
the bio-psychosocial theory, intergenerational theory, social learning theory, patriarchy and
socialization theory, interpersonal theory, the power control and feminist theory were utilized to
gather explanations and understanding of violent behavior.
Method:
The study utilized a mixed method approach through a survey questionnaire administered in
English and Fijian (n = 216) supplemented by a small number of face-to-face interviews (n =
16).
Results:
Results from this study supported the theoretical explanations of most of the mentioned
theories where 36% of male and 28% of female participants admitted to being abused at home.
Moreover, 64% of males reported witnessing acts of violence at home while 72% of women
admitted witnessing such violent acts. This includes witnessing acts of violence by parents,
siblings, caregivers, guardians or violence towards another individual, including animals.
Discussion:
The seven theoretical explanations helped identify and flesh out many of the more sensitive and
complex issues associated with abusive behavior.
Pacific Islands Health Research Symposium 2012
Page 29
Violence Against Women: A Public Health Approach
Avelina Rokoduru*, Dr Timaima Tuketei, Iloi Rabuka, Dr Viema Kunabuli, Dr Roman Chute,
Rusieli Taukei, Sulueti Duvaga
*Pacific Sexual and Reproductive Health Research Centre, Research Unit, Fiji National University, Email:
[email protected]
Introduction:
Issues surrounding Violence Against Women (VAW) in Fiji have been addressed by NGOs using
mainly feminist, legal and human rights perspectives. Using a public health approach, CMNHS
conducted a VAW study in 2010 and its secondary analysis in 2011. There is none or little data
available from Fiji MOH for VAW-related injuries including patient treatment and management
at health facilities. What’s not known include types of injuries sustained, those most commonly
seen; types of treatment given; how health professionals managed VAW injuries at remote
centres; and, whether professional health staff were adequately trained to address VAW.
Method:
Mainly quantitative, an operational research adopting a survey and facility records review were
used for this study.
Results:
16 health facilities across Fiji were used. 98 health workers perceptions were gathered with
3,027 VAW cases presented at those facilities for 2005 – 2009. Health facilities have existing
processes and systems addressing VAW which only need strengthening. VAW solutions should
be geared towards behaviour change.
Discussion:
This pilot study established that processes and systems were already in place. However, it was not
able to establish the cause/s of violence because reviewed records did not contained personal
information. Further studies are recommended to establish cause/s of violence against women
and to identify personal or community-based coping mechanisms or solutions to address VAW.
Currently there are no Pacific studies looking at VAW from a public health perspective and this
study could be a model to do just that for the region.
Pacific Islands Health Research Symposium 2012
Page 30
Research in Transgender and Men who have sex with Men in Fiji
Sepesa Raisili*
*Males Empowerment Network (Fiji), Fiji, Email: [email protected]
Introduction:
MENFiji commissioned an Integrated Behavioral and Biological Surveillance (IBBS) study to assess
the current level of knowledge and understanding, and identify sexual practices and behavior
pertaining to STI and HIV amongst men who have sex with men (MSM), and Transgenders
(TG) in Fiji. The findings of the study will contribute to the design of interventions including
strengthening the provision of user-friendly health care services ultimately addressing gaps in
the national HIV response.
Methods:
Participants were selected using Respondent Driven Sampling (RDS), in which respondents are
recruited by their peers. The survey team provided support at all levels of the study ensuring
confidentiality of information collected and identity of each respondent. Written consent was
sought from each respondent before participation at each level. The study utilized MENFiji’s
networks to create awareness about the survey.
Results:
A total of 464 respondents - 213 (45.9%) recruited in Suva, and 251 (54.1%) recruited in Lautoka
participated in the study. Findings of the survey indicated an urgent need for an increased effort
in regards to prevention in addition to the strengthening of health care services provision.
Discussion:
The study identified a low level of condom use and accessing of health care services. Therefore
direct involvement of members of target population in surveys and discussion of its findings is
vital to ownership of programs and change in behavior.
Pacific Islands Health Research Symposium 2012
Page 31
Growing NCD Workforce Capacity in the Pacific: a brief update
Dr Judith McCool*, Dr Malakai Ofanoa, Dr Teuila Percival, Dr Vili Nosa
*International Health Social & Community Health, School of Population Health, University of Auckland.
Background:
In response to the need for on-going professional development and collegiality in the face of
the NCD crisis, the WHO WPRO and SPC conducted the third NCD Forum to bring together NCD
coordinator from across all 22 Pacific Countries and Territories for networking, information
sharing and professional development training (via guest presentations and workshops).
Aim:
A brief questionnaire was developed to gauge the current training needs among NCD coordinators
who attended the recent NCD Forum in Tonga (August 2011).
Method:
Topics covered in the self-complete questionnaire include: current NCD priorities, NCD
training and workforce development needs and preferences for delivery. Questionnaires were
anonymous and were completed and returned during the Forum. Results were entered into
Excel for descriptive analysis.
Results:
NCD surveillance, prevention planning, and policy followed by monitoring/evaluation and
community development were identified as priority areas for development. Preferences for the
delivery of professional development include tailored short courses and workshop delivered
either in country, followed by distance or on-line learning modules. Intensive training via site
visits, secondments and postgraduate courses were also suggested. In this brief report we present
a perspective on options for accelerating progress via targeted capacity building initiatives that
meet the needs of the region’s workforce. We identified that professional development options
to strengthening monitoring and evaluation, programme planning and leadership training
were priority areas. We advocate for the inclusion of younger voices in the fight against NCDs;
they represent the majority of Pacific population base, are underutilised are the future of the
region.
Pacific Islands Health Research Symposium 2012
Page 32
Identifying risk of non-communicable diseases: ethnic and gender differences
in the Pacific
Dr Wendy Snowdon,* Mary Malakellis, Lynne Millar, Prof Boyd Swinburn
*C-POND, Fiji National University, Email: [email protected]
Aim:
The risk of developing non-communicable diseases (NCDs) is commonly identified using body
mass index (BMI) and waist circumference (WC). The accuracy of these measures may vary by
ethnicity. The aim of this research was to identify the BMI and WC action points with the highest
sensitivities and specificities for identifying risk of NCDs in Pacific Islanders.
Methods:
This study utilised existing NCD survey datasets from Fiji (iTaukei), Nauru, Solomon Islands and
Wallis and Futuna. The data related to weight, height, fasting blood glucose and total cholesterol
and blood pressure were used to produce a regional dataset. The optimal action points for each
predictor variable (BMI, WC) with respect to each outcome factor (blood pressure, glucose
and cholesterol) were identified using ROC curve analysis in Stata. The analysis was performed
regionally and sub-divided by age subgroup, gender and ethnic group.
Results:
The overall sample size was 8642, of which 55% were women and 70% were Melanesians. The
optimal action points in the Micronesians/Polynesians (highest specificity and sensitivity) were
29.6kg/m2 for men and 31.9 for women for BMI and 96.2cm for WC for identifying two of more
outcome factors. For the Melanesian only grouping BMIs of 24.9 and 28.6kg/m2 respectively,
and WC 89.6cm for women and 85.6cm for men were identified.
Conclusions:
Action points for Melanesians were considerably lower than those for other Pacific Islanders,
and region-wide values may therefore be inappropriate. Action points for men and women may
also be advisable in Melanesians.
Pacific Islands Health Research Symposium 2012
Page 33
Socio-cultural influences on ‘outside-home’ eating patterns for adolescents in
Fiji
Jillian T Wate*, Dr Helen Mavoa, Dr Wendy Snowdon , Ateca Kama, Ramneek Goundar,
Professor Boyd Swinburn
*C-POND, Fiji National University, Suva, Fiji, Email: [email protected]
Introduction:
There is a high prevalence of adolescent obesity in Fiji, especially among iTaukei (Indigenous
Fijians) and their ‘outside-home’ eating patterns are obesogenic. The current study examined
socio-cultural influences on adolescents’ ‘outside-home’ dietary patterns in Fiji.
Methods:
Semi-structured interviews were conducted with 48 iTaukei and 48 IndoFijian adolescents (24
males and 24 females per group) recruited from schools. Trained interviewers representing each
ethnic and gender group conducted the 40-50 minute interviews. Interview transcripts were
subjected to collaborative thematic and constant comparative analyses.
Results:
Consuming unhealthy food and drinks at recess seemed to be more common in adolescents
who skipped breakfast, had more spending money and where their school canteens had more
unhealthy options. More iTaukei purchased lunch from the school canteens whereas a stronger
tradition of home-prepared food was apparent among IndoFijian adolescents whose mothers
prepared their lunches and after school snacks. Strong culture of sharing both food and money
at school highlighted the influence of peers in food choices. Females were more likely to share
food at school because they sat around in groups while males played or went to prayer meetings.
Availability of spending money influenced the types of food and drinks adolescents’ consumed
on the way home from school.
Discussion:
The home preparation of food amongst IndoFijians, sharing of food and money among peers and
amount of spending money given to adolescents are critical socio-cultural influences on ‘outsidehome’ eating of Fijian adolescents and need to be incorporated into initiatives to improve the
healthiness of their eating patterns.
Pacific Islands Health Research Symposium 2012
Page 34
Knowledge exchange in Fiji: the Translational Research on Obesity Prevention
in Communities project
Gade Waqa*, Dr Helen Mavoa, Dr Peter Kremer, Dr Wendy Snowdon, Rigieta Nadakuitavuki,
Prof Boyd Swinburn
*C-POND, Fiji National University, Suva, Fiji. Email: [email protected]
Introduction:
Obesity is a significant public health issue among Pacific populations requiring multiple
approaches to reduce rising risks of lifestyle-related non-communicable diseases. The Pacific
TROPIC (Translational Research on Obesity Prevention In Communities) project designed and
delivered a knowledge-broking programme in Fiji to facilitate the use of obesity-related evidence
when developing policies to reduce obesity.
Methods:
Purposive sampling was used to recruit six organisations than met specific selection criteria.
Each organisation received 1) a series of tailored workshops targeting evidence-informed policymaking skills and 2) support to develop evidence-informed policy briefs to reduce obesity.
TROPIC support for policy brief development was delivered via one-on-one sessions, small group
activities, electronic feedback and telephone interactions, averaging 30 hours per participant.
The programme was evaluated by process diaries and a validated self-assessment survey tool
that measured skills required for evidence-informed decision making pre and post-programme.
Survey data were analysed with repeated measure t-tests.
Results:
Fifty-two policy developers from four government ministries and two non-government
organisations participated in at least one of the two TROPIC components. Of the 52% of
participants who completed the workshops, 33% submitted policy briefs to higher level officers.
Preliminary analyses of the surveys indicated a significant increase in participants’ ability to
assess evidence and non-significant increases in acquiring and adapting evidence.
Discussion:
Participants who completed briefs had more mentoring and support than those who started
briefs but did not complete them. The evidence-informed policy making skills developed by
participants during TROPIC will be sustained if organisations continue to support an evidenceinformed culture.
Pacific Islands Health Research Symposium 2012
Page 35
SESSION 6
11.00am - 12.30pm
Determinants of fruit and vegetable consumption among urban residents in Fiji
Emily Morgan, Penina Vatucawaqa, Dr Karen Lock
*London School of Hygiene and Tropical Medicine, United Kingdom, Email:[email protected]
Introduction:
Low fruit and vegetable consumption has been found in Fiji and is a major risk factor for both
micronutrient deficiencies and diet-related non-communicable diseases. The objective of this
study was to identify the determinants of fruit and vegetable consumption among urban and
peri-urban consumers in the Suva-Nausori corridor, the most densely populated area in Fiji.
Methods:
Eight focus group discussions were conducted with adults in the Suva-Nausori corridor in July
2012. Participants (mostly women) from both major ethnic groups were recruited through local
religious and community organizations. The topic guide explored influences on the selection of
fruit and vegetables, local preferences and uses, and the various locations where participants
obtain fruits and vegetables. Discussions were held in English, Fijian, and Hindi. Data were
analysed using thematic analysis.
Results:
The discussions identified health perceptions and traditional meal planning as important
motivators for the inclusion of fruits and vegetables in participants’ diets. Other key determinants
in the selection of specific products were availability (including from home production), price,
taste/appearance, convenience, and the supply process. The relative importance of these factors
varied between communities. Both market and non-market channels for fruit and vegetable
acquisition were found to be important.
Discussion:
Among Suva-Nausori consumers, fruit and vegetables appear to be perceived as healthful
foods that are essential components and/or complements to certain meals. However,
consumption is tempered by a number of factors, namely availability and price. These findings
suggest the potential for both agricultural and consumer interventions to address sub-optimal
consumption.
Pacific Islands Health Research Symposium 2012
Page 37
Study on the Dietary Pattern of Molituva & Vusuya Communities- Tailevu.
Kiti Bulamainaivalu*, Salanieta Naliva, Sabiha Khan
*Department of Public Health & Primary Care, College of Medicine , Nursing&Health Science , Fiji National
University, Fiji. Email: [email protected]
Introduction:
Non communicable diseases (NCDs) are increasing rapidly in the world. Addressing major risk
factors by improving the diet, increasing physical activity, and controlling the use of tobacco and
alcohol can have a significant effect on lessening the incidence of NCDs.
Objectives:
To assess the dietary pattern of the community, identify NCDs risk factors such as smoking,
kava and alcohol consumption, type of physical activity and determine food security in the
community.
Methods:
Cross sectional survey, using the secondary data from the 2010 Needs Assessment and
Community Profiling survey by the 3rd Year MBBS and Year 2 DDPHN students at Molituva
and Vusuya Villages under the Sub-Divisional Medical Officer, Rewa. The dietary pattern of the
community was collected from the questionnaire by the DDPHN2 students. 52 households were
interviewed of which 26 were from Molituva and 27 from Vusuya village.
Results:
Cereals were the major food consumed (87%), sugar (72%), root crops (48%), animal protein
(38%) and pulses (6%). 96.43% and 40.30% of households in Vusuya and Molituva do gardening
indicating food security in the communities. The common age group that smokes (43%),
consumes kava (85%) and alcohol (42%) are from 22-45 years old. More than 50% do physical
activity, with more males than females.
Conclusion:
The most dramatic changes over the years as evident from the 2004 National Nutrition Survey
(NNS) and the 1994 Naduri survey which is consistent with this study has been an increase in
energy intake (calories) from cereals, root crops and sugar. Intervention program at grass root
level should tackle low participation of women in physical activity. There is also a need to initiate
intervention programs for smoking, alcohol & kava consumption at an early age.
Pacific Islands Health Research Symposium 2012
Page 38
Effect of processing on the cyanide content of cassava products in Fiji
Bandana Chand*
*CEST, Fiji National University, Suva, Fiji.
Introduction:
In Fiji cassava (Manihot esculenta Crantz, Euphorbiaceae) is one of the most important root
crops. According to the 2004 National Nutrition Survey, 59.2% of the Fijian population consumes
cassava on a daily basis while 31% of the Indian population consumes cassava on a weekly basis.
Substantial quantity of anti-nutrient factor cyanogenic glucoside, linamarine and a small amount
of lotaustralin is also present in cassava that interferes with digestion and uptake of nutrients.
The aim of this study was to determine the cyanide content of cassava products available and
consumed in Fiji and to find out if the products available in Fiji meet the standards set by Codex
Alimentarius of 10mg/kg.
Methods:
Cyanide content of twelve cassava based food items with cassava as the main ingredient was
tested for the cyanide content using the pictrate method. The samples were divided into three
groups: grated products; fried products and minimally processed products. The absorbance
was measured in a spectrophotometer at 510 nm and the total cyanide content in mg HCN
equivalents/kg fresh weight = ppm calculated by multiplying the absorbance by 396. This gives
an accurate total cyanide analysis down to a minimum of 1 ppm total cyanide. The results were
analyzed by SPSS by one way ANOVA and pair-wise comparison was made post hoc using Tukey
t-tests.
Results:
The results showed that the cyanide content ranged from 2.21 to 44.14 mg HCN equivalent/kg.
Grated cassava products exhibited lower cyanide content as compared with minimally processed
cassava products and fried cassava products. One way ANOVA revealed that there was significant
differences in the cyanide content in samples in the fried products category as the P<0.05.
Discussion:
This research shows that the processing method determines the amount of cyanide in the
final product consumed. Since cyanogenic glycosides are water soluble, a higher percentage of
cyanides are removed when cassava products are processed in water. Fried cassava products had
higher levels of cyanide as it is not soluble in lipids/oil, hence less cyanide is lost during frying.
Pacific Islands Health Research Symposium 2012
Page 39
IndoFijian mothers’ ideas of their young children’s diets
Astika Raj*, Dr Helen Mavoa, Dr Wendy Snowdon, Gade Waqa.
*C-POND, Fiji National University, Suva, Fiji Email: [email protected]
Introduction:
Childhood malnutrition and obesity are of concern in Fiji, yet there is limited understanding of
sociocultural and socioeconomic factors that influence the diets of young children.
Methods:
Semi-structured interviews were conducted with 24 IndoFijian (Fijians of Indian descent)
mothers whose oldest child was aged two to three years. Participants were recruited through
eight maternal child health clinics in and around Suva. A trained IndoFijian researcher conducted
the interviews with mothers in Hindi to seek descriptions of and explanations for actual and
best diets of their child from the age of six months. Interviews were transcribed, translated into
English, validated and then entered onto N-Vivo 8 for thematic analysis.
Results:
All mothers indicated that they wanted their child to have the best diet; ideas about optimal diets
for young children ranged from providing a nutritious diet to giving young children whatever
they wanted. Cost primarily determinant food provided, especially when selecting milk powder
and commercial infant food before children transitioned to “family food.” Mothers indicated
that relatives and maternal child health clinics were the main influences on food that mothers
provided for their child. Participants’ mothers also were a key source of advice, particularly on
providing nutritious meals on very limited budgets.
Conclusions:
Identification of factors that determine the provision of optimal diets for infants and young
children is critical to the reduction of childhood malnutrition and obesity in Fiji. This research
indicates that cost is an issue, and that the extended family are key influences on children’s
diets.
Pacific Islands Health Research Symposium 2012
Page 40
The relationship between climate variables and infectious disease
Dr Lachlan McIver*, Jyotishma Rajan-Naicker, Dr Simon Hales, Dr Sheetal Singh, Akanisi
Dawainavesi
*Fiji Ministry of Health/World Health Organization, Fiji; Email: [email protected]
Introduction:
Fiji is one of seven countries participating in a global pilot project focused on climate change and
health. The Fiji project - entitled “Piloting Climate Change Adaptation to Protect Human Health”
(PCCAPHH) – has the overall objective of increasing the adaptive capacity of the health sector to
respond to climate-sensitive diseases (CSD’s) such as dengue fever, leptospirosis, typhoid fever
and diarrhoeal illness.
Methods:
The PCCAPHH project to date has analysed the historical incidence of notified cases of dengue
fever, leptospirosis, typhoid and diarrhoeal illness in Fiji over the period 1995-2009, along with
clustering of these CSD’s in space and time. High-incidence areas and disease clusters were
mapped using geographic information systems technology. Empirical modeling of disease cases,
climate variables (such as temperature, rainfall and humidity) and extreme weather events
(tropical depressions and floods) was carried out using Poisson regression.
Results:
Several subdivisions in Fiji appear to have an increased CSD burden. The modeling carried out
to date suggests that the strongest relationships between climatic factors and cases of CSD’s
include typhoid in Ba subdivision (pseudo r2=0.66); dengue fever in Suva (0.6); and leptospirosis
in Bua (0.59).
Discussion:
An understanding of the relationships between climate variables and CSD’s in Fiji may enable
the construction of climate-based disease early warning systems, which have the potential to
decrease the impact of epidemic-prone CSD’s by improving community understanding and the
timeliness and effectiveness of public health control measures.
Pacific Islands Health Research Symposium 2012
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Meningitis in children in Fiji: etiology, epidemiology, and neurological
sequelae
Viema Lewagalu Biaukula*, Lisi Tikoduadua, Kristy Azzopardi, Anna Seduadua, Beth
Temple, Peter Richmond, Roy Robins-Browne, Edward Kim Mulholland, Fiona Mary Russell
*Department of Public Health and Primary Care, College of Medicine Nursing and Health Sciences, Fiji
National University, Suva, Fiji.
Objectives:
To describe the etiology, epidemiology, neurological sequelae, and quality of life of children aged
one month to less than 5 years admitted with meningitis to the Colonial War Memorial Hospital
(CWMH), Suva, Fiji.
Methods:
Over a 3 year period, all eligible children with suspected meningitis admitted to CWMH were
investigated. Of these, those who could were tested for a four-fold rise in antibody titers to
Haemophilus influenzae type b (Hib) and pneumococcal surface adhesin A (PsaA). Cerebrospinal
fluid (CSF) was taken for testing. CSF was also tested by PCR. Pneumococcal isolates were
serotyped . Following discharge, cases underwent a neurological assessment, audiometry, and
quality of life assessment (Pediatric Quality of Life Inventory tool).
Results:
There were 70 meningitis cases. Meningitis was more common in the I-Taukei children.
Enterovirus was the commonest etiological agent and was outbreak associated. S. pneumoniae
was the most common bacterial cause of meningitis with an annual incidence of 9.9 per 100,000
under 5 years old (95% CI 4.9-17.7) and a case fatality rate of 36%. Sequelae were more frequent
in cases of bacterial meningitis. Quality of life was significantly lower in patients with bacterial
meningitis than in those with viral meningitis (p=0.003) or meningitis of unknown etiology
(p=0.004).
Conclusions:
An outbreak of enterovirus occurred making it the most common etiological agent identified. In
the absence of this outbreak, S. pneumonia was the commonest cause of childhood meningitis
in Fiji. Bacterial meningitis is associated with serious sequelae and a reduced quality of life.
Pacific Islands Health Research Symposium 2012
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Attitudes towards HIV/AIDS among Pharmacy Students at Fiji National
University
Prashant Sarup*, Numa Vera, Paraniala Silas C Lui
*Ministry of Health, Fiji. Email: [email protected]
Objectives:
To measure the attitude of Pharmacy students at Fiji School of Medicine toward HIV/AIDs,
including fear of contagion, professional resistance, and negative emotions.
Methods:
A six point Likert scale was used containing 15 items to measure the attitude towards HIV/AIDS
among Pharmacy students at the College of Medicine, Nursing & Health Sciences. Sub-scales
were Fear of Contagion, Professional Resistance and Negative Emotion. Data was collected by
means of a closed ended Likert scale questionnaire and analysed in Epi Info. Social desirability
was measured using 5 items from the Marlowe-Crown Social Desirability Scale.
Results:
Out of 89 students, 79 returned the questionnaire with a response rate of 89%. 60% of the
students showed a negative attitude towards HIV/AIDS. More than 50% students in all the years
showed professional resistance towards HIV/AIDS treatment. There was no significant difference
in the attitude towards HIV/AIDS across different year of study, gender and career choice.
Conclusions:
Our study identified substantial levels of negativity in Pharmacy students towards HIV/AIDS
patients. There is a need for educational interventions in the Bachelor of Pharmacy curriculum
in order to reduce negative attitudes towards HIV/AIDS patients.
Pacific Islands Health Research Symposium 2012
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How accurate are existing models to estimate the size of the HIV-positive
population in the South Pacific context?
Dr Jito Vanualailai*, Nola Vanualailai
*University of the South Pacific. Email: [email protected]
Background:
In 2003, we published a paper that provides post-2002 estimates of HIV-positive individuals in
Fiji based on reported cases between and including the years 1989 and 2002. As opposed to
the use of models based on vulnerable populations, we advocated the use of models based
on officially recorded figures. We used the growth curves, namely, the Logistic and Gompertz
curves, which are biologically inspired and known to be relatively accurate in predicting the
short-term trajectory of the observed HIV-positive population size for countries experiencing
the initial stages of growth.
Objective:
The objective of this study is to extend our 2003 model to include the actual figures between and
including 2003 and 2011,generate a set of new estimations from the extended model, and then
compare the new estimations with those provide by the original 2003 model, revised estimations
by UNAIDS and estimations provided by the Fiji Government in early 2012.
Results:
UNAIDS, in 2007, acknowledged that its models were providing overestimations. It provided
revised estimations between and including the years 1990 and 2010 for countries around the
world. The revised UNAIDS estimations are reasonable. The Fiji Government also provided its
estimations based on simple exponential growth. However, exponential curves are faulty since
they assume that the growth will continue unabated. We show that our estimations have
sharper bounds than those provided by UNAIDS and based on the Logistic and Gompertz curves
described in the 2003 model. The curves are not exponential.
Conclusion:
Based on our more accurate estimations derived from our 2003 model, we argue that the
extended model also provides better estimates at least for the next 5 years 2012 – 2016. With
our model, it is now possible for South Pacific island nations themselves to quickly carry out, at
the end of every year as data becomes available, relatively easier and more accurate short-term
estimations.
Pacific Islands Health Research Symposium 2012
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SESSION 7
1.30pm - 2.50pm
Dental Caries and Dietary Pattern of Pre-school children in Honiara, Solomon
Island.
Anne Pajata, Dr Joji Ralovo*
*Department of Oral Health, Fiji National University, Fiji. Email: [email protected]
Dental caries is a multi-factorial disease which is prevalent in the Pacific amongst both children
and adults. Untreated dental caries leads to pain, loss of function and oro-facial infection.
Aim:
To investigate the relationship between diets, oral hygiene practices on the level of caries (dmft)
in preschool children in Honiara, and to establish if there is a relationship between dental caries
level in preschool children and the socio-economic status of their parents/care-givers.
Methods:
A cross-sectional survey of 18 kindergartens in Honiara (n=200). Caries experience was recorded
using the WHO survey form and data collected was analyzed using Epi Info.
Results:
Majority of participants (96.5%) were exposed to sugary foods by the age of 3 years and 32%
reported consuming fizzy drinks at least three times in a week. Early childhood caries was
prevalent amongst 3 year olds (mean dmft 3.2) and continually increased with age. On oral
hygiene practices, 98.5% of participants have a toothbrush, brush twice a day (72%), supervised
while brushing (53%) and 99% uses fluoridated toothpaste. Children whose parents had less
income had higher mean dmft (7.3) compared to children whose parents earn higher income
(mean dmft 4.9). A similar pattern was observed in children whose parents highest level of
education is primary school with mean dmft of 6.6 and children whose parent’s highest level of
education is tertiary level had mean dmft of 4.6.
Conclusions:
This study concludes that there is a significant relationship (p<0.005) between early sugary diet
consumption and early childhood caries (ECC). Also there is a significant relationship between
socio-economic status of parents and child’s level of dental caries.
Pacific Islands Health Research Symposium 2012
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Ring the Recess Bells and Let the Children Play
Jeremy Dorovolomo*
*University of the South Pacific, Fiji. Email: [email protected]
Introduction:
School recess is one of the contexts in which children can be physically active. The importance
of recess to children is often undervalued and underestimated. Such situations often impede
the child’s opportunity to be physically active, salient to the prevention of non-communicable
diseases. Thus, the aim of the study was to investigate if recess activities are conducive to a
physical active environment.
Methods:
168 class four pupils of five primary schools in Suva, Fiji, were purposely sampled for school type
such as being Muslim, Catholic, Hindu, Fijian, or parent-controlled. Data were collected by class
four teachers through direct observations of recess play using a standard form for thirty minutes
each day over three months and also by participating in five focus group discussions.
Results:
SPSS was used to conduct descriptive and Kruskal-Wallis tests, showing that while all schools
participated in all observed recess activities, certain schools interestingly participated more
significantly in particular activities. For example, School A class four pupils predominantly
participated in more active play, as a result of having school rules that do not restrict recess play.
Or School B pupils were more engaged significantly in non-active play due to religious restrictions
to play and movement, and so forth.
Discussions:
This study indicates that children’s recess play is influenced by the school ethos, school rules,
religion, and gender.
Pacific Islands Health Research Symposium 2012
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Implications for trade agreements on health outcomes in Samoa
Jacinta Fa’alili-Fidow*, Dr Judith McCool, Dr Teuila Percival.
*School of Population Health, University of Auckland, New Zealand. Email: j.fa’[email protected]
Introduction:
As a developing Pacific nation, Samoa is intending to use trade as a development strategy to
build economy and reduce poverty. However case studies from developing countries around
the world provide proof that free trade also has pitfalls, and can create increased access to
unhealthy products and establish further inequalities across populations
Methods:
A series of key informant interviews with key trade and public health stakeholders were
undertaken during June and July 2011. A list of key stakeholders with roles, responsibilities
and/or experience in the field of trade and/or health was compiled and later refined to provide
a balanced representation of different sectors and positions. Four face to face interviews were
undertaken with stakeholders in NZ; three further face to face interviews were conducted in
Samoa. The interviews lasted on average 60 minutes
Results
A range of both conflicting and convergent opinions about the risk and benefits for Samoa for
pursing free-trade agreement were articulated. Most concerns related to the potential for loss
of independence and sovereignty in terms of determining the health of the Samoan population
through binding and inequitable trade agreements. Health benefits of trade included flow-on
effects of employment, health innovation and women’s participation in business.
Discussion:
The findings provide the basis for assessing the relationship between upstream health
determinants on the daily lives of families living in Samoa. Our findings provide valuable
information that could potentially be used for Samoa’s negotiations in PACER Plus, as well as
other trade negotiations with more developed countries.
Pacific Islands Health Research Symposium 2012
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Are children in Fiji less content with life than other children?
Associate Professor Marj Moodie, Dr Solveig Petersen, Dr Helen Mavoa, Gade Waqa,
Ramneek Goundar, Professor Boyd Swinburn
*Deakin University, Australia. Email: [email protected]
Introduction:
Whilst measurement of pediatric quality of life has developed as a strong research area, there
have been no studies in Pacific Island populations. This paper explores the health-related quality
of life (HRQoL) in a general population sample of children in Fiji and compares the results to
those of children from other countries.
Methods:
A total of 8,947 adolescents from 17 secondary schools on the Fijian island of Viti Levu completed
the Pediatric Quality of Life Inventory (PedsQL) adolescent questionnaire, which covers physical,
emotional, social and school functioning and wellbeing. The results were analysed by age, gender
and ethnicity, and were compared to those of children from 13 other countries.
Results:
Children in Fiji reported significantly lower HRQoL compared to children from the other countries,
including clinical samples of children with diseases. HRQoL was particularly low in girls due to
lower physical and emotional functioning, and amongst iTaukei primarily due to lower social and
school functioning.
Discussion:
The low HRQoL of children in Fiji is of concern and has adverse implications at both the individual
and population level. There are likely to be multiple contributing factors. Whilst this study
cannot establish causal factors, lower socio-economic status, income inequalities, rapid societal
transitions, and cultural values and expectations are among potential contributing factors.
More research is warranted to verify the results in Fiji and also in other lower and middle income
countries, and to explore in depth potential explanations and solutions.
Pacific Islands Health Research Symposium 2012
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Strengthening Church - Government Partnerships for Primary Health Care in
Papua New Guinea
Judith Ascroft, Margareth Samei*, Rohan Sweeney, Irene Semos
*Divine Word University, PNG. Email: [email protected]
Introduction:
Stewardship of mixed public and private health systems in countries such as Papua New
Guinea (PNG), where almost 50% of primary health care services are provided by church-based
organisations, is challenging.
This paper draws lessons from partnerships between church and government health service
providers in low-and-middle-income countries to contribute to strengthening the partnership
between church and government providers in PNG.
Methods:
A literature review of published and grey international literature explored how health care
services provided by church-based organisations and government differ and how governments
can best engage non-state providers in primary health care.
Results:
The research revealed important implications for PNG and factors for enhancing the partnership,
including:
• Clearly defined roles and responsibilities
• Enabling remote providers to reflect local contexts within national policies
• Assured funding commitments from government and improved transparency in church
financial reporting
• Collaboration in policy development, planning and implementation
• Using the church sector’s strength in training health workers to improve human resource
management
• Acknowledging and managing the differences in culture and style
• Incorporating support from development partners, church health networks.
Discussion:
The review identifies limitations in the global evidence in several important areas, including:
• characterising the differences in the provision of health services between faith-based and
government providers
• understanding the relationships between faith and health in specific contexts
• how church-based organisations might achieve better health outcomes
• the effect of contracting on health outcomes, equity and quality of health service delivery.
Pacific Islands Health Research Symposium 2012
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Estimates of the Prevalence of Hearing Loss and Summary of Hearing Services
in the Pacific
Natasha Houghton, Dr Michael Sanders*, Dr Ofa Dewes, Dr Judith McCool, Prof. Peter
Thorne.
*University of Auckland, New Zealand. Email: [email protected]
Background:
Hearing impairment (HI) is one of the most common disabilities ranking sixth in the global burden
of disease. Untreated HI in children can lead to delayed speech and language development and
cognitive skills; affecting education and employment opportunities. These factors act as drivers
towards poverty, dependency, and social isolation. However, up to 50% of HI is preventable and the
negative effects can be significantly reduced by early intervention and support programmes.
Objective:
This project aimed to estimate the prevalence of HI in the Pacific (with a focus on the Cook
Islands, Fiji, Niue, Samoa, Tokelau and Tonga) and to identify the services which currently exist
or are being developed in these nations. Audiological, Otological, Educational and Social Support
services are included.
Data Sources:
The data were collected through a review of the literature, both published and grey, via email
correspondence with service providers and through interviews with experts in this area.
Results:
There is a lack of accurate information on the prevalence of HI in the Pacific.Estimates suggest
that as high as 20-23% of the population may suffer from at least a mild HI with up to 11% having
a moderate impairment or worse.
Conclusions:
A number of organisations have been identified who are doing substantial work within the
Pacific to provide services. Despite this, the majority of the needs of people with HI remain
unidentified and unaddressed. This research underscores the urgent need for further initiatives
for both identification and service provision for Pacific hearing impaired populations.
Pacific Islands Health Research Symposium 2012
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Stigma and Sex-work: Social Determinates of Health for Sex workers in Fiji
Kate Saxton*, Lani Matanatabu
*Pacific Counseling and Social Services (Transitioning to Empower Pacific), Fiji
Introduction:
Research has shown that sex workers are exposed to multiple physical and psychological health
issues. An American study revealed that sex workers faced significant barriers accessing health
services. Given the relative ‘taboo’ natures of sex work in the Pacific Islands it not surprising that
sex workers in Fiji face similar barriers to accessing adequate and effective health care. This
research aims to highlight the need for adequate and accessible health care services for sex
workers in Fiji, as well as highlighting current barriers to health care provision.
Methods:
One on one interviews were conducted with female and transgender sex workers during
‘outreach’ work in Nadi, Suva and Labasa. In addition a group interview with 12 sex workers
was held in Lautoka.
Results:
Preliminary Results suggest that 60% of sex-workers have been exposed violence; nearly 20%
identified that they had been raped. Those who had been working in sex-work for 5+ years
displayed good knowledge of STIs and were more likely to report being in good physical health.
Those who had been working in the industry for less than 2 years reported issues with anxiety,
depression, anger management and substance abuse. In addition, they were less likely to use
condoms, had limited knowledge of where to go for HIV testing, and were less likely to access
treatment for symptoms of STIs or physical violence.
Discussion:
The second stage of the research project includes interviewing health care providers and attitudes
to sex work. A more detailed data analysis and discussion is due for completion June 2012.
Pacific Islands Health Research Symposium 2012
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National Health Accounts in Fiji
Nola Vanualailai , Dr Wayne Irava
*Research Unit, College of Medicine, Nursing and Health Sciences, Fiji National University, Fiji. Email: nola.
[email protected]
Background:
There is growing global interest in the use of National Health Accounts (NHA) as a comprehensive tool for
measuring health expenditures and impacting policy change. Fiji recently successfully utilized the NHA
based on the internationally recognized System of Health Accounts (SHA) in a collaborative effort between
the Ministry of Health (MOH), the World Health Organization (WHO) and the CHIPSR of the Fiji National
University (FNU), resulting in the publication “Fiji National Accounts” that reports on the 2007-2010 health
expenditures.
Objective:
1.To collect and analyze data on health expenditures over the period 2007-20010 for the Fiji Government
and the Private sector.
2.To compare the findings with those of other Pacific island countries’, namely Samoa’s, Tonga’s and
Vanuatu’s over the same period.
Methods:
The NHA is a standard set of tables that present various aspects of a nation’s health expenditures. It
encompasses public, private and donor expenditures. The Fiji Government’s health expenditure, which
represents public expenditures, was extracted from the MOH EPICOR system from 2003-2010. Private and
donor expenditures over the period 2007-2010 were obtained through surveys and the (HIES-2008) report
was also used as a source. Stata software was used to carry out the analysis.
Results:
The Total Health Expenditure (THE) increased from FJ$204.3 to FJ$250.4 million over the period 2007-2010.
As a proportion of the GDP during this period, the figures represent almost 4% and 5%, respectively. Funding
sources: The Government’s spending decreased over the period, from 71.2% in 2007 of the total expenditure
to 60.8% in 2010. Proportionally, the private sector expenditures increased from 25.4% to 30.4% and donors
make up the rest (3.4% to 8.8%).Financing agents: In 2010, almost 63% of public financing was channeled
through MOH. Private funds were mainly channeled via households, private insurance, NGOs and other
private firms.
Health providers: Hospitals accounted for more than 50% of health funding, followed by ambulatory, retail
and medical goods providers. Health functions: Most of the health expenditures were spent on in-patient
services followed by out-patient care and training. Comparison: The percentage of THE with respect to the
GDP in 2010 was 4.8%, which is below the WHO recommended minimum of 5%, lower than Tonga’s and
Samoa’s. Out-of-pocket expenditures in Fiji were 16% of THE in 2010, compared to Samoa’s 11%, Tonga’s
10% and Vanuatu’s 8%.
Conclusion:
The decrease in the Government’s spending on health has resulted in an increase in personal spending. This
obviously has an impact on personal incomes, especially in cases where an individual does not have access
to some form of medical coverage by a third party. The Government will need to implement some policies
that will mitigate the impact of increased health costs on an individual.
Pacific Islands Health Research Symposium 2012
Page 53
SESSION 8
3.15pm - 4.30pm
Pacific Islands Health Research Symposium 2012
Page 30
Need and options for strengthening governance and management of Health
Research in the Pacific Islands for improved efficiency, quality and utilisation.
Dr Manju Rani*
*WHO Regional Office for Western Pacific, Manila, Philippines. Email: ([email protected])
Despite repeated global calls for increased investment in health research, securing increased
research investments can be challenging, especially in poor countries where research may
compete with health service delivery for funding, personnel and time. Advocacy for increased
funding can be further undermined by doubts among stakeholders about the efficiency, quality
and effectiveness of research. Some of these issues emanate from inadequate governance and
management systems for health research to ensure accountability and quality, to track and
steer the research portfolio, and to ensure access to research outputs especially in developing
countries. There is consequently substantial potential for duplication, non-reporting, and
wastage of research efforts.
A recent expert consultation convened by WHO Regional office identified essential health
research governance and management functions that must be performed by appropriate
organizational entities to maximize returns on health research investments.
Two closely linked interventions or strategies for research governance and management were
identified that may offer considerable potential: (1) prospective research registration in publicly
accessible national health research registries linked with the processes for ethics review of
research and for providing access to research outputs; (2) policies and systems for systematic
archiving and access to health research data.
Web-based prospective National Health Research Registries are proposed as a primary tool
for research management and governance (stewardship, oversight, priority setting, tracking of
financial investments) in addition to its role in improving accountability and transparency in
health research. The process for prospective registration of health research can be combined
with proposal submission process for ethics review to reduce burden on researchers. The WHO
Regional office for Western Pacific has developed a prototype system and is making it available
for use and adaptation in some of the countries.
Many health research databases, even from large-scale and national surveys that hold significant
long-term and wider value, are not systematically preserved and provided access to, limiting
returns on research investment. The global-level dialogue and increasing trend in adoption of
data-sharing by major research funders in developed countries have not yet trickled down to
developing countries. Proactive efforts are needed to develop health research data archiving
and access policies and their implementation.
There may be several challenges associated with establishing national health registries or
with health research data archiving including resistance from researchers, which need to be
proactively managed by maximizing the direct benefits to researchers. Costs to perform these
functions are legitimate and necessary research costs that must be shouldered by research
funding organizations.
Pacific Islands Health Research Symposium 2012
Page 55
Dr. Manju Rani
Biographical Information
Dr. Manju Rani is Senior Technical Officer for Health
Research Policy at the WHO Regional office for the Western
Pacific. She received her medical degree (MBBS) from Delhi
University in India, and PhD degree in public health from
Bloomberg School of Public Health, Johns Hopkins University
in USA. She has worked and published on wide ranging
public health issues including reproductive health, tobacco
control, non-communicable diseases, health inequities, and
health service delivery. Between 2004 and September 2010,
she was a scientist in Expanded Program of Immunization
at WHO Regional Office for Western Pacific. Between 2001
and 2004, she worked on several assignments at World
Bank including publication of World Development Report
(2004) “Making Services Work for Poor”. She held several
management and supervisory position in the public sector in
India between 1993 and 1998.
Pacific Islands Health Research Symposium 2012
Page 56
APPENDIX - PROGRAMME
Pacific Islands Health Research Symposium: Social Determinants of Health
6-7th September 2012, Tanoa International Hotel, Nadi
6th September 2012
Time
Session
8am
9am
Opening and
welcome
9:30am
Keynote
presentation
10:10am
10:15am
11am
Room 1:
Room 2:
12pm
1:15pm
Session 1
Details
Opening
Registration
Speaker
Chair: Dr Wendy Snowdon
Minister for Health,
Dr Neil Sharma
FNU-Dean CMNHS,
Prof Ian Rouse
Prof Sharon Friel,
Australian National University
Overview of programme and arrangements
Photo session and morning break
Session 2: Non-communicable diseases
Chairs: Dr Viliami Puloka &
A/Prof Marj Moodie
Rachel Sorumana, Ministry of Health,
• Knowledge, attitudes and practices of people with
Solomon Islands
Type 2 diabetes and guardians toward diabetes
Dr Satupaitea Viali, Samoa
• Prevalence of rheumatic heart disease among
Primary Schoolchildren in Samoa detected by
Echocardiographic screening
Dr Kantara Tiim,
• Oral cancer in Kiribati: Knowledge and screening
University of Melbourne and FNU
practices of health care professionals
Session 2: Sexual health
Chairs: Margareth Samei & Mabel
Taoi
Lanieta Matanatabu, PCSS, Fiji
• HIV, health and prisoners in Fiji
Room 1:
• Forced sex: Sexual quicksand in the Pacific
• Barriers to condom and other contraceptive uptake
study in Vanuatu
Lunch break
Session 3: Diets and nutrition
Room 2:
• iTaukei mothers’ perceptions of their young children’s
diets
• Processed foods available in the Pacific Islands
• Sodium in processed foods in the Pacific Islands
countries and territories
• Social determinates of behaviours related to salt
consumption in the Cook Islands
Session 3: Health services
• Initial defaulter in new smear PTB: 10 year
observational study in Fiji
• Patient compliance to hypertension treatment in
Tuvalu
• Patient knowledge and compliance with antibiotic
therapy at Outpatients pharmacy, CWM hospital,
Suva
• Evaluation of laboratory surveillance system for
dengue fever causes in Fiji
Avelina Rokoduru, PacS-RHRC, FNU
Dr Tima Tuiketei, CMNHS, FNU
Chairs: Dr Temo Waqanivalu &
Dr Greg Dever
Laisa Vereti, C-POND, FNU
Dr Wendy Snowdon, C-POND, FNU
Astika Raj, C-POND, FNU
Tae Tutai, Ministry of Health, Cook
Islands
Chairs: Dr Christian Ezeala &
Dr Michael Sanders
Sharan Ram, CMNHS, FNU
Tiemain Angela Kilei,
Ministry of Health, Fiji
Chaaya Chandra, Ministry of Health,
Fiji
Aminiasi Tavui, Ministry of Health, Fiji
Time
2:45pm
3:25pm
5pm
Session
Details
Break
Room 1:
Session 4: Gender-related health
Room 2:
• MSM and trans gender in Suva and Lautoka. A tale of
two cities
• Theoretical approaches to explaining domestic
violence in Fiji
• Violence against women: A Public health approach
• Research in transgender and men who have sex with
men in Fiji
Session 4: Non-communicable diseases
Speaker
Chairs: Dr Simon Hales &
Nola Vanualailai
Praneel Maharaj, PacS-RHRC, FNU
Akisi Ravono, CMNHS, FNU
Avelina Rokoduru, PacS-RHRC, FNU
Sepesa Rasili, MENFiji
Chairs: Dr Jacqui Webster &
Dr Isimeli Tukana
Dr Judith McCool, Uni Auckland
• Growing NCD workforce in the Pacific: a brief update
• Identifying risk of non-communicable diseases: ethnic Dr Wendy Snowdon, C-POND, FNU
and gender differences in the Pacific
Jillian Wate, C-POND, FNU
• Socio-cultural influences on ‘outside-home’ eating
patterns for adolescents in Fiji
Gade Waqa, C-POND, FNU
• Knowledge exchange in Fiji: The Translational
Research on Obesity prevention in Communities
project
End of formal programme for the day
Special session: 5:15pm Room 1 – Launch of “Salt: the hidden danger’, WHO and George Institute
Followed by cocktails
7th September
Time
Details
Session 5: Social determinants of health in the region: Panel
discussion
Panel:
Anjana Bhushan, WHO
Dr Viliami Puloka, SPC
Prof Sharon Friel, ANU
9am
10:30am
11am
Room
1:
Room
2:
12:30pm
1:30pm
Room
1:
Session 6: Diets and food
Break
• Determinants of fruit and vegetable consumption among urban
residents in Fiji
• Study on the dietary patterns of Molituva and Vusuya communities
- Tailevu
• Effects of processing on the cyanide content of cassava products
in Fiji
• Indo-Fijian mothers’ ideas of their young children’s diet
Session 6: Communicable disease
• Invited presentation: Are children in Fiji less content with life than
other children?
Session 7: Health systems
• Strengthening church-government partnerships for primary health
care in Papua New Guinea
• Estimates of the prevalence of hearing loss and summary of
hearing services in the Pacific
• Stigma and sex-work: Social determinates of health for sex
workers
• Invited presentation: National Health Accounts in Fiji
2:50pm
Chairs: Rachel Sorumana &
Gade Waqa
Emily Morgan, LSHTM, UK
Kiti Bulamainaivalu, CMNHS,
FNU
Bandna Chand, CEST, FNU
Astika Prasad, C-POND, FNU
Chairs: Dr Judith McCool &
Avelina Rokoduru
Dr Lachlan McIver,
WHO/Ministry of Health Fiji
Viema Biaukula, CMNHS,
FNU
Prashant Sarup, Ministry of
Health, Fiji
Dr Jito Vanualailai, USP
• The relationship between climate variables and infectious
disease
• Meningitis in children in Fiji: etiology, epidemiology and
neurological sequelae
• Attitudes towards HIV/AIDS among Pharmacy students at Fiji
National University
• Invited presentation: HIV modelling in the Pacific
Lunch break
Open discussion on Pacific Public Health Association
Session 7: Health
Chairs:Dr Satu Viali &
Dr Lachlan McIver
• Dental caries and Dietary Pattern of Pre-school children in
Honiara, Solomon Islands
• Ring the recess bells and let the children play
• Implications for trade agreements on health outcomes in Samoa
Room
2:
Speaker
Chairs:
Prof Boyd Swinburn
& Dr Berlin Kafoa
Break
Dr Joji Ralovo, CMNHS, FNU
Jeremy Dorovolomo, USP, Fiji
Jacinta Fa’alili-Fidow,
University of Auckland
A/Prof Marj Moodie,
Deakin University
Chairs: Dr Tima Tuiketei &
Dr Manju Rani
Margareth Samei, Divine Word
University, PNG
Dr Michael Sanders, University
of Auckland
Kate Saxton, PCSS, Fiji
Nola Vanualailai, CMNHS,
FNU
Time
3:15pm
4:30pm
Room
1:
Session 8: Plenary
•
•
Details
Invited Speaker: Need and options for strengthening governance
and management of Health Research in the Pacific Islands
Closing remarks
Conference ends
Speaker
Chair: Prof Ian Rouse
Dr Manju Rani, WHO
Dr Berlin Kafoa, CMNHS, FNU
The funding support of AusAID is gratefully acknowledged. The additional financial
support from the Fiji Medical Association, Secretariat of the Pacific Community and
World Health Organization is appreciated.