Negotiating Change: Ideas, Institutions, and Political Actors in Tobacco Control Policy Making in Mauritius.

CONTEXT: This article explains the policy process that occasioned the development of comprehensive tobacco control policies in Mauritius from 1980 to 2019. It does so by drawing theoretical insights from John Kingdon's streams framework, historical institutionalism, and ideational perspectives to explicate how tobacco control rose to the status of government policy agenda. METHODS: The main sources of data are government documents, media reports, archival studies, grey literature, and published books and articles. These sources were supplemented by key informant interviews with government officials, civil society groups, and other vested interest groups. FINDINGS: This article finds that the prevalence of noncommunicable diseases in the late 1980s, the political commitment of Mauritius's Labour government to comprehensive tobacco control, the institutional legacies of Mauritius's Public Health Act of 1925, and the administrative capacity of Mauritius's Ministry of Health and Quality of Life are the primary factors that drove tobacco control policies in Mauritius. CONCLUSION: The findings from this study will enrich our understanding of policy change and the politics of tobacco control in the global south. Future research should investigate why some countries in Africa have failed to adopt comprehensive tobacco control policies despite ratifying the Framework Convention on Tobacco Control.

Are diabetes and dental care providers in the Republic of Mauritius advising patients about the importance of oral health in diabetes management?

Diabetes and dental care providers may greatly contribute in the early detection of oral diseases and diabetes, respectively, and in the prevention of complications of diabetes. However, there is limited collaboration and referrals between these two groups of health professionals. OBJECTIVE: To investigate whether diabetic providers are addressing the importance of oral care in the management of diabetes and whether dental care providers are advising their patients with diabetes about the importance of glycaemic control. METHOD: Descriptive statistics was used to report data collected from 720 patients with diabetes using a closed-end questionnaire. Logistic regression analysis revealed the factors significantly impacting whether participants received advice from healthcare providers. RESULTS: The majority of participants did not receive advice from either diabetes (84%) or dental (75%) care providers regarding the reciprocal nature of diabetes and periodontitis. The factors significantly affecting receiving advice from diabetes care providers were place of residence (p = 0.003), self-reported type of diabetes (p = 0.000) receiving advice from dental care providers (p = 0.000); from dental care providers - education (p = 0.020), place of residence (p = 0.004), the number of years since diagnosis of diabetes (p = 0.002), frequency of dental visits (p = 0.000) and receiving advice from diabetes care providers (p = 0.000). CONCLUSION: Diabetes and dental care providers in Mauritius are not addressing oral health care as an essential component of diabetes care. Patients with diabetes are neither being advised about the importance of regular dental visits by their treating doctor, nor about the importance of glycaemic control in the prevention of oral complications by their dentist.

Tobacco industry tactics in response to cigarette excise tax increases in Mauritius.

BACKGROUND: In response to high smoking rates, especially among men, Mauritius launched a National Action Plan on Tobacco Control in 2008. It changed its tax system from a mixed system to a uniform specific system. Despite these interventions, cigarette consumption and smoking prevalence in Mauritius decreased only marginally in the subsequent decade. METHOD: Using publicly available data, we decompose the retail price of cigarettes into tax and net-of-tax components, between 2011 and 2017. We cover premium, popular and economy cigarettes. RESULTS: Since its introduction in 2008, the nominal excise tax was increased six times. Between 2011 and 2017, the real value of the excise tax increased by 47%. Meanwhile, British American Tobacco (BAT) increased the real net-of-tax price of premium cigarettes by 61.8% and of popular cigarettes by 47.2%, thus overshifting the tax increase. On economy cigarettes, BAT decreased the real net-of-tax price by 14.7%, thus undershifting the excise tax increase. CONCLUSION: Through its pricing strategy, BAT has greatly undermined Mauritius's tobacco control policy. However, BAT cannot continue undershifting the excise tax on economy brands, since the net-of-tax proportion of the retail price is very low already. BAT would have little choice but to increase the retail price on economy brands in response to future excise tax increases. The government of Mauritius is encouraged to keep the specific excise tax structure but to increase the rate at which it is levied.

Assessing health system challenges and opportunities for better noncommunicable disease outcomes: the case of Mauritius.

BACKGROUND: The objectives of the study reported in this paper were: (a) to score the coverage of core NCD population-based interventions and individual services in Mauritius; (b) to analyse and score the presence of 15 common health system challenges that impede delivery of core NCD interventions and services in Mauritius; and (c) to provide policy recommendations for Mauritius to address health system barriers to delivery of NCD interventions and services. METHODS: The Mauritius country assessment applied the guidelines developed by the World Health Organization Regional Office for Europe for systematically scoring coverage of NCD interventions and assessing health system challenges for improving NCD outcomes. The assessment used qualitative research design approach. RESULTS: Of the 24 core population-based interventions for addressing key NCD risk factors, 16.7% were rated extensive, 37.5% moderate and 45.8% limited. Three (20%), 8 (53%) and 4 (27%) of the 15 individual/personal CVD, diabetes and cancer services were rated extensive, moderate and limited respectively. The top five health system challenges hampering scale-up of coverage of population-based NCD interventions in Mauritius were inadequate interagency cooperation; limited application of explicit priority setting approaches; inadequate change management; sub-optimal distribution and mix human resources; insufficient population empowerment; and insufficient political commitment. The top five challenges had average scores of between 3.1 (interagency cooperation) and 2.4 (distribution and mix of human resources). The top five health system challenges constraining expansion in coverage of individual NCD services were limited integration of evidence into practice; limited use of explicit priority-setting approaches; inadequate application of information and technology solutions; insufficient population empowerment; and sub-optimal distribution and mix of human resources. The top five challenges for individual interventions had mean scores varying between 2.6 (integration of evidence into practice) and 1.7 (distribution and mix of human resources). CONCLUSIONS: Mauritius needs to increase its domestic general government investments into the national health system and requisite multi-sectoral action to address the priority health system challenges with a view of bridging the existing gaps in coverage of NCD population-based interventions and individual services.

Programmatic mapping to determine the size and dynamics of sex work and injecting drug use in Mauritius.

HIV in Mauritius is in a concentrated phase. Most HIV infection is among key populations (KPs) including female sex workers (FSW), people who inject drugs (PWID), men who have sex with men (MSM), and transgender sex workers (TGSW). The objective of this research was to use geographical mapping to determine the precise locations, typologies and population estimates of each KP in Mauritius. From May to July 2014 a programmatic mapping approach determined national estimates and information on the specific locations, "hotspots", frequented by KPs in Mauritius. Data were collected through multiple levels of activity. Key informants provided information about hotspots where KPs congregated and were actively engaged in risky behaviours. Validation of hotspots was done by engaging KPs. A total of 17 248 KP members were estimated spread over 1 964 hotspots in Mauritius. The largest KP was PWID with an estimate of 7 598 (range: 4 091-6 223), followed by 6 223 (range: 5 090-7 456) FSWs, spread over 694 and 731 hotspots respectively. A total of 2 020 (range: 1 595-2 446) MSM and 294 geographic MSM hotspots, and 1 407 TGSWs (range: 1 165-1 649) distributed over 245 hotspots. This research provided Mauritius with validated KPs size estimations and provided the first national data on KP hotspots and operational dynamics. The use of these data will strengthen HIV prevention, intervention, and programme planning in the country through focusing efforts to systematically target high-risk areas.

Strategies and approaches to vector control in nine malaria-eliminating countries: a cross-case study analysis.

BACKGROUND: There has been progress towards malaria elimination in the last decade. In response, WHO launched the Global Technical Strategy (GTS), in which vector surveillance and control play important roles. Country experiences in the Eliminating Malaria Case Study Series were reviewed to identify success factors on the road to elimination using a cross-case study analytic approach. METHODS: Reports were included in the analysis if final English language draft reports or publications were available at the time of analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for vector control in malaria elimination was developed, reviewed, formatted as a matrix, and case study data was extracted and entered into the matrix. A workshop was convened during which participants conducted reviews of the case studies and matrices and arrived at a consensus on the evidence and lessons. The framework was revised and a second round of data extraction, synthesis and summary of the case study reports was conducted. RESULTS: Countries implemented a range of vector control interventions. Most countries aligned with integrated vector management, however its impact was not well articulated. All programmes conducted entomological surveillance, but the response (i.e., stratification and targeting of interventions, outbreak forecasting and strategy) was limited or not described. Indoor residual spraying (IRS) was commonly used by countries. There were several examples of severe reductions or halting of IRS coverage and subsequent resurgence of malaria. Funding and operational constraints and poor implementation had roles. Bed nets were commonly used by most programmes; coverage and effectiveness were either not measured or not articulated. Larval control was an important intervention for several countries, preventing re-introduction, however coverage and impact on incidence were not described. Across all interventions, coverage indicators were incomparable, and the rationale for which tools were used and which were not used appeared to be a function of the availability of funding, operational issues and cost instead of evidence of effectiveness to reduce incidence. CONCLUSIONS: More work is required to fill gaps in programme guidance, clarify the best methods for choosing and targeting vector control interventions, and support to measure cost, cost-effectiveness and cost-benefit of vector surveillance and control interventions.

Assessing the influence of switching barriers on patients' expectations and tolerance zone.

PURPOSE: The purpose of this paper is to look at the influence of switching barriers on patients' private general practitioner (GP) service expectations and tolerance zone DESIGN/METHODOLOGY/APPROACH: From 750 questionnaires distributed to a convenience sample, 257 were completed and returned, yielding a 34 per cent response rate. FINDINGS: There was a significant association between switching barriers and what patients expected from their GPs. Switching barriers did not have a significant association with the tolerance zone. PRACTICAL IMPLICATIONS: Private GPs can develop strategies to overcome switching barriers. For example, they can develop personal relationships with their patients, re-familiarise themselves with the patient's medical history before the consultation and provide better services to patients who perceive high switching barriers and hence higher adequate expectations. ORIGINALITY/VALUE: This study contributes to the existing literature relating to healthcare service quality.

The economic benefits of malaria elimination: do they include increases in tourism?

BACKGROUND: Policy makers have speculated that one of the economic benefits of malaria elimination includes increases in foreign direct investment, particularly tourism. METHODS: This study examines the empirical relationship between the demand for travel and malaria cases in two countries with large tourism industries around the time in which they carried out malaria-elimination campaigns. In Mauritius, this analysis examines historical, yearly tourist arrivals and malaria cases from 1978-1999, accounting for the background secular trend of increasing international travel. In Dominican Republic, a country embarking upon malaria elimination, it employs a time-series analysis of the monthly, international tourist arrivals from 1998-2010 to determine whether the timing of significant deviations in tourist arrivals coincides with malaria outbreaks. RESULTS: While naïve relationships exist in both cases, the results show that the relationships between tourist arrivals and malaria cases are relatively weak and statistically insignificant once secular confounders are accounted for. CONCLUSIONS: This suggests that any economic benefits from tourism that may be derived from actively pursuing elimination in countries that have high tourism potential are likely to be small when measured at a national level. Rather, tourism benefits are likely to be experienced with greater impact in more concentrated tourist areas within countries, and future studies should seek to assess these relationships at a regional or local level.

Oral Health Behaviour and Predictors of Oral Health Behaviour Among Patients With Diabetes in the Republic of Mauritius.

OBJECTIVES: To investigate the oral care habits and assess the determinants of oral care behaviour among people with diabetes in the Republic of Mauritius. METHODS: The present study draws on data collected from 589 dentate persons with diabetes by means of a close-ended questionnaire. Multivariate logistic regression analyses were used to estimate the association of different demographic and clinical factors with recommended dental hygiene practices. RESULTS: The majority of the participants brushed at least twice daily (84.2%), never flossed (88.6%), attended dental clinics on need only (87.1%), and did not monitor their blood glucose levels regularly (69.9%). Neither awareness about the increased risk of periodontal disease and xerostomia nor receiving advice from diabetes care providers was found to be associated with good oral hygiene or increased service utilisation. The experience of oral diseases did not encourage recommended oral health practice, with participants without experience with periodontal disease being 3 times more likely to floss (odds ratio [OR], 2.9; P = .045). Regular dental visits were strongly associated with self-reported type 1 diabetes (OR, 7.8; P = .025). Participants from urban areas were more than twice as likely to visit their dental care provider at least once annually (OR, 2.3; P = .006). Regular dental attendance (OR, 3.7; P = .011) and flossing (OR, 4.5; P = .012) were strongly associated with one another. CONCLUSION: There is widespread noncompliance with regular flossing and dental service utilisation. Our findings highlight the need for an emphasis on preventive care through the provision of integrated medical and dental interventions to high-risk individuals suffering from both diabetes and chronic periodontitis.

Use of Perindopril Arginine/Indapamide/Amlodipine in the Management of Hypertension in Two Sub-Saharan African Island Countries of Madagascar and Mauritius.

INTRODUCTION: Most patients with hypertension in sub-Saharan Africa require two or more drugs to control their blood pressure. Triple fixed-dose combination therapy of perindopril arginine/indapamide/amlodipine is more effective in lowering blood pressure, offers better target organ protection and has increased adherence compared to monotherapy and free combination therapy, and is safe to use. This observational study evaluates the effectiveness of perindopril arginine/indapamide/amlodipine in controlling blood pressure at least 1 month after treatment initiation and assesses patient- and physician- reported drug tolerance over a 3-month period in Madagascar and Mauritius. METHODS: A total of 198 patients with hypertension in ambulatory care who had been on fixed-dose combination of perindopril arginine, indapamide, and amlodipine for at least 4 weeks were included. The main outcome measures were changes in systolic and diastolic blood pressure, attainment of blood pressure control under 140/90 mmHg and 130/80 mmHg, self-reported drug tolerance by the patient, and perceived drug tolerance by the treating physician. Data was collected at 1 month and 3 months. RESULTS: Mean systolic blood pressure was significantly lower at the 1-month (- 3.4 mmHg, p = 0.002) and 3-month (- 8.5 mmHg, p < 0.0001) visits. Diastolic blood pressure also decreased significantly (- 2.4 mmHg at 1-month, p = 0.017 and - 5.4 mmHg at the 3-month visits, p < 0.0001). At 3 months, 80.4% of the patients attained blood pressure targets less than 140/90 mmHg and 42.7% attained targets less than 130/80 mmHg on the basis of their baseline blood pressure. Excellent drug tolerance was reported by more than 90% of patients and physicians at the 1-month visit and by more than 95% at the 3-month visit. CONCLUSION: Triple fixed-dose therapy of perindopril arginine/indapamide/amlodipine continues to show additional blood pressure-lowering capacity even months after initiating the treatment in patients with hypertension in Madagascar and Mauritius. It is also well tolerated by patients with hypertension and assessed as safe to use by physicians.

Costs and financial feasibility of malaria elimination.

The marginal costs and benefits of converting malaria programmes from a control to an elimination goal are central to strategic decisions, but empirical evidence is scarce. We present a conceptual framework to assess the economics of elimination and analyse a central component of that framework-potential short-term to medium-term financial savings. After a review that showed a dearth of existing evidence, the net present value of elimination in five sites was calculated and compared with effective control. The probability that elimination would be cost-saving over 50 years ranged from 0% to 42%, with only one site achieving cost-savings in the base case. These findings show that financial savings should not be a primary rationale for elimination, but that elimination might still be a worthy investment if total benefits are sufficient to outweigh marginal costs. Robust research into these elimination benefits is urgently needed.

A first assessment of marine meso-litter and microplastics on beaches: Where does Mauritius stand?

Marine litter is a major global concern that is threatening marine ecosystems. This study assessed the meso-litter and microplastics density around Mauritius Island, South West Indian Ocean (SWIO) region. WIOMSA guidelines were used for meso-litter and microplastics sampling from October to December 2019 at 12 sites. A total of 1095 meso-litter items (weighing 1250 g) was sampled. Plastics were the most abundant litter category. 'Shoreline and recreational activities' were the main meso-litter source. Microplastics density was highest at the vegetation line (VL) zone. Fragments, mostly blue-coloured, were the most encountered type of microplastics, and polyethylene was the most prevalent polymer type. This study provides important baseline data which can be used by relevant authorities for more effective waste management strategies and awareness campaigns that will help further mitigate the marine litter problem in Mauritius, and to check the effectiveness of management measures in place.

Lived experiences of older adults living in the community during the COVID-19 lockdown - The case of mauritius.

Adoption of strict social distancing and sanitary measures were inevitable in the attempt to thwart the spread of the Covid-19 virus. These measures, however, came at a cost for older adults who faced major mental health issues because of social isolation. The impact of social isolation remains well documented in the wake of the pandemic. This paper explored the lived experiences of older adults living in the community during the Covid-19 sanitary lockdown in the small-island state of Mauritius. As a small-island state with family structures that still skew towards extended or modified extended families, it was interesting to explore whether older adults would be reporting feelings of social isolation as was being reported elsewhere. This study utilized a qualitative approach using a lifeworld hermeneutical approach with 15 older adult participants, recruited through convenience and snowball sampling, in the community. Data were collected using a narrative approach supplemented by an interview guide. Thematic analysis was used to identify themes from transcribed and translated data. Six themes were discovered: Fears of the virus and fear of deprivation; Reliving and recreating bonds; Active contribution to family life; Being and feeling valued within the family; Rediscovering family time and family moments; and Fear of going back to 'normal'. The study revealed positive experiences of the lockdown period characterised by an increase bonding in the family, deepening of familial bond, and increased value despite an initial apprehension of the lockdown. A renewed sense of purpose as well as deepening of bonds was reported by older adults. Some limitations in relation to data trustworthiness and respondents bias, however, could not be avoided since the study was carried out during sanitary lockdown period. The feelings of social isolation and depression reported by older adults who lived alone were not seen in this study, suggesting that the family structure may have a role to play in mitigating these effects. There would also be a need to explore similar small-island states or similar cultures where the effects of sanitary lockdowns may be different from current literature.

The role of ritual behaviour in anxiety reduction: an investigation of Marathi religious practices in Mauritius.

While the occurrence of rituals in anxiogenic contexts has been long noted and supported by ethnographic, quantitative and experimental studies, the purported effects of ritual behaviour on anxiety reduction have rarely been examined. In the present study, we investigate the anxiolytic effects of religious practices among the Marathi Hindu community in Mauritius and test whether these effects are facilitated by the degree of ritualization present in these practices. Seventy-five participants first experienced anxiety induction through the public speaking paradigm and were subsequently asked to either perform their habitual ritual in a local temple (ritual condition) or sit and relax (control condition). The results revealed that participants in the ritual condition reported lower perceived anxiety after the ritual treatment and displayed lower physiological anxiety, which was assessed as heart-rate variability. The degree of ritualization in the ritual condition showed suggestive albeit variable effects, and thus further investigation is needed. We conclude the paper with a discussion of various mechanisms that may facilitate the observed anxiolytic effects of ritual behaviour and should be investigated in the future. This article is part of the theme issue 'Ritual renaissance: new insights into the most human of behaviours'.

[Chikungunya on Reunion Island: chronicle of an epidemic foretold]. / Chikungunya à l'île de la Réunion: chronique d'une épidémie annoncée.

Chikungunya is a viral disease transmitted by a mosquito of the genus Aedes. It is currently epidemic on Reunion Island, in the Indian Ocean. It is essentially characterized by an influenza syndrome but associated with polyarthralgia and an eruption. The disabling and chronic nature of the arthralgia is the most remarkable clinical aspect of chikungunya infection. Severe and unusual forms have appeared, not previously described in the literature. These forms must be studied to determine whether there is a direct relation between the chikungunya virus and the severity factors. Treatment is solely symptomatic, combining analgesic and/or antiinflammatory agents. There is no vaccine. The epidemic is not limited to Reunion: cases of chikungunya have also been reported in neighboring islands (Maurice, Seychelles, and Madagascar). Travelers planning to visit the region should be counseled.

[Holiday dreams with a downside: uncommon tapeworm infection in an infant]. / Traumurlaub mit Folgen -- ein ungewöhnlicher Bandwurmbefall bei einem zweieinhalbjährigen Kind.

Eight weeks after his return from Mauritius, a 2.5-year-old boy started to show signs of gastrointestinal illness including diarrhoea with frequent ill-smelling stools as well as restlessness, insomnia and apathy. Proglottids excreted with the faeces were diagnosed as Raillietina madagascariensis (Davain, 1870), the tropical rat tapeworm. Treatment with praziquantel (10 mg/kg BW) proved to be efficient.