RESUMEN
Until the early twentieth century, populations on many Pacific Islands had never experienced measles. As travel to the Pacific Islands by Europeans became more common, the arrival of measles and other pathogens had devastating consequences. In 1911, Rotuma in Fiji was hit by a measles epidemic, which killed 13% of the island population. Detailed records show two mortality peaks, with individuals reported as dying solely from measles in the first and from measles and diarrhoea in the second. Measles is known to disrupt immune system function. Here, we investigate whether the pattern of mortality on Rotuma in 1911 was a consequence of the immunosuppressive effects of measles. We use a compartmental model to simulate measles infection and immunosuppression. Whilst immunosuppressed, we assume that individuals are vulnerable to dysfunctional reactions triggered by either (i) a newly introduced infectious agent arriving at the same time as measles or (ii) microbes already present in the population in a pre-existing equilibrium state. We show that both forms of the immunosuppression model provide a plausible fit to the data and that the inclusion of immunosuppression in the model leads to more realistic estimates of measles epidemiological parameters than when immunosuppression is not included.
Asunto(s)
Brotes de Enfermedades , Sarampión , Sarampión/mortalidad , Sarampión/epidemiología , Sarampión/historia , Humanos , Brotes de Enfermedades/historia , Niño , Lactante , Preescolar , Adolescente , Fiji/epidemiología , Historia del Siglo XX , Masculino , Adulto , Adulto Joven , Femenino , Persona de Mediana Edad , Terapia de InmunosupresiónRESUMEN
OBJECTIVES: We analysed 4 y of laboratory data to characterise the species and determine the antimicrobial susceptibility profiles of enterococci as human pathogens in Fiji. The study also investigated the molecular epidemiology amongst the subset of vancomycin-resistant enterococci (VRE). METHODS: This retrospective study reviewed bacteriological data from Colonial War Memorial Hospital (CWMH) and other healthcare facilities in the Central and Eastern divisions of Fiji. Phenotypic, antimicrobial susceptibility and vanA and vanB PCR testing were performed using locally approved protocols. The first clinical isolates per patient with antimicrobial susceptibility testing results in a single year were included in the analysis. Data was analysed using WHONET software and Microsoft Excel. RESULTS: A total of 1817 enterococcal isolates were reported, 1415 from CWMH and 402 from other healthcare facilities. The majority of isolates, 75% (n = 1362) were reported as undifferentiated Enterococcus spp., 17.8% (n = 324) were specifically identified as Enterococcus faecalis and 6.7% (n = 122) as E. faecium. Overall, 10% of the enterococci isolates were from blood cultures. Among isolates from CWMH, <15% of E. faecium were susceptible to ampicillin, and 17.2% were vancomycin resistant. Overall, 874 enterococcal isolates (including the undifferentiated species) were tested against vancomycin, of which 4.8% (n = 42) were resistance. All of the VRE isolates tested (n = 15) expressed vanA genes. CONCLUSIONS: This study demonstrates the clinical importance of VRE, particularly van A E. faecium in the national referral hospital in Fiji. Enhanced phenotypic and molecular surveillance data are needed to better understand enterococci epidemiology and help guide specific infection prevention and control measures and antibiotic prescribing guidelines.
Asunto(s)
Antibacterianos , Proteínas Bacterianas , Enterococcus , Infecciones por Bacterias Grampositivas , Pruebas de Sensibilidad Microbiana , Centros de Atención Terciaria , Humanos , Fiji/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Estudios Retrospectivos , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Enterococcus/efectos de los fármacos , Enterococcus/genética , Enterococcus/aislamiento & purificación , Enterococcus/clasificación , Atención Primaria de Salud , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Ligasas de Carbono-Oxígeno/genética , Enterococcus faecalis/genética , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/aislamiento & purificación , Epidemiología Molecular , Enterococcus faecium/genética , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/aislamiento & purificaciónRESUMEN
Pacific Island countries have experienced periodic dengue, chikungunya and Zika outbreaks for decades. The prevention and control of these mosquito-borne diseases rely heavily on control of Aedes aegypti mosquitoes, which in most settings are the primary vector. Introgression of the intracellular bacterium Wolbachia pipientis (wMel strain) into Ae. aegypti populations reduces their vector competence and consequently lowers dengue incidence in the human population. Here we describe successful area-wide deployments of wMel-infected Ae. aegypti in Suva, Lautoka, Nadi (Fiji), Port Vila (Vanuatu) and South Tarawa (Kiribati). With community support, weekly releases of wMel-infected Ae. aegypti mosquitoes for between 2 to 5 months resulted in wMel introgression in nearly all locations. Long term monitoring confirmed a high, self-sustaining prevalence of wMel infecting mosquitoes in almost all deployment areas. Measurement of public health outcomes were disrupted by the Covid19 pandemic but are expected to emerge in the coming years.
Asunto(s)
Aedes , Virus del Dengue , Dengue , Wolbachia , Infección por el Virus Zika , Virus Zika , Animales , Humanos , Aedes/genética , Aedes/microbiología , Mosquitos Vectores/genética , Mosquitos Vectores/microbiología , Wolbachia/genética , Fiji/epidemiología , VanuatuRESUMEN
BACKGROUND: Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population. OBJECTIVES: The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects. METHODS: This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023. RESULTS: A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services. CONCLUSION: The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.
Asunto(s)
Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Prevalencia , Samoa/epidemiología , Islas del Pacífico/epidemiología , Fiji/epidemiología , Vanuatu/epidemiología , Melanesia/epidemiología , Tonga/epidemiología , Micronesia/epidemiologíaRESUMEN
The benefits of emergency care systems in low- and middle-income countries are well-described. Passed in the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Assembly (WHA) Resolution 76.2 emphasizes the importance of communication, transportation and referral mechanisms, and the linkages between communities, primary care, and hospital care. Literature describing prehospital care and ambulance system development is scarce, with little data on the effectiveness and cost effectiveness of different options. Prehospital care systems in Pacific Island countries are under-developed. In Fiji, out-of-hospital care is fragmented with an uncoordinated patchwork of ambulance providers. There is no scope of practice or training requirement for providers and no patient care records. There are no data relating to demand, access, and utilization of ambulance services.In response to a surge of COVID-19 cases in 2021, the Fiji government created a Prehospital Emergency Care Coordination Center (PHECCC) in the capital Suva, which was operational from July-October 2021. Access was via a toll-free number, whereby the public could receive a medical consultation followed by phone advice or dispatch of an ambulance for a home assessment, followed by transportation to hospital, if required. The PHECCC also provided coordination of inter-facility transport and retrieval of the critically ill.The system that was created met many of the prehospital care standards set by emergency care leaders in the region and created the first dataset relating to ambulance demand and utilization. This is the first article to document prehospital system development in the Pacific region.
Asunto(s)
COVID-19 , Servicios Médicos de Urgencia , Humanos , Pandemias , Fiji/epidemiología , COVID-19/epidemiología , AmbulanciasRESUMEN
BACKGROUND: Corona Virus Disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization (WHO) has had significant impact on dentistry in Fiji. Due to lack of previous study, this study aims to explore the perspective of Dental Officers (DOs) and Dental Managers (DMs) on the effects of COVID-19 on dental service delivery in Fiji Islands. METHODS: This qualitative study was conducted amongst 30 DOs and 17 DMs between 9th August to 12th September, 2021. It was conducted in the government dental clinics, private dental clinics and the School of Dentistry and Oral Health clinic (SDOH), in the Central Division, Fiji. The study settings were randomly selected. Purposive sampling method was used for the selection of participants who met the study criteria. Semi-structure open ended questionnaires were used for data collection through in-depth interviews via zoom. Manual thematic analysis of the data was conducted to derive themes and codes. RESULTS: The participants interviewed for the study included more female DOs (66.7%) and male DMs (58.8%). Seven themes emerged from data analysis: range of services delivered, appointment versus walk-in patients for aerosol generating procedures (AGPs), impact of pandemic on clinic opening hours, impact of COVID-19 on patient numbers, quality of services delivered, resources and infrastructure, perceptions about the burden of disease. CONCLUSION: COVID-19 has significantly affected dental service delivery. Mostly emergency dental services were delivered. AGPs were delivered on appointment basis. Most participants stated the quality of services had improved. Participants stated that they were not given adequate resources and the infrastructure was not up to standard to provide dental services during the pandemic. The dental disease burden had increased during the pandemic as per the participants. Future research can be conducted amongst other dental professionals in other divisions of the country.
Asunto(s)
COVID-19 , Humanos , Masculino , Femenino , COVID-19/epidemiología , Fiji/epidemiología , Aerosoles y Gotitas Respiratorias , Encuestas y Cuestionarios , Atención OdontológicaRESUMEN
AIM: This study aims to describe the incidence and outcomes of acute kidney injury at Fiji's tertiary referral hospital. METHODS: A retrospective study of adults aged ≥ 18 years hospitalised at the Colonial War Memorial Hospital between 1 January and 30 June, 2015 was conducted. Acute kidney injury was defined using the 2012 Kidney Disease Improving Global Outcomes (KDIGO) guidelines by medical record review. RESULTS: One hundred ten (2.1%) of 5140 hospitalised patients met the diagnostic criteria for acute kidney injury. Fifty-two cases (47%) of acute kidney injury were stage 1, 11 (10%) cases were stage 2, and 47 (43%) cases were stage 3. Acute sepsis (n = 68) and dehydrating illness (n = 52) were the most common causes. Thirty-nine patients had urinalysis and 36 received imaging; none underwent kidney biopsy. Treatment included antibiotics (n = 91), intravenous fluids (n = 84) and vasopressors (n = 25). Twenty-one (19%) patients were treated with intermittent haemodialysis. Forty-seven patients (43%) with acute kidney injury died including 16 (76%) dialysed patients. Crude mortality at 7 days was 19 (40%). Of the 63 patients who survived their primary illness, 29 (46%) had a follow-up assessment at 3 months. CONCLUSION: In patients needing hospitalisation for acute kidney injury in Fiji, the most common causes were sepsis and dehydration. Mortality was high, in particular in those who received dialysis. Follow-up after acute kidney injury is incomplete.
Asunto(s)
Lesión Renal Aguda , Sepsis , Adulto , Humanos , Estudios Retrospectivos , Incidencia , Fiji/epidemiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/terapia , Mortalidad Hospitalaria , Centros de Atención Terciaria , Sepsis/diagnóstico , Sepsis/epidemiología , Sepsis/terapia , Factores de RiesgoRESUMEN
OBJECTIVE: To determine population-based rates of non-fatal complications of rheumatic heart disease (RHD). DESIGN: Retrospective cohort study based on multiple sources of routine clinical and administrative data amalgamated by probabilistic record-linkage. SETTING: Fiji, an upper-middle-income country, where most of the population has access to government-funded healthcare services. PARTICIPANTS: National cohort of 2116 patients with clinically apparent RHD aged 5-69 years during 2008 and 2012. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was hospitalisation for any of heart failure, atrial fibrillation, ischaemic stroke and infective endocarditis. Secondary outcomes were first hospitalisation for each of the complications individually in the national cohort as well as in hospital (n=1300) and maternity (n=210) subsets. Information on outcomes was obtained from discharge diagnoses coded in the hospital patient information system. Population-based rates were obtained using relative survival methods with census data as the denominator. RESULTS: Among 2116 patients in the national cohort (median age, 23.3 years; 57.7% women), 546 (25.8%) were hospitalised for an RHD complication, a substantial proportion of all cardiovascular admissions in the country during this period in those aged 0-40 years (heart failure, 210/454, 46.3%; ischaemic stroke 31/134, 23.1%). Absolute numbers of RHD complications peaked during the third decade of life with higher population-based rates in women compared with men (incidence rate ratio 1.4, 95% CI 1.3 to 1.6, p<0.001). Hospitalisation for any RHD complication was associated with substantially increased risk of death (HR 5.4, 95% CI 3.4 to 8.8, p<0.001), especially after the onset of heart failure (HR 6.6, 95% CI 4.8 to 9.1, p<0.001). CONCLUSIONS: Our study defines the burden of RHD-attributable morbidity in the general population of Fiji, potentially reflecting the situation in low-income and middle-income countries worldwide. Hospitalisation for an RHD complication is associated with markedly increased risk of death, re-emphasising the importance of effective early prevention.
Asunto(s)
Isquemia Encefálica , Insuficiencia Cardíaca , Accidente Cerebrovascular Isquémico , Cardiopatía Reumática , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Embarazo , Adulto Joven , Adulto , Cardiopatía Reumática/diagnóstico , Estudios Retrospectivos , Fiji/epidemiologíaRESUMEN
Problem: From April to September 2021, Fiji experienced a second wave of coronavirus disease (COVID-19) precipitated by the Delta variant of concern, prompting a need to strengthen existing data management of positive COVID-19 cases. Context: With COVID-19 cases peaking at 1405 a day and many hospital admissions, the need to develop a better way to visualize data became clear. Action: The Fiji Ministry of Health and Medical Services, the World Health Organization and the United Nations Office for the Coordination of Humanitarian Affairs collaborated to develop an online clinical dashboard to support better visualization of case management data. Outcome: The dashboard was used across Fiji at national, divisional and local levels for COVID-19 management. At the national level, it provided real-time reports describing the surge pattern, severity and management of COVID-19 cases across the country during daily incident management team meetings. At the divisional level, it gave the divisional directors access to timely information about hospital and community isolation of cases. At the hospital level, the dashboard allowed managers to monitor trends in isolated cases and use of oxygen resources. Discussion: The dashboard replaced previous paper-based reporting of statistics with delivery of trends and real-time data. The team that developed the tool were situated in different locations and did not meet physically, demonstrating the ease of implementing this online tool in a resource-constrained setting. The dashboard is easy to use and could be used in other Pacific island countries and areas.
Asunto(s)
COVID-19 , Humanos , Fiji/epidemiología , COVID-19/epidemiología , COVID-19/terapia , SARS-CoV-2 , HospitalesRESUMEN
Fish poisoning (FP) affects human health, trade and livelihood in Fiji, where management has depended mainly on traditional ecological knowledge (TEK). This paper investigated and documented this TEK through a 2-day stakeholder workshop, group consultation, in-depth interviews, field observations, and analyses of survey data from the Ministry of Fisheries, Fiji. Six TEK topics were identified and classified as preventative and treatment options. The preventive approach involves identifying toxic reef fishes, the spawning season of edible seaworms, hotspot areas of toxic fishes, folk tests, and locating and removing toxic organs. For example, 34 reef fish species were identified as toxic. The FP season was associated with the spawning of balolo (edible seaworm) and the warmer months of October to April (cyclone seasons). Two well-known toxic hotspots associated with an abundance of bulewa (soft coral) were identified. Folk tests and locating and removing toxic fish organs are also practised for moray eels and pufferfish. At the same time, various locally available herbal plants are used to treat FP as the second line of defence. The TEK collated in this work can help local authorities better identify the sources of toxicity, and applying TEK preventive measures could stem the tide of fish poisoning in Fiji.
Asunto(s)
Intoxicación por Ciguatera , Enfermedades Transmitidas por los Alimentos , Tetraodontiformes , Animales , Humanos , Fiji/epidemiología , Intoxicación por Ciguatera/epidemiología , Peces , AnguilasRESUMEN
BACKGROUND: This two-study paper developed a climate change risk perception model that considers the role of posttraumatic growth (i.e., a reappraisal of life priorities and deeper appreciation of life), resource loss, posttraumatic stress, coping, and social support. METHOD: In Study 1, participants were 332 persons in the Philippines who experienced Super Typhoon Haiyan. In Study 2, participants were 709 persons in Fiji who experienced Cyclone Winston. Climate change can increase the size and destructive potential of cyclones and typhoons as a result of warming ocean temperatures, which provides fuel for these storms. Participants completed measures assessing resource loss, posttraumatic stress, coping, social support, posttraumatic growth, and climate change risk perception. RESULTS: Structural equation modeling was used to develop a climate change risk perception model with data collected in the Philippines and to confirm the model with data collected in Fiji. The model showed that climate change risk perception was influenced by resource loss, posttraumatic stress, coping activation, and posttraumatic growth. The model developed in the Philippines was confirmed with data collected in Fiji. CONCLUSIONS: Posttraumatic growth played a central role in climate change risk perception. Public health educational efforts should focus on vividly showing how climate change threatens life priorities and that which gives life meaning and can result in loss, stress, and hardship. Disaster response organizations may also use this approach to promote preparedness for disaster threats.
Asunto(s)
Tormentas Ciclónicas , Crecimiento Psicológico Postraumático , Humanos , Filipinas/epidemiología , Cambio Climático , Fiji/epidemiología , PercepciónRESUMEN
During November-December 2021, we performed a SARS-CoV-2 seroprevalence survey in Central and Western Divisions of Fiji. A total of 539 participants 8-70 years of age were 95.5% (95% CI 93.4%-97.1%) seropositive, indicating high community levels of immunity. Seroprevalence studies can inform public health responses to emerging SARS-CoV-2 variants.
Asunto(s)
COVID-19 , Humanos , Fiji/epidemiología , COVID-19/epidemiología , SARS-CoV-2 , Estudios Seroepidemiológicos , Anticuerpos AntiviralesRESUMEN
INTRODUCTION: Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas. METHODS: This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis. RESULTS: Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community. CONCLUSION: The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.
Asunto(s)
Ejercicio Físico , Sobrepeso , Masculino , Femenino , Humanos , Fiji/epidemiología , Obesidad/epidemiología , Promoción de la Salud/métodosRESUMEN
Introduction: The COVID-19 pandemic has had a significant impact on mental health globally. To understand the impact of the pandemic on mental health in Fiji, this study aimed to investigate the prevalence of anxiety disorder and depression among the young adults. Method: An online survey was conducted to assess the prevalence of anxiety disorder and depression among the general population in Suva, Fiji during the COVID-19 pandemic. A total of 1,119 Fiji adults participated in the study. The study was conducted between May 20 to June 30, 2022, using a snowball sampling via social media platforms. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales were used to measure anxiety and depression, respectively. The COVID-19 related stressors was evaluated using the adapted SARS stressors assessment. Univariate and multivariate logistic regression analysis was performed to determine the factors influencing mental health among respondents. Results: The result shows that a significant portion of individuals experienced each of the stressors, with the highest prevalence seen for hearing information about the severity of COVID-19. The prevalence of anxiety and depression was found to be 45% and 49%, respectively. Being female, having pre-existing illness and COVID-19 stressors were a risk factor to develop anxiety and depression. On the other hand, employed individuals and having high BMI was a protective factor against developing depression during COVID-19 lockdown. Conclusion: These findings highlight the importance of addressing the mental health needs of the Fijian population during the COVID-19 pandemic and beyond.
Asunto(s)
COVID-19 , Humanos , Femenino , Adulto Joven , Masculino , COVID-19/epidemiología , COVID-19/psicología , Estudios Transversales , Salud Mental , SARS-CoV-2 , Prevalencia , Pandemias , Fiji/epidemiología , Depresión/epidemiología , Depresión/psicología , Control de Enfermedades Transmisibles , Factores de RiesgoRESUMEN
BACKGROUND: Gender equality, zero hunger and healthy lives and well-being for all, are three of the Sustainable Development Goals (SDGs) that underpin Fiji's National Development Plan. Work towards each of these goals contributes to the reduction of non-communicable diseases (NCDs). There are gender differences in NCD burden in Fiji. It is, however, unclear whether a gender lens could be more effectively included in nutrition and health-related policies. METHODS: This study consisted of three components: (i) a policy content analysis of gender inclusion in nutrition and health-related policies (n = 11); (ii) policy analysis using the WHO Gender Analysis tool to identify opportunities for strengthening future policy; and (iii) informant interviews (n = 18), to understand perceptions of the prospects for gender considerations in future policies. RESULTS: Gender equality was a goal in seven policies (64%); however, most focused on women of reproductive age. One of the policies was ranked as gender responsive. Main themes from key informant interviews were: 1) a needs-based approach for the focus on specific population groups in policies; 2) gender-related roles and responsibilities around nutrition and health; 3) what is considered "equitable" when it comes to gender, nutrition, and health; 4) current considerations of gender in policies and ideas for further gender inclusion; and 5) barriers and enablers to the inclusion of gender considerations in policies. Informants acknowledged gender differences in the burden of nutrition-related NCDs, yet most did not identify a need for stronger inclusion of gender considerations within policies. CONCLUSIONS: There is considerable scope for greater inclusion of gender in nutrition and health-related policies in Fiji. This could be done by: 1) framing gender considerations in ways that are actionable and inclusive of a range of gender identities; 2) undertaking advocacy through actor networks to highlight the need for gender-responsive nutrition and health-related policies for key stakeholder groups; 3) ensuring that data collected to monitor policy implementation is disaggregated by sex and genders; and 4) promoting equitable participation in nutrition related issues in communities and governance processes. Action on these four areas are likely critical enablers to more gender equitable NCD reduction in Fiji.
Asunto(s)
Enfermedades no Transmisibles , Femenino , Fiji/epidemiología , Política de Salud , Humanos , Masculino , Política Nutricional , Formulación de Políticas , Desarrollo SostenibleRESUMEN
BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of death globally, and the World Health Organization (WHO) has recommended a comprehensive policy package for their prevention and control. However, implementing robust, best-practice policies remains a global challenge. In Fiji, despite political commitment to reducing the health and economic costs of NCDs, prevalence of diabetes and cardiovascular disease remain the highest in the region. The objective of this study was to describe the political and policy context for preventing diet-related NCDs in Fiji and policy alignment with WHO recommendations and global targets. We used a case study methodology and conducted (1) semi-structured key informant interviews with stakeholders relevant to diet-related NCD policy in Fiji (n = 18), (2) documentary policy analysis using policy theoretical frameworks (n = 11), (3) documentary stakeholder analysis (n = 7), and (4) corporate political activity analysis of Fiji's food and beverage industry (n = 12). Data were sourced through publicly available documents on government websites, internet searches and via in-country colleagues and analysed thematically. RESULTS: Opportunities to strengthen and scale-up NCD policies in Fiji in line with WHO recommendations included (1) strengthening multisectoral policy engagement, (2) ensuring a nutrition- and health-in-all policy approach, (3) using a whole-of-society approach to tighten political action across sectors, and (4) identifying and countering food industry influence. CONCLUSION: Diet-related NCD policy in Fiji will be strengthened with clearly defined partner roles, responsibilities and accountability mechanisms, clear budget allocation and strong institutional governance structures that can support and counter industry influence. Such initiatives will be needed to reduce the NCD burden in Fiji.
Asunto(s)
Enfermedades no Transmisibles , Dieta , Fiji/epidemiología , Política de Salud , Humanos , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/prevención & control , Políticas , Formulación de PolíticasRESUMEN
Globally, the spread of COVID-19 has led to the closure of schools, thereby accelerating the expansion of the online learning environment. Though, Fiji National University students' (FNU), had no option than to quickly adopt to this mode of learning, within limited period, their learning experiences are yet to be examined and documented. We used phenomenological study design to explore students' online learning challenges, coping strategies and their perceptions on the causes of COVID-19. A total of 120 in-depth interviews were conducted with FNU students, at different levels and colleges, and analysed thematically, using inductive approach. The three themes emerged included COVID-19 misconception beliefs among students, online learning challenges during the COVID-19 pandemic and online learning coping strategies during the COVID-19 pandemic. The misconception beliefs identified were natural occurrence, manmade for depopulation, unreal/fake and as a means of soliciting for funds. The challenges included ineffective tutorial sessions, lack of learning devices, unstable internet service, inadequate learning environment, socio-cultural practices, feeling of loneliness, anxiety and stress, and difficulties accessing online platforms and acquiring practical skills. The coping strategies used by students ranged from support from family and counsellors, help-seeking, frequent communication, time management, learning flexibility to control over learning environment. The findings highlight the need for policy makers, school managers, lecturers and other key stakeholders to address online learning challenges to improve online learning among FNU students. Relevant information should be provided on the COVID-19 pandemic to clear misconceptions.