Genetic heterogeneity in the Salmonella Typhi Vi capsule locus: a population genomic study from Fiji.

Typhoid fever is endemic in many parts of the world and remains a major public health concern in tropical and sub-tropical developing nations, including Fiji. To address high rates of typhoid fever, the Northern Division of Fiji implemented a mass vaccination with typhoid conjugate vaccine (Vi-polysaccharide conjugated to tetanus toxoid) as a public health control measure in 2023. In this study we define the genomic epidemiology of Salmonella Typhi in the Northern Division prior to island-wide vaccination, sequencing 85% (n=419) of the total cases from the Northern and Central Divisions of Fiji that occurred in the period 2017-2019. We found elevated rates of nucleotide polymorphisms in the tviD and tviE genes (responsible for Vi-polysaccharide synthesis) relative to core genome levels within the Fiji endemic S. Typhi genotype 4.2. Expansion of these findings within a globally representative database of 12 382 S. Typhi (86 genotyphi clusters) showed evidence of convergent evolution of the same tviE mutations across the S. Typhi population, indicating that tvi selection has occurred both independently and globally. The functional impact of tvi mutations on the Vi-capsular structure and other phenotypic characteristics are not fully elucidated, yet commonly occurring tviE polymorphisms localize adjacent to predicted active site residues when overlayed against the predicted TviE protein structure. Given the central role of the Vi-polysaccharide in S. Typhi biology and vaccination, further integrated epidemiological, genomic and phenotypic surveillance is required to determine the spread and functional implications of these mutations.

Knowledge, attitudes, and readiness about critical antimicrobial resistant organisms among healthcare workers at colonial war memorial hospital in Fiji: a pre and post intervention study.

BACKGROUND: Gram-negative bacteria resistant to carbapenems are also known as critical antimicrobial resistant organisms. Their emergence at Colonial War Memorial Hospital (CWMH), the largest hospital in Fiji, is a major clinical concern. This study was conducted to determine the knowledge, attitudes, and readiness of healthcare workers (HCW) at CWMH regarding management of patients with infections caused by critical antimicrobial resistant organisms. METHODS: A questionnaire was designed using a Likert scale to assess knowledge, attitudes, and readiness. Two cross-sectional studies were conducted, before and after the implementation of targeted educational activities which were informed by the pre-intervention study findings. RESULTS: A total of 393 and 420 HCW participated in the pre- and post-intervention studies, respectively. The majority of respondents were female (77.3%) and 18-34 years of age (67%). HCW professional roles included nurses (56.3%), doctors (31.6%), and laboratory personnel (12.2%). In the post-intervention study, significantly more HCW reported having received infection prevention and control (IPC) and antimicrobial resistance education and training (26.8% in pre to 45.5% in post intervention, p < 0.001). The majority of nurses and doctors (> 85% to ≥ 95%) were aware of how AMR organisms spread in healthcare settings and knew the IPC measures to prevent transmission of AMR infections including hand hygiene, standard and transmission-based precautions. Attitudes towards AMR were positive, with 84.2% pre intervention and 84.8% of HCW post intervention expressing their willingness to change their work environment to assist with AMR prevention. Perceived readiness to address the problem showed mixed results. Improvements in laboratory AMR surveillance data availability were noted (29.4-52.4%, p < 0001). Modest improvement in the hospital's capacity for outbreak response (44-51.9%, p = 0.01), and treatment of AMR infections (38.9-44.4%, p = 0.01) was reported. CONCLUSIONS: Our data revealed high levels of staff awareness and knowledge about AMR and IPC. However, readiness for outbreak response and treatment of critical AMR infections requires more attention. Improving AMR prevention and containment in CWMH will likely require sustained and multisectoral interventions with strong administrative commitment.

Training health workers and community influencers to be Vaccine Champions: a mixed-methods RE-AIM evaluation.

INTRODUCTION: Increasing trust and confidence in vaccines is a global priority, as countries have grappled with delivering COVID-19 vaccines, maintaining routine childhood vaccination rates and introducing new vaccines. Community-based vaccine promotion interventions are commonly implemented, but effectiveness evidence is limited. In 2022, supported by the Australian Government and in partnership with Fiji's Ministry of Health and UNICEF, we codesigned, delivered and comprehensively evaluated a vaccine education and communication training programme for health workers and community influencers to promote COVID-19 and routine immunisation. METHODS: The Vaccine Champions programme included three phases: (1) codesign with Fiji stakeholders; (2) vaccine education and communication training for Vaccine Champions and (3) support for Champions to deliver community vaccine discussion sessions over 6 months.The RE-AIM framework evaluation measured programme reach, effectiveness, adoption, implementation and maintenance. Mixed-methods data were collected through interviews, surveys and field notes, integrating qualitative and quantitative data to triangulate findings. Primary outcomes included Champions' knowledge, communication self-efficacy, trust in COVID-19 vaccines, programme satisfaction and community members' intention to vaccinate. RESULTS: We trained 35 Champions (27/35 female), including health workers, faith and community influencers. Half had a health background (17/35). Champions conducted 54 discussion sessions, reaching 1717 community members. Most Champions (22/35) conducted at least 1 session, with 16 running 3 or more. Champions who did not run sessions reported barriers like lack of confidence and competing duties. Training increased Champions' communication self-efficacy and trust in COVID-19 vaccines. Community member intention to vaccinate increased from 41% (394/960) to 83% (822/991) before and after a session. The programme was well received with interest in continued engagement. CONCLUSION: Training health workers and community Vaccine Champions can promote vaccine confidence. Programmes require government support and engagement for sustainability. Robust evaluation frameworks are needed to build the evidence base.

Individual mangrove trees provide alternative reef fish habitat on backreefs.

Mangrove trees occur in a variety of geomorphic and sedimentary settings. Yet, studies investigating their role as habitat providers often focus on the most common biophysical types, such as deltaic, estuarine, open coast or lagoonal mangroves on soft sediments, disregarding less typical environments. Here, we investigated the influence of individual mangrove trees growing on a consolidated backreef system (Laucala Bay, Fiji) on habitat use by reef fishes. Combining field surveys and an experiment, we quantified the extent to which reef mangrove trees serve as habitat for solitary or shoaling reef fishes. Using mangrove tree mimics, we disentangled effects attributable to the physical structure of trees from those related to their bio-chemical properties. We found that fish numbers were 3.7 times higher within close proximity to the mangrove trees than at control sites and correlated significantly with root system perimeter. The roots of larger trees sheltered aggregations of juveniles and adults at incoming and high tides. Mangrove trees and mimics attracted fishes alike. We show that mangrove trees on backreefs provide habitat for shoaling and adult reef fishes in addition to serving as nursery areas, an ecosystem service otherwise lacking on backreef areas with low structural complexity.

A qualitative exploration of food choice motives of urban indigenous food gatekeepers in Fiji: Implications for the use of the food choice questionnaire.

Pacific Island Countries (PICs) have exceptionally high rates of obesity and non-communicable diseases. The causes are complex but one prominent factor is the notable shift from traditional plant and seafood diets to diets high in unhealthy processed foods. Literature is sparse on the motives behind food choice decisions of Pacific Islanders. The widely used Food Choice Questionnaire (FCQ) (Steptoe et al., 1995) is a multi-dimensional tool capturing nine potential food choice motives. This study used a hybrid thematic analysis. Fourteen in-depth semi-structured interviews with urban indigenous Fijian mothers were conducted to (1) explore how the nine FCQ motives impact food choice (2) to examine conceptual equivalence of the nine FCQ motives and (3) to identify additional food choice motives, not captured in the FCQ. Mothers identified seven of the nine FCQ motives (i.e., health, mood, convenience, sensory appeal, weight control and familiarity) and three new food choice motives (i.e., food that is filling, religious dietary restrictions and food quality) as important determinants of food choice. Moreover, while choosing foods that promote health and well-being was identified as an important food choice motive, mothers also identified four other motives, that they considered important, which lead to over-eating and unhealthy eating. Food choice is a complex, layered decision, driven by multiple considerations, some more important than others. These findings can inform diet-related interventions and policy within this community. Adapting the FCQ for broader PIC use through further qualitative exploration in PICs, and validating the adapted FCQ with larger samples will enhance its utility in measuring food choice motives in PICs.

An assessment of latrine front-end characteristics and associated surface E. coli indicated faecal contamination in rural Fiji.

In Fiji, 90% of the population has access to basic sanitation; however, there are still persistent health risks from endemic faecal-oral diseases such as typhoid fever. There is a need to assess the contribution of existing sanitation facilities in the faecal pathogen transmission pathway. This study was conducted as part of a larger planetary health study across 29 rural communities within five river catchments. This specific research aimed to characterise latrine front-ends, both infrastructure and usage behaviour, and to assess the faecal contamination levels on various frequently contacted latrine surfaces in rural Fiji. A sanitation survey, along with observation and latrine swab sampling, was conducted in households over three phases: baseline (n = 311) (Aug-Dec 2019), endline (n = 262) (Jun-Sep 2022) and an in-depth front-end study (n = 12) (Oct-Nov 2022). Of 311 households, almost all had pedestal-type latrines, predominately cistern-flush (83%), followed by pour-flush (13%), and then hole-type (pit) latrines (4%). Washable latrine floors had significantly higher E. coli densities (6.7 × 102 CFU/25 cm2) compared to non-washable floors (1.3 × 102 CFU/25 cm2) (p = 0.05), despite washable floors indicating improved latrines. The in-depth front-end analysis found that moist latrine surfaces had significantly elevated E. coli densities (1.2 × 103 CFU/25 cm2) compared to the dry ones (14.3 CFU/25 cm2) (p < 0.001), highlighting the importance of maintaining dry latrine surfaces. Latrine floors and mid-walls were the most frequently contaminated surfaces, emphasising the need to clean and disinfect these surfaces. Only 46% of the households reported always using soap for handwashing after defecation, exacerbating the risk of transmitting faecal pathogens. This study highlights that latrine cleanliness and hygiene are as crucial as latrine infrastructures for the effective disruption of faecal pathogens transmission during latrine use.

Coral Sr/Ca-SST reconstruction from Fiji extending to ~1370 CE reveals insights into the Interdecadal Pacific Oscillation.

The southwestern tropical Pacific is a key center for the Interdecadal Pacific Oscillation (IPO), which regulates global climate. This study introduces a groundbreaking 627-year coral Sr/Ca sea surface temperature reconstruction from Fiji, representing the IPO's southwestern pole. Merging this record with other Fiji and central tropical Pacific records, we reconstruct the SST gradient between the southwestern and central Pacific (SWCP), providing a reliable proxy for IPO variability from 1370 to 1997. This reconstruction reveals distinct centennial-scale temperature trends and insights into Pacific-wide climate impacts and teleconnections. Notably, the 20th century conditions, marked by simultaneous basin-scale warming and weak tropical Pacific zonal-meridional gradients, deviate from trends observed during the past six centuries. Combined with model simulations, our findings reveal that a weak SWCP gradient most markedly affects IPO-related rainfall patterns in the equatorial Pacific. Persistent synchronous western and central Pacific warming rates could lead to further drying climate across the Coral Sea region, adversely affecting Pacific Island nations.

Assessing the role of sustainability competencies in enhancing psychological first aid effectiveness for disaster responders in Fiji.

Background: Psychological first aid (PFA) is essential for mental health and wellbeing after traumatic events. Integrating competency-based outcomes is crucial with the increasing demand for effective psychological first-aid interventions. This study examines the correlation between sustainability competencies and PFA principles within Fiji's disaster responder's context. Method: The research was guided by a theoretical framework based on a comprehensive review of sustainability competencies and PFA principles. A cross-sectional survey assessed the importance of sustainability competencies in disaster responders to deliver PFA effectively. The survey used a stratified random sampling method to get diverse PFA-trained participants (66%) and non-PFA trained (34%), aiming to understand how these competencies can impact PFA success in various disaster situations. The survey, encompassing various domains of disaster response and a diverse range of respondents age, gender, and years of experience, employed the Likert scale to assess the importance of competencies such as integrated problem-solving, strategic, systems thinking, self-awareness, normative, collaboration, anticipatory, and critical thinking. Results: The study involved 49 PFA-trained participants (55% female, 45% male) and 15 non-PFA-trained participants (53% female, 46% male), excluding 10 responses from the latter group due to ambiguous answers to critical questions. The correlation between age, experience, and the valuation of professional competencies among disaster responders indicates that disaster responders, with extensive experience and PFA training, rated competencies as "important," reflecting a perspective shaped by long-term career development and practical experiences. Equally, younger and early career responders emphasize competencies as "very important," indicating an initial recognition of their significance. The appraisal patterns across different age groups, especially among those with PFA training, suggest a tendency to moderate assessments of competency importance with increasing experience. Statistical analysis, including mean, median, standard deviation, and variance, provided a detailed understanding of the data, underscoring competencies like self-awareness in both data sets and integrated problem-solving and collaboration within PFA-trained responders as the key for effective PFA interventions. Conclusion: The study underlines the critical need to integrate sustainability competencies into the PFA curriculum in Fiji's unique sociocultural context. This interplay between age, experience, and competency assessment stresses the diverse factors influencing perceptions in the disaster response field beyond experience alone. The results show that sustainability competencies are the ultimate to the effectiveness of PFA measurement and interventions. The research lays the foundation for future studies to develop validated tools for assessing sustainable competencies in different cultural contexts, thereby improving the effectiveness of PFA in disaster management. Integrating these competencies into PFA training could significantly strengthen PFA intervention and competency-based evaluation.

Barriers to Early Diagnosis of Breast Cancer amongst women in the Fiji Islands: A Qualitative Study.

OBJECTIVE: To investigate the factors that may account for the delay in diagnosis and treatment in Fijian female breast cancer patients. METHODS: This study adopted a qualitative approach to gain an in-depth understanding of individual barriers and participants' experiences within the Fijian context. Utilising semi-structured interviews, the study interviewed breast cancer survivors, community women, healthcare professionals, and traditional healers. RESULTS: Two primary themes emerged from participants' narratives relating to barriers to early breast cancer detection: (1) individual-related factors and (2) healthcare system-related factors. Within these, five sub-themes were identified. For individual-related factors, these included: cultural & religious beliefs, social support, and awareness & misconception. For healthcare system factors, the sub-themes were: House of death and limited community accessibility to screening and awareness initiatives. CONCLUSION: The results highlighted the need for targeted interventions that consider the importance of cultural beliefs, improve awareness, and foster trust in the healthcare system.

Characteristics and predictors of pain among women who underwent cesarean section in Fiji.

Aim: To identify the characteristics and predictors of post cesarean section (CS) pain among women.Materials & methods: This quantitative study was conducted at Labasa hospital in Fiji over a 6-month period. A total of 312 mothers who received spinal, epidural and general anesthesia were included. Their pain score was assessed using the visual analogue scale 24 h postoperatively.Results: 70.8% women had either moderate or severe pain on the visual analogue scale. About 41.3% women expressed dissatisfaction with their pain management and 70.5% women had difficulties in performing activities due to pain. Lower parity was noted to be a positive predictor of pain among women undergoing CS.Conclusion: Adequate pain management for post-CS patient at Labasa hospital is lacking.

Pain & pain control methods after surgical birth in Labasa, FijiWhat is the study about? This study looked at what affects pain in women after delivering a baby through surgery, also known as surgical birth or cesarean section (CS), at Labasa Hospital in Fiji. Over 6 months, 312 mothers who had surgical births with different types of pain-reducing medicines took part in this study. Their pain was checked 24 h after surgery using a pain scale.What were the results? The results showed that 70.8% of women felt moderate to severe pain after their surgical birth. In addition, 41.3% of the women were not happy with their pain control, and 70.5% had difficulties doing their daily activities because of the pain. The study also found that first-time mothers were more likely to feel more pain after their surgical birth.What do the results mean? The key point of the study is that many women at Labasa Hospital are not getting enough pain relief after their surgical birth, especially first-time mothers. This shows there is a need to improve pain control methods for these patients. A better pain control could help these mothers get better more comfortably and feel more satisfied with their care.

A tuberculosis elimination-focused geospatial approach to optimising access to diagnostic GeneXpert machines in Fiji.

OBJECTIVES: Fiji could be the first country to eliminate tuberculosis. To inform this strategy, we aimed to identify how many GeneXpert® machines are required to enable over 90% of Fijians to be within one-hour easy access. METHODS: We used Geographic Information System (Quantum GIS; QGIS), OpenStreetMap and population data (Kontur) to map possible facilities in relation to QGIS generated 60-min drive-time isochrones, with correction for missing road data. For outer islands, we calculated a distance to nearest hub operation. RESULTS: The solution comprised 24 GeneXpert® machines, allocating 7 GeneXpert® to Viti Levu, 6 GeneXpert® to Vanua Levu and 11 to other islands. This resulted in 827,810 people, 93.6% of Fiji's population, being within 1 h of a machine. Twenty-one thousand four hundred seventy-nine people on outer islands were an average of 43 km by water from the nearest facility. CONCLUSIONS: We conclude that over 90% of Fijians could be within an hour of a GeneXpert® machine with placement of 24 machines.

'First of all, I need training': a qualitative study evaluating the Fiji community health worker training program.

BACKGROUND: Fiji faces a growing burden of diseases and a significant emigration of health workers, heightening the role of community health workers (CHWs) in healthcare delivery. Effective training is crucial for CHWs to enhance their capacity and service quality. This study evaluates CHW training in Fiji, aiming to identify areas for improvement. METHODS: A qualitative study was conducted, encompassing a review of national policies on CHW training, six focus group discussions, and interviews with CHWs and their supervisors across Fijian subdivisions. This study was collaboratively designed with Fiji's Ministry of Health and Medical Services (MOHMS). Data was transcribed, coded, and thematically analysed using the Community Health Workers Assessment and Improvement Matrix (CHW-AIM). FINDINGS: While CHW training policies in Fiji are well-established, discrepancies exist between the policy and its implementation. Challenges include inconsistent training for new recruits, limited resources, and variability in training content and frequency of training across divisions, especially concerning noncommunicable disease (NCD) training. INTERPRETATION: To enhance the CHW training program in Fiji, a restructuring and standardisation of both pre-service and in-service training is necessary, tailored to the needs of each division. Investment in ongoing capacity building, alongside the development and revision of training guidelines, particularly for managing NCD complications in the community, is crucial. Implementing these changes will enable CHWs in Fiji to be better equipped for providing essential community-based care.

Energy, nutrient and overall healthiness of processed packaged foods in Fiji, a comparison between 2018 and 2020.

In Fiji, packaged foods are becoming increasingly available. However, it is unknown if nutrition composition of these foods has changed. This study aims to assess changes in energy, nutrient content and healthiness of packaged foods by comparing data from five major supermarkets in Fiji in 2018 and 2020. Foods were categorised into 14 groups; nutrient composition information was extracted and healthiness assessed using Health Star Rating (HSR). Descriptive statistics and a separate matched products analysis was conducted summarising differences in nutrient content and HSR. There was limited evidence of change in the nutrient content of included products however, there was a small reduction in mean saturated fat in the snack food category (-1.0 g/100 g, 95% CI -1.6 to -0.4 g/100 g). The proportion of products considered healthy based on HSR, increased in the convenience foods category (28.4%, 95% CI 8.3 to 48.5) and decreased in non-alcoholic beverages (-35.2%, 95% CI -43.6 to -26.9). The mean HSR score increased in the fruit and vegetables category (0.1 (95% CI 0.1, 0.2)) and decreased for non-alcoholic beverages (-1.1 (-1.3, -0.9)) and the sauces, dressings, spreads, and dips category (-0.3 (-0.3, -0.2)). Strengthened monitoring of the food supply is needed to improve the healthiness of foods available.

Perception of Type 2 Diabetes Mellitus (T2DM) patients on diabetes self-care management in Fiji.

INTRODUCTION: The prevalence of diabetes has increased globally where Type 2 Diabetes Mellitus (T2DM) is more common than any other type of diabetes. Self- care management education of diabetes provides skills and information for diabetic patients to effectively perform their own self diabetic self-care for optimum glycemic index control. As T2DM is a growing health issue in Fiji, promoting diabetes self manages among patients is a need, however there is lack of evidence in this regard. Therefore, the aim of this study is to explore the perception of T2DM patients on diabetic self-care management. METHOD: This study used a qualitative method among T2DM patients regarding diabetic self-care management in Central Division, Fiji in 2022. This study was conducted in SOPD (Special Out Patient Department) clinics in the three chosen governmental health centers in the central division of Fiji. The study sample inclusion criteria were only T2DM patients, and no other types of diabetes, patients who are 18years and above, patients who are attending clinic at least for more than 6 months, self-identified as Fijian participants of any ethnicity or gender. The study settings were also purposively selected but the study sample was selected using purposive sampling. In depth interview using semi-structured open-ended questionnaires was used to collect data. Thematic analysis was done, followed by reviewing themes, defining and naming them. RESULTS: Thirty patients participated in this study. Five major themes emerged from the in-depth interview including; patient factors that affect diabetes self-care management, behavior and attitude towards T2DM self-care management, health services delivery, challenges and barriers faced by patients to perform diabetes self-care management, and recommendations to improve patient self-care management. Patients in this study have good knowledge about T2DM and the self-care management they have to perform. It is the patients' attitude and behavior towards T2DM self-care management that affects patients to perform self-care management. The study also showed patients have gained good knowledge from Health Care Workers (HCW). Socio-economic and psychological status also played a vital part in patients' self-care management. Apart from challenges, there were opportunities to learn the difficulties patients face in order to perform self-care management. CONCLUSION: The results of this study revealed a combination of individual, cultural, and health systematic related factors as the mots influencer of diabetes self-management among patients in Fiji. Patients have to take ownership of their own health in order to improve their blood sugar reading and reduce complication of diabetes. Tailored interventions that consider patients' belief and address potential challenges would be useful. A lot is needed in terms of upgrading facilities for the comfort of patients and need to collaborate more with other multidisciplinary team and stakeholders.

Extreme mortality during a historical measles outbreak on Rotuma is consistent with measles immunosuppression.

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.

Life histories in Fiji as reconstructed from first millennium CE Sigatoka Sand Dune burials using isotopes.

This paper aims to re-examine the dietary practices of individuals buried at Sigatoka Sand Dunes site (Fiji) in Burial Ground 1 excavated by Simon Best in 1987 and 1988 using two approaches and a reassessment of their archaeological, bioarchaeological and chronological frame. First, stable carbon and nitrogen isotope analysis was applied to document dietary changes between childhood and adulthood using an intra-individual approach on paired bone-tooth. Second, the potential adaptation of the individuals to their environment was evaluated through regional and temporal comparisons using inter-individual bone analysis. Ten AMS radiocarbon dates were measured directly on human bone collagen samples, placing the series in a range of approximately 600 years covering the middle of the first millennium CE (1,888 to 1,272 cal BP). δ13C and δ15N ratios were measured on bone and tooth collagen samples from 38 adult individuals. The results show that δ15N values from tooth are higher than those s from bone while bone and tooth δ13C values are similar, except for females. Fifteen individuals were included in an intra-individual analysis based on paired bone and tooth samples, which revealed six dietary patterns distinguished by a differential dietary intake of marine resources and resources at different trophic levels. These highlight sex-specific differences not related to mortuary practices but to daily life activities, supporting the hypothesis of a sexual division of labour. Compared to other Southwest Pacific series, Sigatoka diets show a specific trend towards marine food consumption that supports the hypothesis of a relative food self-sufficiency requiring no interactions with other groups.

'Letting it be': a grounded theory about dementia care in Fiji.

OBJECTIVES: This research study aimed to discover how dementia affecting older people was perceived, experienced, and managed by stakeholders in the Pacific Island country of Fiji. METHOD: A transformational grounded theory approach was used. Semi-structured interviews and focus groups with key stakeholders in the major towns of Suva, Lautoka, and Nadi were carried out. Transcripts were analysed in line with transformational grounded theory methods. RESULTS: A total of 50 participants (40 service providers, eight family caregivers, one person with dementia, and one village elder) shared their views and experiences about dementia. A grounded theory about dementia care management was constructed. 'Letting it be' is the grounding socio-cultural construct that interweaves and binds together the processes of dementia care management. It expresses a compassionate approach to caring for older people with dementia that involves searching for knowledge and support, and application of traditional care practices within the strength of family and community networks. CONCLUSION: In Fiji, support for dementia centres on the integration of community understandings, and promotion of cultural values of wellbeing and care, with service provision. It also focuses on support for families and communities through social welfare, community networks, and education.

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

OBJECTIVES: We analysed 4 y of laboratory data to characterise the species and determine the antimicrobial susceptibility profiles of enterococci as human pathogens in Fiji. The study also investigated the molecular epidemiology amongst the subset of vancomycin-resistant enterococci (VRE). METHODS: This retrospective study reviewed bacteriological data from Colonial War Memorial Hospital (CWMH) and other healthcare facilities in the Central and Eastern divisions of Fiji. Phenotypic, antimicrobial susceptibility and vanA and vanB PCR testing were performed using locally approved protocols. The first clinical isolates per patient with antimicrobial susceptibility testing results in a single year were included in the analysis. Data was analysed using WHONET software and Microsoft Excel. RESULTS: A total of 1817 enterococcal isolates were reported, 1415 from CWMH and 402 from other healthcare facilities. The majority of isolates, 75% (n = 1362) were reported as undifferentiated Enterococcus spp., 17.8% (n = 324) were specifically identified as Enterococcus faecalis and 6.7% (n = 122) as E. faecium. Overall, 10% of the enterococci isolates were from blood cultures. Among isolates from CWMH, <15% of E. faecium were susceptible to ampicillin, and 17.2% were vancomycin resistant. Overall, 874 enterococcal isolates (including the undifferentiated species) were tested against vancomycin, of which 4.8% (n = 42) were resistance. All of the VRE isolates tested (n = 15) expressed vanA genes. CONCLUSIONS: This study demonstrates the clinical importance of VRE, particularly van A E. faecium in the national referral hospital in Fiji. Enhanced phenotypic and molecular surveillance data are needed to better understand enterococci epidemiology and help guide specific infection prevention and control measures and antibiotic prescribing guidelines.

Strengthening rural community water safety planning in Pacific Island countries: evidence and lessons from Solomon Islands, Vanuatu, and Fiji.

Pacific Island Countries (PICs) collectively have the lowest rates of access to safely managed or basic drinking water and sanitation globally. They are also the least urbanised, have dynamic socioeconomic and increasing climate-linked challenges. Community-based water managers need to respond to variability in water availability and quality caused by a range of hazards. Water Safety Planning (WSP), a widely adopted approach to assessing water supply, offers a risk-based approach to mitigating both existing and future hazards. WSP is adaptable, and making modifications to prescribed WSP to adapt it to the local context is common practice. Within the Pacific Community Water Management Plus research project, we used formative research and co-development processes to understand existing local modifications, whether further modifications are required, and, to develop additional modifications to WSP in Fiji, Vanuatu and Solomon Islands. The types of additional local modifications we recommend reflect the unique context of PICs, including adjusting for community management of water supplies and required collective action, community governance systems, levels of social cohesion in communities, and preferred adult-learning pedagogies. Incorporating modifications that address these factors into future WSP will improve the likelihood of sustained and safe community water services in Pacific and similar contexts.