Ongoing transmission of lymphatic filariasis in Samoa 4.5 years after one round of triple-drug mass drug administration.

BACKGROUND: Lymphatic filariasis (LF) remains a significant global issue. To eliminate LF as a public health problem, the World Health Organization (WHO) recommends multiple rounds of mass drug administration (MDA). In certain scenarios, including when elimination targets have not been met with two-drug MDA, triple-drug MDA (using ivermectin, diethylcarbamazine and albendazole) is recommended. In this study, we report on antigen (Ag) and microfilaria (Mf) prevalence in eight primary sampling units (PSUs) in Samoa 4.5 years after one round of triple-drug MDA. METHODOLOGY: In 2023, community surveys were conducted in eight PSUs that had been surveyed previously in 2018 (between 1.5 and 3.5 months post triple-drug MDA) and 2019 (six to eight-months post triple-drug MDA). Fifteen houses were randomly selected in each PSU with household members aged ≥ 5 years invited to participate. Blood samples were tested for Ag and Mf. PRINCIPAL FINDINGS: Ag-positive participants were observed in six of the eight PSUs, and Ag prevalence was significantly above the 1% threshold in four PSUs. The presence of Mf-positive participants in five PSUs confirms the presence of residual active infections. CONCLUSIONS/SIGNIFICANCE: This study provides evidence of persistent LF transmission in Samoa 4.5 years after one round of triple-drug MDA, confirming that one round was insufficient for interruption of transmission in this setting. Our findings highlight the negative impact of delaying MDA rounds, for example, due to public health emergencies.

Associations between fasting glucose rate-of-change and the missense variant, rs373863828, in an adult Samoan cohort.

BACKGROUND: The A allele of rs373863828 in CREB3 regulatory factor is associated with high Body Mass Index, but lower odds of type 2 diabetes. These associations have been replicated elsewhere, but to date all studies have been cross-sectional. Our aims were (1) to describe the development of type 2 diabetes and change in fasting glucose between 2010 and 2018 among a longitudinal cohort of adult Samoans without type 2 diabetes or who were not using diabetes medications at baseline, and (2) to examine associations between fasting glucose rate-of-change (mmol/L per year) and the A allele of rs373863828. METHODS: We describe and test differences in fasting glucose, the development of type 2 diabetes, body mass index, age, smoking status, physical activity, urbanicity of residence, and household asset scores between 2010 and 2018 among a cohort of n = 401 adult Samoans, selected to have a ~2:2:1 ratio of GG:AG: AA rs373863828 genotypes. Multivariate linear regression was used to test whether fasting glucose rate-of-change was associated with rs373863828 genotype, and other baseline variables. RESULTS: By 2018, fasting glucose and BMI significantly increased among all genotype groups, and a substantial portion of the sample developed type 2 diabetes mellitus. The A allele was associated with a lower fasting glucose rate-of-change (ß = -0.05 mmol/L/year per allele, p = 0.058 among women; ß = -0.004 mmol/L/year per allele, p = 0.863 among men), after accounting for baseline variables. Mean fasting glucose and mean BMI increased over an eight-year period and a substantial number of individuals developed type 2 diabetes by 2018. However, fasting glucose rate-of-change, and type 2 diabetes development was lower among females with AG and AA genotypes. CONCLUSIONS: Further research is needed to understand the effect of the A allele on fasting glucose and type 2 diabetes development. Based on our observations that other risk factors increased over time, we advocate for the continued promotion for diabetes prevention and treatment programming, and the reduction of modifiable risk factors, in this setting.

Accelerometer-Based Estimates of Physical Activity and Sedentary Time Among Samoan Adults.

BACKGROUND: The prevalence of obesity-related cardiometabolic disease in Samoa is among the highest globally. While physical activity is a modifiable risk factor for obesity-related disease, little is known about physical activity levels among adult Samoans. Using wrist-worn accelerometer-based devices, this study aimed to characterize physical activity among Samoan adults. METHODS: Samoan adults (n = 385; 55% female, mean [SD] age 52 [10] y) wore Actigraph GT3X+ devices for 7 to 10 days. General linear models were used to examine mean daily minutes of sedentary time, light physical activity, and moderate to vigorous physical activity by various participant characteristics. RESULTS: Time spent in moderate to vigorous physical activity did not differ statistically between men (88 [5] min; 95% confidence interval [CI], 80-97) and women (78 [4] min; 95% CI, 70-86; P = .08). Women, however, spent more time than men in light physical activity: 380 (7) minutes (95% CI, 367-393) versus 344 (7) minutes (95% CI, 329-358; P < .001). While there were no differences in physical activity by census region, education, or occupation among women, men in urban areas spent significantly less time in moderate to vigorous physical activity than those in peri-urban and rural areas (P = .015). Women with class II/III obesity spent more time in sedentary activities than those with healthy weight or overweight/class I obesity (P = .048). CONCLUSIONS: This study characterizes physical activity among Samoan adults and highlights variation by sex, urbanicity, and weight status. In providing initial device-measured estimates of physical activity in Samoa, this analysis establishes a baseline from which the success of future attempts to intervene on physical activity may be assessed.

Associations of childhood BMI traits with blood pressure and glycated haemoglobin in 6-9-year-old Samoan children.

INTRODUCTION: Prevalence and risk factors for elevated glycated haemoglobin (HbA1c) and blood pressure (BP) are poorly understood among Pacific children. We examined associations of HbA1c and BP in 6-9 year-olds with body mass index (BMI) at ages 2, 5, and BMI velocity between 2-9 years in Samoa. METHODS: HbA1c (capillary blood) and BP were measured in n = 410 Samoan children who were part of an ongoing cohort study. Multilevel models predicted BMI trajectory characteristics. Generalized linear regressions assessed associations of childhood characteristics and BMI trajectories with HbA1c and BP treated as both continuous and categorical outcomes. Primary caregiver-reported childhood characteristics were used as covariates. RESULTS: Overall, 12.90% (n = 53) of children had high HbA1c (≥5.7%) and 33.17% (n = 136) had elevated BP. BMI at 5-years and BMI velocity were positively associated with high HbA1c prevalence in males. A 1 kg/m2 per year higher velocity was associated with a 1.71 (95% CI: 1.07, 2.75) times higher prevalence of high HbA1c. In females, higher BMI at 5-years and greater BMI velocity were associated with higher BP at 6-9 years (95% CI: 1.12, 1.40, and 1.42, 2.74, respectively). CONCLUSION: Monitoring childhood BMI trajectories may inform cardiometabolic disease screening and prevention efforts in this at-risk population.

Characterization of per- and polyfluoroalkyl substances (PFAS) concentrations in a community-based sample of infants from Samoa.

Per- and polyfluoroalkyl substances (PFAS) are persistent contaminants with documented harmful health effects. Despite increasing research, little attention has been given to studying PFAS contamination in low- and middle-income countries, including Samoa. Using data and biosamples collected through the Foafoaga o le Ola ("Beginning of Life") Study, which recruited a sample of mothers and infants from Samoa, we conducted an exploratory study to describe concentrations of 40 PFAS analytes in infant cord blood collected at birth (n = 66) and infant dried blood spots (DBS) collected at 4 months post-birth (n = 50). Of the 40 PFAS analytes tested, 19 were detected in cord blood, with 10 detected in >50% of samples (PFBA, PFPeA, PFOA, PFNA, PFDA, PFUnA, PFTrDA, PFHxS, PFOS, and 9Cl-PF3ONS); and 12 analytes were detected in DBS, with 3 detected in >50% of samples (PFBA, PFHxS, and PFOS). PFAS concentrations were generally lower than those reported in existing literature, with the exception of PFHxS, which was detected at higher concentrations. In cord blood, we noted suggestive (p < 0.05) or significant (p < 0.006) associations between higher PFHxS and male sex; higher PFPeA and residence in Northwest 'Upolu (NWU) compared to the Apia Urban Area (AUA); lower PFUnA and 9Cl-PF3ONS and greater socioeconomic resources; lower PFOA and higher parity; higher PFDA and higher maternal age; and lower PFUnA, PFTrDA, and 9Cl-PF3ONS and higher maternal BMI. In DBS, we found suggestive (p < 0.05) or significant (p < 0.025) associations between lower PFBA and residence in NWU versus AUA; lower PFBA and PFHxS and higher maternal age; and higher PFBA and higher maternal BMI. Finally, we observed associations between nutrition source at 4 months and DBS PFBA and PFHxS, with formula- or mixed-fed infants having higher concentrations compared to exclusively breastfed infants. This study represents the first characterization of PFAS contamination in Samoa. Additional work in larger samples is needed to identify potentially modifiable determinants of PFAS concentrations, information that is critical for informing environmental and health policy measures.

Male androphilia, fraternal birth order, and female fecundity in Samoa: A 10-y retrospective.

Two separate but related literatures have examined familial correlates of male androphilia (i.e., sexual attraction and arousal to masculine adult males). The fraternal birth order effect (FBOE) is a widely established finding that each biological older brother a male has increased the probability of androphilia 20-35% above baseline rates. Other family demographic variables, such as reproduction by mothers, maternal aunts, and grandmothers, have been used to test evolutionary hypotheses that sexually antagonistic genes lead to androphilia among males, lowering or eliminating reproduction, which is offset by greater reproductive output among their female relatives. These proposed female fecundity effects (FFEs), and the FBOE, have historically been treated as separate yet complementary ways to understand the development and evolution of male androphilia. However, this approach ignores a vital confound within the data. The high overall reproductive output indicative of an FFE results in similar statistical patterns as the FBOE, wherein women with high reproductive output subsequently produce later-born androphilic sons. Thus, examination of the FBOE requires analytic approaches capable of controlling for the FFE, and vice-versa. Here, we present data simultaneously examining the FBOE and FFE for male androphilia in a large dataset collected in Samoa across 10 y of fieldwork, which only shows evidence of the FBOE.

Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa.

In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.

Mapping communities as complex adaptive systems: A study of the response to violence against women by communities in Samoa.

This paper explores the concept of communities as complex adaptive systems in the context of violence against women (VAW) prevention. Using thematic network analysis on data from 80 semi-structured interviews with community members in Samoa, we found that communities exhibit many properties of complex adaptive systems. Within nested systems, diverse and dynamic agents interact based on their knowledge and attitudes, which changes over time, leading to emergent and unpredictable outcomes. The functioning of communities and their response to VAW is a product of non-linear and emerging relationships and interactions between systems components at the community level. The approach we propose for conceptualising communities as complex adaptive systems provides a structured method for designing and evaluating community-based interventions that are grounded in the local context and existing resources. With in-depth knowledge of how a community works, interventions can be better equipped to address wicked problems such as VAW.

Climate micro-mobilities as adaptation practice in the Pacific: the case of Samoa.

Recent debates on climate mobilities have largely ignored the dynamics of mobility patterns including short-distance and short-duration circular movements to enhance adaptative capacity and resilience of households and individuals, enabling them to remain in place despite facing increasingly severe climatic risks. This paper explores Pacific Islanders' climate-related mobilities with reference to cases from Samoa. It first conceptualizes Samoan mobility, which is rooted in Samoan culture, norms and worldviews, and then uses this as a framework to examine ways in which people shift and diversify their residential locations for climate-associated reasons. The study employs a comparative case study approach using conversational (the Pacific-originated talanoa-style) interviews with 40 participants in two villages in Samoa-one urban and the other rural. Findings suggest that shifting spatially and temporarily between two residences (a practice called fa'a-'aigalua) occurs not only within the village but across villages. Thereby, villagers reduce the risk of incurring physical harm from climate-related disasters, while minimizing the risk of cultural harm from place detachment. Our study challenges the discourse of 'vulnerable Pacific Islanders' by demonstrating the adaptability of Samoans to changing socio-ecological and climatic circumstances and their ability to develop a variety of climate resilience strategies, including micro-mobilities and circular migration. This article is part of the theme issue 'Climate change adaptation needs a science of culture'.

Scabies prevalence after ivermectin-based mass drug administration for lymphatic filariasis, Samoa 2018-2019.

BACKGROUND: Scabies is a common skin infestation caused by the Sarcoptes scabei mite. Ivermectin, one of three drugs used in mass drug administration (MDA) for lymphatic filariasis, is also effective for treating scabies. Ivermectin-based MDA was first conducted in Samoa in August 2018, with ivermectin being offered to those aged ≥5 years. Here, we report scabies prevalence in Samoa after MDA. METHODS: We conducted household surveys 1.5-3.5 months (Survey 1) and 6-8 months (Survey 2) after the 2018 MDA in 35 primary sampling units. We conducted clinical examination for scabies-like rash and used International Alliance for the Control of Scabies classification criteria. We estimated scabies prevalence by age, gender and region. Multivariable logistic regression was used to assess factors associated with prevalence. RESULTS: We surveyed 2868 people (499 households) and 2796 people (544 households) aged 0-75 years in Surveys 1 and 2, respectively. Scabies prevalence increased from 2.4% (95% CI 2.1-2.7%) to 4.4% (95% CI 4.0-4.9%) between surveys. Scabies was associated with younger age (0-4 years: aOR 3.5 [2.9-4.2]; 5-15 years: aOR 1.6 [1.4-1.8] compared to ≥16 years), female gender (aOR 1.2 [95% CI 1.1-1.4]; region (aOR range from 1.4 [1.1-1.7] to 2.5 [2.1-3.1] between regions), large households (aOR 2.6 [2.0-3.4] households ≥13), and not taking MDA in 2018 (aOR 1.3 [95% CI 1.1-1.6]). CONCLUSIONS: We found moderate prevalence of scabies in two population-representative surveys conducted within 8 months of the 2018 MDA for lymphatic filariasis. Prevalence appeared to increase between the surveys, and ongoing surveillance is recommended, particularly in young children.

Knowledge and attitudes of female caregivers in Samoa to childhood hearing loss and hearing services.

OBJECTIVES: To assess the knowledge and attitudes of 150 female caregivers in Samoa to childhood hearing loss and hearing services, and to compare findings between urban (n = 100) and rural-dwelling (n = 50) caregivers. METHODS: A semi-structured interview using a 26-item questionnaire was administered to participants in the Samoan language. Participants were required to respond "yes", "no", or "unsure". RESULTS: Highest awareness of aetiology of childhood hearing loss was found for otitis media (88.7%), followed by noise exposure (64.7%) and family history (38%). Highest awareness of public health measures that may prevent/reduce otitis media was found for routine childhood immunizations (74.7%) and breast-feeding for first 6 months of life (69.3%). Overall, 40% of Samoan caregivers agreed that curses may cause childhood hearing loss. There was overwhelming support for community-based hearing services for newborns/infants (98%) and school students (97.3%). CONCLUSIONS: There is positive support for community-based hearing health services for children among female caregivers of Samoa. There was high awareness of otitis media as a major cause of childhood hearing loss, as well as good knowledge of public health measures that reduce/minimise the risk of otitis media.

Love Shouldn't Hurt - E le Saua le Alofa: Co-designing a theory of change for preventing violence against women in Samoa.

Despite the widespread adoption of Theories of Change (ToC) for programme evaluation, the process of collaboratively developing these theories is rarely outlined or critical analysed, limiting broader methodological discussions on co-production. We developed a ToC as part of E le Saua le Alofa ('Love Shouldn't Hurt') - a participatory peer-research study to prevent violence against women (VAW) in Samoa. The ToC was developed in four phases: (1) semi-structured interviews with village representatives (n = 20); (2) peer-led semi-structured interviews with community members (n = 60), (3) community conversations with 10 villages (n = 217) to discuss causal mechanisms for preventing VAW, and (4) finalising the ToC pathways. Several challenges were identified, including conflicting understandings of VAW as a problem; the linearity of the ToC framework in contrast to intersecting realities of people's lived experiences; the importance of emotional engagements, and theory development as a contradictory and incomplete process. The process also raised opportunities including a deeper exploration of local meaning-making, iterative engagement with local mechanisms of violence prevention, and clear evidence of ownership by communities in developing a uniquely Samoan intervention to prevent VAW. This study highlights a clear need for ToCs to be complemented by indigenous frameworks and methodologies in post-colonial settings such as Samoa.

Pollution and ecological risk assessments for heavy metals in coastal, river, and road-deposited sediments from Apia City in Upolu Island, Samoa.

This study was the first to investigate the pollution and ecological risks of heavy metals in coastal, river/stream and road-deposited sediments (RDS) from Apia in Samoa. Cr and Ni concentrations in sediment samples were higher than those of other metals. River sediments and RDS had relatively high EF values around the intensive commercial areas, with a moderate to significant enrichment of Cu, Zn, Cd, and Pb. The results indicate that Cr and Ni have a natural origin from volcanic parent materials, while Cu, Zn, Cd, and Pb originated from anthropogenic activities, such as traffic emissions and the discharge of municipal wastewater. The assessments of pollution and ecological risk revealed that coastal sediments adjacent to the river are anthropogenically contaminated and present a moderate ecological risk. This study demonstrates that metals that have accumulated in the urban impermeable layer and river/stream bed have flowed into the coastal environment through runoff.

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience.

Evidence-based policy toolboxes are essential for decision makers to effectively invest in and scale up maternal-child health and nutrition programs, and breastfeeding is no exception. This special issue focuses on the experiences implementing the Becoming Breastfeeding Friendly (BBF) toolbox in England, Scotland, and Wales. BBF is an initiative that includes a toolbox for decision making based on the Complex Adaptive System-based Breastfeeding Gear Model. The BBF initiative experience in Great Britain presented in this special issue illustrates how versatile BBF is as it can be readily adapted to the specific application context. In this instance one country, England was trained by the Yale School of Public Health team that developed BBF. England, in turn, trained and assisted Scotland and Wales with the implementation and oversight of BBF in those countries. The positive experience implementing BBF in Great Britain is fully consistent with findings related to this initiative in other countries with contrasting economic, social, political and health care systems; including Germany, Ghana, Mexico, Myanmar, and Samoa. In all instances BBF has led to breastfeeding policy improvements with strong implications for enabling breastfeeding environments including maternity benefits, workforce development, the Baby Friendly Hospital Initiative and behavior change communication campaigns. In conclusion, BBF is a powerful tool to help guide the effective scaling up of evidence-based programmes to advance breastfeeding protection, promotion and support globally.

The Vave campaign: impact evaluation of a cancer awareness raising multi-media campaign in Samoa.

Cancer is a leading cause of premature death and disability in Samoa. Recognizing the importance of symptom awareness and early detection, the Samoa Cancer Society (SCS) developed the 'Vave' (quickly) campaign as the first multi-media cancer awareness campaign in Samoa. The campaign adopted a three-pronged community engagement approach including mass media; printed resources; and community outreach at culturally appropriate locations including churches, villages and schools. The campaign promoted three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To measure impact, data were collected using several methods around the outreach education sessions (pre- and post-surveys), campaign recall (survey) and Vave-related enquiries received by SCS. The findings revealed the campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. However, it is of note that almost 30% of campaign recall respondents stated they were unsure or would not see a doctor if concerned about a sign of cancer. The reasons given being a lack of knowledge, lack of trust in hospitals and preference for traditional healing. This suggests more targeted culturally sensitive strategies are needed including partnering with traditional healers. Further, advocacy efforts are needed to address the structural barriers to cancer detection and treatment together with continuing education around causes and symptoms of cancer targeting the hard-to-reach communities in Samoa.

Cancer is a number one killer and cause of disability in Samoa. Identifying cancer early can lead to better health outcomes. Ability to understand signs and symptoms of cancer among community members is crucial in facilitating early detection. Recognizing this, the Samoa Cancer Society (SCS) developed the first ever multi-media cancer awareness campaign in Samoa­the 'Vave' which means 'quickly'. The campaign used mass media; printed resources; and community outreach to spread three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To understand how effective the campaign was, data were collected through surveys and statistics on Vave-related calls to SCS. The campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. Efforts are needed to address the structural barriers to cancer early detection and continuing education targeting the hard-to-reach communities in Samoa.

The roles of emergency medical teams in response to Samoa's 2019 measles outbreak.

Problem: On 15 November 2019, Samoa's Government declared a state of emergency in response to a rapidly worsening measles outbreak. The outbreak overwhelmed Samoa's health system, necessitating international assistance, including from emergency medical teams (EMTs). Context: Measles spread globally throughout 2019, with cases rising by more than 300% in the first quarter of 2019, as compared with 2018. Given Samoa's low immunization coverage with a measles-containing vaccine at the time, at 40% for the first dose and 28% for the second, the country was soon overwhelmed with measles cases, hospitalizations and deaths. Action: Following a request for international assistance, 18 EMTs from around the world deployed to Samoa, bringing more than 550 additional clinical, public health and logistics personnel to the country's measles response. Working alongside Samoan health workers, EMTs provided critical surge assistance in clinical management, vaccination, surveillance, infection prevention and control, risk communication and community engagement, and mental health and psychosocial support. Outcome: A total of 1867 hospitalized measles patients were treated from 30 September 2019 to 13 January 2020, with 83 measles-related deaths recorded. EMTs provided essential surge support across Samoa's health system during the most acute phase of the response, helping to care for the ill and control the outbreak. Discussion: Samoa's measles response triggered a large-scale and unique EMT activation, with teams integrated into Samoa's hospitals and health centres. The response demonstrated the critical role that EMTs can play in outbreak response and the importance of strong coordination to ensure optimal use of international clinical surge support by a health system in crisis.

Spatial-temporal and phylogenetic analyses of epidemiologic data to help understand the modes of transmission of endemic typhoid fever in Samoa.

Salmonella enterica serovar Typhi (S. Typhi) is either widely distributed or proximally transmitted via fecally-contaminated food or water to cause typhoid fever. In Samoa, where endemic typhoid fever has persisted over decades despite water quality and sanitation improvements, the local patterns of S. Typhi circulation remain unclear. From April 2018-June 2020, epidemiologic data and GPS coordinates were collected during household investigations of 260 acute cases of typhoid fever, and 27 asymptomatic shedders of S. Typhi were detected among household contacts. Spatial and temporal distributions of cases were examined using Average Nearest Neighbor and space-time hotspot analyses. In rural regions, infections occurred in sporadic, focal clusters contrasting with persistent, less clustered cases in the Apia Urban Area. Restrictions to population movement during nationwide lockdowns in 2019-2020 were associated with marked reductions of cases. Phylogenetic analyses of isolates with whole genome sequences (n = 186) revealed one dominant genotype 3.5.4 (n = 181/186) that contains three Samoa-exclusive sub-lineages: 3.5.4.1, 3.5.4.2, and 3.5.4.3. Variables of patient sex, age, and geographic region were examined by phylogenetic groupings, and significant differences (p<0.05) associated genetically-similar isolates in urban areas with working ages (20-49 year olds), and in rural areas with age groups typically at home (<5, 50+). Isolates from asymptomatic shedders were among all three sub-lineages. Whole genome sequencing provided evidence of bacterial genetic similarity, which corroborated 10/12 putative epidemiologic linkages among cases and asymptomatic shedders, as well as 3/3 repeat positives (presumed relapses), with a median of one single nucleotide polymorphism difference. These findings highlight various patterns of typhoid transmission in Samoa that differ between urban and rural regions as well as genomic subtypes. Asymptomatic shedders, detectable only through household investigations, are likely an important reservoir and mobile agent of infection. This study advances a "Samoan S. Typhi framework" that supports current and future typhoid surveillance and control efforts in Samoa.

Intra- and Intersexual Mate Competition in Two Cultures : A Comparison of Women's Response to Mate Competition with Women and Gender-Nonbinary Males in Samoa and among the Istmo Zapotec.

The present study examined women's mate competition tactics in response to female and feminine-male rivals in two cultures in which competition against both occurs. In Samoa and the Istmo Zapotec (Southern Mexico), women not only compete with other women (intrasexually) but also compete with rival feminine males (intersexually) in order to access/retain the same masculine men as sexual/romantic partners. Using a mixed-method paradigm, women were asked about their experiences of intra- and intersexual mate competition, and these narratives were recorded. The tactics reportedly employed by participants, and those attributed to mate competitors, were categorized according to established taxonomies of mate competition tactics, and their frequencies compared. Within-culture, the likelihood that participant women had ever experienced intra- and intersexual mate competition did not differ. Furthermore, participants reported a similar pattern of behavioral tactics whether their rival was another woman or a feminine male. These included benefit provisioning tactics during mate acquisition and cost-inflicting tactics during mate retention. Similarly, the mate competition tactics attributed to rival women and rival feminine males bore a striking resemblance, focused on enticing target men. Results highlight the mate competition tactics employed by women outside of a Euro-American context, and the way cultural factors impact mating landscapes presumed to be exclusively heterosexual. The presence of feminine males, alongside masculine men's willingness to engage in sexual activity with them, induces women in such cultures to compete intersexually in comparable ways to intrasexual competition with rival women.

Netball Shoots for Physical and Mental Wellbeing in Samoa: A Natural Experiment.

Sport-for-development programs claim to address key determinants of recreational physical activity participation and subsequent development outcomes in low-income settings. We conducted a natural experiment with pre-post measures taken from women in the 12 villages in Samoa, some of which voluntarily participated in the sport-for-development intervention. The intervention comprised a six-week netball league delivered by local volunteers who attended coaching workshops, received ongoing support from the national governing body and were provided with infrastructure and equipment to conduct local training sessions. Changes in netball participation, recreational physical activity, body composition, mental wellbeing and socio-ecological determinants of physical activity were compared between intervention and comparison villages using a univariate ANOVA. The intervention reached women who participated in little recreational physical activity and had poor physical and mental wellbeing. Program uptake was higher in villages with the strongest social support for netball participation. Local social support and capacity to independently organize netball activities increased. There were concurrent improvements in netball participation, physical activity levels, mental wellbeing and body weight in the intervention villages. Our findings support scaling-up of the intervention in similar settings but preceding this with formative evaluation to identify low active communities that are "primed" to participate in the proposed activity.