Risk factors for community-acquired pneumonia in pre-school-aged children.

AIM: To identify risk factors for children developing and being hospitalised with community-acquired pneumonia. METHODS: Children <5 years old residing in urban Auckland, New Zealand were enrolled from 2002 to 2004. To assess the risk of developing pneumonia, children hospitalised with pneumonia (n= 289) plus children with pneumonia discharged from the Emergency Department (n= 139) were compared with a random community sample of children without pneumonia (n= 351). To assess risk of hospitalisation, children hospitalised with pneumonia were compared with the children discharged from the Emergency Department. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were used to estimate the risk of pneumonia and hospitalisation with pneumonia. RESULTS: After adjustment for season, age and ethnicity there was an increased risk of pneumonia associated with lower weight for height (OR 1.28, 95% CI 1.10-1.51), spending less time outside (1.96, 1.11-3.47), previous chest infections (2.31, 1.55-3.43) and mould in the child's bedroom (1.93, 1.24-3.02). There was an increased risk of pneumonia hospitalisation associated with maternal history of pneumonia (4.03, 1.25-16.18), living in a more crowded household (2.87, 1.33-6.41) and one with cigarette smokers (1.99, 1.05-3.81), and mould in the child's bedroom (2.39, 1.25-4.72). CONCLUSIONS: Lower quality living environments increase the risk of pneumonia and hospitalisation with pneumonia in New Zealand. Poorer nutritional status may also increase the risk of pneumonia. Improving housing quality, decreased cigarette smoke exposure and early childhood nutrition may reduce pneumonia disease burden in New Zealand.

Interview with Dr Colin Tukuitonga: from crisis to action in Pacific communities.

The island communities in the Pacific contribute very little to global carbon emissions, yet they are among the most vulnerable to the effects of climate change. Dr Colin Tukuitonga, a general practitioner by training, was born and raised on Niue Island in the Pacific. He has held senior public health roles in the New Zealand Government and, since 2014, has served as Pacific Community Director-General. He spoke to us about how climate change is affecting the health of people living in Pacific Island countries and the relevance of Australia's climate change policy responses to these neighbouring countries.

Preventing chronic diseases: taking stepwise action.

The scientific knowledge to achieve a new global goal for the prevention of chronic diseases--a 2% yearly reduction in rates of death from chronic disease over and above projected declines during the next 10 years--already exists. However, many low-income and middle-income countries must deal with the practical realities of limited resources and a double burden of infectious and chronic diseases. This paper presents a novel planning framework that can be used in these contexts: the stepwise framework for preventing chronic diseases. The framework offers a flexible and practical public health approach to assist ministries of health in balancing diverse needs and priorities while implementing evidence-based interventions such as those recommended by the WHO Framework Convention on Tobacco Control and the WHO Global Strategy on Diet, Physical Activity and Health. Countries such as Indonesia, the Philippines, Tonga, and Vietnam have applied the stepwise planning framework: their experiences illustrate how the stepwise approach has general applicability to solving chronic disease problems without sacrificing specificity for any particular country.

Awareness of sudden infant death syndrome risk factors among mothers of Pacific infants in New Zealand.

AIM: To describe the awareness of Sudden Infant Death Syndrome (SIDS) risk factors among mothers of Pacific infants in New Zealand. METHODS: The data were gathered as part of the Pacific Islands Families Study in which 1376 mothers were interviewed when their infants were six weeks old. Included in this interview were questions designed to examine the mothers' awareness of SIDS risk factors. RESULTS: Over one third (38.8%) of mothers were unable to accurately report a SIDS risk factor, 53.4% reported the risk associated with putting the baby to sleep in a prone position, 31.5% maternal smoking, and 19.5% correctly reported other SIDS risk factors. Lack of awareness of SIDS risk factors was significantly associated with Samoan and Cook Islands Maori ethnicity, being Pacific Islands born, having no post school qualifications, lower household income, not being fluent in English, having more than five children, and not attending antenatal classes. CONCLUSIONS: Despite SIDS prevention efforts, a considerable number of mothers in this cohort reported no awareness of SIDS risk factors. More effective methods are needed to provide consistent SIDS prevention information across Pacific ethnic groups.

Infant bed-sharing among Pacific families in New Zealand.

AIM: To describe infant bed-sharing among Pacific families in New Zealand. METHODS: The data were gathered as part of the Pacific Island Families: First Two Years of Life (PIF) Study in which 1376 mothers were interviewed when their infants were six-weeks-old. Maternal reports of infant bed-sharing practices were assessed by questions about infant sleep location and the number of people who usually shared a mattress with the infant. RESULTS: Over half of the mothers (54.9%) reported that their infants shared a mattress with other people, 44.2% sharing with one other person, the remainder sharing with two or more people. Of the bed-sharing infants, 4.7% slept on a mattress on top of the bed, and 4.7% only slept part of the night in the shared bed. CONCLUSIONS: Together with effective information delivery, the educational and housing issues that many Pacific families in New Zealand face need to be addressed so that parents can make informed decisions about infant care practices.

Health status and epidemiological capacity and prospects: WHO Western Pacific Region.

BACKGROUND: This article on the state of epidemiology in the WHO Western Pacific Region (WPR) is the first in a series of eight articles commissioned by the International Epidemiological Association (IEA) to identify global opportunities to promote the development of epidemiology. METHODS: Global mortality and disease data were used to summarize the burden of mortality, disease, risk factor and patterns of inequalities in the region. Medline bibliometrics were used to estimate epidemiological publication output by country. Key informant surveys, Internet and literature searches and author knowledge and networks were used to elicit perspectives on epidemiological training, research, funding and workforce. Findings The WPR has the lowest age-standardized disability-adjusted life-years (DALY) rate per 1000 of the six WHO regions, with non-communicable disease making the largest percentage contributions in both low- and middle-income countries (LMICs, 68%) and high-income countries (HICs, 84%) in the WPR. The number of Medline-indexed epidemiological research publications per year was greatest for Japan, Australia and China. However, the rate per head of population was greatest for Micronesia and New Zealand. The substantive focus of research roughly equated with burden of disease patterns. Research capacity (staff, funding, infrastructure) varies hugely between countries. Epidemiology training embedded within academic Masters of Public Health programmes is the dominant vehicle for training in most countries. Field epidemiology and in-service training are also common. The Pacific Island countries and territories, because of sparse populations over large distances and chronic workforce and funding capacity problems, rely on outside agencies (e.g. WHO, universities) for provision of training. Cross-national networks and collaborations are increasing. CONCLUSION: Communicable disease surveillance and research need consolidation (especially in eastern Asian WPR countries), and non-communicable disease epidemiological capacity requires strengthening to match disease trends. Capacity and sustainability of both training and research within LMICs in WPR are ongoing priorities. China in particular is advancing quickly. One role for the IEA in building capacity is facilitating collaborative networks within WPR.

Tobacco smoking prevalence in Pacific Island countries and territories: a review.

AIM: To comprehensively review adult and youth smoking prevalence data in Pacific Island countries and territories (PICT). METHODS: MEDLINE search for period 1986-2006 and search of World Health Organization and Centres for Disease Control and Prevention databases. RESULTS: Smoking prevalence in PICT ranges from 22%-57% (males) and from 0.6%-51% (females). All PICT male populations (except Palau) report higher rates than in Australia and New Zealand. Nauru, Tokelau, French Polynesia, New Caledonia, and Kiribati report high rates of female smoking. Youth rates of smoking range from 3%-68% (although unavailable for many PICT). Palau, Northern Mariana Islands, Guam, Cook Islands, and American Samoa report very high levels of youth smoking in both males and females. Smoking prevalence appears to have decreased in the last 30 years in male populations with a variable picture in female populations. CONCLUSIONS: PICT continue to show high levels of smoking prevalence, with youth smoking rates particularly concerning. There is a need for more robust and systematic collection and publication of smoking prevalence data in PICT, especially youth data, but this should not delay urgently required action to reduce tobacco use in PICT. The Framework Convention on Tobacco Control provides a powerful tool, but its provisions should be implemented rapidly, particularly increased tobacco taxation.

Polymorphism in intron 1 of the interferon-gamma gene influences both serum immunoglobulin E levels and the risk for chronic hepatitis B virus infection in Polynesians.

Intron 1 of the interferon-gamma (IFNG) gene contains two polymorphisms. The 12 CA-repeat allele of the +875 IFNGCA microsatellite and the T allele of the +A874T single nucleotide polymorphism (SNP) have been associated with increased in vitro IFNG production and a variety of clinical phenotypes. The purpose of this study was to determine whether these polymorphisms influence total serum IgE levels [tsIgE] and the outcome of a hepatitis B virus (HBV) infection. IFNGCA and +A874T were typed in 186 asthmatics of Niuean ancestry and in Polynesian women with a chronic HBV infection (n = 60) and with natural immunity to the HBV (n = 66). The IFNGCA genotype was associated with [tsIgE] in asthmatic children (n = 51, p = 0.004) but not adults (n = 135, p = 0.87). The data were consistent with a co-dominant influence of the 12 CA-repeat allele on high [tsIgE]. The IFNGCA genotype was also associated with the risk for chronic HBV infection (chi (2) = 11.6, p = 0.003) because of a dominant effect of the 12 CA-repeat allele on developing natural immunity in homozygotes (OR = 5.8, p = 0.003) and heterozygotes (OR = 2.7, p = 0.01). Similar associations were found for the T allele of the +A874T SNP. The possibility that these associations were due to linked alleles in the adjacent 783 bp of the promoter and 3'-untranslated region of the IFNG gene was excluded by direct sequencing. In summary, high-IFNG-producing alleles in intron 1 of the IFNG locus are associated with high [tsIgE] in asthmatic children from Niue and with natural immunity to the HBV in Polynesian women. These findings are consistent with a previous report of an association between +875 IFNGCA and [tsIgE] and provide preliminary evidence of a new association with the outcome of an HBV infection.

Twelve-month and lifetime prevalences of mental disorders and treatment contact among Pacific people in Te Rau Hinengaro: the New Zealand Mental Health Survey.

OBJECTIVE: To show the 12 month and lifetime prevalences of mental disorders and 12 month treatment contact of Pacific people in Te Rau Hinengaro: The New Zealand Mental Health Survey. METHOD: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over including Maori (n = 2457), Pacific people (n = 2236), people of mixed Pacific and Maori ethnicity (n = 138), and 'Others' (a composite group of predominantly European descent) (n = 8161). Ethnicity was measured by self-identified ethnicity using the New Zealand 2001 Census of Population and Dwellings question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorders. The overall response rate was 73.3%. RESULTS: Pacific people have high rates of mental illness: the unadjusted 12 month prevalence for Pacific people was 25.0% compared with 20.7% for the total New Zealand population. There were also higher 12 month prevalences of suicidal ideation (4.5%) and suicide attempts (1.2%). Only 25.0% of Pacific people who had experienced a serious mental disorder had visited any health service for their mental health reason compared with 58.0% of the total New Zealand population. The prevalence of mental disorder was lower among Pacific people born in the Islands than among New Zealand-born Pacific people. CONCLUSION: Pacific people experience high prevalence of mental disorder and New Zealand-born Pacific people experience significantly higher prevalence than Island-born Pacific people.

Health problems among six-week old Pacific infants living in New Zealand.

BACKGROUND: The purpose of this paper is to describe maternal reports of various health problems experienced by their Pacific infants in the first six weeks of their lives and to examine the infant, maternal and socio-demographic factors associated with infant health problems. MATERIAL/METHODS: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which mothers in the cohort (n=1376) were interviewed about the health problems experienced by their infants (n=1398) in the first six weeks of life. RESULTS: Fifty-five percent of mothers reported that their infant had experienced minor health problems, and 15.6% reported moderate to severe infant health problems. Most mothers (98%) reported that they had a regular family doctor or health clinic to go to if their infant had a health problem. We found no meaningful associations between infant, maternal, or socio-demograhic variables and general infant health problems, possibly because of the wide range of infant illnesses reported. Since 43% of the infant health problems reported were related to breathing difficulties we carried out univariate and multivariate analyses on this specific health problem. Factors significantly associated (p<0.05) with infant breathing problems were maternal cigarette smoking during the last trimester, cold housing, and residing in New Zealand for over 10 years. CONCLUSIONS: The high rate of infant health problems, in particular infant breathing problems, among Pacific infants in this cohort and the significant links with modifiable factors warrant priority action by housing and health agencies to minimise the consequences of these risk factors.

Genetic diversity and linkage disequilibrium in the Polynesian population of Niue Island.

Isolated populations that recently have been derived from small homogeneous groups of founders should have low genetic diversity and high levels of linkage disequilibrium and should be ideal for mapping ancestral polymorphisms that influence complex genetic disease susceptibility. Populations that fulfill these criteria have been difficult to identify. We have been looking for Polynesian populations with these characteristics, because Polynesians have high rates of complex genetic diseases. In Niue Islanders all ancestral female (mitochondrial HSVI sequence) and 90.4% of ancestral male (Y-chromosome haplogroup) lineages are of Southeast Asian origin. The frequency of European Y-chromosome haplogroups is 7.2%. The diversities of mitochondrial HSV1 sequences (h = 0.18 +/- 0.05) and Y-chromosome haplo-groups (h = 0.18 +/- 0.05) are lower than values published for any other population. Ten autosomal microsatellites spaced over 5.8 cM show low allele numbers in Niue Islanders relative to Europeans (55 vs. 88 total alleles, respectively) and a modest reduction in heterozygous loci (0.71 +/- 0.02 vs. 0.78 +/- 0.02, p = 0.04). The higher linkage disequilibrium (d2) between these loci in Niue Islanders relative to Europeans (p = 0.001) is negatively correlated (r = -0.47, p = 0.01) with genetic distance. In summary, Niue Islanders are genetically isolated and have a homogeneous Southeast Asian ancestry. They have reduced autosomal genetic diversity and high levels of linkage disequilibrium that are consistent with the influence of genetic drift mechanisms, such as a founder effect or bottlenecks. High-powered linkage disequilibrium studies designed to map ancestral polymorphisms that influence complex genetic disease susceptibility may be feasible in this population.

Pacific Islands Families: First Two Years of Life Study--design and methodology.

AIMS: Knowledge about the health, psychosocial, and behavioural characteristics of Pacific peoples with young children resident in New Zealand is limited. The Pacific Islands Families: First Two Years of Life (PIF) Study was designed to redress this knowledge gap. This paper describes the design and methodology of the PIF Study. METHODS: Mothers of Pacific infants born at Middlemore Hospital between 15 March and 17 December 2000 were recruited. Maternal home interviews covering sociodemographic, cultural, environmental, child development, family and household dynamics, childcare, lifestyle, and health issues were undertaken at approximately 6-weeks, 12-months, and 24-months postpartum. Paternal home interviews and child development assessments were conducted at approximately 12-months and 24-months postpartum. Information from Middlemore's Hospital Discharge Summary records and Plunket's 6-week and 6-month assessments was also captured. RESULTS: 1708 mothers were identified, 1657 were invited to participate, 1590 (96%) consented to a home visit; and, of these, 1,477 (93%) were eligible for the PIF study. Of those eligible, 1,376 (93%) participated at 6-weeks, 1224 (83%) participated at 12-months, and 1144 (77%) participated at 24-months. No important differential attrition was observed. Paternal interviews and child assessments were conducted on 825 fathers and 1241 infants at 12-months and on 757 fathers and 1064 children at 24-months. CONCLUSIONS: The PIF study is a large, scientifically and culturally robust longitudinal study that has achieved respectable participation rates in a historically hard-to-reach population. We believe that results from this study will inform future policy development within New Zealand.

SIDS or Sitisi: plight and response of Pacificans in New Zealand (Aotearoa).

Sudden Infant Death Syndrome (SIDS) or Sitisi was considered a rare event among Pacificans worldwide. However, recent findings in New Zealand (Aotearoa) have shown that at least 33% of Pacific infant deaths in New Zealand since 1991 have been due to Sitisi, and the incidence of Sitisi among Pacificans has been on the increase since 1986. These findings have necessitated the development of a Pacific response, especially since a National SIDS Prevention Programme in Aotearoa, implemented in 1991, had led to decreasing rates amongst Pakeha (Europeans) only. This paper reports the Pacificans' experience with Sitisi and the response to the control of yet another epidemic amongst migrants. The response included research; community consultation; and training of Pacifically appropriate Community SIDS Educators. The importance and initiation of community-based strategies is central to the Pacificans' response to Sitisi and its determinants. The success of this approach provides a model for intervention and health promotion, at least, among Pacificans globally.

Problems with damp and cold housing among Pacific families in New Zealand.

AIMS: To describe reported problems with damp and cold housing among Pacific families in New Zealand and their associations with two facets of maternal health, namely postnatal depression and asthma. METHODS: The data were gathered as part of the Pacific Islands Families: First Two Years of Life (PIF) Study in which 1376 mothers were interviewed when their infants were six weeks old. Mothers were questioned with regard to problems with dampness or mould and cold housing, facets of maternal health (assessed using the Edinburgh Postnatal Depression Scale), and asthma. RESULTS: Over one third of the mothers (37%) reported that their homes had dampness/mould problems, and over half reported problems with cold housing (53.8%). Damp and cold housing were significantly associated with a number of variables including large household size, state rental housing, and financial difficulty with housing costs. Damp and cold housing were also both significantly related to maternal depression and incidence of asthma. CONCLUSIONS: Efforts to reduce problems with damp and cold housing are needed to improve maternal health. To this end, advice regarding the importance of home heating and ventilation may be beneficial.

Smoking among mothers of a Pacific Island birth cohort in New Zealand: associated factors.

AIMS: The present study investigated (among mothers of a Pacific Island birth cohort) the rates of smoking before, during, and after pregnancy as well as factors predictive of smoking during pregnancy. METHODS: Data were gathered as part of the Pacific Islands Families (PIF) Study. In this study, mothers of a cohort of 1398 Pacific infants born in Middlemore Hospital, Auckland during 2000 were interviewed when their infants were 6 weeks old. Mothers were questioned about their maternal health, and lifestyle behaviours such as cigarette smoking. Additional data were obtained from hospital records. Analyses focused on 1365 biological mothers. RESULTS: Overall, 339 (approximately one-quarter) of the mothers reported smoking during pregnancy. 331 (76.1%) of the 435 smokers (before pregnancy) continued to smoke during pregnancy, and eight mothers commenced smoking once pregnant. Smoking rates for each trimester were 23.7% in the first, 21.0% in the second, and 20.4% in the third trimester of pregnancy, respectively. Multivariate analyses showed that smoking was significantly associated with several factors, including indicators of disadvantage and degree of westernisation. CONCLUSIONS: Greater efforts are needed to reduce smoking during pregnancy among Pacific women. Findings can be used to inform public health policy and smoking cessation programmes for Pacific families.

Factors associated with not breastfeeding exclusively among mothers of a cohort of Pacific infants in New Zealand.

AIMS: This study investigated the association between not breastfeeding exclusively (among mothers of a cohort of Pacific infants in New Zealand) and several maternal, sociodemographic, and infant care factors. METHODS: The data were gathered as part of the Pacific Islands Families (PIF) Study. Infant feeding information was obtained through interviews with mothers (6 weeks post-birth) and from hospital records for 1247 of the 1365 biological mothers. RESULTS: Factors significantly associated with not exclusively breastfeeding at hospital discharge included smoking, unemployment prior to pregnancy, years in New Zealand, not seeing a midwife during pregnancy, caesarean delivery, and twin birth status. Factors significantly associated with cessation (before 6 weeks post-birth) of exclusive breastfeeding (for mothers who initially breastfed exclusively) included smoking, employment prior to pregnancy, being in current employment, high parity, dummy use, not receiving a visit from Plunket, infant not discharged at the same time as the mother, infant not sharing the same room as the parent(s) at night, regular childcare, and having a home visit for the infant from a traditional healer. CONCLUSIONS: Aside from smoking, different factors were associated with initiation and maintenance of exclusive breastfeeding. Identification of risk factors should assist targeting women who are at heightened risk of not breastfeeding exclusively.