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.

Gap analysis of diabetes-related foot disease management systems in Pacific Islands Countries and Territories.

BACKGROUND: Pacific Island Countries and Territories (PICTs) are known to have high prevalence of Diabetes Mellitus and high incidence of diabetes-related foot disease. Diabetes-related foot disease can lead to lower limb amputation and is associated with poor outcomes, with increased morbidity and mortality. The purpose of this study was to gain a better understanding of diabetes-related foot disease management in selected countries in PICTs and to identify potential barriers in management of diabetes-related foot disease management in the region. METHODS: A cross-sectional survey was sent to eleven hospitals across six selected PICTs. The survey instrument was designed to provide an overview of diabetes-related foot disease (number of admissions, and number of lower limb amputations over 12 months) and to identify clinical services available within each institution. Two open-ended questions (free text responses) were included in the instrument to explore initiatives that have helped to improve management and treatment of diabetes-related foot diseases, as well as obstacles that clinicians have encountered in management of diabetes-related foot disease. The survey was conducted over 6 weeks. RESULTS: Seven hospitals across four countries provided responses. Number of admissions and amputations related to diabetes-related foot disease were only reported as an estimate by clinicians. Diabetes-related foot disease was managed primarily by general medicine physician, general surgeon and/or orthopaedic surgeon in the hospitals surveyed, as there were no subspecialty services in the region. Only one hospital had access to outpatient podiatry. Common themes identified around barriers faced in management of diabetes-related foot disease by clinicians were broadly centred around resource availability, awareness and education, and professional development. CONCLUSION: Despite the high prevalence of diabetes-related foot disease within PICTs, there appears to be a lack of functional multi-disciplinary foot services (MDFs). To improve the outcomes for diabetes-related foot disease patients in the region, there is a need to establish functional MDFs and engage international stakeholders to provide ongoing supports in the form of education, mentoring, as well as physical resources.

Hepatitis B Prevalence and Risk Factors in Foreign-Born Asians and Pacific Islanders at a Federally Qualified Health Center in Hawai'i, 2015-2020.

The objective of this study was to estimate the prevalence of chronic hepatitis B infection in foreign-born Asians and Pacific Islanders at Kalihi-Palama Health Center in Honolulu, Hawai'i, and to assess the association between both chronic and resolved hepatitis B infection and risk factors such as household exposure to hepatitis B virus and geographic location of birthplace. The study involved cross-sectional data from 997 participants who accessed medical services at Kalihi-Palama Health Center between September 2015 and July 2020. The prevalence of chronic hepatitis B was 10.7%. On multivariable logistic regression analysis, the adjusted prevalence odds ratio of chronic hepatitis B infection was 3.3 times greater (95% confidence interval: 1.1, 9.2) for those who reported household contact with a person with hepatitis B infection than those who reported no such contact. No association was found with place of birth in this study population. Age was a significant predictor of chronic hepatitis B, with participants between 35-44 years of age having the highest prevalence. Age was also a significant predictor of resolved hepatitis B infection, with participants 65 years of age or older having the highest prevalence. These findings emphasize the need for targeted screening and appropriate follow-up-including vaccination or treatment-in this at-risk population.

High resilience of Pacific Island forests to a category- 5 cyclone.

Assessing how forests respond to, and recuperate from, cyclones is critical to understanding forest dynamics and planning for the impacts of climate change. Projected increases in the intensity and frequency of severe cyclones can threaten both forests and forest-dependent communities. The Pacific Islands are subject to frequent low-intensity cyclones, but there is little information on the effects of high intensity cyclones, or on how forest stewardship practices may affect outcomes. We assess the resistance and resilience of forests in three community-stewarded sites on the island of Tanna, Vanuatu, to the wind-related effects of 2015 Category-5 Cyclone Pam, one of the most intense cyclones to make landfall globally. Drawing on transect data established pre-and post-cyclone, we (1) test whether windspeed and tree structural traits predict survival and damage intensity, and whether this varies across sites; (2) assess post-cyclone regeneration of canopy, ground cover, seedlings, and saplings, and how community composition shifts over time and across sites. In sites that sustained a direct hit, 88 % of trees were defoliated, 34 % sustained severe damage, and immediate mortality was 13 %. Initial mortality, but not severe damage, was lower in areas that received an indirect hit and had lower windspeed. Larger trees and those with lighter wood had a higher probability of uprooting and snapping, respectively. Canopy and ground cover regenerated within three years and seedling and sapling regeneration was widespread across life histories, from pioneer to mature forest species. Three species of non-native vines recruited post-cyclone but within 5 years had largely declined or disappeared with canopy closure. Tanna's historical cyclone frequency, combined with customary stewardship practices that actively maintain a diversity of species and multiplicity of regeneration pathways, are likely responsible for the island's resistance and resilience to an intense tropical cyclone.

Clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands: A systematic review and meta-analysis.

Dengue, Zika and chikungunya outbreaks pose a significant public health risk to Pacific Island communities. Differential diagnosis is challenging due to overlapping clinical features and limited availability of laboratory diagnostic facilities. There is also insufficient information regarding the complications of these arboviruses, particularly for Zika and chikungunya. We conducted a systematic review and meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals (CI) for the clinical manifestations of dengue, Zika and chikungunya in the Pacific Islands. Based on pooled prevalence estimates, clinical features that may help to differentiate between the arboviruses include headache, haemorrhage and hepatomegaly in dengue; rash, conjunctivitis and peripheral oedema in Zika; and the combination of fever and arthralgia in chikungunya infections. We estimated that the hospitalisation and mortality rates in dengue were 9.90% (95% CI 7.67-12.37) and 0.23% (95% CI 0.16-0.31), respectively. Severe forms of dengue occurred in 1.92% (95% CI 0.72-3.63) of reported cases and 23.23% (95% CI 13.58-34.53) of hospitalised patients. Complications associated with Zika virus included Guillain-Barré syndrome (GBS), estimated to occur in 14.08 (95% CI 11.71-16.66) per 10,000 reported cases, and congenital brain malformations such as microcephaly, particularly with first trimester maternal infection. For chikungunya, the hospitalisation rate was 2.57% (95% CI 1.30-4.25) and the risk of GBS was estimated at 1.70 (95% CI 1.06-2.48) per 10,000 reported cases. Whilst ongoing research is required, this systematic review enhances existing knowledge on the clinical manifestations of dengue, Zika and chikungunya infections and will assist Pacific Island clinicians during future arbovirus outbreaks.

The coral chronicles.

On a remote Pacific island, clues to El Niño's future are preserved in ancient reefs.

Management of saltwater intrusion using 3D numerical modelling: a first for Pacific Island country of Vanuatu.

Small island countries like Vanuatu are facing the brunt of climate change, sea level rise (SLR), tropical cyclones, and limited or declining access to freshwater. The Tagabe coastal aquifer in Port Vila (the capital of Vanuatu) shows the presence of salinity, indicating saltwater intrusion (SWI). This study aims to develop and evaluate effective SWI management strategies for Tagabe coastal aquifer. To manage SWI, the numerical simulation model for the study area was developed using the SEAWAT code. The flow model was developed using MODFLOW and the transport model was developed using MT3DMS. Whereby SEAWAT solved flow and transport equations simultaneously. The model was calibrated, and different scenarios were evaluated for the management of SWI. The SLR was also considered in the model simulations. The results indicated that increased population, pumping rates, and SLR affect the SWI rates. To manage the SWI, we introduced hydraulic barriers like barrier wells and injection wells which effectively managed SWI in Tagabe coastal aquifer. The results from this study are significantly important whereby, the water managers, site owners, and governing bodies can use the management strategies presented in this study to create policies and regulations for managing SWI rates in Port Vila. Additionally, the water industry, private businesses, and investors who wish to extract groundwater from the Tagabe can use this study as a reference for daily or yearly freshwater production rates without the risk of SWI.

Floristic homogenization of South Pacific islands commenced with human arrival.

The increasing similarity of plant species composition among distinct areas is leading to the homogenization of ecosystems globally. Human actions such as ecosystem modification, the introduction of non-native plant species and the extinction or extirpation of endemic and native plant species are considered the main drivers of this trend. However, little is known about when floristic homogenization began or about pre-human patterns of floristic similarity. Here we investigate vegetation trends during the past 5,000 years across the tropical, sub-tropical and warm temperate South Pacific using fossil pollen records from 15 sites on 13 islands within the biogeographical realm of Oceania. The site comparisons show that floristic homogenization has increased over the past 5,000 years. Pairwise Bray-Curtis similarity results also show that when two islands were settled by people in a given time interval, their floristic similarity is greater than when one or neither of the islands were settled. Importantly, higher elevation sites, which are less likely to have experienced human impacts, tended to show less floristic homogenization. While biotic homogenization is often referred to as a contemporary issue, we have identified a much earlier trend, likely driven by human colonization of the islands and subsequent impacts.

Conclusions de la quinzième Réunion des ministres de la Santé du Pacifique, Nuku’alofa (Tonga), 20-22 septembre 2023

La quinzième Réunion des ministres de la Santé du Pacifique a rassemblé, du 20 au 22 septembre 2023, les responsables de la santé de l’ensemble du Pacifique sous les auspices du gouvernement du Royaume des Tonga et avec le concours de l’Organisation mondiale de la Santé (OMS) et de la Communauté du Pacifique (CPS).

Les débats se sont concentrés sur quatre principaux points de l’ordre du jour : 1) repenser les ressources humaines pour la santé ; 2) s’attaquer aux facteurs d’obésité, en particulier chez les enfants et les jeunes ; 3) faire progresser l’information sanitaire et la transformation numérique dans le secteur de la santé ; et 4) renforcer la résilience des systèmes de santé.

Le présent document expose les engagements pris par les ministres ayant participé à la réunion.

Outcome of the Fifteenth Pacific Health Ministers Meeting, Nuku’alofa, Tonga, 20-22 September 2023

The Fifteenth Pacific Health Ministers Meeting brought together health leaders from across the Pacific, hosted by the Government of the Kingdom of Tonga with support from the World Health Organization (WHO) and the Pacific Community (SPC) from 20-22 September 2023.

The event focused on four main agenda items: (1) rethinking human resources for health; (2)tackling the drivers of obesity, particularly for children and young people; (3) advancing health information and digital transformation in the health sector; and, (4) strengthening health system resilience.

This document outlines the commitments made by the ministers who attended the event.

Research on the changes and predictions of the burden of type 2 diabetes mellitus in Pacific Island countries from 1990 to 2019.

AIMS: To assess the burden of type 2 diabetes in Pacific Island countries and predict future trends. METHODS: We analyzed and processed data using R and Excel software, performed Joinpoint 4.7.0 software analysis to investigate changing trends in disease burden, and used an autoregressive integrated moving average model to forecast future trends. RESULTS: Our study showed that from 1990 to 2019, the burden of type 2 diabetes in Pacific Island countries continues to increase, with the standardized incidence rate showing the most significant growth. Moreover, there were significant differences in the burden of type 2 diabetes between regions. In 2019, American Samoa had the highest standardized incidence rate, while Fiji had the highest standardized death rate and disability-adjusted life year rate. The standardized incidence rate peaked at ages 65-69 years, while the standardized death rate and disability-adjusted life year rate peaked at ages 95 years and 70-74 years respectively. Type 2 diabetes burden was higher among males than females. Based on our forecasting, from 2020 to 2030, the standardized incidence rate is expected to continue to rise, while the standardized death rate and disability-adjusted life year rate will slowly decline. CONCLUSIONS: Our study highlights that the burden of type 2 diabetes in Pacific Island countries has been increasing from 1990 to 2019. Therefore, it is imperative to strengthen disease prevention and control measures in the region.

Food tax policies in Pacific Island Countries and Territories: systematic policy review.

OBJECTIVE: To systematically identify and review food taxation policy changes in Pacific Island Countries and Territories (PICTs). DESIGN: Food taxation polices, regarding excise taxes and tariffs applied from 2000 to 2020 in twenty-two PICTs, and their key characteristics were reviewed. The search was conducted using databases, government legal repositories and broad-based search engines. Identified documents for screening included legislation, reports, academic literature, news articles and grey literature. Key informants were contacted from each PICT to retrieve further data and confirm results. Results were analysed by narrative synthesis. SETTING: Noncommunicable diseases (NCD) are the leading cause of premature death in PICTs and in many jurisdictions globally. An NCD crisis has been declared in the Pacific, and food taxation policy has been recommended to address the dietary risk factors associated with. Progress is unclear. RESULTS: Of the twenty-two PICTs included in the study, fourteen had food taxation policies and five introduced excise taxes. Processed foods, sugar and salt were the main target of excise taxes. A total of eighty-four food taxation policy changes were identified across all food groups. There was a total of 279 taxes identified by food group, of which 85 % were tariffs and 15 % were excise taxes. Individual tax rates varied substantially. The predominant tax design was ad valorem, and this was followed by volumetric. CONCLUSIONS: A quarter of PICTs have introduced food excise taxes from 2000 to 2020. Further excise taxes, specifically tiered or nutrient-specific designs, could be introduced and more systematically applied to a broader range of unhealthy foods.

Does structural form matter? A comparative analysis of pooled procurement mechanisms for health commodities.

INTRODUCTION: Pooled procurement can be seen as a collaboration initiative of buyers. Such mechanisms have received increased attention during the Covid-19 pandemic to improve access to affordable and quality-assured health commodities. The structural form of pooled procurement mechanisms ranges from a third-party organization that procures on behalf of its buyers to a buyer's owned mechanism in which buyers operate more collaboratively. However, little is known about how these types of pooled procurement mechanisms differ in terms of characteristics, implementation and developmental process. To fill this gap, we compared four pooled procurement mechanisms. Two buyer's owned mechanisms: the Organisation of the Eastern Caribbean States (OECS) and the Pacific Island Countries (PIC). And two third-party mechanisms: the Global Drug Facility (GDF) and the Asthma Drug Facility (ADF). METHODS: For this qualitative study, we used a multiple case-study design. The cases were purposefully selected, based on a most-similar case study design. We used the Pooled Procurement Guidance to collect data on individual cases and compared our findings between the case studies. For our analysis, we drew upon peer-reviewed academic articles, grey literature documents and 9 semi-structured interviews with procurement experts. RESULTS: Buyers within a buyer's owned mechanisms differ in procurement systems, financing structures, product needs and regulatory and legal frameworks. Therefore, buyers within such mechanisms require relative alignment on motivations, goals and operations of the mechanism. Our study showed that buyers' relative homogeneity of characteristics and their perceived urgency of the problems was particularly relevant for achieving that alignment. Third-party organization mechanisms require less alignment and consensus-building between buyers. To participate, buyers need to align with the operations of the third-party organization, instead of other buyers. Elements that were essential for the successful implementation and operation of such mechanisms included the procurement secretariat's ability to create local and global awareness around the problem, to induce political will to act upon the problem, to mobilize sufficient funding and to attract qualified staff. CONCLUSION: To successfully sustain pooled procurement mechanisms over time, key actors should drive the mechanism through continuous and reflexive work on stakeholder engagement, mobilization of funding and alignment of interests and needs.

Belt and road initiative and healthy silk road: an alternative path for Pacific island countries to participate in global public health governance.

Pacific island countries (PICs) located in a region with relatively insufficient capacity to respond to public health emergencies, establishing reliable public health cooperation is conducive to maintaining security and stability. The belt and road initiative (BRI) launched by China attempts to provide a novel form of international cooperation and has supported multi-channel investment and construction. This article elucidates the history of public health cooperation between China and PICs, as well as the current situation of the BRI in the field of public health and emphasizes that there are numerous constraints in the public health cooperation between China and PICs. Given the profound impact of COVID-19 on diplomatic strategies, gradual cooperation in the field of public health may be the initial exploration of the BRI in the PICs, but it also means that the initiative must deal with challenges from geopolitical competition and cultural differences.