CANINE HOOKWORM PRESENCE IN TONGATAPU, TONGA.

Dogs are common in Tonga, where they exist in a close relationship with humans as pets and guard dogs and often are free-roaming due to limited property fencing and the need to scavenge for food. Little is known about the health status of these dogs and the type and level of pathogens carried by them. In this study, blood and fecal samples were analyzed to identify the presence of endoparasites and determine packed cell volume (PCV) values for dogs in Tonga. The current data deficit in this area made it necessary to develop a methodology and collect preliminary data to assist with future research in Tonga. Fecal analysis revealed hookworm in 73% of dogs, primarily those 4-12 mo old. Hematologic evaluation revealed low to borderline low PCV in 87% of dogs. The zoonotic nature of some of the pathogens identified poses a public health risk, with a particular risk for children.

A study of Samoan, Tongan, Cook Island Maori, and Niuean infant care practices in the Growing Up in New Zealand study.

BACKGROUND: Despite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Maori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children. METHODS: Analysis comprised of data collected in 2009-2010 from 1089 Samoan, Tongan, Cook Islands Maori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants. RESULTS: Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing. CONCLUSION: The impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.

Human resources for health country profiles: Kingdom of Tonga

The Human Resources for Health Country Profiles: Kingdom of Tonga provides a comprehensive analysis of the health workforce in Tonga based on the latest information available on human resources. The document will serve as a baseline for projections and a guide for framing policies and strategies for the planning, management, development and distribution of the country’s health workforce, including the development of a new National Human Resources for Health Strategic Plan and implementation of Tonga’s Package of Essential Health Services.

Diversity and distribution of benthic dinoflagellates in Tonga include the potentially harmful genera Gambierdiscus and Fukuyoa.

Benthic dinoflagellates that can cause illness, such as ciguatera poisoning (CP), are prevalent around the Pacific but are poorly described in many locations. This study represents the first ecological assessment of benthic harmful algae species in the Kingdom of Tonga, a country where CP occurs regularly. Surveys were conducted in June 2016 in the Tongatapu island group, and in June 2017 across three island groups: Ha'apai, Vava'u, and Tongatapu. Shallow subtidal coastal habitats were investigated by measuring water quality parameters and conducting quadrat surveys. Microalgae samples were collected using either macrophyte collection or the artificial substrate method. Benthic dinoflagellates (Gambierdiscus and/or Fukuyoa, Ostreopsis, and Prorocentrum) were counted using light microscopy, followed by molecular analyses (real-time PCR in 2016 and high throughput sequencing (metabarcoding) in 2017) to identify Gambierdiscus and Fukuyoa to species level. Six species were detected from the Tongatapu island group in 2016 (G. australes, G. carpenteri, G. honu, G. pacificus, F. paulensis, and F. ruetzleri) using real-time PCR. Using the metabarcoding approach in 2017, a total of eight species (G. australes, G. carpenteri, G. honu, G. pacificus, G. cheloniae, G. lewisii, G. polynesiensis, and F. yasumotoi) were detected. Species were detected in mixed assemblages of up to six species, with G. pacificus and G. carpenteri being the most frequently observed. Ha'apai had the highest diversity with eight species detected, which identifies this area as a Gambierdiscus diversity 'hotspot'. Vava'u and Tongatapu had three and six species found respectively. Gambierdiscus polynesiensis, a described ciguatoxin producer and proposed causative agent of CP was found only in Ha'apai and Vava'u in 2017, but not in Tongatapu in either year. Ostreopsis spp. and Prorocentrum spp. were also frequently observed, with Prorocentrum most abundant at the majority of sites. In 2016, the highest number of Gambierdiscus and/or Fukuyoa cells were observed on seagrass (Halodule uninervis) from Sopu, Tongatapu. In 2017, the highest numbers of Gambierdiscus and/or Fukuyoa from artificial substrate samples were recorded in the Halimeda dominant habitat at Neiafu Tahi, Vava'u, a low energy site. This raised the question of the effect of wave motion or currents on abundance measurements from artificial substrates. Differences in detection were noticed between macrophytes and artificial substrates, with higher numbers of species found on artificial substrates. This study provides a baseline of benthic dinoflagellate distributions and diversity for Tonga that may be used for future studies and the development of monitoring programmes.

Effects of inappropriate cause-of-death certification on mortality from cardiovascular disease and diabetes mellitus in Tonga.

BACKGROUND: Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). METHODS: Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. RESULTS: Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/103 (95%CI: 3.0-3.7/103) versus 2.9/103 (95%CI: 2.6-3.2/103), and in women were 1.1/103 (95%CI: 0.9-1.3/103) versus 0.9/103 (95%CI: 0.8-1.1/103). Conversely, alternative diabetes mortality rates were significantly lower than the unaltered rates over 2001-18 in men (p < 0.0001) and women (p = 0.013); for 2010-18, these measures in men were 1.3/103 (95%CI: 1.1-1.5/103) versus 1.9/103 (95%CI: 1.6-2.2/103), and in women were 1.4/103 (95%CI: 1.2-1.7/103) versus 1.7/103 (95%CI: 1.5-2.0/103). Diabetes mortality rates increased significantly over 2001-18 in men (unaltered: p < 0.0001; alternative: p = 0.0007) and increased overall in women (unaltered: p = 0.0015; alternative: p = 0.014). CONCLUSIONS: Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.

Tonga national emergency medical team response to the 2022 Hunga Tonga-Hunga Ha'apai volcanic eruption and tsunami: the first deployment of the Tonga Emergency Medical Assistance Team (TEMAT).

Problem: The undersea Hunga Tonga-Hunga Ha'apai volcano erupted on 15 January 2022, causing a tsunami that affected Tonga as well as other countries around the Pacific rim. Tonga's international borders were closed at the time due to the coronavirus disease pandemic, but clinical surge support was needed to respond to this disaster. Context: Tonga's Ministry of Health formed the Tonga Emergency Medical Assistance Team (TEMAT) in 2018 to provide clinical care and public health assistance during disasters, outbreaks and other health emergencies. TEMAT was activated for the first time in January 2022 to respond to medical and public health needs following the eruption and tsunami. Action: On 16 January 2022, a five-person TEMAT advance team was deployed to conduct initial damage assessments and provide casualty care. Subsequently, TEMAT rotations were deployed to provide clinical care and public health support across the Ha'apai island group for over 2 months. Outcome: TEMAT deployed to the islands most affected by the volcanic eruption and tsunami within 24 hours of the event, providing emergency clinical, psychosocial and public health services across four islands. TEMAT reported daily to the Ministry of Health and National Emergency Management Office, providing critical information for response decision-making. All TEMAT actions were documented, and an after-action review was conducted following the deployment. Discussion: TEMAT's deployment in response to the 2022 volcanic eruption and tsunami highlighted the importance of national emergency medical teams that are prepared to respond to a range of emergency events.

Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands.

Globally, the child health focus has been on reducing under-5-year mortality, with large populations in low-resource regions prioritised. Children in older age groups, particularly in less populated regions such as the Pacific, have received limited attention. Child health research in the Pacific region has been lacking, and research approaches for the region have historically been from Western biomedical paradigms. We completed the study of primary school children's health over a period of 5 years. Firstly, we conducted a literature review, then we completed an audit of hospital admissions of primary school children, then we completed a two-round Delphi process and finally, we piloted the survey in three primary schools. Our results found there were high levels of oral health problems, ear health, obesity and exposure to violence and poverty impacting on the quality of health of primary school-age children. Identifying these indicators was made possible by the partnerships and trust established by the study team and provides specific and measurable targets for future work to improve the quality of child health outcomes. This paper describes key field work lessons learnt for research in the Pacific region. It must: (i) be on the platform of relationship, cultural safety and local ownership; (ii) include consideration of holistic Pacific paradigms of health; (iii) be adaptive to the context and environment; and (iv) be committed to long-term partnership and work.

Regional transportation and influence of atmospheric aerosols triggered by Tonga volcanic eruption.

A cataclysmic submarine volcano at Hunga Tonga-HungaHa'apai (HTHH) near Tonga, erupted violently on 15 January 2022, which injected a plume of ash cloud soaring into the upper atmosphere. In this study, we examined the regional transportation and potential influence of atmospheric aerosols triggered by HTHH volcano, based on active and passive satellite products, ground-based observations, multi-source reanalysis datasets and atmospheric radiative transfer model. The results indicated that about 0.7 Tg (1 Tg = 109 kg) sulfur dioxide (SO2) gas were emitted into stratosphere from the HTHH volcano, and were lifted to an altitude of 30 km. The regional averaged SO2 columnar content over the western Tonga increased by 10-36 Dobson Units (DU), and the mean aerosol optical thickness (AOT) retrieved from satellite products increased to 0.25-0.34. The stratospheric AOT values caused by HTHH emissions increased to 0.03, 0.20, and 0.23 on 16, 17, and 19 January, respectively, accounting for 1.5%, 21.9%, and 31.1% of total AOT. Ground-based observations also showed an AOT increase of 0.25-0.43, with the maximum daily average of 0.46-0.71 appeared on 17 January. The volcanic aerosols were remarkably dominated by fine-mode particles and posed strong light-scattering and hygroscopic abilities. Consequently, the mean downward surface net shortwave radiative flux was reduced by 2.45-11.9 Wm-2 on different regional scales, and the surface temperature decreased by 0.16-0.42 K. The maximum aerosol extinction coefficient was 0.51 km-1 appeared at 27 km, which resulted in an instantaneous shortwave heating rate of 1.80 Khour-1. These volcanic materials stayed stable in the stratosphere and completed one circle around the earth within 15 days. This would exert a profound influence on the energy budget, water vapor and ozone exchange in the stratosphere, which deserves to be further studied.

The Early Microbial Colonizers of a Short-Lived Volcanic Island in the Kingdom of Tonga.

The island of Hunga Tonga Hunga Ha'apai (HTHH) in the Kingdom of Tonga was formed by Surtseyan eruptions and persisted for 7 years before being obliterated by a massive volcanic eruption on 15 January 2022. Before it was destroyed, HTHH was an unparalleled natural laboratory to study primary succession on a newly formed landmass. We characterized the microbial communities found on the surface sediments of HTHH using a combination of quantitative PCR, marker gene sequencing, and shotgun metagenomic analyses. Contrary to expectations, photosynthetic cyanobacteria were not detected in these sediments, even though they are typically dominant in the earliest stages of primary succession in other terrestrial environments. Instead, our results suggest that the early sediment communities were composed of a diverse array of bacterial taxa, including trace gas oxidizers, anoxygenic photosynthesizers, and chemolithotrophs capable of metabolizing inorganic sulfur, with these bacteria likely sourced from nearby active geothermal environments. While the destruction of HTHH makes it impossible to revisit the site to conduct in situ metabolic measurements or observe how the microbial communities might have continued to change over time, our results do suggest that the early microbial colonizers have unique origins and metabolic capabilities. IMPORTANCE The volcanic island of Hunga Tonga Hunga Ha'apai in the Kingdom of Tonga represents a very rare example of new island formation and thus a unique opportunity to study how organisms colonize a new landmass. We found that the island was colonized by diverse microbial communities shortly after its formation in 2015, with these microbes likely originating from nearby geothermal environments. Primary succession in this system was distinct from that typically observed in other terrestrial environments, with the early microbial colonizers relying on unique metabolic strategies to survive on the surface of this newly formed island, including the capacity to generate energy via sulfur and trace gas metabolism.

Microplastic pollution in the intertidal and subtidal sediments of Vava'u, Tonga.

Plastic pollution research on a global scale intensified considerably in the current decade; however, research efforts in the South Pacific are still lagging. Here, we report on microplastic contamination of intertidal and subtidal sediments in the Vava'u archipelago, Tonga. While providing the first baseline data of its type in Tonga, the study also advances methods and adjusts them for low-budget research. The methods were based on density separation of microplastics from the sediment using CaCl2, a high-density salt which due to its high solubility, low cost and availability. Once separated, microplastics were quantified by microscopic analysis and polymers characterized via FTIR spectroscopy. Microplastics in intertidal and subtidal sediments were found in concentrations of 23.5 ± 1.9 and 15.0 ± 1.9 particles L-1 of sediment, respectively. The dominant type of microplastics in both intertidal (85 %) and subtidal sediments (62 %) were fibres.

Phonological encoding in Tongan: An experimental investigation.

This study is the first to report chronometric evidence on Tongan language production. It has been speculated that the mora plays an important role during Tongan phonological encoding. A mora follows the (C)V form, so /a/ and /ka/ (but not /k/) denote a mora in Tongan. Using a picture-word naming paradigm, Tongan native speakers named pictures containing superimposed non-word distractors. This task has been used before in Japanese, Korean, and Vietnamese to investigate the initially selected unit during phonological encoding (IPU). Compared with control distractors, both onset and mora overlapping distractors resulted in faster naming latencies. Several alternative explanations for the pattern of results-proficiency in English, knowledge of Latin script, and downstream effects-are discussed. However, we conclude that Tongan phonological encoding likely natively uses the phoneme, and not the mora, as the IPU.

Culture, church, and collective: a qualitative study about gambling harm prevention and reduction in Aotearoa/New Zealand-a Tongan male perspective.

BACKGROUND: In New Zealand, Pacific people continue to be more at risk of gambling harm than the general population, despite increasing public health efforts and treatment service provisions introduced to address this social and health issue. In looking at why this is so, our first concern was to ask why the delivery of the prevailing gambling-focussed programmes was not influencing Pacific gambling behaviours. In seeking to answer this question, it was important to explore ethnic-Pacific-specific factors of gambling harm prevention and reduction. METHODS: The research design was interpretivist/constructivist and phenomenological, applied through the lens of a Tongan worldview. Participants comprised Tongan male elders and youth. Recruitment of participants was through snowball sampling from churches and kava-drinking circles. A total of 28 elders and 18 youth participated through focus group talanoa and individual talanoa. This study employed descriptive thematic analysis. RESULTS: Participants were not aware of any policy document or problem-gambling preventative programmes. Four key themes were raised, which include raising the awareness of existing gambling harm treatment providers, the church influence in addressing gambling harm, community-based strategies, and cultural-based approaches. CONCLUSIONS: This study proposes several recommendations such as more awareness of gambling harm providers in community, increasing cultural spaces and church engagements, and calls for further research in addressing the prevention and reduction of gambling harm amongst the Tongan community in New Zealand.

Microplastic pollution in the surface waters of Vava'u, Tonga.

Marine plastic pollution, particularly microplastics, has been recognised as a global issue in the recent years, but research efforts in the Pacific are lagging. We carried out research on microplastics contamination of surface waters of the Vava'u archipelago, Tonga. Since microplastics smaller than the standard mesh size (333-335 µm) are readily reported in the literature on microplastics, we used a finer plankton net (100 µm) to determine the proportion of captured microplastics smaller than 300 µm. Isolated microplastics were counted and measured using stereomicroscope with polymer identification performed by FTIR spectroscopy. The analysis revealed high microplastics concentrations (329,299.7 ± 40,994.2 pcs km-2 or 1.05 ± 0.13 pcs m-3). The proportion of particles smaller than 300 µm was 40 %. The predominant type of microplastics in surface waters were small bits of white film, which we associated with cement-filled white bags used to construct docks throughout Vava'u, often heavily eroded.

The January 2022 eruption of Hunga Tonga-Hunga Ha'apai volcano reached the mesosphere.

Explosive volcanic eruptions can loft ash, gases, and water into the stratosphere, which affects both human activities and the climate. Using geostationary satellite images of the 15 January 2022 eruption of the Hunga Tonga-Hunga Ha'apai volcano, we find that the volcanic plume produced by this volcano reached an altitude of 57 kilometers at its highest extent. This places the plume in the lower mesosphere and provides observational evidence of a volcanic eruption injecting material through the stratosphere and directly into the mesosphere. We then discuss potential implications of this injection and suggest that the altitude reached by plumes from previous eruptions, such as the eruption of Mount Pinatubo in 1991, may have been underestimated because of a lack of observational data.

Multisystem inflammatory syndrome following mild COVID-19 in an unvaccinated Tongan adult.

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. We describe an illustrative case of MIS-A in an otherwise well, SARS-CoV-2 unvaccinated 25-year-old Tongan man who presented to hospital 30 days after mild COVID-19 illness. We highlight the progression of his illness, including treatment in the Intensive Care Unit (ICU) for cardiogenic shock, and detail temporal evolution of clinical, laboratory and radiographic features of his illness. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

The effectiveness of uloa as a model supporting Tongan people experiencing mental distress.

This article is based on a larger research project, which investigates the effectiveness of a culturally appropriate model, namely uloa, when working with Tongan people. Uloa is a communal method of fishing in Tonga, which includes all members of the community. A previous paper described the three phases of uloa: presenting the concept to health providers and community groups; phase two amended the model based on phase one. This paper reports on phase three and findings related to the increased awareness of uloa model within the mental health services and to raise awareness of how to work with Pacific people and adjust the health service to suit the needs of this population to test its effectiveness. Using reflexive thematic analysis, results highlighted a number of patterns both across the groups, described as napanapangamalie (harmony, balance), ngaue fakataha (working together/oneness), and toutai (fisher). These findings continue to support that the conventional biomedical approach employed in the mental health services overlooks elements of Tongan constructions of mental illness and the intersections between Tongan and biopsychosocial themes. Care that is based only on the 'medicine' rather than bringing the spiritual aspect into care planning (fake leaves) will not serve the needs of the Tongan community.

The wave blown around the world.

The atmospheric wave from the Tonga eruption drove faster-than-normal tsunamis.

Global fast-traveling tsunamis driven by atmospheric Lamb waves on the 2022 Tonga eruption.

On 15 January 2022, the Hunga Tonga-Hunga Ha'apai volcano erupted, producing tsunamis worldwide including first waves which arrived more than 2 hours earlier than what is expected for conventional tsunamis. We investigated the generation and propagation mechanisms of the tsunami "forerunner," and our simulation found that fast-moving atmospheric Lamb waves drove the leading sea height rise whereas the scattering of the leading waves related to bathymetric variations in the Pacific Ocean produced subsequent long-lasting tsunamis. Tsunamis arriving later than the conventionally expected travel time are composed of various waves generated from both moving and static sources, which makes the tsunami, due to this eruption, much more complex and longer-lasting than ordinary earthquake-induced tsunamis.

Atmospheric waves and global seismoacoustic observations of the January 2022 Hunga eruption, Tonga.

The 15 January 2022 climactic eruption of Hunga volcano, Tonga, produced an explosion in the atmosphere of a size that has not been documented in the modern geophysical record. The event generated a broad range of atmospheric waves observed globally by various ground-based and spaceborne instrumentation networks. Most prominent was the surface-guided Lamb wave (≲0.01 hertz), which we observed propagating for four (plus three antipodal) passages around Earth over 6 days. As measured by the Lamb wave amplitudes, the climactic Hunga explosion was comparable in size to that of the 1883 Krakatau eruption. The Hunga eruption produced remarkable globally detected infrasound (0.01 to 20 hertz), long-range (~10,000 kilometers) audible sound, and ionospheric perturbations. Seismometers worldwide recorded pure seismic and air-to-ground coupled waves. Air-to-sea coupling likely contributed to fast-arriving tsunamis. Here, we highlight exceptional observations of the atmospheric waves.