Climate variability and water-related infectious diseases in Pacific Island Countries and Territories, a systematic review

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

BackgroundHistorically, Pacific island countries and territories (PICTs) have been more severely affected by influenza pandemics than any other part of the world. We herein describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in PICTs from 2009 to 2010.MethodsThe World Health Organization gathered reports of influenza-like-illness and laboratory-confirmed pandemic H1N1 cases from all 23 Pacific island countries and territories, from April 2009 through August 2010. Data were gathered through weekly email reports from Pacific island countries and territories and through email or telephone follow-up.ResultsPacific island countries and territories started detecting pandemic H1N1 cases in June 2009, firstly in French Polynesia, with the last new detection occurring in August 2009 in Tuvalu. Nineteen Pacific island countries and territories reported 1,972 confirmed cases, peaking in August 2009. No confirmed pandemic H1N1 cases were identified in Niue, Pitcairn and Tokelau; the latter instituted strict maritime quarantine. Influenza-like-illness surveillance showed trends similar to surveillance of confirmed cases.Seven Pacific island countries and territories reported 21 deaths of confirmed pandemic H1N1. Case-patients died of acute respiratory distress syndrome or multi-organ failure, or both. The most reported pre-existing conditions were obesity, lung disease, heart disease, and pregnancy.Pacific island countries and territories instituted a variety of mitigation measures, including arrival health screening. Multiple partners facilitated influenza preparedness planning and outbreak response.ConclusionsPandemic influenza spread rapidly throughout the Pacific despite enormous distances and relative isolation. Tokelau and Pitcairn may be the only jurisdictions to have remained pandemic-free. Despite being well-prepared, Pacific island countries and territories experienced significant morbidity and mortality, consistent with other indigenous and low-resource settings.For the first time, regional influenza-like-illness surveillance was conducted in the Pacific, allowing health authorities to monitor the pandemic’s spread and severity in real-time.Future regional outbreak responses will likely benefit from the lessons learned during this outbreak.

BackgroundNon-Communicable Diseases (NCD) are the leading cause of death in the Pacific Island Countries and Territories (PICTs) accounting for approximately 70% of mortalities. Pacific leaders committed to take action on the Pacific NCD Roadmap, which specifies NCD policy and legislation. To monitor progress against the NCD Roadmap, the Pacific Monitoring Alliance for NCD Action (MANA) was formed and the MANA dashboard was developed. This paper reports on the first status assessment for all 21 PICTs.MethodsThe MANA Dashboard comprises 31 indicators across the domains of leadership and governance, preventive policies, health system response and monitoring processes, and uses a ‘traffic light’ rating scheme to track progress. The dashboard indicators draw on WHO’s best-buy interventions and track highly cost-effective interventions for addressing NCDs. The MANA coordination team in collaboration with national NCD focal points completed Dashboards for all 21 PICTs between 2017 and 2018 in an agreed process. The data were analysed and presented within each area of the MANA dashboard.ResultsThis assessment found that PICTs are at varying stages of developing and implementing NCD policy and legislation. Some policy and legislation are in place in most PICTs e.g. smoke free environment (18 PICTs), alcohol licensing (19 PICTs), physical education in schools (14 PICTs), reduction of population salt consumption (14 PICTs) etc. However, no PICTs has policy or legislation on tobacco industry interference, controlling marketing of foods and drinks to children, and reducing trans-fats in the food supply, and only 7 PICTs have policies restricting alcohol advertising. Eighteen PICTs implement tobacco taxation measures, however only five were defined as having strong measures in place. Nineteen PICTs have alcohol taxation mechanisms and 13 PICTs have fiscal policies on foods to promote healthier diets.ConclusionThis baseline assessment fills a knowledge gap on current strengths and areas where more action is needed to scale up NCD action in a sustained ‘whole of government and whole of society approach’ in PICTs. The findings of this assessment can be used to identify priority actions, and as a mutual accountability mechanism to track progress on implementation of NCD policy and legislation at both national and Pacific level.

BackgroundComprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable.MethodsFrom January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a ‘traffic light’ (present, in progress, not present) matrix. Each PICT’s overall status in achieving IPC core components was summarised using descriptive statistics.ResultsFifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records.ConclusionsIdentifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR.

Knowledge gaps in ecotoxicology studies of marine environments in Pacific Island Countries and Territories – A systematic review

Introduction: Alcohol has become embedded into the cultural, economic, and social fabric of Pacific Island Countries and Territories (PICT); however, it continues to be a neglected health issue for many PICT. This scoping literature review explores current alcohol advertising policies in each PICT.
 Methods: This review utilises the 'Preferred Reporting Items for Systematic Review and Meta-Analyses for Scoping reviews' to identify literature on alcohol advertising policies. Twenty-five sources, ranging from 1963 to 2020, form the final data synthesis.
 Findings: The results of this review reveal that not all PICT have alcohol advertising restrictions in place. Health warning labels as a means of deterring alcohol use are also inconsistent across PICT but aid in consumer decisions. A notable concern in alcohol advertising is the use of culture as a marketing ploy.
 Conclusion: This review provides essential information on alcohol advertising in PICT. Nine PICT enforce some form of alcohol advertising prohibition, and ten do not. In countries with alcohol advertising, drinking behaviours vary, demonstrating a need for further research on the implementation efforts of current policies. In countries with no alcohol advertising, alcohol use is normalised and portrayed as unproblematic. The use of health warning labels is also not consistent amongst PICT. The use of culture as a marketing ploy is unacceptable as it belittles culture and is disrespectful to leaders. Understanding the alcohol advertising restrictions that work in each PICT can help decrease alcohol consumption and the harms associated with its misuse across all PICT.
 Keywords: Alcohol, Advertising, Pacific.

Background: Like other LMICs, many Pacific Island countries and territories (PICTs) have fragile and overburdened health systems with which to combat an increasing burden of cancer. Additionally, a combination of small geographically dispersed populations, limited resources, isolation and frequent natural disasters make cancer control in Pacific Islands also significantly different to elsewhere in the world. No prior work has provided a stocktake of current capacity for diagnosis and treatment of cancer across the region to date. Aim: To describe the specialized health services available for cancer control in the Pacific region, and show the complexity associated with accessing cancer care for Pacific Islanders. Methods: A cross-sectional review of medical services and human resources available for cancer control was undertaken for 21 Pacific Community (SPC) member countries and territories in April-May 2018 , specifically diagnosis (pathology and radiology) and treatment (chemotherapy, radiotherapy and surgical modalities and overseas referrals for services not available on-island) by contacting individual countries and territories. Common travel routes were mapped individually for 4 PICTs; Papua New Guinea, Solomon Islands, Kiribati and Tokelau; as examples of the unique challenges faced by rural dwelling Pacific Islanders when accessing the highest level of care available in-country. Results: Capacity for cancer diagnosis and care is extremely limited in the Pacific region. The exceptions are the 2 French territories (French Polynesia and New Caledonia) and Guam where a near full complement of services for diagnosis and treatment are operational. Some pathology services are generally available in the larger PICTs, while specimens are sent to affiliated off island laboratories for the rest. Plain x-ray and ultrasound are available at 1 or more locations in all PICTs. General and gynecologic surgery is the most widespread treatment modality available. Some to full chemotherapy administered in 7 and radiotherapy in 3 (formerly 4) PICTs. Overseas referrals for medical services not available in-country are a common feature to all PICTs health systems. A need to travel long distances to access health care is a challenged faced by Pacific Islanders on outer islands and rural villages. Examples will be presented. Conclusion: Cancer control services are few and far between in the Pacific region, and PICTs will always likely rely on overseas referrals for care not available. Access barriers exist for those on outer islands and in villages, and an unknown number seek treatment late or not at all for these reasons. Governments need to invest into strengthening primary and secondary care services, making them an option that is more easily accessible to remote populations. Collaboration between transport and health sectors to look at ways to improve frequency, regulation and safety of modes of transportation to outer islands to improve current systems.

By the middle of February 2021, the COVID-19 pandemicsCovid-19 are still ongoing. Globally, 110 million cases have been recorded. More than 2.4 million people have died from the disease caused by the novel SARS-CoV-2 virus. Figures presented in this chapter are taken from the WHO database (WHO 2021), except those from Hawai’i (New York Times database 2021) and Easter Island (France24 2021). All currencies have been converted into USD using Oanda database (Oanda 2020) as of February 9, 2021. In many Pacific Island Countries and Territories (PICT), however, morbidityMorbidity and mortalityMortality have been low. Most PICs have no cases. Where cases exist, mortalityMortality has been low with a few exceptions. That being said, social and economic consequencesEconomic consequences are severe in all places. The chapter gives a brief reflection on historical experience with epidemics in the Pacific Island region. The remainder of the chapter looks at the epidemiologyEpidemiology of the COVID-19Covid-19 pandemicsPandemic, the “who, when, and where” of COVID-19 in the Pacific Islands, its associated risk factors, and possible ways to controlControl the pandemicsPandemic. Medical preparednessPreparedness of PICT health systemsHealth systems in PICTs, and their material and organizational constitution are covered as well as the support PICT received from outside to deal with the situation. The chapter also provides an account of social and economic impactsEconomic impacts of COVID-19Covid-19, including challenges to care for Pacific Islanders away from home. SomeFiji PICs (Fiji, Solomon Islands, Tonga, and Vanuatu) Solomon Islands had to deal with severe tropical cyclones just at the time when governments tried to implement measures against COVID-19Covid-19. To conclude, the chapter provides recommendations of how to strengthen PICT capabilities and capacities to improve preparednessPreparedness against similar medical treats in the future. In the chapter, FijiFiji and Papua New Guinea (PNG) stand inPapua New Guinea (PNG) the center of analysis. Some other Pacific Islands and Territories were included, where reported cases emerged and/or where important situations arose. In a few instances, the chapter also looks at the situation Pacific Islanders faced outside their countries.

UN Sustainable Development Goal (SDG) 2: Zero Hunger links ending hunger to achieving food security, improving nutrition, and promoting sustainable agriculture. The Pacific Island Countries and Territories (PICTs) is a region where such linkages can be investigated as the PICTs are confronting climate change while facing a decrease in available arable land and increasing rates of urbanisation. Around 80% of all Pacific Islanders still rely on agricultural produce from their own gardens or from small holder farmers to support or to supplement their diets. The Food and Agriculture Organisation (FAO) has declared the years 2019–2028 to be the Decade of Family Farming. Food imports are increasingly common in PICTs, and can provide cheap, although not particularly nutritious foods, leading to generalised health problems. Increased reliance on imports is itself an indicator of diminishing food security, and with the PICTs facing a range of food security challenges, it is timely to assess the existing literature in the PICTs on the relationship between smallholder farming and food security. This scoping review analyses 49 peer reviewed and grey literature studies in English from 1970–2019 concerning the relationship between food security and small holder farming in the PICTs. It identifies four main themes: (1) Community adaptation, resilience and crop diversification; (2) Decreased availability of local foods and land; (3) Changes in diet; (4) Gender and agricultural production. The review shows Pacific peoples quickly adapt to changing circumstances to plant different crops both for food and for sale, and it identifies the role of small holder agriculture as crucial to: (1) growing local foods to support food security, and (2) expanding domestic asset creation to promote economic development, especially for women.

Pacific Island Countries and Territories (PICTs) are experiencing a Diet-Related Non-Communicable Disease (DR-NCD) health crisis(1). Increasing rates of DR-NCDs such as Type 2 diabetes and cardiovascular disease have been linked to dietary transitions and increasing food insecurity in the region(2). Anthropogenic climate change has also been identified as a significant threat to food security in PICTs(3). Additionally, the impacts of the COVID-19 Pandemic have been identified as both a contributor to food insecurity in the region and as an opportunity to transform PICT food systems and reduce rates of DR-NCDs(4). Yet, the drivers of dietary change, food security and agricultural practices in peripheral PICT communities are not well documented or understood. To determine how these drivers may change in the future and the impacts this may have on Pacific peoples, a deeper understanding of the historical and contemporary drivers of change is necessary. The aim of this scoping review was to collate existing information to improve this understanding, by mapping key factors evident in the literature that underpin the links between DR-NCDs and food security with a focus on women in PICT peripheral communities, to better clarify the challenges, working definitions and conceptual boundaries in the research area. The review maps where research has been conducted geographically and how the links between DR-NCDs and food security in PICTs have been investigated over time and identifies projections and suggestions for the future. The scoping review was conducted in accordance with a pre-defined protocol available online(5). A total of 476 peer-reviewed sources and 126 grey literature sources were identified by the initial search criteria. Two independent researchers completed title/abstract and full text screening using Covidence, and data extraction using a data extraction tool. The resulting data was quantified in table format, with common themes and ideas presented qualitatively. Sources spanned all sectors of PICT food systems with a heavy focus on production from fisheries and agriculture. Most PICTs were represented in the findings. Many drivers of change within food systems were identified, some of which included the impacts of anthropogenic climate change, the COVID-19 pandemic, and urbanisation. The drivers impacted all four pillars of food security, and many were directly or indirectly related to dietary and lifestyle changes associated with DR-NCD risk factors. This data is accompanied by an interpretation of results and a narrative summary. These results provide a useful platform to further explore the drivers of dietary change, food security, agricultural practices and DR-NCD’s in this region.

Water, sanitation and hygiene (WASH) systems in schools contribute to successful education by promoting good health and supporting school attendance. Girl students and students with disability face significant challenges when there are inadequate WASH systems. Pacific Island Countries and Territories (PICTs) have some of the lowest levels of improved WASH systems on earth. The aim of this review was to document the characteristics and effectiveness of approaches to improve WASH systems that promote the health and education of girl students, and students with disability in PICTs. This systematic scoping review comprehensively searched peer-reviewed and grey literature about WASH, PICTs, schoolgirls and students with disability. At best, there are only fleeting mentions in the grey literature about WASH and disability in schools in PICTs. Inclusion and exclusion criteria resulted in 12 publications being included: 1 review; 7 original research; 4 commentaries/project reports. A holistic approach to WASH in schools in PICTs must consider how the entire school WASH system can be inclusive of girls and children with disability. Incorporating local PICT learning epistemologies (ways of knowing) and local PICT pedagogies (ways of learning) are required to ensure new WASH systems reduce existing inequalities for girls and students with disability.

BackgroundOverweight, obesity and their consequences are challenges to sustainable social and economic development in Pacific island countries and territories (PICTs). Complementing previous analyses for adults, the purpose of this paper is to synthesise available data on overweight, obesity and their risk factors in adolescents in the region. The resulting Pacific perspective for the younger generation will inform both the national and regional public health response to the crisis of noncommunicable diseases.MethodsWe examined the prevalence of overweight, obesity, physical activity and carbonated sugar-sweetened beverage (SSB) consumption, by using published results of two cross-sectional surveys: the Global School-Based Student Health Survey (GSHS) and the Youth Risk Behavior Surveillance System (YRBSS). GSHS was conducted in ten PICTs between 2010 and 2013 and provided results for 13–15 year olds. YRBSS surveys, conducted repeatedly in five PICTs between 1999 and 2013, provided results for grade 9–12 students (approximately 14–18 years) and enabled examination of trends.ResultsObesity prevalence ranged from 0 % in female students in Vanuatu to 40 % in males in Niue (GSHS). Among grade 9–12 students (YRBSS), obesity was highest in American Samoa (40 % of males; 37 % of females). Approximately 60 % of students in the Cook Islands, Niue and Tonga (GSHS) and American Samoa (YRBSS), were overweight. In both surveys, less than half of students reported engaging in sixty minutes of physical activity on at least 5 days of the past week. Daily consumption of carbonated SSBs in the past month was reported by over 42 % of students in six PICTs (GSHS), and in the past week by more than 18 % of students in three PICTs (YRBSS). In PICTs conducting YRBSS, obesity prevalence remained high or increased within the period 1999–2013.ConclusionThere is a need for urgent action on overweight, obesity and their risk factors in Pacific youth. The multiple social, economic and physical determinants of this public health crisis must be addressed. This requires all sectors within government and society in PICTs to implement and evaluate policies that will protect and promote the health of their populations across the life course.

A generalized epidemic of HIV infection has been evolving in Papua New Guinea over the last decade, whereas in other Pacific Island countries and territories (PICT) HIV transmission has generally been less widespread. Programmes to detect HIV infection in pregnant women and to prevent mother to child transmission (MTCT) during either delivery or breast-feeding can decrease the incidence of infection in infants. The limited health infrastructure present in some PICT may delay the implementation of effective programmes to decrease MTCT of HIV. We used a standardized questionnaire to survey health-care providers in 22 PICT for information on the epidemiology of HIV infection and strategies used during 2004 to prevent MTCT of HIV infection in their country. We supplemented these survey responses with data obtained from regional organizations supporting national responses to HIV. We obtained responses from 21 PICT. The reported prevalence of known HIV infection was >150 per 100 000 persons in Papua New Guinea, approximately 100 per 100 000 persons in French Polynesia, Guam, New Caledonia and Tuvalu and <50 per 100 000 persons in the remaining 14 PICT. Other than in Papua New Guinea, where an estimated 500 pregnant women had HIV infection diagnosed in 2004, reported HIV infection among pregnant women was rare. Ten PICT reported that an HIV antibody test was offered as a routine component of antenatal care and 11 reported that antiretroviral medications were available for the prevention of MTCT of HIV infection. The prevalence of HIV infection differs greatly between PICT with a varying risk of MTCT of HIV infection. Successful prevention of MTCT of HIV infection throughout the PICT will require improved uptake of antenatal HIV antibody testing and better access to antiretroviral medications.

To systematically identify and review food taxation policy changes in Pacific Island Countries and Territories (PICTs). 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. 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. 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. 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.

Climate change affects weather patterns, leading to changes in average temperatures, increased frequency, variability, and intensity of extreme weather events, especially in the Pacific Island countries. Climate change poses the greatest threats to the sustainability of smallholder dairy farming in Fiji, with the farmers being highly vulnerable, yet their adaptive capacity is low. Additionally, the Pacific’s current and future sustainable livestock development will heavily depend on its ability to cope with climate variability and adapt to future climate changes. Available data indicate that there is high spatial and temporal variability of rainfall over Fiji Island with the mean annual rainfall ranging from 1600 to 3600 mm, with Rotuma station receiving the highest rainfall over Fiji Island. Rainfall in Fiji has shown an increasing and decreasing trend, where both minimum and maximum temperatures have shown a decreasing trend. This will have a great impact on the smallholder dairy farmers who consist of over 95% of the existing farmers. Using available information and drawing from other contexts or countries where data or information is unavailable, we provide an overview of dairy production in Fiji as a prototype to other Pacific Island Countries and Territories (PICTs), highlighting smallholder dairy systems in the Fijian dairy sector, challenges, and opportunities of the dairy sector in the PICTs. We conclude that climate change significantly impacts dairy production in Fiji and the Pacific.