Hospitals In Fiji Research Articles

Factors Predicting the Quality of Care Among Nurses in Tertiary Hospitals in Fiji: A Cross-sectional Study

Quality of care by nurses is a key factor in determining the success of healthcare delivery around the globe, which is impacted by a shortage of nurses, excessive workloads, and unfavorable working conditions, including in the Republic of Fiji Islands. Using the Quality Health Outcome Model, this descriptive-predictive, cross-sectional study examined the quality of care and its predictors among 744 Fijian registered nurses from three tertiary hospitals. Instruments for data collection were the Demographic Data Sheet, the Quality of Care Scale, the Participation in Decision Making Scale, the Relational Coordination Survey, the Perception of Organizational Change Scale, the Job Satisfaction Scale, and the Organizational Commitment Questionnaire. Descriptive statistics and logistic regression analysis were applied to analyze the data. This study’s findings are informative and offer a glimmer of hope since 72.58% of participants perceived the overall quality of care as good/excellent, indicating a positive baseline. Two factors, relational coordination and job satisfaction, significantly affected the perception of the quality of care. The study model explained 8.90% of the variance in quality of care, with relational coordination being the strongest predictor. These findings provide a clear path to improvement. A comprehensive model should be developed and tested to better understand the factors predicting Fiji’s quality of care before it can be used to design an effective intervention. Developing nursing skills, improving good communication and work environments, and providing high-quality education and training among nurses can significantly improve the quality of care. In addition, support from the government for appropriate medical equipment, recruitment and retention strategies for nurses, and promotion of standard of care from the Ministry of Health and Medical Services are recommended to enhance the quality of care, further bolstering this hopeful outlook. Further Fijian nursing research is clearly needed on this topic in the future.

Understanding Fijian health system challenges in the prevention of mother-to-child transmission of HIV services in the three tertiary hospitals in Fiji

ABSTRACT Mother-to-child transmission is the most common route of human immunodeficiency virus transmission in children, which could be prevented with proper treatment and access to care. Health system challenges can impede the effectiveness of prevention of mother-to-child transmission (PMTCT) programmes. We aim to understand the health system challenges to the provision of PMTCT services for pregnant women in three tertiary hospitals in Fiji. Data were collected using in-depth interviews in the three tertiary hospitals and associated health clinics in Fiji between April–May 2013 and February–March 2014. Ethical approvals were obtained. A total of 58 healthcare providers were interviewed including doctors (n = 12), midwives (n = 19), nurses (n = 14), laboratory technicians (n = 5) and counsellors (n = 8). The data were analysed using thematic analysis. We found that the healthcare workers faced a wide range of health system challenges including institutional and human resource challenges. Staff shortage, limited PMTCT training and shortage of supplies were barriers to the quality of PMTCT services. Our findings would be useful in developing strategies to overcome barriers as it would be imperative in improving the quality of PMTCT service provision in Fiji and other similar settings.

Molecular and clinical epidemiology of carbapenem resistant Acinetobacter baumannii ST2 in Oceania: a multicountry cohort study

Carbapenem resistant Acinetobacter baumannii (CRAb) is categorised by the World Health Organization (WHO) as a pathogen of critical concern. However, little is known about CRAb transmission within the Oceania region. This study addresses this knowledge gap by using molecular epidemiology to characterise the phylogenetic relationships of CRAb isolated in hospitals in Fiji, Samoa, and other countries within the Oceania region including Australia and New Zealand, and India from South Asia. In this multicountry cohort study, we analysed clinical isolates of CRAb collected from the Colonial War Memorial Hospital (CWMH) in Fiji from January through December 2019 (n=64) and Tupua Tamasese Mea'ole Hospital (TTMH) in Samoa from November 2017 through June 2021 (n=32). All isolates were characterised using mass spectrometry, antimicrobial susceptibility testing, and whole-genome sequencing. For CWMH, data were collected on clinical and demographic characteristics of patients with CRAb, duration of hospital stay, mortality and assessing the appropriateness of meropenem use from the treated patients who had CRAb infections. To provide a broader geographical context, CRAb strains from Fiji and Samoa were compared with CRAb sequences from Australia collected in 2016-2018 (n=22), New Zealand in 2018-2021 (n=13), and India in 2019 (n=58), a country which has close medical links with Fiji. Phylogenetic relationships of all these CRAb isolates were determined using differences in core genome SNPs. Of CRAb isolates, 49 (77%) of 64 from Fiji and all 32 (100%) from Samoa belonged to CRAb sequence type 2 (ST2). All ST2 isolates from both countries harboured blaOXA-23, blaOXA-66 and ampC-2 genes, mediating resistance to β-lactam antimicrobials, including cephalosporins and carbapenems. The blaOXA-23 gene was associated with two copies of ISAba1 insertion element, forming the composite transposon Tn2006, on the chromosome. Two distinct clusters (group 1 and group 2) of CRAb ST2 were detected in Fiji. The first group shared common ancestral linkage to all CRAb ST2 collected from Fiji's historic outbreak in 2016/2017, Samoa, Australia and 54% of total New Zealand isolates; they formed a single cluster with a median (range) SNP difference of 13 (0-102). The second group shared common ancestral linkage to 3% of the total CRAb ST2 isolated from India. Fifty eight of the 64 patients with CRAb infections at the CWMH had their first positive CRAb sample collected 72h or more following admission. Meropenem use was deemed inappropriate in 15 (48%) of the 31 patients that received treatment with meropenem in Fiji. Other strains of CRAb ST1, ST25, ST107, and ST1112 were also detected in Fiji. We identified unrecognised outbreaks of CRAb ST2 in Fiji and Samoa that linked to strains in other parts of Oceania and South Asia. The existence of Tn2006, containing the blaOXA-23 and ISAba1 insertion element, within CRAb ST2 from Fiji and Samoa indicates the potential for high mobility and dissemination. This raises concerns about unmitigated prolonged outbreaks of CRAb ST2 in the two major hospitals in Fiji and Samoa. Given the magnitude of this problem, there is a need to re-evaluate the current strategies used for infection prevention and control, antimicrobial stewardship, and public health measures locally and internationally. Moreover, a collaborative approach to AMR surveillance within the Oceania region with technical, management and budgetary support systems is required to prevent introduction and control transmission of these highly problematic strains within the island nation health systems. This project was funded by an Otago Global Health Institute seed grant and Maurice Wilkins Centre of Research Excellence (CoREs) grant (SC0000169653, RO0000002300).

Cost analysis and critical success factors of the use of oxygen concentrators versus cylinders in sub-divisional hospitals in Fiji

BackgroundOxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide.MethodsData sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars.ResultsCritical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost.ConclusionIntroducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.

The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji

BackgroundIn 2012, Fiji became the first independent Pacific island country to introduce rotavirus vaccine. We describe the impact of rotavirus vaccine on all-cause diarrhoea admissions in all ages, and rotavirus diarrhoea in children <5 years of age. MethodsAn observational study was conducted retrospectively on all admissions to the public tertiary hospitals in Fiji (2007–2018) and prospectively on all rotavirus-positive diarrhoea admissions in children <5 years at two hospital sites (2006–2018, and 2010–2015), along with rotavirus diarrhoea outpatient presentations at one secondary public hospital (2010–2015). The impact of rotavirus vaccine was determined using incidence rate ratios (IRR) of all-cause diarrhoea admissions and rotavirus diarrhoea, comparing the pre-vaccine and post-vaccine periods. All-cause admissions were used as a control. Multiple imputation was used to impute missing stool samples. FindingsAll-cause diarrhoea admissions declined among all age groups except among infants ≤2 months old and adults ≥55 years. For children <5 years, all-cause diarrhoea admissions declined by 39% (IRR)=0•61, 95%CI; 0•57–0•65, p-value<0•001). There was an 81% (95%CI; 51–94%) reduction in mortality among all-cause diarrhoea admissions in children under <5 years. Rotavirus diarrhoea admissions at the largest hospital among children <5 years declined by 87% (IRR=0•13, 95%CI; 0•10–0•17, p-value<0•001). Among rotavirus diarrhoea outpatient presentations, the IRR was 0•39 (95%CI; 0•11, 1.21, p-value=0.077). InterpretationsMorbidity and mortality due to rotavirus and all-cause diarrhoea in Fiji has declined in people aged 2 months to 54 years after the introduction of the RV vaccine. FundingSupported by WHO and the Australian Government.

Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumonia hospital admissions in Fiji: a time-series analysis

In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction. We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data. Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months. The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region. Department of Foreign Affairs and Trade of the Australian Government.

Paediatric Osteomyelitis in Fiji.

Osteomyelitis can lead to significant morbidity and long-term disability if early treatment is not initiated in a timely manner. For developing countries this can lead to a significant burden on the healthcare system. This study aims to describe the demographic variables, aetiology and outcomes of treatment and to calculate the incidence of paediatric osteomyelitis in Fiji. The micro-organism profile and the outcomes for treatment were analysed. This is a retrospective review of medical records of all paediatric patients presenting to hospitals in Fiji over a 5-year period (2006-2010) with a diagnosis of osteomyelitis. Data were collected from the three divisional hospitals in Fiji (Colonial War Memorial Hospital, Lautoka Hospital and Labasa Hospital). Two hundred and twenty patients were identified. An annual incidence of 18.1 cases/100,000 paediatric population was identified. The highest incidence was in the itaukei (ethnic Fijian) population (21 cases/100,000). Males were at a higher risk of developing osteomyelitis (20.8/105 vs. 10.7/105). Staphylococcus Aureus was identified in 86% of all positive blood and 81% of all positive pus cultures, and it was sensitive to cloxacillin in 100% of cases. The most common factor identified preceding the development of osteomyelitis was trauma (55%) followed by skin sepsis (32%). Fifty-four per cent of the cases had chronic osteomyelitis, and the most common mode of presentation was in the form of an abscess (48%) followed by sinus/sequestrum (24%). The age group most commonly affected was between 5 and 9years of age (19.6/105). Children with chronic osteomyelitis were more likely to require operative intervention in addition to antibiotics as compared to acute osteomyelitis (85 vs. 24%). The success rate of treating acute osteomyelitis was 92% compared to 61% for chronic osteomyelitis. Paediatric osteomyelitis poses a significant problem in Fiji, especially in the male, ethnic Fijian population between 5 and 9years of age. The chance of complete resolution after treatment of acute osteomyelitis is very good. Therefore, interventions aimed at early diagnosis and treatments are required.

Occupational Stress and Burnout among Surgeons in Fiji

This study examined the levels of occupational stress and burnout among surgeons in Fiji. A document set comprising a cover letter; a consent form; a sociodemographic and supplementary information questionnaire; the Maslach Burnout Inventory (MBI); the 12-item General Health Questionnaire (GHQ-12); the Alcohol Use Disorders Identification Test (AUDIT); and the Professional Quality of Life (ProQOL) questionnaires were provided to surgeons from three public divisional hospitals in Fiji. Thirty-six of 43 (83.7%) invited surgeons participated in the study. According to their MBI scores, surgeons suffered from low (10, 27.8%), moderate (23, 63.9%), and high (3, 8.3%) levels of burnout. Comparatively, 23 (63.9%) demonstrated moderate burnout according to their ProQOL scores. Substantial psychiatric morbidity was observed in 16 (44.0%) surgeons per their GHQ-12 scores. Consumption of alcohol was noted in 29 (80.6%) surgeons, and 12 (33.4%) had AUDIT scores characterizing their alcohol use in excess of low-risk guidelines or as harmful or hazardous drinking. Surgeons of Fijian nationality showed higher MBI emotional exhaustion and depersonalization scores compared with surgeons of other nationalities. Surgeons with an awareness of the availability of counseling services at their hospitals showed low AUDIT and ProQOL burnout scores. Smokers, alcohol drinkers, and kava drinkers showed higher AUDIT scores. This study highlights a level of occupational stress and burnout among surgeons in Fiji and a lack of awareness of their mental and physical well-being. The authors recommend that occupational stress and burnout intervention strategies be put in place in hospitals in Fiji.

Typhoid fever in Fiji: a reversible plague?

The country of Fiji, with a population of approximately 870 000 people, faces a growing burden of several communicable diseases including the bacterial infection typhoid fever. Surveillance data suggest that typhoid has become increasingly common in rural areas of Fiji and is more frequent amongst young adults. Transmission of the organisms that cause typhoid is facilitated by faecal contamination of food or water and may be influenced by local behavioural practices in Fiji. The Fijian Ministry of Health, with support from Australian Aid, hosted a meeting in August 2012 to develop comprehensive control and prevention strategies for typhoid fever in Fiji. International and local specialists were invited to share relevant data and discuss typhoid control options. The resultant recommendations focused on generating a clearer sense of the epidemiology of typhoid in Fiji and exploring the contribution of potential transmission pathways. Additionally, the panel suggested steps such as ensuring that recommended ciprofloxacin doses are appropriate to reduce the potential for relapse and reinfection in clinical cases, encouraging proper hand hygiene of food and drink handlers, working with water and sanitation agencies to review current sanitation practices and considering a vaccination policy targeting epidemiologically relevant populations.

Comparing the Occurrence of Oral Squamous Cell Carcinoma in New Zealand and the Fiji Islands from 2000-2010

Introduction: Despite numerous studies on the prevalence of oral squamous cell carcinoma in geographically diverse populations, no detailed data analysis has been carried out in the Fiji Islands. The most recent analysis of oral cancer in New Zealand was published in 1995. Aim: To determine the occurrence of OSCC in New Zealand and the Fiji Islands from 2000-2010. Method: Data on oral squamous cell carcinoma in New Zealand and the Fiji Islands were obtained from the Cancer Registers of both countries, the Oral Pathology Diagnostic Service of the University of Otago and Histology Departments at the three Divisional Hospitals in Fiji. Results: In the 11-year period under examination, a total of 1916 cases of oral squamous cell carcinoma were recorded in New Zealand and 124 in the Fiji Islands. The annual age standardized incidence rate for oral squamous cell carcinoma in New Zealand was 4.2 per 100,000 persons in comparison to the Fiji Islands where a rate of 1.3 per 100,000 persons was recorded. The male to female ratio for New Zealand was 1.85:1 and 1:1 for the Fiji Islands. Conclusion: There was a low occurrence of oral squamous cell carcinoma in the Fiji Islands compared to New Zealand.

Epidemiological differences in oral squamous cell carcinoma in New Zealand and fiji

<h3>Background</h3> Oral squamous cell carcinoma (OSCC) is the sixth most common cancer in the world and is a severely debilitating disease. The aim of this research was to compare demographic characteristics and risk factors of oral cancer in New Zealand and the Fiji Islands between 2000-2010. <h3>Methods</h3> The data were obtained from the Cancer Registries of NZ and Fiji, Medlab Dental Oral Pathology Diagnostic Services (University of Otago) and from the Histology departments at the three main referral hospitals in Fiji. <h3>Results</h3> There were 1916 cases of OSCC in NZ in the study period and 124 in Fiji, which accounted for 89% of all oral malignancies in NZ and 93% in Fiji. The annual age standardised incidence rate for New Zealand and Fiji was 4.2 and 1.3 per 100,000 persons, respectively. Similar numbers of males and females developed oral cancer in Fiji and their mean age was 57 years. In New Zealand, more men suffered from this disease (mean age of 63 years). Tongue cancer was the most common site of involvement in both countries. <h3>Conclusion</h3> There was a low prevalence of OSCC in Fiji compared to NZ. Tongue cancers were most common in both countries. Early detection and diagnosis is paramount to improve survival rates.

Patient perception of healthcare services in Fiji: analysis of functional and psychological dimensions

Government run hospitals in Fiji are not well equipped in terms of facilities, specialist doctors, nurses and various specialised medical supplies. For government-run hospitals in Fiji, the real measure of success is that of patient satisfaction delivered across all areas of hospitals and through the services delivered. Present research measures the customers’ perception of healthcare service delivery in government-run hospitals of Fiji. The study uses the functional and psychological dimensions of customers’ perception and satisfaction as the basis for formulating a strategy for delivering healthcare services more effectively, efficiently and to the best of customer/patient satisfaction. The study revealed that there is a positive relationship between the satisfaction variables, with a strong significant correlation existing between the ‘operational quality’ with ‘nursing care’ factors, indicating that when patients are satisfied with the operational services the quality of nursing is generally considered to be satisfactory.

Healthcare service delivery and customer satisfaction: insight from government hospitals in Fiji

This paper seeks to examine the healthcare service delivery and customer satisfaction in Fiji. This study uses the functional and psychological dimensions of customers' satisfaction as the basis for formulating a strategy for delivering healthcare services to the best of customer/patient's satisfaction. The study revealed that there is a positive relationship between the satisfaction variables, with a strong significant correlation existing between the 'operational quality' and 'nursing care' factors, indicating that when patients are satisfied with the operational services the quality of nursing is generally considered to be satisfactory. There was also a relatively strong significant correlation between the 'operational services' and 'physician care' factors, suggesting that the presence of operational services influences the satisfaction level of the 'physician care'.

Differences in health-promotion behaviour among the chronically ill in three South Pacific island countries

In this study, the Health Promoting Lifestyle Profile was used to compare health-promoting behaviours in three groups of chronically ill people being treated as outpatients at clinics and hospitals in Fiji, Nauru, and Kiribati. Significant differences were found between males and females and among groups in relation to practices and attitudes towards health responsibility, physical activity, nutrition, and stress management. Health professionals and educators must develop ways to transmit the message of healthy lifestyles to populations that do not pay much attention to conventional health-education methods.

A study on medical behavior in Fiji. On the illness behavior.

Study on medical behavior is one of the useful approaches to examine the relationship of individual health-related motivations to utilization of selective health services. And also, Abernathy et al.(1972) emphasised an ability to determine the factors influencing an individual's decision to seek care would be an important contribution to the management of primary care facilities and removal of barriers that deny certain portions of a population access to care. The medical behavior consists of three kinds of definitions; health behavior, illness behavior and sick-role behavior developed by Kasl and Cobb(1966). The health behavior is the activity undertaken by those who believe themselves to be in good health, for the purpose of preventing or detecting disease, in an asymptomalic stage. The illness behavior is the activity undertaken by those who fell ill to define the state of their health and to discover a suitable remedy while the sick-role behavior formulated in sociological conception by T. Parsons, is the activity undertaken by those who consider themselves to be ill and anticipated to have an important social role, and then is related to social factors of the population (Segall A. 1976). The purpose of the present study was to examine the actual situation of health condition, the daily behavior for the restoration of health and the utilization of medical care services at some divisional hospitals in Fiji, from the viewpoint of the illness behavior.

Incidence of Diverticulitis

The hospital admission rates for symptomatic colonic diverticulitis (International Code No. 572.1) in the populations served by the main teaching hospitals in Fiji, Singapore, Nigeria and North East Scotland have been estimated. In non-Europeans the condition is very rare occurring in about only one person in a million per year. It is some forty times commoner in Europeans living in the Tropics, and about eighty times more common in Scotland. It is considered that the difference is due principally to the greater age and low-residue diet of the European populations.