Small Pacific Island Nation Research Articles

Feasibility of Healthy Beverages Policies in American Samoa and Federated States of Micronesia: Water and Coconut Water Only Community Interventions.

American Samoa and the Federated States of Micronesia (FSM) are two small Pacific Island nations that have some of the highest noncommunicable disease (NCD) mortality rates in the world. Supported by church leaders to address obesity as an NCD risk factor, American Samoa, and Chuuk and Kosrae States of FSM selected the implementation of healthy beverages as a nutrition intervention through a water- and coconut water-only pledge in church events. The consumption of water and coconut water was tracked. Across 105 church events in the three jurisdictions, the count of water bottles before and after events decreased from 142.8 to 22.3, the number of coconuts before and after events decreased from 19.6 to 1.2, and cups of water before and after events decreased from 52.9 to 7.6. The promotion of healthy beverages in church settings holds promise in the Pacific as a feasible, accessible, and culturally responsive nutrition approach, given limited access to other nutritional alternatives, e.g., fresh fruits and vegetables. Supplemental health promotion messaging to maintain knowledge and attitudes about healthy is recommended for future scaling up.

Measuring Diabetes Complications, Risk Factors and Capacity for Managing Diabetes: An Initial Step to Improve Diabetes Care at The Primary Health Centre in Tonga

Background: The small Pacific Island nation like Tonga has faced a crisis for decades due to premature loss of lives and disabilities due to diabetes. However, there is limited peer-reviewed literatures on the rates of diabetes complications and capacity for providing quality diabetes care in Tonga. The lack of adequate information in local context triggers significant challenges to make informed decision, proper planning, and effective implementation to improve diabetes care. Aim: This study aims to determine the prevalence of diabetes complications and associated risk factors among people with diabetes, and the capacity for managing diabetes as an initial step towards strengthening diabetes care at the primary health care setting in Tonga. Methods: This cross-sectional study was conducted on a sample of 207 people with diabetes from the primary health care centre in Tonga. People with diabetes were screened by qualified health professional using a standardised protocol, and the capacity of diabetes care was assessed by a standardised assessment form. Results: Of the 207 people with diabetes aged between 20 and 80 years screened for diabetes related complications, 135 (74%) had family history of diabetes, 57 (28%) female subjects had history of gestational diabetes, and 28 (14%) subjects were current smokers. The prevalence of overweight was 51%, obese was 38% and hypertension was 44%. The percentage of subjects with high cholesterol was 42%. HbA1c was measured and subjects with good, poor, and very poor blood glucose control were 15%, 49% and 36% respectively. The percentage of people with diabetes who had retinopathy was 18% and who were at risk of developing diabetic foot ulcer was 14%. This study also found that people with diabetes did not attend regular follow-up visits at the health care centre and the capacity to provide quality diabetes care services is limited. Conclusion: This study highlighted the urgent need to improve the quality and accessibility of diabetes care to reduce diabetes complications. The findings also provided a timely reminder to government and development partners to invest additional resources to effectively manage diabetes at the primary health care level. Tonga will require to strengthen a resilient health system to improve screening for early detecting of diabetes complications and enhance management services at the primary health care setting.

Modeling thiamine fortification: a case study from Kuria atoll, Republic of Kiribati.

In 2014, there was an outbreak of beriberi on Kuria, a remote atoll in Kiribati, a small Pacific Island nation. A thiamine‐poor diet consisting mainly of rice, sugar, and small amounts of fortified flour was likely to blame. We aimed to design a food fortification strategy to improve thiamine intakes in Kuria. We surveyed all 104 households on Kuria with a pregnant woman or a child 0–59 months. Repeat 24‐h dietary recalls were collected from 90 men, 17 pregnant, 44 lactating, and 41 other women of reproductive age. The prevalence of inadequate thiamine intakes was >30% in all groups. Dietary modeling predicted that rice or sugar fortified at a rate of 0.3 and 1.4 mg per 100 g, respectively, would reduce the prevalence of inadequate thiamine intakes to <2.5% in all groups. Fortification is challenging because Kiribati imports food from several countries, depending on price and availability. One exception is flour, which is imported from Fiji. Although resulting in less coverage than rice or sugar, fortifying wheat flour with an additional 3.7 mg per 100 g would reduce the prevalence of inadequacy to under 10%. Kiribati is small and has limited resources; thus, a regional approach to thiamine fortification is needed.

Defending Democracy: Taking Stock of the Global Fight Against Digital Repression, Disinformation, and Election Insecurity

Amidst the regular drumbeat of reports about Russian attempts to undermine U.S. democratic institutions from Twitter bots to cyber-attacks on Congressional candidates, it is easy to forget that the problem of election security is not isolated to the United States and extends far beyond safeguarding insecure voting machines. Consider Australia, which has long been grappling with repeated Chinese attempts to interfere with its political system. Yet Australia has taken a distinct approach in how it has sought to protect its democratic institutions, including reclassifying its political parties as “critical infrastructure,” a step that the U.S. government has yet to take despite repeated breaches at both the Democratic and Republican National Committees. This Article analyzes the Australian approach to protecting its democratic institutions from Chinese influence operations and compares it to the U.S. response to Russian efforts. It then moves on to discuss how other cyber powers, including the European Union, have taken on the fight against digital repression and disinformation, and then compares these practices to the particular vulnerabilities of Small Pacific Island Nations. Such a comparative study is vital to help build resilience, and trust, in democratic systems on both sides of the Pacific. We argue that a multifaceted approach is needed to build more resilient and sustainable democratic systems. This should encompass both targeted reforms focusing on election infrastructure security — such as requiring paper ballots and risk-limiting audits — with deeper structural interventions to limit the spread of misinformation and combat digital repression.

Opportunities and Challenges of Implementing the International Valuation Standards in Fiji

In the face of globalisation and changing economies property valuation, standards have evolved immensely over the years with the majority of the countries – including small pacific island nations – adopting internationally recognised valuation standards. Smaller nations’ attraction to this change is understandable given it enhances users’ confidence in the reports, especially foreign users who have or are looking to make significant investments in the country. However, the data infrastructure and technical expertise in these countries differ significantly from the larger countries that were involved in the design of these standards. This raises the question of whether the International Valuation Standards can be effectively implemented in smaller, Pacific nations. This paper aims to contribute to this discussion by highlighting three key categories of challenges faced by property valuation firms in Fiji, and then discussing how addressing these issues presents an opportunity for the valuation field to implement the International Valuation Standards more effectively, resulting in better property valuation practices.

Smallholder Farmer Perceptions of Postharvest Loss and Its Determinants in Fijian Tomato Value Chains

The Fiji Islands, like many small Pacific island nations, are thought to incur high rates of postharvest loss. Little work has been undertaken to quantify the amount of loss within Pacific horticultural value chains, or identify the key determinants. This study sought to quantify postharvest loss within Fijian smallholder tomato value chains and to examine the relative importance of current on-farm practices as possible contributors to this loss. A semi-structured survey of 115 smallholder tomato farmers in Sigatoka Valley and eastern Viti Levu was undertaken, covering socio-economic and demographic parameters, production and postharvest handling practice, and postharvest loss based on farmer recall. On-farm postharvest loss for smallholder farmer tomato value chains was between 26.1% in Sigatoka Valley and 27.6% in eastern Viti Levu. This finding was consistent with quantification of postharvest loss in Fijian tomato chains by direct determination, but is relatively high when compared to smallholder tomato value chain loss in Sub-Saharan Africa. When Fijian tomato value chains were segregated according to specific postharvest handling practice, the contributors to postharvest loss were often associated with on-farm decision-making. Those value chains that only harvested once a week, or in the early morning (before 7 am) or mid-day onwards, stored harvest product in the field for more than three hours, did not sort or grade prior to on-farm ripening, or used packing sheds that had relatively open designs, all had consistently higher levels of postharvest loss. The prevalence of specific postharvest handling practice in both locations is further reported. While this study highlights the impact of current on-farm postharvest handling practices on tomato value chain loss, what remain unclear are the underlying drivers associated with current postharvest handling behaviour and the decision-making that shapes quality and logistic control activities.

‘Governance’, ‘communication’, ‘capacity’, ‘champions’ and ‘alignment’: factors underpinning the integration of sport-for-development within national development priorities in Tonga

Sport-for-Development (SfD) organizations and practitioners aim to positively impact physical and mental health, contribute to the promotion of peace in post-conflict settings, address a range of societal inequalities, as well as improve community cohesion and build social capital. SfD practitioners regularly align outcomes with international development priorities such as the Sustainable Development Goals, and more specific health and development priorities at the regional and national level. The aim of our paper is to critically analyse factors underpinning the integration of Australian-funded Sport-­for-Development programs within the national health and development priorities of Tonga, a small Pacific Island nation. We utilised a qualitative research design including 32 interviews and 5 focus groups, local document analysis and direct observation. Factors underpinning integration included the perceived governance strength of sporting stakeholders; alignment throughout program objectives and evaluation outcomes; inter-agency and inter-personal communication; capacity of the local implementation base and the identification of development ‘champions’. Without foreign funders addressing these critical factors, SfD risks being confined to fragmented and isolated project-based programming with only the potential for contributing to broader health and development priorities.

Predicting the impact of household contact and mass chemoprophylaxis on future new leprosy cases in South Tarawa, Kiribati: A modelling study.

BackgroundThe country of Kiribati is a small Pacific island nation which had a new case detection rate of 191 per 100,000 in 2016, and is one of the few countries yet to reach the WHO leprosy elimination goal. Chemoprophylaxis of household contacts of new cases, or to the whole population in a highly endemic areas have been found to be effective in reducing new case rates. This study investigated the potential impact of different chemoprophylaxis strategies on future cases in South Tarawa, the main population centre of Kiribati.MethodologyThe microsimulation model SIMCOLEP was calibrated to simulate the South Tarawa population and past leprosy control activities, and replicate annual new cases from 1989 to 2016. The impact of six different strategies for delivering one round of single dose rifampicin (SDR) chemoprophylaxis to household contacts of new cases and/or one or three rounds of SDR to the whole population was modelled from 2017 to 2030.Principal FindingsOur model predicted that continuing the existing control program of high levels of public awareness, passive case detection, and treatment with multidrug treatment would lead to a substantial reduction in cases but this was less effective than all modelled intervention scenarios. Mass chemoprophylaxis led to a faster initial decline in cases than household contact chemoprophylaxis alone, however the decline under the latter was sustained for longer. The greatest cumulative impact was for household contact chemoprophylaxis with three rounds of mass chemoprophylaxis at one-year intervals.ConclusionsThe results suggest that control of leprosy would be achieved most rapidly with a combination of intensive population-based and household chemoprophylaxis. These findings may be generalisable to other countries where crowding places social contacts as well as household contacts of cases at risk of developing leprosy.

Elimination of lymphatic filariasis as a public health problem in Niue under PacELF, 1999\u20132016

BackgroundLymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide. Niue is a small self-governing South Pacific island nation with approximately 1600 residents that was formerly LF endemic. Here, we review the progress made towards eliminating LF in Niue since 1999.MethodsThis study has reviewed all the available literature relating to LF in Niue to assess surveillance efforts and the elimination of transmission. Reviewed documentation included both published and unpublished works including historical reports of LF, WHO PacELF records, and Niue Country Reports of the national LF elimination program.FindingsNiue conducted mapping of baseline LF endemicity by testing the total present and consenting population for LF antigen with immunochromatographic test (ICT) in 1999, when circulating filarial antigen prevalence was 3.1% (n = 1794). Five nationwide annual mass drug administration (MDA) rounds with albendazole (400 mg) and diethylcarbamazine citrate (DEC) were undertaken from 2000 to 2004, with coverage reported from distribution records ranging from 78 to 99% of the eligible population, which excluded pregnant women and children under 2 years of age. A further whole population survey using ICT in 2001 found 1.3% positive (n = 1630). In 2004, antigen prevalence had reduced to 0.2% (n = 1285). A similar post-MDA survey in 2009 indicated antigen prevalence to be 0.5% (n = 1378). Seven positive cases were re-tested and re-treated every six months until negative.ConclusionsAfter five rounds of MDA, Niue had reduced the LF antigen population prevalence in all ages from 3.1% to below 1% and maintained this prevalence for a further five years. Due to Niue’s small population, surveillance was done by whole population surveys. Niue’s results support the WHO recommended strategy that five to six rounds of annual MDA with effective population coverage can successfully interrupt the transmission of LF. Niue received official acknowledgement of the validation of elimination of LF as a public health problem by the WHO Director-General and WHO Western Pacific Regional Office (WPRO) Regional Director at the 67th session of the Regional Committee for the Western Pacific held in Manila in October 2016.

Future Proofing Higher Education in the Pacific with Open and Flexible Learning

Affordable access to higher education is a major challenge for small Pacific island nations. The University of the South Pacific which is owned and governed by twelve island nations in this region plays a special role in meeting this challenge. In its fiftieth year, a few recent developments at USP provide a useful case study for how this challenge can be addressed to provide affordable access to educational opportunity for residents of twelve Pacific Island nations in various stages of development.The island nations served by the University of the South Pacific are spread over 33 million square kilometers of the Pacific, with several official languages and many more indigenous languages, and use seven distinct currencies. As USP celebrates its fiftieth year in 2018, it has embarked upon two specific initiatives that will enable the university to map out a pathway for the future of education for the next generation and within the context of current and new strategies for the design and implementation of meaningful education throughout the member nations. These initiatives are the development of a flexible learning policy and an Open Education Resources policy. Taking pages from the fields of Technology, Education (Learning and Teaching), and Design, these two USP policies seek to “future proof” the university for the next generation and others after that. Being future proofed means being able to stand the test of time in the face of changing contexts and challenges. University policies are most effective when they are designed to withstand and accommodate prospective changes in the educational landscape. These policies reflect agreed-upon principles that will withstand social and political changes. This paper is a commentary on the content of these policy initiatives around flexible learning and open education practices, their values and principles.

Understanding and integrating technology: a case study of the Fiji sugar industry

In the global market, while sugar is produced in 110 countries, only two small Pacific Island nations, Fiji and Papua New Guinea are involved in sugar production. In Fiji, the sugar industry has an important role to play in rural development, however, the industry must adjust to changes in the international trading market. This includes the cultivars of sugarcane cultivated to increase the level of production and to implement appropriate solutions for the native land tenure system to facilitate increases in farm production. As the sugar industry in Fiji is vertically integrated, there is the need for an approach that is well coordinated to implement the new and redesigned policies.

Developing an obesity intervention in Micronesia: From needs assessment to planning

Evidence-based obesity reduction programs in the Pacific are scarce to nonexistent. Using a community-based participatory research model (CBPR) we developed a collaboration between our university and a small Pacific Island nation. We established an advisory council of local stakeholders and then conducted an extensive needs assessment with youth, parents, professionals, and lay public. Only 9% of participants had tried a weight loss program. There was a strong tendency to engage in binge-eating cycles; difficulty eating healthy during frequent community celebrations with few healthy food options available in general; and limited traditions that involved physical activity. Participants wanted to learn how to increase their physical activity, make healthier food choices, and learn to reward themselves for healthy behaviors. Diets were most frequently high in energy or protein foods, followed by starch, sugary and fried foods; they ate vegetables and fruits least often. Together, our team then created the culturally relevant Fit Kit Palau©. We highlight lessons learned including how to determine partnerships; manage multiple cultural and geographic barriers; build capacity; and balance program fidelity with responsivity. As the program moves forward, we hope to increase access, engagement, and adherence and provide a model for other PI countries.

Mining and Socio-Ecological Resilience in Mineral-Rich Small States: An Integrative Approach to Phosphate Mining on Nauru

This paper considers how extractive industries can play a more constructive role in the development trajectories of small-island states despite a negative legacy of extraction. We consider the case of Nauru, a small Pacific island nation which historically had some of the world's finest phosphate reserves that propelled its population to great wealth. However, errant planning and financial mismanagement led to a crash in the country's fortunes and led it to become dependent on foreign aid. This paper considers how such an economy can be rebuilt through smart investment in ecological restoration, branding of mineral products for ecological and developmental value and using the capital generated to develop a more diversified economic base.

Paradoxical effects of the cortisol response to stress: More cravings now, less alcohol use later

Evidence-based obesity reduction programs in the Pacific are scarce to nonexistent. Using a community-based participatory research model (CBPR) we developed a collaboration between our university and a small Pacific Island nation. We established an advisory council of local stakeholders and then conducted an extensive needs assessment with youth, parents, professionals, and lay public. Only 9% of participants had tried a weight loss program. There was a strong tendency to engage in binge-eating cycles; difficulty eating healthy during frequent community celebrations with few healthy food options available in general; and limited traditions that involved physical activity. Participants wanted to learn how to increase their physical activity, make healthier food choices, and learn to reward themselves for healthy behaviors. Diets were most frequently high in energy or protein foods, followed by starch, sugary and fried foods; they ate vegetables and fruits least often. Together, our team then created the culturally relevant Fit Kit Palau©. We highlight lessons learned including how to determine partnerships; manage multiple cultural and geographic barriers; build capacity; and balance program fidelity with responsivity. As the program moves forward, we hope to increase access, engagement, and adherence and provide a model for other PI countries.

The Effects of Chewing Betel Nut with Tobacco and Pre-pregnancy Obesity on Adverse Birth Outcomes Among Palauan Women.

The small Pacific Island nation of Palau has alarmingly high rates of betel nut with tobacco use and obesity among the entire population including pregnant women. This study aimed to determine the effects of betel nut with tobacco use and pre-pregnancy obesity on adverse birth outcomes. This study used retrospective cohort data on 1171 Palauan women who gave birth in Belau National Hospital in Meyuns, Republic of Palau between 2007 and 2013. The exposures of interest were pre-pregnancy obesity and reported betel nut with tobacco use during pregnancy. The primary outcomes measured were preterm birth and low birth weight among full-term infants. A significantly increased risk for low birth weight among full-term infants was demonstrated among those women who chewed betel nut with tobacco during pregnancy when other known risk factors were controlled for. Additionally, pre-pregnancy obesity was associated with a significantly increased risk for preterm birth when other known risk factors were controlled for. Both betel nut with tobacco use and pre-pregnancy obesity were associated with higher risks for adverse birth outcomes. These findings should be used to drive public health efforts in Palau, as well as in other Pacific Island nations where these studies are currently lacking.

Development, Dependency and HIV Risk in Kiribati

A study was undertaken in Kiribati, a small Pacific island nation, that has a low-level HIV epidemic but a high incidence of STIs among seafarers, their spouses (and children), and those involved in sex work. There are connections between development and dependency and HIV risk in Kiribati. Kiribati is a peripheral and dependent small island state underwritten by conditional aid and financial assistance and advice from donor countries, entwined in, and subject to, external globalising processes. We found two major factors related to Kiribati’s dependency engendered HIV risk. The first is Kiribati’s reliance on transnational seafaring. Long periods away from home, shipboard and port mateship cultures, and infrequent condom use in casual and paid sexual relations while in overseas ports, exacerbated by heavy alcohol use, have rendered i-Kiribati seafarers vulnerable to HIV. The second factor is related to the labour force participation of young women, which is extremely limited. In this context, some young i-Kiribati women choose to work on board, foreign fishing vessels selling sex. They stay with one client while on board a boat—for up to three months—and sex work is not only an economic transaction, but also emotional and affective labour. It is a pattern that makes consistent condom use problematic. Having multiple sequential seafarer partners may in fact generate considerable HIV vulnerability.

The Nourishing Sea: Partnered Guardianship of Fishery and Seabed Mineral Resources for the Economic Viability of Small Pacific Island Nations

While island biogeography and modern economics portray Pacific island nations as isolated, ecologically fragile, resource poor and barely viable economies forever dependent on foreign aid, Pacific island history and culture conceives of their islands as intimately inter-linked to the surrounding ocean and of that ocean as an avenue to expanded resource bases, both terrestrial and aquatic. Pacific Islanders live in the most aquatic human zone on Earth, with the highest territorial ratios of sea to land. Recent studies are revealing the continuity and success of traditional near-shore guardianship of maritime resources in a number of Pacific islands. Sustainable development of seabed minerals and pelagic fisheries may offer enhanced income potential for small island nations with limited terrestrial resources. As offshore ecosystems are poorly policed, sustainable development is best realized through comprehensive planning centred on partnerships between local communities, their governments, marine scientists and commercial enterprises. The success or failure of Pacific Islanders in reasserting their maritime guardianship is now a matter of global significance given the decimation of most fisheries beyond the Pacific and the vast, but uncertain, medicinal, mineral and food resource potential of this huge area of the planet.

Climate change adaptation in a small Pacific island nation

Kiribati, a small Pacific island nation, is at severe risk of climate change. The geography and historic, linear development of its capital on the South Tawara atoll mean that many key public assets are at risk from impacts of coastal erosion and thus vulnerable to climate-change effects. An adaptation project started in 2003, which included developing a means of assessing coastal vulnerability and a process for proactive management of the coast. Guidelines offering alternatives to traditional coastal engineering methods were provided, and practical application of these guidelines was demonstrated at selected high-risk pilot sites in 2006–2010. Appropriate technology for increasing resilience was shown through application of simple but effective tools to identify and select adaptation options; recognition that customary responses ingrained over lifetimes will not be changed by a short-term project; and use of tried-and-tested quality improvements to traditional construction techniques. Rather than introducing completely new and unfamiliar measures, the pilot works enhanced and built on existing knowledge.

Decision-makers, donors and data: factors influencing the development of mental health and psychosocial policy in the Solomon Islands

Mental disorders and psychosocial problems are common, and present a significant public health burden globally. Increasingly, attention has been devoted to these issues in the aftermath of violent conflict. The Solomon Islands, a small Pacific island nation, has in recent years experienced periods of internal conflict. This article examines how policy decisions regarding mental health and wellbeing were incorporated into the national agenda in the years which followed. The study reveals the policy shifts, contextual influences and players responsible. The Solomon Islands' experience reflects incremental change, built upon longstanding but modest concern with mental health and social welfare issues, reinforced by advocacy from the small mental health team. Armed conflict and ethnic tensions from 1998 to 2003 promoted wider recognition of unmet mental health needs and psychosocial problems. Additional impetus was garnered through the positioning of key health leaders, some of whom were trained in public health. Working together, with an understanding of culture and politics, and drawing on external support, they drove the agenda. Contextual factors, notably further violence and the ongoing risk of instability, a growing youth population, and emerging international and local evidence, also played a part.

Researching in cross cultural contexts: A socially just process

In this paper, we explore culture and its relationship to cross cultural research. The context for this research is Vanuatu, a small South Pacific Island nation. The action research process used was a collaboration between two New Zealand academics, two Ni Vanuatu women researchers and 13 participants over a two year period. The focus of the action research was the design and delivery of a culturally appropriate educational leadership development programme for women. The collaborative research process raised a number of ethical and methodological considerations, for example, the importance of mutually respectful relationships, working in partnership, collaboration, capacity building, transparent communication and consideration of the local context. Using stories from the Vanuatu context, we illustrate how we navigated culture to be able to research in socially just ways. Being involved in socially just, cross cultural research calls for a thoughtful, well-designed and culturally informed approach throughout all stages of the research process, from initial planning through to follow up and capacity building and finally, the sharing of research findings.