7th Interscholastic Student HIV & Sexual Health Research Symposium 2021

On Wednesday 23 June 2021 a one-day event was hosted by Auckland University of Technology’s (AUT) Child and Youth Health Research Centre (CYHRC) at South Campus, Manukau City. This annual event was initiated in 2014 and is a collaboration by researchers from AUT, University of Auckland and Massey University. It aims to provide an opportunity for postgraduate students with projects focusing on Human Immunodeficiency Virus (HIV) and Sexual Health to present their studies and to meet and network with other researchers with similar interests. This successful event incorporated much stimulating discussion with the oral presentations by postgraduate students; and there were 40 attendees (both face to face and online) from academic, NGO and public sectors, including New Zealand Aids Foundation (NZAF), District Health Boards, GP clinics. The presentations demonstrated a wide range of topics including HIV counselling programmes in India; blood donor policies among Gay and Bisexual Men in New Zealand; and the role of social media apps in providing sexual and reproductive health information for users. An innovation in 2021 was that of a plenary session at the end of the presentations providing a general forum for discussion based on the theme, 'HIV and Sexual Health in a Post Covid World. Key experts and students discussed their experiences led by a panel of four HIV/Sexual Health researchers. Indigenous Pacific perspectives were also shared along with policy directions and implications. Key takeaways relevant within the post covid context were the need for more research support in the field of HIV and Sexual and Reproductive Health and the impact of HIV/Sexual Health among vulnerable marginalised groups. Here in this special section of vol 4 of Pacific Health, 2021, we present the abstracts from the oral presentations.

Children as decision makers: the Hayman Park community project in Aotearoa New Zealand

Introduction: Our study explores the efficacy of community consultation in redesigning the Hayman Park playground from a community perspective. Hayman Park is located in Manukau City centre in the south of New Zealand’s capital city, Auckland. It has a mixed community of Pasifika, Māori and other ethnic groups with a younger demographic than the average. Methods: We used a qualitative approach to examine participants’ perceptions. Of the 27 adults (N = 27) who participated, three (n = 3) were available for one-on-one, face-to-face interviews post project. Two transcripts recorded during focus group activities involving 27 children (N = 27) were also analysed. We found that six (n = 6) children expressed opinions during their involvement. Their views, alongside those of adults, were parsed into emergent categories and themes. Results and Discussion: We identified three themes: health and well-being; community and individual needs; and the effectiveness of community partnership. Responses from both adults and children indicated that participants felt they had achieved better health and well-being. Feedback showed significant gains in knowledge and awareness. However, participants wanted a deeper relationship with project leaders. Conclusion: We conclude that the Hayman Park project is a good example of how involving local communities in designing the spaces they live in can engender positive outcomes. However, the project did not fulfil participants’ desire for more meaningful engagement with the leading stakeholders.

Overseas Medical Referral: the health system challenges for Pacific Island Countries

The delivery of specialised clinical services in the small Island nations of the Pacific region is an increasing challenge in the context of a rising burden of non-communicable diseases. Resources are limited and case-loads too low to support local specialists. This article focuses on the common practice of Overseas Medical Referral (OMR), which is an increasing challenge in the region. We collected interview and secondary data across 16 Pacific Island Countries. We found that OMR policies are often weak or incomplete, systems inadequate and reforms needed. Integrating OMR fully into national health referral systems and national strategic planning and prioritisation processes is needed. There is an additional need for collection of routine data on OMR service providers in the recipient countries and the outcomes of clinical care. With these reforms, a move towards increased regional cooperation and some form of strategic purchasing is possible.

Mapping the Spatial Variability of Sexually Transmitted Infections Across Fiji Health Regions

Introduction: Sexually transmitted infections (STIs) are a significant public health problem in countries within the South Pacific, including Fiji. If untreated, curable STIs such as chlamydia, gonorrhea, and syphilis can cause infertility, adverse outcomes in pregnancy, and can increase the risk of contracting HIV in infected individuals. Methods: This research used cartographic software to map and analyze the spatial distribution of selected STIs across health regions in Fiji. Total rates of STIs, as well as the prevalence of gonorrhea and syphilis specifically, were examined for the years of 2007 and 2016 to determine how spatial distribution patterns have changed over this period, and how resources might currently be most effectively mobilized to address this public health issue. Results/Discussion: Our findings suggest that while some specific regions with high prevalence rates for 2007 and 2016 should be targeted for intervention in the short term, lack of data collecting and reporting raises concerns about the accuracy of rate estimations in non-urban areas. Conclusion: Analyzing the spatial distribution of the prevalence of STIs in a given population can better inform the development and implementation of intervention strategies at local scales, thus improving health outcomes for countries and their communities. Overall, consistent and transparent STI data collection and reporting procedures are necessary for effective long-term management and minimization of STI spread in Fiji.

Healthy Cities South Auckland: A focus on youth leadership and sustainability in the post-COVID world

Introduction: This paper draws on a presentation given at the American Public Health Association (APHA) annual meeting in Philadelphia in 2019 (Drs. Conn and Field). It is based on an innovative public health initiative in the Aotearoa New Zealand context, which incorporates key themes relating to sustainable and healthy cities in the post-COVID world. Method: Healthy cities South Auckland began in 2019, and involves Auckland University of Technology (AUT) faculty and students, many of whom are from indigenous Māori and Pacific Island communities, working collaboratively. The initiative aims to improve the health and wellbeing of the urban population using a series of codesigned projects that prioritise youth leadership and principles of sustainability. Current projects include an investigation of healthy food youth enterprise and the role of urban sustainable food environments; and student, faculty, and industry codesign of future-oriented public health higher education. Discussion: Whilst this public health initiative is grounded in known principles of community action and determinants of health, it is innovative in the close and contextualised attention to Māori and Pacific youth leadership and to a more overt sustainability agenda. Emphasising the shift from healthy cities focusing on people, to one that focuses on the inextricable link between people and the natural environment, the initiative is underpinned by indigenous guardianship concepts, such as Māori Kaitiakitanga (guardianship of the natural order) and Pacific Va (healthy spaces). Traditionally associated with rural and marine spaces, a valuable new development is the application of indigenous principles by youth in an urban setting and for a public health agenda. These notions resonate with global shifts such as the ‘school strikes for climate change’ movement and seem particularly apt in a post-COVID world which must mobilise new ways of bringing about transformative change. These include addressing disease outbreaksand chronic disease and health inequities, while also taking into consideration the contexts of community, culture and natural environments. Conclusion: In the Aotearoa New Zealand context, strengths-based approaches are a vital way forward, positioning Māori and Pacific young people as champions. Notions of healthy cities as sustainable cities; based on indigenous guardianship applied to 21st century urban spaces; youth activism and urban health in the digital age; and partnership between academia, youth, and industry are significant areas for further study, providing useful lessons for cities’ agendas, both locally and internationally.

Trends in Social Support Experienced by Pacific Men and Women over the Adult Lifespan: An Age-Based Latent Growth Model

Introduction: Our study investigated the development of social support experienced by Pacific men and women across the adult lifespan in New Zealand (18 to 65 years of age). Methods: We examined differences in social support using data from the first six annual waves of the New Zealand Attitudes and Values Study (N = 501 women and 238 men) using an age-based latent growth model. Results and Discussion: Mean levels of social support decreased as Pacific peoples aged. More specifically, Pacific men demonstrated a significant decrease in social support and older Pacific men demonstrated the lowest levels of support of all Pacific peoples. In comparison, Pacific women maintained higher levels of social support compared to Pacific men, with social support remaining relatively stable across the lifespan of Pacific women. Conclusion: Our research explores the importance of social support and its link to health and wellbeing among Pacific communities in New Zealand. This is important because we need to understand the factors that could buffer outcomes of low social support such as mental illness and possibly suicide among Pacific peoples.

Microbial Analysis of Drinking Water from Nadi to Lautoka Area in Viti Levu Fiji

Introduction: Access to sufficient and safe drinking water is essential for human health and welfare. Countries in the Pacific Region like Fiji frequently face issues with access to safe drinking water and supply problems. Fluctuations in water resource availability, often untreated water and faulty treatment facilities, pollution, lack of proper water management frameworks and most importantly lack of water monitoring resources are all factors that influence Pacific Island Countries. Apart from this, Pacific Islands and their water supplies are susceptible to climate hazards such as floods, cyclones and drought. The Western Division of Fiji Islands is highly prone to adverse climatic conditions; therefore regular monitoring of the various drinking water sources is essential to ensure safety of people. This study was conducted in the Lautoka to Nadi corridor where 25 sites were randomly selected for water analysis processing from January to February 2019. Method: Physio-chemical analysis, such as measuring pH and turbidity as well as simple microbial analysis, was conducted on the water samples. Specific growth media was used to determine the different types of bacteria (Coliform, Escherichia coli and Salmonella enterica) present in the water samples; Lauryl Tryptose Broth, Eosin Methlylene Blue Agar, Xylose Lysine Deoxycholate was used. Turbidity was measured using a digital turbidity meter and pH value was determined employing a digital meter. Results and Discussion: From the analysis it was determined that overall the pH levels of samples (6.02-8.30) falls within the permissible limits; whereas turbidity was generally higher in untreated water sources with ranges from 3 to 8 nephelometric turbidity units. Microbial content was higher in untreated water samples. Other sources such as springs and creeks recorded the most significant number of Coliforms when compared to other sources and some samples indicated the presence of Escherichia coli and Salmonella enterica. Conclusion: From the study it can be concluded that all the water samples tested positive for bacterial contamination particularly Coliforms and it was higher in untreated water. Water from the Municipality had almost all physio-chemical and bacteria parameters within the World Health Organization limits, except for turbidity which was generally above 1NTU. However, this was not the case for untreated water which in some samples contained high levels of harmful bacteria. Monitoring needs to be carried out to better understand water quality and implement counter measures.

Health literacy, culture and Pacific peoples in Aotearoa, New Zealand: A review

The social and cultural determinants of health among Pacific people must be addressed to understand the underlying factors related to poor health outcomes. Such factors may include (but are not be limited to) culture, religion, education, socioeconomic status and health literacy. One study, using the lens of Pacific culture, found that almost 90% of Pacific males and females aged 15 years and over have low health literacy. Individuals with low health literacy are less likely to manage ill health, seek professional medical assistance or interpret nutrition related information. It is possible that the high rates of non-communicable diseases (NCDs) as a significant issue in the Pacific population, including amongst Pacific mothers, are in some part associated with low levels of health literacy, which in turn link to cultural determinants of health. Findings from this review show that inadequate health literacy was consistent among adult females, particularly older adults of low socioeconomic status, lower level of education, non-English speakers and adults with compromised health status. Further, culture may play a role in attainment of adequate health literacy. These individuals were more likely to report worse chronic physical conditions, such as diabetes, including lack of knowledge of their condition such as the inability to identify normal blood sugar levels, the range of a normal blood pressure or how to self-manage hypoglycaemia. Public health practitioners should apply effective communication using a culturally and ethnically tailored approach to support Pacific peoples to understand health messages, improve health behaviours and health status. The author reviewed 33 papers on the issue of health literacy definitions, measurement and determinants; Pacific peoples and NCDs; and discussed it in the light of a cultural determinants’ approach.

Our people, our food, our planet

Video link: Our people, our food, our planet: Sustainable food systems policy in the Pacific Pacific Island Countries and Territories are facing a health crisis with non communicable diseases (NCDs) currently accounting for more than 80% of deaths. In the 21st century, advances in health intervention and policy render this figure unacceptable. Multiple risk factors contribute to the NCD crisis; a leading driver being obesity due to changing dietary practices arising from the global food system. A system which is dominated by processed foods high in starch and sugars. This situation is compounded by changes in the natural and built environments relating to climate change. Tackling this issue is beyond the sole domain of public health and is, therefore, more suited to a planetary health approach. This paper applies a sustainable food systems approach to analysing NCD policy developments in the Pacific region. In particular, three domains of policy which impact diets in the Pacific are examined: food production, climate change and sustainability, and trade. It is argued that countering the NCD crisis demands a global multisectoral approach, with governments leading the way, to develop integrated policy and interventions that will secure the future wellbeing and protection of our people, our food, our planet.

The Epidemiology of Respiratory Distress Syndrome in Neonates in Fiji: A Retrospective Cohort Study

Introduction The commonest cause of death in preterm neonates worldwide is respiratory distress syndrome (RDS). In Fiji, prematurity and RDS have been identified as important causes of neonatal mortality and surfactant was added to supportive care in 2015. This retrospective cohort study describes the RDS epidemiology in Fiji’s major neonatal centre prior to surfactant introduction. Methods RDS-related intensive care admissions in 2013 and 2014 were reviewed and clinical information was extracted from medical records. Subsequent readmissions of RDS cases were also retrieved. Results The rate of RDS was 6.7 (95% confidence interval 5.5 – 8.0) per 1,000 live births. There were 36 RDS deaths. No cases who died received more than one dose of corticosteroids, compared to 25.3% of survivors. Conclusion Death from RDS was high, and is consistent with that in other low- and middle-income countries prior to the uptake of surfactant therapy. Improving antenatal corticosteroid use and access to surfactant therapy is likely to improve outcomes.