Promoting evidence-based policies, programs and services for ageing and health in Fiji

Population ageing presents significant implications for economies, health systems and social protection globally. In Pacific Island countries, the once young populations are ageing rapidly, yet national health systems remain vastly unprepared to cope with the complex needs of a growing number of older persons. The ability of Pacific governments to ‘re-orient health systems to respond to the needs of older people’ (WHO, 2014), is hindered by a lack of knowledge of what’s needed and what works for the care of older persons in their context. Limited translatable epidemiological data to underpin predictions of demographic and disease trends, lack of knowledge and coordination of multi-sectoral policies and services for the older population, and poor understanding of the preferences of older persons themselves, present significant barriers to driving evidence-based health policies and programs to enhance healthy ageing. This report presents the findings of a 2019/2020 scoping study of policy, program and service priorities to guide an effective health system response to population ageing in one of the most rapidly ageing Pacific Island countries, Fiji

The case for improving road safety in Pacific Islands: a population‐based study from Fiji (TRIP 6)

Abstract Objective : To estimate the incidence and demographic characteristics associated with road traffic injuries (RTIs) resulting in deaths or hospital admission for 12 hours or more in Viti Levu, Fiji. Methods : Analysis of the prospective population‐based Fiji Injury Surveillance in Hospitals database (October 2005 – September 2006). Results: Of the 374 RTI cases identified (17% of all injuries), 72% were males and one third were aged 15–29 years. RTI fatalities (10.3 per 100,000 per year) were higher among Indians compared to Fijians. Two‐thirds of deaths (largely ascribed to head, chest and abdominal trauma) occurred before hospital admission. Conclusion and implications: While the RTI fatality rate was comparable to the global average for high‐income countries, the level of motorisation in Fiji is considerably lower. To avert rising RTI rates with increasing motorisation, Fiji requires a robust road safety strategy alongside effective trauma‐care services and a reliable population‐based RTI surveillance system

Driving following Kava Use and Road Traffic Injuries: A Population-Based Case-Control Study in Fiji (TRIP 14)

<div><p>Objective</p><p>To investigate the association between kava use and the risk of four-wheeled motor vehicle crashes in Fiji. Kava is a traditional beverage commonly consumed in many Pacific Island Countries. Herbal anxiolytics containing smaller doses of kava are more widely available.</p><p>Methods</p><p>Data for this population-based case-control study were collected from drivers of ‘case’ vehicles involved in serious injury-involved crashes (where at least one road user was killed or admitted to hospital for 12 hours or more) and ‘control’ vehicles representative of ‘driving time’ in the study base. Structured interviewer administered questionnaires collected self-reported participant data on demographic characteristics and a range of risk factors including kava use and potential confounders. Unconditional logistic regression models estimated odds ratios relating to the association between kava use and injury-involved crash risk.</p><p>Findings</p><p>Overall, 23% and 4% of drivers of case and control vehicles, respectively, reported consuming kava in the 12 hours prior to the crash or road survey. After controlling for assessed confounders, driving following kava use was associated with a four-fold increase in the odds of crash involvement (Odds ratio: 4.70; 95% CI: 1.90–11.63). The related population attributable risk was 18.37% (95% CI: 13.77–22.72). Acknowledging limited statistical power, we did not find a significant interaction in this association with concurrent alcohol use.</p><p>Conclusion</p><p>In this study conducted in a setting where recreational kava consumption is common, driving following the use of kava was associated with a significant excess of serious-injury involved road crashes. The precautionary principle would suggest road safety strategies should explicitly recommend avoiding driving following kava use, particularly in communities where recreational use is common.</p></div

Distribution of acute (previous 12 hours) and usual (past 12 months) kava use among cases and controls.

<p>Distribution of acute (previous 12 hours) and usual (past 12 months) kava use among cases and controls.</p

Distribution of kava consumption and potential confounders for cases and controls, Fiji, 2006.

<p>Distribution of kava consumption and potential confounders for cases and controls, Fiji, 2006.</p

Case and control selection and recruitment, Viti Levu, Fiji, 2006.

<p>Case and control selection and recruitment, Viti Levu, Fiji, 2006.</p

A profile of Injury in Fiji: findings from a population-based injury surveillance system (TRIP-10)

<p>Abstract</p> <p>Background</p> <p>Over 90% of injury deaths occur in low-and middle-income countries. However, the epidemiological profile of injuries in Pacific Islands has received little attention. We used a population-based-trauma registry to investigate the characteristics of all injuries in Viti Levu, Fiji.</p> <p>Method</p> <p>The Fiji Injury Surveillance in Hospitals (FISH) database prospectively collected data on all injury-related deaths and primary admissions to hospital (≥12 hours stay) in Viti Levu during 12 months commencing October 2005.</p> <p>Results</p> <p>The 2167 injury-related deaths and hospitalisations corresponded to an annual incidence rate of 333 per 100,000, with males accounting for twice as many cases as females. Almost 80% of injuries involved people aged less than 45 years, and 74% were deemed unintentional. There were 244 fatalities (71% died before admission) and 1994 hospitalisations corresponding to crude annual rates of 37.5 per 100,000 and 306 per 100,000 respectively. The leading cause of fatal injury was road traffic injury (29%) and the equivalent for injury admissions was falls (30%). The commonest type of injury resulting in death and admission to hospital was asphyxia and fractures respectively. Alcohol use was documented as a contributing factor in 13% of deaths and 12% of admissions. In general, indigenous Fijians had higher rates of injury admission, especially for interpersonal violence, while those of Indian ethnicity had higher rates of fatality, especially from suicide.</p> <p>Conclusions</p> <p>Injury is an important public health problem that disproportionately affects young males in Fiji, with a high proportion of deaths prior to hospital presentation. This study highlights key areas requiring priority attention to reduce the burden of potentially life-threatening injuries in Fiji.</p