Impact of Influenza in South-East Asia

Influenza infection is asymptomatic in up to 75% of cases, but outbreaks result in significant morbidity. Reports found that severe influenza complications tend to occur among the very young (<5 years) and very old (>65 years), especially those with underlying co-morbidities like diabetes mellitus and heart disease. Even with no co-morbidity, some older persons with severe influenza may require hospitalisation or intensive care, with increased risk of myocardial infarction and stroke. In South-East Asia, influenza was often seen as a mild problem and was not deemed notifiable until the appearance of the Influenza A(H1N1) pandemic in 2009. For decades the data made available were based on extrapolated estimates collected mainly from paediatric populations, resulting in inconsistent findings. Following expanded surveillance across the region using national surveillance systems for influenza-like illness (ILI) and severe acute respiratory illness (SARI), and better diagnostic methods, improved estimates of disease burden was achieved in South-East Asia. However, two studies conducted in 2008-2010 reported findings ranging from 2-3% to 11%. With regards to increased risk of complications, the estimated global annual attack rates for influenza were 5-10% in adults and 20-30% in children, resulting in 3-5 million cases of severe illness and 290,000-650,000 deaths. A study In Singapore reported that influenza is associated with annual excess mortality rates (EMR) of 11-14.8 per 100 000 person-years, especially affecting the elderly;these rates are comparable to that of the USA. As for hospitalisation rates of children under 5 years with seasonal influenza, the USA estimated a rate of 1.4 per 100,000. Comparable rates were reported in Singapore (0.7-0.9), Thailand (2.4), Viet Nam (3.9-4.7), and the Philippines (4.7). In 2018, an updated study reported a mean annual influenza-associated respiratory EMR of 4.0-8.8 per 100 000 individuals, with South-East Asia showing a high mortality rate of 3.5-9.2 per 100,000 individuals. It was already estimated in Thailand in 2004 that influenza resulted in USD23-63 million in economic costs, with the main contribution from lost productivity due to missed workdays. Thus, comparable to countries in temperate climate, the clinical and socioeconomic impact of influenza in South-East Asia appear to be just as substantial. With the emergence of the COVID-19 pandemic in 2020, global influenza incidence dropped dramatically. In South-East Asia, the trend in influenza detections was similar to the rest of the world, with numbers slightly higher than average in early 2020, followed by a quick drop-off by the end of April 2020. After April 2020, the detection rate remained low until late July 2020, when Influenza A(H3N2) predominated in Cambodia, Malaysia, the Philippines, Singapore, Thailand and Timor-Leste;influenza B in Lao People's Democratic Republic but with an upsurge in A(H3N2) activity. Following a two-year hiatus, influenza outbreaks began to re-emerge significantly since early 2022. From February through August 2022, influenza activity in the southern hemisphere remained lower than in pre-COVID-19 pandemic years, but was at the highest level compared to similar periods since the start of the COVID-19 pandemic. Reasons for the reduction during the COVID-19 pandemic include non-pharmaceutical interventions (NPIs), reduced population mixing and reduced travel, and possibly viral interference between SARS-CoV-2 and influenza virus in the same host. In general, the reduction in influenza detections however does not appear to be associated with lack of testing. The World Health Organisation (WHO) continues to recommend that vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses. Although influenza vaccine is not commonly used in most countries in South-East Asia, its burden is similar in other parts of the world where influenza vaccine is now routinely used. Currently, the countries in South-East Asia that are providing free influenza vacc na ion for those at high risk include Thailand, Singapore, the Philippines and Lao People's Democratic Republic.Copyright © 2023

Telemedicine to Timor-Leste: implementing an international cardiac telehealth service during population dislocation, floods and COVID-19.

BACKGROUND: The East Timor Hearts Fund has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. AIM: To develop collaborative telehealth services between Australia and Timor-Leste in the context of international border closures due to the COVID-19 pandemic. METHODS: Scoping discussions identified major challenges (structural, patient related and medical system related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared with an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. RESULTS: Twenty-three patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared with an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients; 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23; 73.9%) and Dili based (18/23; 78.3%), with a mean age of 25.9 ± 7.2 years. The majority (12/23; 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-min walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. Eleven (47.8%) patients were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at the current inability to provide interventional services was highlighted. CONCLUSION: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.

International Scholarships and Southern Agency: An Ethnography of Alumni, Scholars, and Applicants

International scholarships are an established mode of aid distribution for many donor countries and a life-changing educational opportunity for recipients from the global South. This article draws upon ethnographic field research centred on Dili, Timor-Leste, focussing on case studies of a scholarship applicant, a scholar, and an alumnus. It employs the concept of Southern agency, investigating individual practices shaped by influences that both constrain and enable action, namely local infrastructure, family and kinship groups, literacies, and the colonial legacy. Scholarship places are limited and extremely competitive, while assigning a moral imperative for alumni to learn and return to contribute to local development, often resulting in the re-production of socially normed roles echoing the colonial era. The global upheaval in higher education resulting from the COVID-19 pandemic emphasises the need for alternative interventions in the global South, including greater investment in local higher education institutions, and online learning. [ FROM AUTHOR] Copyright of Journal of Studies in International Education is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The COVID-19 laboratory response in Timor-Leste; a story of collaboration.

Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.

The epidemiology of the COVID-19 pandemic in the small, low-resource country of Timor-Leste, January 2020 - June 2022.

Abstract: Timor-Leste, a small, mountainous half-island nation which shares a land border with Indonesia and which is 550 km from Australia, has a population of 1.3 million and achieved independence for the second time in 2002. It is one of the poorest nations in Asia. In response to the global coronavirus disease 2019 (COVID-19) pandemic, the Timor-Leste Ministry of Health undertook surveillance and contact tracing activities on all notified COVID-19 cases. Between 1 January 2020 and 30 June 2022, there were 22,957 cases of COVID-19 notified which occurred in three waves, the first which was delayed until April 2021 (community transmission of B.1.466.2 variant following major flooding), followed by waves in August 2021 (B.1.617.2 Delta variant transmission) and February 2022 (B.1.1.529 Omicron variant transmission). There were 753 people hospitalised due to COVID-19 and 133 deaths. Of the 133 deaths, 122 (92%) were considered not fully vaccinated (< 2 COVID-19 vaccines) and none had received boosters. Timor-Leste implemented measures to control COVID-19, including: rapid closure of international borders; isolation of cases; quarantining of international arrivals and close contacts; restrictions on internal travel; social and physical distancing; and, finally, a country-wide vaccination program. The health system's capacity was never exceeded.

The China Alternative. Changing Regional Order in the Pacific Islands

The presence of China poses a challenge to the dominance of Western powers and their allies, who have set the agenda in the Pacific since the end of the Second World War. [...]today, the region has been characterised by (post-)colonial power structures. In her opening remarks, Dame Meg Taylor clearly states that the Pacific Island states regard the presence of China in the region as a positive development because it gives PIF countries access to markets, technology, financing and infrastructure. The Boe Declaration of the PIF meeting in 2018, which states that "climate change remains the single greatest threat to the livelihoods, security and wellbeing of the peoples of the Pacific" (ix) - is the principal element of efforts by Pacific Island state leaders to implement the "Blue Pacific" concept and stands in stark contrast to the environmental and security policy of PIF member country Australia as well as that of the previous Trump administration. In Australia alone, economic damage caused each year by Beijing's punitive actions in response to bans on Huawei equipment (Australia excludes the Chinese company from the country's 5G roll-out) and COVID-19 demands (Canberra's call for an independent investigation into the origins of the virus) runs into the billions annually.

Journalism education 'truth' challenges An age of growing hate, intolerance and disinformation

This keynote commentary at the 2021 Asian Congress for Media and Communication (ACMC) conference with the theme Change, Adaptation and Culture: Media and Communication in Pandemic Times is addressed through a discussion of three main issues: 1. The COVID-19 Pandemic and how it is being coped with;2. A parallel Infodemic-a crisis of communication, and the surge of 'disinformation' and truth challenges in this 'age of hatred and intolerance';and 3. The global Climate Emergency and the disproportionate impact this is having on the Asia-Pacific region. Finally the author concludes with an overview of some helpful strategics for communicators and educators from his perspective as a journalist and media academic with a mission.

Telemedicine to Timor-Leste: Implementing an International Cardiac Telehealth Service During Population Dislocation, Floods and COVID-19

Background: The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID-19 pandemic, development of collaborative telehealth services was required. Methods: Scoping discussions identified major challenges (structural, patient-related and medical system-related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results: 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili-based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.

Making Money, Missing Home: Reflections on Timorese Informal Labour Migration to Britain

In the two decades of economic recovery in post-Independence Timor-Leste (2002–2022), there has been a growing interest and commitment, especially among young people, to pursue temporary and circular labour migration. In this paper I draw on a survey of returned Fataluku-speaking labour migrants who have spent varying periods of time working in the UK (Britain) and reflect on their experiences and the benefits or otherwise that have resulted from these efforts. The survey was undertaken in late 2019, just before the onset of the global Covid-19 pandemic. The subsequent lockdown and border closures marked the effective end of this remarkable, two-decade long, informal Timorese circular labour migration to the UK. A post-Covid landscape may yet see a lively resumption of this livelihood pathway, but it will do so in the uncertain terrain of a post-Brexit landscape in the UK and the prospects of new labour migration options available closer to home in Australia under the Seasonal Workers Program and Pacific Labour Schemes (PLS). [ FROM AUTHOR] Copyright of Asia Pacific Journal of Anthropology is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Digital Transformation as a Demographic and Economic Integrated Policy for Southeast Asian Developing Countries

The age of Southeast Asian developing countries’ populations is still younger than that of other regions around the world. However, recent statistics show that the tide is now turning in this regard, with many of these populations beginning to age at rates much faster than many other countries. Such developments require immediate policy action in order to create a sustainable path towards economic growth before demographic changes become less benign in the medium term. In this study, we discuss the economic consequences of population aging, increases in the economic support ratio, and a declining potential growth rate. We argue that it is essential for Southeast Asian developing countries to raise total factor productivity (TFP) growth rates so as to achieve more sustainable economic outcomes. By conducting panel regressions using data from 82 countries across the 1996–2019 study period, our study shows that increasing research and development (R&D) spending and the facilitation of structural changes that transform the digital economy landscape are key policy options that promote TFP growth.

Expanding teacher's creativity during Covid-19 era at timor-leste border area in 2020

The life of East Timor residents in the New Settlements becomes a certain problem. The problem of becoming Indonesian makes a certain point to be solved. The problem is about how to handle students creatively in the era of pandemic Covid-19. Objectives of this research consist of some points. (1) To find out teacher's creativity in doing approach to students who are learning at home related to the pandemic Covid-19 era in the border area of Timor-Leste. (2) To seek and to expand models of creativity in the context of teaching from home or school for students who are staying at home in the border of Indonesia and Timor-Leste area. The research method uses qualitative method especially literature studies, contemporary newspaper studies, and survey studies on teacher's creativity in Europe schools. The results of research are: (1) In fact, the technology and creativity are keys to the learning process in the era with the challenges of Covid-19 pandemic. (2) According to the results of the study, students who are learning at home have difficulty accessing the internet. (3) The quality and creativity of teachers need to be considered, expanded, and improved. (4) According to the results of this study, teachers' creative abilities were at a moderate level because teachers were shocked by the spread of Covid-19. © 2021 ACM.

COVID-19 and food systems in Pacific Island Countries, Papua New Guinea, and Timor-Leste: Opportunities for actions towards the sustainable development goals.

Context: The COVID-19 pandemic has impacted global food systems. This has led to different strategies by communities, governments, and businesses involved in food systems to mitigate and adapt to the unfolding pandemic. Small Island Developing States are particularly exposed to the conflation of risks from COVID-19 disease, economic downturns, underlying climate vulnerabilities and biosecurity risks. Objective: Our study aimed to identify the food systems vulnerabilities, impacts, and opportunities for supporting resilience and sustainable development in selected Pacific Island countries, Papua New Guinea, and Timor-Leste. The study focused on the impacts from the first six months of the pandemic (February-July 2020), with remote data collection and analysis done between May and July 2020. Methods: We conducted 67 interviews, and triangulated information with desktop and news sources emerging at the time. We present results on the effect on smallholder livelihoods, supply chains, governance, communities and employment. Overall, the major impacts of COVID-19 have been on economies, posing risks to future food security and further hampering progress towards key Sustainable Development Goals. Results and conclusions: We found that unemployment and economic contraction have been the most severe effects to date, with long-term consequences for food value chains and smallholder farmers. Disruptions to tourism, labour migration, and remittances have led to varying socio-economic impacts throughout the region. Vulnerable groups, notably women, urban poor, and youth, have been disproportionately affected by unemployment. Timor-Leste has had some social protection measures, whereas in Pacific Countries these have been varied. The lockdowns and State of Emergency initially influenced the distribution and marketing of food, but local food economies are starting to stabilise. The continued functioning of international food supply chains reduced the risk of food insecurity in high import dependent nations, notably import dependent countries like Tuvalu and Kiribati. Significance: The results have significance for three recovery pathways. The first recovery pathway relates to revisiting value chains in light of restricted travel. The second recovery pathway exists through leveraging the adaptive capacities of communities to stimulate innovative agriculture that also integrates climate adaptation and nutrition. The third recovery pathway relates to addressing the structural challenges that perpetuate inequalities and poverty while finding new ways of implementing inclusive policies and research. Our study presents a set of comparative examples of managing a food system shock that can inform future systems-oriented research and policy for sustainable development.