Use of the HESPER Web to Assess Perceived Needs Immediately After Multiple Disaster Events in Fiji.

OBJECTIVE: In January 2022, Fiji was hit by multiple natural disasters, including a cyclone causing flooding, an underwater volcanic eruption, and a tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters. METHODS: A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data. RESULTS: In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD = 3). The top 3 most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public. CONCLUSIONS: The top 3 needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters and may require more attention from responding actors. The HESPER Web was considered a usable tool for needs assessment in a sudden onset disaster.

Implementation and use of a national electronic dashboard to guide COVID-19 clinical management in Fiji.

Problem: From April to September 2021, Fiji experienced a second wave of coronavirus disease (COVID-19) precipitated by the Delta variant of concern, prompting a need to strengthen existing data management of positive COVID-19 cases. Context: With COVID-19 cases peaking at 1405 a day and many hospital admissions, the need to develop a better way to visualize data became clear. Action: The Fiji Ministry of Health and Medical Services, the World Health Organization and the United Nations Office for the Coordination of Humanitarian Affairs collaborated to develop an online clinical dashboard to support better visualization of case management data. Outcome: The dashboard was used across Fiji at national, divisional and local levels for COVID-19 management. At the national level, it provided real-time reports describing the surge pattern, severity and management of COVID-19 cases across the country during daily incident management team meetings. At the divisional level, it gave the divisional directors access to timely information about hospital and community isolation of cases. At the hospital level, the dashboard allowed managers to monitor trends in isolated cases and use of oxygen resources. Discussion: The dashboard replaced previous paper-based reporting of statistics with delivery of trends and real-time data. The team that developed the tool were situated in different locations and did not meet physically, demonstrating the ease of implementing this online tool in a resource-constrained setting. The dashboard is easy to use and could be used in other Pacific island countries and areas.

'Some of my patients only come to renew their prescriptions. They are not interested in any additional advice or support'. Physicians' perceptions on their roles in cardiovascular diseases risk reduction and management in Fiji.

BACKGROUND: Primary health care (PHC) physicians' perceptions are vital to understand as they are the first-line health care providers in cardiovascular diseases (CVD) risk assessment and management. This study aims to explore PHC physicians' perceptions on their roles and their perceptions on management and risk reduction approaches on CVD risk reduction and management in Fiji. METHODS: This is a qualitative study conducted in the Suva Medical area among 7 health centers from 1 August to 31 September, 2021. Purposive sampling was used to recruit physicians who worked in the Suva medical area as PHC physicians with at least 6 months' experience in the Special Outpatients Department clinics. In-depth interview were conducted using a semi-structured questionnaire over the telephone and recorded on a tablet device application. The interview content was then transcribed, and thematic analysis was done. RESULTS: This study included 25 PHC physicians. From the thematic analysis, 2 major themes emerged with 6 subthemes. Theme 1 was CVD management skills with 3 subthemes including education, experience and trainings, beliefs and attitudes of physicians, self-confidence and effectiveness in CVD risk reduction and management. Theme 2 was roles and expectations with 3 subthemes including perceptions of effective treatment, perceptions of physicians' roles and perceptions of patients' expectations. Physicians generally see their role as central and imperative. They perceive to be important and leading toward combating CVDs. CONCLUSIONS: Physicians' perceptions on their commitment to prevention and management of CVDs through their skills and knowledge, beliefs and motivation should be acknowledged. It is recommended that the physicians are updated on the current evidence-based medicine. Limitations include results that may not be the reflection of the entire physician and multidisciplinary community and the difficulties in face-to-face interviews due to the coronavirus diseases of 2019 pandemic.

Rapid SARS-CoV-2 Seroprevalence Survey in Central and Western Divisions of Fiji, 2021.

During November-December 2021, we performed a SARS-CoV-2 seroprevalence survey in Central and Western Divisions of Fiji. A total of 539 participants 8-70 years of age were 95.5% (95% CI 93.4%-97.1%) seropositive, indicating high community levels of immunity. Seroprevalence studies can inform public health responses to emerging SARS-CoV-2 variants.

Descriptive analysis of deaths associated with COVID-19 in Fiji, 15 April to 14 November 2021.

Objective: There is limited published information about deaths due to coronavirus disease 2019 (COVID-19) in Fiji, the World Health Organization's Western Pacific Region and low- and middle-income countries. This report descriptively analyses deaths directly associated with COVID-19 in Fiji by age group, sex, ethnicity, geographical location, vaccination status and place of death for the first 7 months of the 2021 community outbreak. Methods: A retrospective analysis was conducted of deaths directly associated with COVID-19 that occurred from 15 April to 14 November 2021 in Fiji. Death rates per 100 000 population were calculated by using divisional population estimates obtained from medical zone nurses in 2021. Results: A total of 1298 deaths relating to COVID-19 were reported, with 696 directly associated with COVID-19 and therefore included in the analysis. Of these, 71.1% (495) were reported from the Central Division, 54.6% (380) occurred among males, 75.6% (526) occurred among people of indigenous (iTaukei) ethnicity and 79.5% (553) occurred among people who were unvaccinated. Four deaths were classified as maternal deaths. The highest percentage of deaths occurred in those aged 370 years (44.3%, 308), and the majority of deaths (56.6%, 394) occurred at home. Discussion: At-risk populations for COVID-19 mortality in Fiji include males, iTaukei peoples, and older (370 years) and unvaccinated individuals. A high proportion of deaths occurred either at home or during the first 2 days of hospital admission, potentially indicating both a reluctance to seek medical care and a health-care system that was stressed during the peak of the outbreak.

Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study.

INTRODUCTION: Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision-making process. This research aimed to explore the factors that influence healthcare workers' experience and perceptions about delivering childhood immunization in Fiji. MATERIALS AND METHODS: A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi-structured open-ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. RESULTS: There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. CONCLUSION: Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level.

Frontline Health Care Workers' (HCWs) perception of barriers to managing COVID-19 in Fiji.

Background: Health Care Workers (HCWs) are at higher risk of COVID-19 infection with their efforts while protecting the greater community and also exposed to hazards, such as psychological distress, fatigue, and stigma. This study aimed to explore the perception of frontline HCWs on barriers of managing COVID-19 in Fiji. Methods: A qualitative study method was approached to conduct this study among the HCWs who worked on the frontline during the COVID-19 pandemic based at ten purposively selected health facilities in the Suva subdivision in the Central Division of Fiji. The Colonial War Memorial Hospital (CWMH), the Fiji Centre for Communicable Diseases (Fiji CDC), Twomey hospital laboratory, and CWMH laboratory did the main control and most of the operations of other divisions were monitored from these settings. A semi-structured open-ended questionnaire was used to collect data using in-depth interviews. The participants' responses were audio-recorded and were later transcribed and analyzed using thematic analysis. Results: A total of twenty-nine HCWs took part in the in-depth interview and the responses were grouped into four themes, which include: workload, poor communication, lack of resources, and hindrance to education. It was also found through this study that some of the HCWs felt tired, frustrated, got rude to patients, and found it difficult to handle situations, which affected them mentally and physically stressed. Conclusion: Managing the COVID-19 cases has been attributed to the presence of many barriers, such as workload, tiredness, frustration, and sometimes difficult-to-handle situations, and the HCWs were indeed affected mentally and physically. Regular training for HCWs and more awareness programs would help the general public to follow the preventive measures, which reduces the cases and would help the HCWs manage COVID-19 well.

What do university students say about online learning and the COVID-19 pandemic in central Fiji? A qualitative study.

Globally, the spread of COVID-19 has led to the closure of schools, thereby accelerating the expansion of the online learning environment. Though, Fiji National University students' (FNU), had no option than to quickly adopt to this mode of learning, within limited period, their learning experiences are yet to be examined and documented. We used phenomenological study design to explore students' online learning challenges, coping strategies and their perceptions on the causes of COVID-19. A total of 120 in-depth interviews were conducted with FNU students, at different levels and colleges, and analysed thematically, using inductive approach. The three themes emerged included COVID-19 misconception beliefs among students, online learning challenges during the COVID-19 pandemic and online learning coping strategies during the COVID-19 pandemic. The misconception beliefs identified were natural occurrence, manmade for depopulation, unreal/fake and as a means of soliciting for funds. The challenges included ineffective tutorial sessions, lack of learning devices, unstable internet service, inadequate learning environment, socio-cultural practices, feeling of loneliness, anxiety and stress, and difficulties accessing online platforms and acquiring practical skills. The coping strategies used by students ranged from support from family and counsellors, help-seeking, frequent communication, time management, learning flexibility to control over learning environment. The findings highlight the need for policy makers, school managers, lecturers and other key stakeholders to address online learning challenges to improve online learning among FNU students. Relevant information should be provided on the COVID-19 pandemic to clear misconceptions.

Abuse of social media duringCOVID-19 pandemic in Fiji.

The spread of misinformation, facilitated by social media and other digital platforms, has proven to be as destructive to global public health as the SARS-CoV-2 virus itself. Fake news adds challenges to human communication efforts, producing tension, misunderstanding, and disbelief. While social platforms such as Facebook, Twitter, Instagram, and Viber, etc. have provided a huge relief during the lockdown helping reduce mental stress and depression as well as facilitating online education, and work from home during the COVID-19 pandemic, it has also raised concerns over the spread of fake news. In such a situation, online fake news poses a new threat to public health communication as more people now depend on the internet to get health-related information. In response, this study seeks to understand how manipulation of news on social media has posed a threat to Fijian public health. Eventually, some of these have resulted in police investigations.

An overview of the Novel Coronavirus (SARS-CoV-2) crisis in Fiji: Correspondence.

Fiji is facing the second wave of COVID-19 and has been recording increased number of COVID-19 cases. The response of Fijian Government is mainly directed towards obtaining international assistance in terms of expertise and vaccinations. While international support is necessary for the country, the Fijian Government also needs to consider the basic needs of the affected Fijians. In response, this article will provide an overview of the current COVID-19 crisis in Fiji to justify the need for reshaping the current approach of the Fijian Government.

The use of careFiji app for contact tracing during the COVID-19 pandemic: Digital gap and challenges faced in Fiji.

Globally, digital contact tracing initiatives has been used as a tool to combat the COVID-19 pandemic. The Fijian Government and Ministry of Health are promoting the use of the "careFiji" app to help in contact tracing. This paper will discuss the rollout of the careFiji app which helps in combating COVID-19 in Fiji, and the challenges caused by the digital gap that has surfaced during the pandemic.

Remote learning and online teaching in Fiji during COVID-19: The challenges and opportunities.

Fiji is a small Pacific Island Country with a population of around 902,536 people. The current pandemic of COVID-19 is impacting the well-being, social life, and economic status of the country. Besides, the well-known health difficulties caused by this virus, education is another crucial sector that has been crippled. To prevent the local transmission of such deadly virus the common exercises used globally are lockdowns (stay-in), social distancing, and use of PPEs (facemask, hand glove, and face shield). As a result, students, and teachers at all levels of school have been obliged to quickly adapt to online learning. Therefore, in this paper, an outlook of COVID-19 and its impact on the educational system is discussed.

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

BACKGROUND: Oxygen 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. METHODS: Data 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. RESULTS: Critical 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. CONCLUSION: Introducing 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.

COVID-19 and vaccination rollout in Fiji: Challenges caused by digital platform.

Since the beginning of the pandemic, a variety of interventions have reduced SARS-CoV-2 virus infection and mortality, including individual precautions such as wearing proper personal protective equipment (i.e., hand gloves, facemasks, and face shields), social distancing, handwashing, and limiting interpersonal interaction to outside situations. The most promising hope for ending the COVID-19 pandemic is the successful launch of COVID-19 vaccines. In response, this letter to editor will disclose the rollout of COVID-19 vaccination and challenges caused by digital platforms in Fiji.

Use of personal protective equipment (PPE) during COVID-19 pandemic: A letter to the editor on "Envisioning the UN Sustainable Development Goals (SDGs) through the lens of clean water sanitation, life below water, and life on land in Fiji".

COVID-19 pandemic is a designated worldwide public health emergency, the use of a variety of plastic-based personal protective equipment (PPE) has escalated as a means of reducing infection. Emerging reports imply that the rapid expansion of PPE during the COVID-19 outbreak has exacerbated microplastics contamination in the ocean. In response, this letter to the editor will disclose the impact of PPEs on clean water sanitation, life below water, and life on land in regards to SDGs 6, 14, and 15, respectively.

Urban-Rural Compliance Variability to COVID-19 Restrictions of Indigenous Fijian (iTaukei) Funerals in Fiji.

Research on coronavirus disease 2019 (COVID-19) has focused primarily on impacts in Western societies despite emerging evidence of increased vulnerability among indigenous peoples such as Pacific Islanders. Using Facebook public posts, this research assessed compliance to COVID-19 restrictions such as social gatherings (SG) and social distancing (SD) in non-COVID-19, indigenous Fijian (iTaukei) funerals in Fiji. Results showed 95% of the 20 funerals exceeding SG limits with greater, and highly variable crowd sizes in rural than urban communities. Additionally, 75% of the 20 funerals did not adhere to the 2-m SD requirement of which 80% were in rural areas. Higher SG and SD compliance in urban funerals could be partially explained by the presence of a recognized authority who enforced crowd size limits, and the heterogeneous urban community who were more likely to flag breaches than their collectivistic, homogeneous, close-knit, rural counterparts. Ultimately, health authorities need to utilize a social lens that incorporates etic and emic differences in culture to ensure maximum compliance.