Rheumatic fever and rheumatic heart diseases in Fiji: a review from the surveillance system (1996 -2000).

The Surveillance System for many Notifiable Diseases in Fiji is described by many as inadequate. This system includes the reporting and recording of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). Prominent amongst the inadequacies of this system is the under reporting and the diagnostic dilemma and classification of he cases. Under-reporting was estimated at about 40% in Viti Levu, 44% in Vanua Levu, and 66% in the outer islands. This paper reviews the Surveillance System pertaining to ARF and RHD and describes the trends and demographic distribution of ARF and RHD in Fiji during the period 1996-2000 while highlighting the problem of the system A retrospective review of admission records of the Pediatric Ward, Colonial War Memorial Hospital (PW/CWMH), Suva, Fiji, from 1996 to 2000 was undertaken. Admission books were cross-checked with patient folders, when required, to avoid inaccurate counting of cases. Data obtained were analyzed and compared with those obtained from the Ministry of Health (MoH) during the same period. Under-reporting of ARF was documented with fewer ARF cases reported less than the actual number of ARF cases admitted to PW/CWMH in 1998 to 2000. On average, 18 ARF cases were reported each year for a cumulative incidence of 2.3 per 100,000 population; 173 RHD cases were reported each year for a cumulative incidence of about 21 per 100,000 population during this 5-year period. The problems seemed to be more prevalent among the Fijians compared to Indians; children in the 5-9 age group were more affected by ARF and those in the 10-14 age group were more affected by RHD. There was no statistically significant difference in the mean age between Fijian and Indian cases for both ARF and RHD. Under-reporting was apparent in the surveillance of ARF and RHD in Fiji. The cumulative incidence of ARF in Fiji appeared much lower than that reported from other Pacific countries. There is a definite need to improve the Disease Surveillance System and to sustain an effective ARF/RHD prevention programme are needed in Fiji.

Fijian participation in health research: analysis of Medline publications 1965-2002.

UNLABELLED: The driving force of health research in the Pacific has been the expatriates. The common practice has been that health professionals from developed countries come and do research, without much involvement by local experts, take the data off shore to analyze and publish elsewhere, without benefiting the researched communities. OBJECTIVES: this paper examines the participation of Fijians in health research publications on Fiji; identifies the most researched health areas; and discusses the implications for health priorities and research capacity development in Fiji. METHODS: Medline published papers were used as database using "Fiji" as the search word. Two hundred and ninety-eight (298) health-related publications were retrieved from July 1965 to April 2002. Direct and indirect interviews were conducted for the identification of authors. Reviewing abstracts and full-textpapers were performed for the ascertainment of studied subjects of papers. RESULTS: The 298 papers identified include 275 (92.3%) descriptive studies (including community/population surveys, case series and cross-sectional studies); four (1.3%) case-control studies; eight (2.7%) cohort studies and 11 (3.7%) unknown-type studies. There were no randomized-controlled trials (RCT) or community intervention trials (CIT). Turning to authorship, there were more expatriates (82.3%) than local researchers (17.7%) out of a total 815 authors. There were fewer Fijians who had been sole and first authors (12.5% and 13.5%, respectively), and a significant difference between the proportion of non-Fijians to have contributed as sole and first author compared to that of Fijians (c2=6.4, df=1; p=0.01). Among the Fijian authors, males contributed five times more than females. Indo-Fijians (58%) participated more than indigenous Fijians (40%). Indigenous Fijian females contributed significantly more than Indo-Fijian females (c2=4.77; df=1; p=0.02). The majority of the authors (70.4%) were in the forties and fifties age groups. The staff from the Fiji School of Medicine (FSM) contributed only 12.9% to the total Fijian authorships. The remaining Fijian authors were affiliated with the Fiji Ministry of Health (MoH), the University of the South Pacific (USP) and other Fiji Government entities. The most researched areas were Non-communicable Diseases (13.4%), Infectious Diseases (11.4%), Health Services (10.4%), Nutrition and Dietetics (9.1%), and Mental Health (7.0%). The least researched areas were Cancer (2.3%), Gerontology (2.0%), Biochemistry (1.7%), Traumatology (1.7%) and Dermatology (1.3%). Only 31 (16.6%) out of 187 journals with papers about Fiji were available in the FSM Library. There was a significant increase of health publications over the studied period (r=0.502; 0.001