Health lhtrend in Focus: Population in Fiji.

Transcription

1 Health lhtrend in Focus: Diseases Affecting the Indigenous Population in Fiji. Dr. Santha Muller, Director and Associate Professor Medical Research Laboratory and Research Center, Fiji National University, Fiji f/

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3 About Fiji Islands Fiji consists of more than 300 islands and about 110 are permanently inhabited covering a total land area of 18,376 square kilometers. Fiji lies in the heart of the Pacific Ocean midway between the Equator and the South Pole. The two largest islands of Viti Levu and Vanua Levu comprise of more than 85% of the total area. Fiji is relatively a small low income country in the Pacific with a largest population of all Pacific island countries. Fiji has an estimated population of which ranks 161 st in Fiji has an estimated population of 893,000 which ranks 161 in the world.

4 History of Fiji Fiji has been inhabited since the 2nd millennium BC, first by the Austronesians and then the Melanesians. The natives of Fiji Fijians or i Taukei. Europeans first came to the area in the 1600's, and the British iih established the Colony of Fiji in 1874.

5 During British itih times!.. Most Indo Fijians are the descendants of indentured laborers brought to Fiji during the nineteenth century by the British. The first indentured laborers from India arrived in Fiji in 1879 and the indenture system lasted until Other immigrants from India arrived in Fiji in the early twentieth century, and they opened small shops in the coastal towns. The Indo Fijians are part of the south Asian diaspora (a community of ethnically related displaced peoples) that includes the Indian Ocean island of Mauritius, Trinidad in the Caribbean, Guyana in South America, South Africa, and North America. Read more: Rica to Georgia/Indo Fijians.html#ixzz3neJOBM3g

6 Present Fiji After nearly a century as British colony, Fiji became independent in 1970, October 10 th. Celebrated the 45 th Fiji day. Today Fiji has one of the most developed economies of the Pacific islands.

7 Demographic Overview: Fiji is a multi cultural country: indigenous itaukei [Fijians] (56.8%), Indo Fijians (37.4%) and other minorities, including Caucasian and Chinese and other Pacific Islanders who either come to study or work in Fiji. Fiji is known to be the most urbanized country in the Pacific which comprises of 49% rural and 51% urban populations

8 Health trend in Fiji CDs Communicable Diseases: HIV/AIDS/ Tuberculosis Dengue g Fever Leptospirosis Rubella Influenza NCDs Non Communicable Diseases: Diabetes. Cancers CVDs and Hypertension Combined risk ik for NCDs Obesity Stroke Amputation

9 HIV A big threat t to Fiji The HIV epidemic is still in the exponential growth phase and is not showing any signs of leveling off. HIV is a real threat to the people of Fiji and, unfortunately, it is claiming a lot of i Taukei lives. Mr Usamate said Minister for Health and Medical Services, Fiji.

10 Fiji is classified as a low HIV prevalence country The confirmed HIV/AIDS cases from 1989 to 2015 is 610. INDIGENOUS Fijians top the number of people living with HIV/AIDS in the country. National Substance Abuse Advisory Council (NSAAC) in a recent survey. The findings revealed that about 87.5 per cent of recorded cases of people living with HIV were itaukei. Of the 493 cases recorded in the past four years, at least 450 were itaukei.

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12 Increasing trend among the natives

13 New HIV Infections Amongst Ethnicities in Fiji [ ] Fijian Fijian of Indian Descent Others Unknown

14 Trend in the number of Tuberculosis cases recorded as Trend in the number of Tuberculosis cases recorded as smear positive at P J Twomey Hospital, Suva, Fiji, ( )

15 Burden and characteristics of tuberculosis cases registered at P J Twomey Hospital,Fiji : public Health action 2014 March 21, 4(1): Between 1950 t0 2010, the males were more affected and 70 % of the TB cases were indigenous Fijian (i Taukei). Drastic increase in tuberculosis cases till now The National Tuberculosis (TB) Strategic Plan is under review by the Ministry of Health as part of plans to strengthen prevention and control

16 Serological confirmed Dengue Fever cases by Ethnic group, Gender in Fiji, (J.Tabua etal 2013) Ethnicity Gender Tota l There was very little Fijian i Fijian Others Female Male difference in total dengue taukei (%) Indian (%) fever cases by gender; Origin (%) however males have a (66 ) 18(29) slightly higher count ( 29 ) 10(71) (66) 1(33) (66) 5(33) (66) 27(28) (56) 75(37) (61) 106 (34) (70) 2 (20) Total 436(60.64) 244(33.94) 39(5.42 ) 339 (47.15) 380 (52.85) 719 The serological confirmed cases were generally stable from 2003 and However, in 2008 there was a sudden rise in the number of dengue fever cases especially ill amongst the Fijian i Taukei.

17 Once again gi!!! Dengue Fever Leptospirosis P e r c e n t a g e P e r c e n t a g e i Taukei Indo Fijian others Ethnicity i 0 i Taukei Indo Fijian others Ethnicity Ref: Fiji communicable disease bulletin 3 rd quarter FCCDC, Ministry of Health, Fiji 2013.

18 NCDs Globally!!! ll Non Communicable Diseases growing global problem causing over 60 % of deaths worldwide. Major problem in LMICs Low and Middle income countries. Many LMICs Cd and NCDs co exist placing great strain on health care issues. The burden of NCDs are expected to rise in the next decade.

19 NCDs in Pacific Especially the island countries facing a high burden of NCDs. The highest rates of Obesity and diabetes are reported in pacific. The paradise changing into fattest Genetic? Environment, food or climate change?

20 NCDs in Fiji In Fiji, one of the major risks to our population is the rising crisis of non communicable diseases (NCD s). In recent decades, NCD s have become the biggest killer in Fiji, causing thousands of deaths every year many of those deaths premature and affecting the lives of many more. Around 80% of deaths in Fiji are caused by an NCD and those numbers are growing.

21 NCDs in Fiji There are three main types of NCD; Cancers Diabetes Cardiovascular Disease (Heart disease such as heart Cardiovascular Disease (Heart disease such as heart attacks and stroke)

22 Cancer prevalence in Fiji Ethnicity Type of cancer HPV Cervical cancer 2 Breast cancer 1 Prostate cancer 3 i Taukei 64% 38% Indo Fijians 32% 50% others Cancer is the third leading cause of death in Fiji and accounts for 10 percent of all deaths annually. Cervical cancer was the biggest killer for women followed by breast cancer, while for men, it was prostate cancer that caused the highest deaths. 1. Fiji times on line: Sunday October 4, Fiji sun online: Cervical cancer top killer October 9 th Fiji times online: ignorance can kill, November 18, 2014.

23 ) SUMMARY OF DIABETIC CASES FROM (Source: National Diabetic Center, Fiji) rising threat of diabetes to Fijian society. Increasing diabetes prevalence also leads to rising rates of kidney disease and amputations.

24 What causes these NCDs in Fiji? There are many risk factors that make you vulnerable to NCDs. Tobacco use and Alcohol drinking at higher risk Physical Inactivity it Lack of exercise. Unhealthy diet high in salt, sugar, fat and processed foods.

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26 NCDs: Three major causes of deaths in Fiji. March 15, 2015 Cardiovascular diseases Diabetes and Strokes

27 Prevalence of common Modifiable risk Factors for NCD Tobacco use and cigarette smoking Alcohol consumption Binge drinking Kava consumption

28 Percentage of smokers by Ethnic groups Ethnicity men women Both sexes i Taukei 51.7%(n= 614) 22.9% (n=765) 37.6% (n=1379) Indo Fijians 39.7%(n=456) 2.1% ( n=623) 20.3% (n=1079)

29 Alcohol consumption by ethnic group (for both sexes) More indo Fijians were current drinkers. Ethnicity N % i Taukei Many Fijians prefer kava drinking Indo Fijians

30 Binge drinking in Fiji Ethnicity N= % more than 5 drinks i Taukei Indo Fijians

31 Kava or Yaqona consumption Age group (years) Men (n) women Both sexes (271) 45.5 (331) 62.4(602) (279) 38.5(426) 58.3(705) (333) 35.6(401) 59.5(734) 5(734) Ethnicity n % i Taukei (236) 31.0(272) 52.6(508) Indo (1119) 38.8 (1430) 59.0(2549) Fijians

32 Combined risk factors of NCDs in Fiji STEPs report 2011 Current daily smokers. Overweight and Obesity Raised blood pressure Consumed less than 5 combined servings of fruit and vegetables. Low level of physical activity.

33 Prevalence of NCD risk categories by age and ethnicity 100% 100% 90% 90% 27 p 80% p 80% 46 e e 70% 70% r r c 60% c 60% e % 3 5 risk factors e 50% 50% n n t a g e 40% 30% 20% % 1 2 risk factors % 0 risk factors t a g e 40% 30% 20% % 3 5 risk factors % 1 2 risk factors % 0 risk factors 10% 10% 0% % i Taukei Indo Fijian AGE Ethnicity

34 Physical activity by ethnicity and age groups % 90% 80% 70% 60% 50% 40% 30% % High % Moderate % Low 10 0 i Taukei Indo Fijians 20% 10% 0%

35 Prevalence of intermediate risk factors for NCDs Weight classification by gender and ethnicity 100% 90% 70 P P 80% e e 60 r 70% r c c 50 60% e e 50% 40 n n t 40% t 30 a 30% a 20 g g 20% e e 10 10% 0% 0 80 Indo fijians i Taukei Men Women Based on BMI

36 Kinds of Medications Ethnicity % seen a traditional healer for Diabetes (n) % taking herbal/traditional treatment for Diabetes (n) % taking prescribed medicines for Diabetes (n) i Taukei 25.8 (51) 14.3 (51) 2.7 (46) Indo 11.3 (58) (58) 25.6 (51) Fijians

37 Amputation ti Demographic data of all DM related amputations performed at the Colonial War Memorial Hospital, Fiji Islands, Source:

38 NCD ScenarioS i Country is in great focus: It is very clear that life style changes led to a huge rise in NCDs especially diabetes and CVDs ( stroke and amputations) The major change is: decline in traditional dietary customs and increased physical inactivity due to urbanization. Diabetes Fiji: Hubs access, educate and provide medical treatment. Obesity prevention Research centers in collaboration with Ministry. STEPS survey Reduction in salt and sugar in foods.

39 NCD policy Fiji has implemented a number of important health initiatives on NCDs: National NCD strategic plan Current NCD plan Disease prevention SNAP risk factors. Key programs: Health promotion fruit and vegetables servings, exercise Tobacco Free initiative Nutrition breast feeding, school canteen, salt reduction etc., Diabetes prevention

40 To summarize: Fiji is fast becoming more modernized. Tourism and the infiltration of western media, imported Asian foods (white rice and noodles) leads to unhealthy living. Indigenous people p almost abandoning traditional rich diets, locally gown indigenous sources such as plantations, bananas and bread fruits. Promoting agriculture and fishing industries.

41 Three way solution Promoting locally grown foods among schools targeting gthe younger and future generation of the country. Developing program for limited drinking both alcohol and kava. Wellness program projects for regular exercises to change the behavior patterns among the affected groups.

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43 References: 1. Fiji communicable disease bulletin 3 rd quarter FCCDC, Ministry of Health, Fiji The trend of tuberculosis cases over 60 years in Fiji s largest treatment centre: Tamani K. Bissell K. Tayler Smith S. Gounder N. N. Linh S. M. Graham03/2014; 4(1): DOI: /pha Fiji: NCD risk factors steps report Retrospective study on the effect of climate variability on the incidence of dengue in fiji from , J.Tabua etal. Orginal Research FJPOH voluem 2, Issue 2, HIV narrative report Fiji: NCD Risk factor STEPS report Burden and characteristics of tuberculosis cases registered at P J Twomey Hospital,Fiji : public Health action 2014 March 21, 4(1): () 42 46

44 Ak Acknowledgments ldg Thanks to: MRL research Team C POND Research Team Dr. Tukana, National Advisor for NCDs. Ministry of Health and Medical Services, Fiji