Notes

Graph-based Region as well as Perimeter Location pertaining to Biomedical Impression Division.
Anti-tuberculosis treatment outcomes were more likely to be successful in patients who were supervised by a family member than in SAT patients. As this method of treatment supervision is not likely to be resource-intensive, we recommend that it continue in Fiji. Metabolism inhibitor Further prospective operational research could be carried out to determine patient preferences for anti-tuberculosis treatment supervision in Fiji, to promote a patient-centred approach.
Fixed-dose combinations (FDCs) of first-line anti-tuberculosis drugs were introduced in Fiji in 2011, and there have been concerns about treatment response.

To evaluate the treatment response to FDCs among tuberculosis (TB) patients.

A retrospective cohort study was undertaken of treatment outcomes of new TB cases registered from January 2010 to April 2013 and weighing ⩾30 kg. Sputum smear conversion of new sputum smear-positive cases and end-of-treatment outcomes of all cases were evaluated for those receiving FDCs and compared to outcomes with previous use of single-drug preparations.

Among new TB patients, 240 received single-drug preparations and 259 received FDCs for the full duration of treatment. The groups were similar in terms of demographic and clinical characteristics. Treatment outcomes were available for 95% of cases. Unknown outcomes were more common in those receiving FDCs. When known, end-of-treatment outcome was the same in the two treatment groups and did not differ between TB types. Sputum smear conversion after the 2-month intensive phase of treatment was similar in the two treatment groups 95% and 97%, respectively.

The introduction of FDCs in Fiji for the treatment of TB cases has not been associated with changes in treatment response.
The introduction of FDCs in Fiji for the treatment of TB cases has not been associated with changes in treatment response.
Tuberculosis (TB) is an ongoing public health challenge in Fiji. Clinical case detection and management are critical for effective TB control. Most TB cases in Fiji are hospitalised for the intensive phase of treatment.

To describe the demographic and clinical characteristics, comorbidities and final treatment outcomes of TB patients hospitalised for the intensive phase of treatment in Fiji.

A retrospective, descriptive study of all TB cases hospitalised during the intensive phase over a 3-year period (2010-2012).

A total of 395 TB hospitalised cases were included, of whom 61% were sputum smear-positive. The largest proportions of cases were among young adults (15-34 years) and the unemployed, respectively 43% and 71%. Diabetes (13%) and smoking (22%) were common comorbidities. Final anti-tuberculosis treatment outcomes were available for 96% of cases; 81% were cured or completed treatment. Default was more common in those with current employment. Death was the final treatment outcome in 4%, and was more common (11%) in the oldest group aged 355 years (OR 5.7, 95%CI 1.9-17).

This study provides original and comprehensive descriptive data on TB cases in Fiji and identifies characteristics associated with poor treatment outcomes.
This study provides original and comprehensive descriptive data on TB cases in Fiji and identifies characteristics associated with poor treatment outcomes.
Three tuberculosis (TB) treatment centres under the Fiji National Tuberculosis Programme.

To determine the prevalence of diabetes mellitus (DM) among TB patients for the period 2010-2012, and to evaluate sputum smear conversion and anti-tuberculosis treatment outcomes, comparing patients with and without DM.

A retrospective descriptive study using routinely collected data from the TB register and in-patient folders.

Of 577 TB patients identified, information on DM was available for 567 (98%), of whom 68 (12%) had DM. Smear status at 2 months was available for 254 (82%) patients with sputum smear-positive pulmonary TB. The sputum smear conversion rate (from positive to negative) was equivalent in TB patients with and without DM (78% vs. 80%, P = 0.66). Anti-tuberculosis treatment outcome information was available for 462 patients; the difference in outcome comparing successfully treated patients with those unsuccessfully treated was not statistically significant (91% in TB patients with DM vs. 84% in TB patients without DM, P = 0.06).

DM is common among TB patients in Fiji. link2 Sputum smear conversion rates were not different in TB patients with and without DM; no difference in treatment success between the two groups was observed.
DM is common among TB patients in Fiji. Sputum smear conversion rates were not different in TB patients with and without DM; no difference in treatment success between the two groups was observed.
The Colonial War Memorial Hospital (CWMH) in Fiji.

To determine the characteristics of patients with diabetes mellitus (DM) who underwent lower limb amputations at the CWMH from 2010 to 2012.

This was a retrospective review of data contained in operating theatre registers and clinical records of DM patients who had undergone amputations during the study period.

Of the 938 amputations performed at the CWMH during the study period, significantly more patients were male than female (54.1% vs. 45.9%) and more i-Taukei (indigenous Fijian) than Indo-Fijian (71% vs. 26.2%); 15.9% of patients had not previously been diagnosed as having DM when they presented with foot sepsis. The rate of smoking was highest in male i-Taukei patients. A large proportion of patients (76.8%) had poor glycaemic control.

This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.
This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.
The national hospital and stroke rehabilitation services of the Fiji Ministry of Health.

To describe patients admitted with stroke to the Fiji Colonial War Memorial Hospital (CWMH) from January 2010 to December 2012, and to report on rehabilitation services accessed during and after admission.

Retrospective descriptive study using patient records.

Of the 328 patients admitted with stroke, 54% were male, 55% i-Taukei and 16% aged <50 years; 75% had hypertension, 41% diabetes and 37% both; 23% (n = 76) died. Of the survivors, 58% (146) received rehabilitation therapy during admission at the CWMH. After discharge, 10% (n = 26) received therapy at the National Rehabilitation Hospital; six accessed the services of the community rehabilitation assistants. Just over half of stroke survivors (52%) remained in CWMH for <1 week (median stay 6 days, IQR 4-11).

The length of stay and access to rehabilitation was inadequate for over half of the stroke survivors. After discharge, very few accessed the available rehabilitation services of the Ministry of Health. It will be crucial to review procedures for tracking patient use of rehabilitation services and to explore why patients are not accessing these services, which are vital to recovery and restoration of function.
The length of stay and access to rehabilitation was inadequate for over half of the stroke survivors. After discharge, very few accessed the available rehabilitation services of the Ministry of Health. It will be crucial to review procedures for tracking patient use of rehabilitation services and to explore why patients are not accessing these services, which are vital to recovery and restoration of function.
Chalasa village, Traditional Authority Mtema, Lilongwe District, Malawi.

To report on the deployment of an electronic register in a rural village with no electricity. Specific objectives were to document 1) challenges in setting up the electronic village register (EVR); 2) demographics of village residents, along with births and deaths over three quarters; and 3) the costs of setting up the system.

A descriptive study.

The main challenges were slow adoption of the EVR by the village headman, lack of health passports for village residents, double counting of some residents and difficult connectivity. These challenges were overcome. In terms of data, of 790 village residents, 379 (48%) were male, 417 (53%) were aged <15 years and 29 (3.6%) ⩾65 years. From April to December 2013, there were 18 births and 5 deaths. The cost of the EVR, including maintenance costs for 12 months, was US$6210.

An EVR was successfully deployed in Chalasa village, rural Malawi, and data on the resident village population, along with quarterly births and deaths, are now available. link3 This is the first step towards a village-level civil registration system in rural Africa.
An EVR was successfully deployed in Chalasa village, rural Malawi, and data on the resident village population, along with quarterly births and deaths, are now available. This is the first step towards a village-level civil registration system in rural Africa.Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.
Cravings in pregnancy are considered to alter dietary intake; however, the nutritional consequences are unknown. The present study aimed to investigate the prevalence of food cravings in pregnancy, and their contribution, as a potentially modifiable determinant of weight gain and the development of obesity in pregnancy.

Healthy pregnant women were participants in the Belfast cohort of the Hyperglycaemia and Adverse Pregnancy Outcome study (HAPO), a prospective observational study examining maternal glycaemia and pregnancy outcome. Diet was assessed at an average of 29 weeks of gestation using a self-administered validated food frequency questionnaire over the previous 2 weeks that included questions on food cravings experienced at any time during pregnancy. Clinical measurements collected included, height, weight, blood glucose and neonatal outcomes. Mean daily nutrient intakes were analysed with appropriate software.

Food cravings were reported by 39% (n = 635) of women, with sweet foods, fruit and dairy products most frequently consumed. Those who craved foods had a higher mean (SD) energy intake [9721 (3016) kJ] (P = 0.002) even when under-reporters were removed [10131 (2875) kJ] (P = 0.008). However, no differences were found in nutrient or food intake between groups when adjusted for energy. Similarly, no differences were observed between groups and glycaemic control, anthropometric measurements or offspring outcome measures.

Cravings commonly occur in pregnancy and contributed to a small increase in energy intake; however, this did not impact on overall dietary intake, nor was it associated with excessive gestational weight gain, maternal glycaemia or offspring outcome measurements.
Cravings commonly occur in pregnancy and contributed to a small increase in energy intake; however, this did not impact on overall dietary intake, nor was it associated with excessive gestational weight gain, maternal glycaemia or offspring outcome measurements.
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