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Samoa, considered the heart of Polynesia, has a medicolegal system with some limitations. There is a need to build a well-organized medicolegal service. The authors briefly outline the medicolegal system in Samoa from its beginning to the present and discuss future improvements.
This investigation studied the potential effects of societal modernization on Samoan children's blood pressure and heart rate reactivity to a standardized television video game procedure. Ethnic Samoan children were sampled from Western Samoa (N = 72), a relatively underdeveloped country with a largely agricultural economy, and American Samoa (N = 70), a territory of the United States that has undergone substantial modernization due to recent economic aid. Results indicated that Western Samoans demonstrated significantly greater systolic blood pressure, diastolic blood pressure, and heart rate reactivity than American Samoans. These data, in conjunction with previous data, suggest that the hemodynamic effects of an acute stressor are inversely associated with societal modernization and an individual's adoption of a lifestyle reflecting integration into a modernized society. Further work is needed to examine the implications of this hypothesis and the associations among concrete measures of modernization and children's cardiovascular risk.
A conceptual analysis focuses on defining child maltreatment from the perspective of two Island nations in the Pacific Basin, American Samoa and the Federated States of Micronesia. Based on a review of the literature on child maltreatment laws and cultural factors in each region, a range definition is proposed. The range definition is comprised of defining features and borderline features for child maltreatment as it exists across these cultures in the Pacific Basin. Defining features were derived from evaluation of child abuse and neglect laws in each specified population. Borderline features were derived from cultural factors in American Samoa and the Federated States of Micronesia. While these Island nations already have child abuse and neglect laws, they are adapted from the United States. The degree at which unreasonable harm becomes abuse is culturally dictated, hence, these territories of the Pacific Basin are seeking culturally specific terminology when defining child maltreatment. The findings of this analysis indicate the significance of transcultural knowledge in nursing practice and the legal accountability nurses hold on the issue of child maltreatment.
There is no routine prenatal screening for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) in pregnancy in Samoa. Testing for chlamydial infection is not available. To gather information on pregnant women, a prevalence survey was conducted in Apia, Samoa, utilizing two prenatal hospital clinics. Pregnant (n=427) women were tested for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis using polymerase chain reaction (PCR), and for syphilis (n=441) by rapid plasmid reagin (RPR) and HIV (n=441) by enzyme-linked immunosorbent assay (ELISA). Results were: chlamydia 30.9% (132); trichomoniasis 20.8%; gonorrhoea 3.3%; syphilis 0.5%; and HIV 0%. Overall 42.7% had at least 1 STD. Young women aged <25 years were three times more likely to have a STD than older women (odds ratio=3.0, 95% confidence intervals 2.0, 4.5). The lack of inexpensive, reliable field diagnostics remain a barrier to sustainable STD control programmes for pregnant women living in developing countries.
This study, funded by the National Cancer Institute, assessed cancer awareness and service needs in American Samoa. Cancer is the second-leading cause of death in American Samoa, yet cancer specific resources are lacking. Assistance is needed to help: 1) increase cancer outreach and community awareness; 2) increase the cancer capacity of health professionals; 3) improve laboratory capacity for cancer screening and detection; and 4) establish a comprehensive and coordinated system of cancer services.
In order to study the occurrence of hydatidiform mole and choriocarcinoma in the island of Western Samoa in the South Pacific, a delivery based study was carried out. All deliveries, both livebirths and stillbirths at the main referral centre (National Hospital), all livebirths at the district hospitals/health centres and all live home deliveries 1980-87 were included. Thirty-two hydatidiform mole cases were recorded on pathological and clinical grounds. No case of choriocarcinoma was encountered. The incidence rate of hydatidiform mole was estimated to be 0.90 per 1000 deliveries, the estimated frequency rate being 1:1109 deliveries. The mean age of cases was 31 years, ranging from 19 to 48. It is suggested that the incidence of trophoblastic disease is not significant in Western Samoa in terms of geographical variations. The importance of methodology in estimating the incidence was also discussed.
Gastroenteritis has been identified traditionally as a major health problem in Western Samoa. In order to establish the extent of the problem, and to identify the viral and bacterial pathogens involved, stool specimens were collected from all children less than 2 years of age admitted to Apia Hospital, Western Samoa, over a 2 year period. Rotavirus was recovered from 5.5% of all admissions (20.5% of those labelled gastroenteritis) and bacterial pathogens were isolated from 2.1% of all admissions (0.9% of all those labelled gastroenteritis). Thus in Apia, as elsewhere, rotavirus is the most commonly identified enteric pathogen associated with infantile diarrhoea.
Obesity and an increasing prevalence of associated conditions such as diabetes and cardiovascular disease are frequently observed in Pacific populations as lifestyles become more modernized. In 1978, a survey conducted in three geographically defined populations in Western Samoa showed large differences in the prevalence of obesity (body mass index (BMI) > or = 30 kg/m2) between rural and urban populations. A follow-up survey using similar methods was performed in 1991 to examine the current level of obesity in these three locations and to assess changes over time. Cross-sectional differences in the prevalence of obesity, mean BMI and waist-hip circumference ratio (WHR) between urban Apia and rural Poutasi and Tuasivi were examined after adjusting for age. There were higher levels of obesity in urban vs rural areas: 74% of women in Apia were obese compared with 62% in Poutasi and 56% in Tuasivi. In men, comparable figures were 57%, 44% and 36% for Apia, Poutasi and Tuasivi respectively. Mean BMIs followed the same pattern. By contrast, WHR varied little between locations. Even in subjects aged 25-34 years, more than 50% of women in all locations, and 45% of urban men were obese. Increasing physical activity in men, but not women, was associated with lower mean BMI. Increasing education level and job status were associated with increasing BMI but these relationships were significant only in men. Multivariate analysis showed age, location (urban), occupation (high status, women), and in men, physical inactivity, to be independently associated with increased risk of obesity. Prevalence of obesity increased dramatically between 1978 and 1991 in all locations, but especially in Tuasivi, where in males the increase was 297% and in females 115%. There was a rightward shift in the distribution of body mass index in both sexes and all locations. These extreme increases in the prevalence of obesity, even in young adults, over the relatively short 13-year study period suggest an increasing burden of chronic diseases facing Western Samoa in the future, and emphasize the need for effective intervention to bring about lifestyle modification.
Early European visitors to Samoa tended to denigrate the authenticity and efficacy of Samoan herbal medicine, yet bioassays indicate pharmacological activity in over 86% of Samoan medicinal plants. Novel anti-inflammatory compounds have been isolated from Alphitonia zyzyphoides and Erythrina variegata, and the anti-HIV compound prostratin has been isolated from Homalanthus nutans. Unfortunately, both Samoan ethnopharmacology and Samoan rain forests are threatened. In order to prevent logging, funds were raised to build a needed village school in exchange for a village covenant to protect the 30,000 acre Falealupo forest. Subsequently, four additional rainforest reserves have been established. Hopefully such conservation measures can save the ethnopharmacological knowledge of Samoa.
Western Samoa is an island state in the Polynesian part of the South Pacific Ocean with a total population of around 160,000. In 5 July 1985 multidrug therapy (MDT) as advised by the WHO was started in leprosy patients there. One hundred and eighteen cases (99 males, 19 females) on the active list were included in the MDT programme. Sixty-three (53.3%) were paucibacillary and 55 (46.6%) were multibacillary. Eighteen patients (15.26%, 15 paucibacillary, 3 multibacillary) were below 15 years of age. In this paper we present a preliminary evaluation of WHO/MDT, in leprosy patients in Western Samoa as of 31 December 1987. Assessment was done on clinical, bacteriological and histopathological grounds. During the evaluation period the acceptance of MDT by Samoan patients was found adequate, even though surveillance is still continuing. As of 31 December 1987 there were 40 patients (34 male, 6 female) on the active list. Thirty-five (87.5%) were on multibacillary and 5 (12.5%) on paucibacillary regimen. Only 2 patients (both paucibacillary) were below 15 years of age. The prevalence rate was now estimated to be 0.25/1000. Leprosy cannot be considered to be a serious public health problem in the country. However there is still need for improvement in case-finding, recording and follow up matters.
Acute respiratory illness is one of the leading causes of childhood mortality in developing nations. We investigated an increase in hospitalizations of children less than 2 years old for severe lower respiratory tract illness (LRI) from October 1986 through December 1986 on the island of American Samoa. Hospitalization rates were highest in children less than 6 months of age (60 of 1000 compared with 22 of 1000 for those 6 to 11 months of age, and seven of 1000 for those 12 to 24 months of age). The outbreak was more severe than in previous years, with ten (19%) of 54 patients admitted to the intensive care unit (ICU) compared with three (7%) of 42 and one (3%) of 40 during the same months of 1985 and 1984. Two patients died. Most patients had clinical bronchiolitis; of 34 patients tested, serologic or nasal aspirate evidence of recent respiratory syncytial virus (RSV) infection was found in 18 (53%). A study of patients younger than 1 year of age demonstrated that patients hospitalized with LRI were more likely to have a household member who smoked cigarettes (18/20, 90%) than outpatient controls without recent respiratory illness (8/15, 53%). Maternal sera obtained between December 1985 and October 1986 showed no protective effect of either detectable IgG or neutralizing antibody to two major groups of RSV. Our study documents the involvement of RSV in an outbreak of severe LRI among infants in a tropical area and further suggests that exposure to cigarette smoke is a risk factor for LRI infants.
We analyzed the records of 50 head-injury patients managed by general surgeons from 1974 to 1981 in American Samoa. Patients were divided into three groups. Group 1 was awake and alert (n = 24). Group 2 was obtunded by talking (n = 7). Group 3 was comatose (n = 20). All patients were managed with diagnostic burr-hole procedures. Eighteen of the 20 unconscious patients had an intracranial hematoma. Five of the seven obtunded patients had an intracranial hematoma. Three of the nine deaths were directly attributable to a delay in diagnosis of an intracranial hematoma. We conclude that a burr-hole procedure in unconscious head-injury patients in rural hospitals is a safe and effective method of diagnosing and treating extradural and subdural hematomas. General surgery residents should receive training in operative head-injury management, to improve the care of the head-injury victim in rural America.
Variation in human apolipoprotein genes is a major source of phenotypic differences in human lipid metabolism. Data regarding genetic variation at apolipoprotein loci in various populations are only beginning to accumulate, and they suggest that different populations vary widely in distribution of apolipoprotein alleles. Using isoelectric focusing-immunoblotting techniques, we screened 67 serum samples from self-identified Samoan residents of American Samoa to investigate structural variation at six apolipoprotein loci: A-I, A-II, A-IV, C-II, E, and H. The APO A-I, A-II, and C-II loci were found to be monomorphic by isoelectrical focusing. In Samoans, the common three-allele polymorphism was observed for APO E, with no striking differences in frequencies from Caucasian populations. The three common alleles of the APO H locus also were identified; however, frequencies of the less common alleles (APO H*I and APO H*3) were different from those observed elsewhere for Caucasians.
Surveys were completed on Tutuila Island, American Samoa, to characterize reef development and assess the impacts of non-point source pollution on adjacent coral reefs at six sites. Multivariate analyses of benthic and coral community data found similar modern reef development at three locations; Aoa, Alofau, and Leone. These sites are situated in isolated bays with gentle sloping foundations. Aoa reefs had the highest estimates of crustose coralline algae cover and coral species richness, while Leone and Alofau showed high abundances of macroalgae and Porites corals. Aoa has the largest reef flat between watershed discharge and the reef slope, and the lowest human population density. Masefau and Fagaalu have a different geomorphology consisting of cemented staghorn coral fragments and steep slopes, however, benthic and coral communities were not similar. Benthic data suggest Fagaalu is heavily impacted compared with all other sites. Reef communities were assessed as bio-criteria indicators for waterbody health, using the EPA aquatic life use support designations of (1) fully supportive, (2) partially supportive, and (3) non-supportive for aquatic life. All sites resulted in a partially supportive ranking except Fagaalu, which was non-supportive. The results of this rapid assessment based upon relative benthic community measures are less desirable than long-term dataset analyses from monitoring programs, however it fills an important role for regulatory agencies required to report annual waterbody assessments. Future monitoring sites should be established to increase the number of replicates within each geological and physical setting to allow for meaningful comparisons along a gradient of hypothesized pollution levels.
Seven years after the 2nd mass treatment of the population with diethylcarbamazine, transmission of subperiodic Wuchereria bancrofti was studied in four villages in Samoa during one year by means of biting catches of Aedes polynesiensis and A. samoanus. 2 villages were coastal, one inland bush and the other an inland coconut plantation community. Overall infection and infective rates from 6702 Ae. polynesiensis were 0.84 and 0.27% respectively, and the infection rate from 2858 Ae. samoanus, collected in 10-minute catches from 24 sites, was 0.65%. No infective Ae. samoanus was found in these samples. 12-hour all-day catches in the 2 coastal villages confirmed active transmission by Ae. polynesiensis. 12-hour all-night catches in the same 2 villages recorded high transmission by Ae. samoanus although there was little evidence of local breeding. The annual transmission potential for Ae. polynesiensis and Ae. samoanus was high in one of the coastal villages and low in the other. A total of 221 infected Ae. polynesiensis and 40 Ae. samoanus were recorded. Of the 72 infective Ae. polynesiensis, 59.1% contained 1 to 2 larvae each (median density 1.4); 70% of the 40 infected Ae. samoanus had 1 to 2 larvae (median density 1.1). From the proportion of infective Ae. polynesiensis the mean probability of survival was estimated as 0.917.
Aedes polynesiensis and Ae. samoanus biting densities and Wuchereria bancrofti infection and infective rates were studied in 47 villages throughout the islands of Samoa Upolu, Manono and Savaii during 1978-79, and microfilaria (mf) rates were surveyed in 28 of the villages. The mf rate was correlated with both infection and infective rates of Ae. polynesiensis in Upolu, but not of Ae. samoanus. In Upolu, Ae. polynesiensis was apparently the major vector. It was relatively more abundant in more cultivated and populated areas, along the northern coast of Upolu, except Apia town area. In Savaii, Ae. samoanus predominated over Ae. polynesiensis except in "plantation" villages. Relatively high biting densities and rates of infection and infectivity indicated that Ae. samoanus was not less important than Ae. polynesiensis as a vector in Savaii. Ae. samoanus preferred natural vegetation, in contrast to Ae. polynesiensis which was found near human habitations in cultivated land. There was no difference between the biting densities of Ae. polynesiensis in "coastal" and "inland" villages, indicating that crab holes (numerous only in some coastal villages) may not influence the density of Ae. polynesiensis. Higher mf rates were associated with villages where Ae. polynesiensis, rather than Ae. samoanus, was dominant, indicating that Ae. polynesiensis was generally a more efficient vector. In the former villages, the difference in mf rates between males and females was smaller than in the latter, probably reflecting a difference in biting habits of the vectors. Ae. polynesiensis infections were recorded in plantations over 2 km from any village, suggesting that both habitats were foci of transmission.
One of the earliest quantitative surveys of soft corals, on a reef flat in Pago Pago Harbour, American Samoa, was repeated 85 years later. The alcyoniid communities there, which were the dominant benthic organisms during the initial survey, have suffered a drastic decline of 99% cover in the interim. The most likely causes of the decline are anthropogenic disturbance associated with reclamation along the harbour from the 1940s to early 1960s, compounded by chronic pollution from industrial wastewater discharge from the mid-1950s to late 1980s. The decline in one dominant species, Sinularia polydactyla, is likely to have serious consequences for the reef as unusually for a soft coral, this had been the major reef building species. Life-history traits of certain Sinularia and Sarcophyton, such as slow growth and low rates of sexual reproduction, mean they will be slower to recover from severe disturbance than many scleractinian corals.
We report the prevalence of sensory loss and hand deformity in 63 patients with Hansen's disease in American Samoa. Open ulceration, the most common deformity, was present in 41% of patients; sensory abnormalities were present in 54% and were bilateral in 65%. The presence of abnormal sensibility correlated with a high percentage of other deformities. Hand abnormalities were most prevalent in lepromatous patients and were related to a prolonged duration of disease. Nerve thickening did not appear to be a helpful clinical finding to assess the degree of sensory loss.