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PubMed1981

The prevalence of hepatitis B infection amongst urban and rural populations in Western Samoa.

A group of 240 urban and 200 rural dwellers in Western Samoa over the age of 20 years was studied for serological evidence of current or past infection with hepatitis B virus (HBV). Overall, 5.5% of subjects were found to be currently infected with HBV and a further 74.5% showed detectable levels of antibody. Antibody to the hepatitis B core antigen was found to be a better marker of past infection than antibody to the surface antigen of the virus. Both the infection rate and carrier rate were higher in males than females and subjects living in rural areas were more likely to be infected than those living in urban areas.

Adult↗
PubMed1991

Cancer incidence in Western Samoa.

This report presents the first data on cancer incidence in Western Samoa, which has one of the largest Polynesian communities in the world. Incidence estimates are based on a systematic retrospective survey of cancer cases identified in the laboratory of pathology, and from hospital records, for the period January 1980 to June 1988. The overall incidence rates are low in both sexes (age-standardized incidence rates are 93.7 for males and 95.7 per 100,000 for females). Although cases may have been missed, it seems likely that incidence rates among Samoans are substantially lower than those recorded in Polynesian populations elsewhere. It is notable that cancers related to tobacco are responsible for less than 17% of all cancers in males, compared to more than 30% in other Polynesians. Stomach cancer remains the most common cancer in males. In females, breast and cervix are equally common and make up almost 40% of all cancers. Liver cancer occurs more commonly in males, and the rates are slightly lower than those of other Polynesians. The high incidence of thyroid cancer seen in some Pacific Island populations is not seen among Samoans.

Adolescent↗
PubMed1997

The association of modernization with dyslipidaemia and changes in lipid levels in the Polynesian population of Western Samoa.

BACKGROUND: Obesity and non-insulin-dependent diabetes mellitus (NIDDM) have increased in prevalence in Polynesian Western Samoans over the 13-year period 1978-1991, as the population undergoes an 'epidemiological transition'. METHODS: We therefore investigated changes in the frequency of dyslipidaemia over the same period in adults aged 25-74 years, and examined factors associated with dyslipidaemia in cross-sectional and longitudinal data. Subjects were drawn from three geographically defined locations representing different degrees of modernization. RESULTS: The age-standardized prevalence of dyslipidaemia increased in each location between 1978 (n = 1197) and 1991 (n = 1748) with the prevalence of hypercholesterolaemia (> or = 5.5 mmol/l) increasing from 18% to 36% (P < 0.001), and that of hypertriglyceridaemia (> or = 2.0 mmol/l) increasing from 9% to 15% (P < 0.001) in the capital city, Apia. In 1991 the highest serum concentrations of total, high density lipoprotein (HDL) and calculated low density lipoprotein (LDL) cholesterol were found in Poutasi (intermediate level of modernization), and the highest triglyceride levels in urbanized Apia. Higher levels of body mass index (BMI), waist-hip ratio (WHR), glucose intolerance, fasting insulin concentration, physical inactivity, educational level, and occupational status were all associated with adverse lipid levels in univariate data. Obesity (BMI in women, WHR in men) and survey location were the most important correlates of abnormal lipid levels in logistic regression models. Fasting insulin was also independently associated with high triglyceride levels in men, while in women the increasing levels of fasting insulin were associated with adverse levels of total, LDL and HDL cholesterol, and triglycerides. In longitudinal data (n = 311), lower baseline levels of cholesterol and triglycerides were associated with greater increases in either parameter at follow-up. Elevated fasting insulin and female gender also predicted increasing cholesterol concentrations, and urban residence predicted an increase in triglyceride levels. CONCLUSIONS: Current levels of dyslipidaemia in Western Samoa are similar to those observed in developed Western populations, and are increasing rapidly. These findings, considered along with the high prevalence of other cardiovascular disease risk factors in Samoans, including smoking, obesity and NIDDM, suggest that cardiovascular disease will be a major health concern in the future.

Adult↗
PubMed1992

Acute hemorrhagic conjunctivitis due to enterovirus 70 in American Samoa: serum-neutralizing antibodies and sex-specific protection.

Acute hemorrhagic conjunctivitis due to enterovirus 70 has caused extensive outbreaks in tropical areas since 1969. Between December 1, 1990, and March 4, 1991, an outbreak of acute hemorrhagic conjunctivitis due to enterovirus 70 occurred in American Samoa, where an outbreak due to the same agent had occurred in 1981. A survey of 5% of the households (134 households, 1,095 individuals) was conducted throughout the island of Tutuila. The outbreak affected 58% of the population, with age-specific attack rates greater than 50% for all age groups except children younger than 2 years. Attack rates were significantly higher for children 2-10 years old (65%) than in the remainder of the population. Women aged 21-40 years had higher rates than did men the same age (66 vs. 49%), possibly because of the close association of women and young children. At higher preepidemic titers, there was evidence of protection from clinical disease among males but not among females. Enterovirus 70 can cause large outbreaks even in a population already exposed in a previous large outbreak; protection due to previous infection is only partial.

Antibodies, Bacterial↗
PubMedDate not supplied

Lifestyle incongruity and adult blood pressure in Western Samoa.

OBJECTIVE: The effects of lifestyle incongruity on blood pressure were tested in a cross-sectional study of 711 modernizing adult men and women, ages 25 to 64 years, residing in nine villages throughout Western Samoa. METHODS: Lifestyle incongruity (LI) was conceptualized as the mismatch between a 21-item material possessions and lifestyle scale and an eight-part occupational rank score. LI was measured by the arithmetic difference between the standardized distributions of lifestyle and occupation. Blood pressure (BP) was measured three times in the seated position, averaged and adjusted for body mass. Sex-stratified analyses were performed and adjusted BP was regressed on LI, age, and socioeconomic rank. RESULTS: In men systolic BP was associated (p < .01) with incongruity between material way of life and occupation. Men with higher occupation scores than lifestyle scores had significantly higher systolic BP. This association was stronger and significant for both systolic and diastolic BP among young (<40 years) men and all men from the more economically developed island. On the other hand, among older women diastolic BP was significantly (p < .01) higher among those whose material lifestyles exceeded their occupational class. CONCLUSIONS: The results in men, especially the young group, suggest two explanations: 1) financial demands from the extended family on young men with better paying jobs may reduce material consumption and produce psychosocial stress; 2) upward socioeconomic mobility marked by good jobs but a lag in material lifestyle may represent work stress. The results in older women support the suggestion of earlier studies that excess material consumption for enhancement of social prestige (living beyond ones' means) leads to stress and elevations in BP.

Adult↗
PubMed1992

Distribution of breeding and control of the filariasis vector Aedes samoanus in leaf axils of Pandanus in Samoa.

Water in leaf axils of the screwpine Pandanus was sampled for mosquito immature stages at seventy villages in Upolu, fifty-five in Savai'i and three in Manono, the main islands of Samoa. Ten plants in every patch of Pandanus plantation were sampled at each village. Among 23,049 mosquito larvae collected from Upolu, 77% were the filariasis vector Aedes (Finlaya) samoanus, 17.7% were Ae. (Fin.) oceanicus and 5.3% were Ae. (Fin.) tutuilae. Out of 6981 larvae taken in Savai'i, 23.2% were Ae. samoanus, 67.6% Ae. oceanicus and 9.2% Ae.tutuilae. When larval counts per plant were analysed for each district, Ae. samoanus was found to predominate in Pandanus in Upolu and Ae. oceanicus in Savai'i. However, the adult density of Ae.samoanus was higher in Savai'i and this was attributed to the large areas of forests with Freycinetia for Ae.samoanus breeding. In Pandanus in Savai'i the number of Ae.samoanus was negligible. In Upolu, with more urbanization and larger plantations, there was greater breeding of Ae.samoanus in Pandanus. Two control trials were conducted against Ae.samoanus larvae in Pandanus, one using a sand culture of the parasitic nematode Romanomermis culicivorax and the other with temephos, an organophosphate insecticide. While R. culicivorax did not adapt to the leaf axil habitat, all plants were without larvae for 5 weeks after treatment with temephos.

Aedes↗
PubMed1993

The relative importance and distribution of Aedes polynesiensis and Ae. aegypti larval habitats in Samoa.

In preparation for a Filariasis Control programme in Samoa, during 1978 monthly larval surveys of the vector mosquito Aedes polynesiensis were carried out in four study villages in the main island of Upolu. A more extensive survey of larval habitat distribution was then made in twenty-two villages of Upolu and eighteen of Savai'i island, to determine the importance of habitat types according to their abundance, volume of water and whether their productivity was permanent or seasonal. Ae.aegypti larval densities and habitat distribution were also monitored and the occurrence of predatory Toxorhynchites amboinensis larvae in northern Upolu was recorded from forty-one collections. Aedes Breteau and container indices fluctuated with the pattern of rainfall in two coastal villages and an inland bush village, but not in a coconut plantation community. The five main Aedes larval habitat types encountered were: 200 litre water-storage drums, discarded tins and bottles, coconut shells, automobile tyres and treeholes. Aedes immatures occurred perennially in drums and tree holes, but breeding discontinued in tins, bottles and coconut shells during the driest month of July. For Ae. polynesiensis in Upolu the Breteau and container indices of 104.5 +/- SD 80.9 and 35.3 +/- 12.4 respectively were significantly higher than those in Savai'i: 33.1 +/- 25.0 and 24.3 +/- 20.0 respectively. Likewise for Ae.aegypti the Breteau and container indices of 50.8 +/- 32.5 and 23.9 +/- 15.6, respectively, were also significantly higher than those in Savai'i: 12.7 +/- 17.1 and 9.4 +/- 13.2 respectively. Habitat types greater or lesser importance were determined by plotting the percentage of each type of cotnainer utilized for Aedes breeding against the percentage of ech type amongst all larva-positive containers. Ae.polynesiensis preferred tree-holes but not water-storage drums. Ae.aegypti preferred drums and tyres; mixed populations of larvae of both species were commonest in these two types of habitat. Ae.polynesiensis occurred in every village. Ae.aegypti was encountered in all twenty-two villages surveyed in Upolu and nine of eighteen villages in Savai'i. Total larval surveys revealed that drums and tree-holes contained the highest numbers of Aedes larvae. The study provided criteria for planning a control programme.

Aedes↗
PubMed1986

Ophthalmic disease in Western Samoa.

Since the last report on eye disease in Western Samoa in 1959 by Dr. Elliott, the population has increased from 97,000 to 158,000. The country now has a full-time ophthalmologist but could benefit from a larger eye care service. The distribution of disease is very similar to that found in 1959, with pterygium, cataract and injuries comprising the most frequent eye problems. Acute angle-closure glaucoma is much more common than open-angle glaucoma and is associated with a plateau iris configuration.

Cataract↗
PubMed1979

An appraisal of rheumatic valvular disease in Western Samoa.

Rheumatic valvular heart disease appears to be common in Western Samoa, although the exact incidence is unknown. The outcome in 170 known cases since 1974 is reviewed. Thirty-six patients underwent cardiac surgery overseas, with one operative and four late deaths and a further 32 patients died while on medical treatment. Advanced disease was present in the majority of the surviving medical patients. Mitral stenosis was the most common problem. Thromboembolism appeared to be uncommon despite the absence of anticoagulant therapy. Bacterial endocarditis was also seldom recognised, but was probably under-diagnosed. At present penicillin prophylaxis is often taken haphazardly and an unknown number of cases receive no treatment at all. A prophylactic programme centred on the screening of schoolchildren is suggested.

Adolescent↗
PubMed1998

Structure of family planning in Samoa.

Increasing family planning acceptance and efficacy is considered a key public health issue in many Pacific island nations. To assess the structure of family planning acceptance in Samoa, structured interviews were conducted with 155 reproductive age women from seven villages in both rural and urban settings. The survey data show accord with returns on contraceptive use from Samoan clinics, and demonstrate that awareness and use of contraception have increased markedly in the previous decade but desired family size remains high in younger women. A notable feature of the Samoan women's contraceptive experience is the lack of diversity of reported contraceptive behaviours and attitudes based on age, urban versus rural residence, and education.

Adult↗
PubMed1981

The prevalence of diabetes in the rural and urban Polynesian population of Western Samoa.

Rural-urban comparisons of diabetes prevalence were made in te Polynesian population of Western Samoa. The prevalence of diabetes in the urban population was almost three times that in the rural (10.1% versus 3.6%). While the urban male and female subjects were significantly more obese than their rural counterparts, the difference in prevalence rate could not be wholly explained on the basis. Diabetes prevalence was still approximately double in urban subjects when we compared the rural and urban populations after removing the differences in obesity and age. The results suggest that, apart from age and obesity, other factors, e.g., differences in diet, physical activity, or stress (or a combination of these), may participate in the rural to urban difference in diabetes prevalence.

Adult↗
PubMed1994

Increasing prevalence of NIDDM in the Pacific island population of Western Samoa over a 13-year period.

OBJECTIVE: A survey of noncommunicable diseases (NCD) in the Pacific island population of Western Samoa in 1978 (n = 1,206) documented a relatively high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) and obesity. A follow-up survey was performed in 1991 (n = 1,776) to assess changes in NCD prevalence and risk factor distribution over 13 years. RESEARCH DESIGN AND METHODS: In both surveys, the same representative villages from one urban and two rural areas were studied, and the survey procedure included an oral glucose tolerance test, anthropometric and blood pressure measurements, and physical activity assessment (1991 only). RESULTS: The age-standardized prevalence of NIDDM in 1991 was 9.5 and 13.4% in Apia (urban) for men and women, respectively. In Poutasi (rural), 5.3% of men and 5.6% of women had NIDDM, and in Tuasivi (rural) the prevalence was 7.0 and 7.5% for men and women, respectively. Age, body mass index (BMI), waist-to-hip circumference ratio, physical inactivity, and family history of diabetes all showed independent association with NIDDM and impaired glucose tolerance. Living in Apia (compared with Poutasi) was also associated with NIDDM. Between 1978 and 1991, the age-standardized prevalence of NIDDM in Apia increased from 8.1 to 9.5% in men and 8.2 to 13.4% in women. In Poutasi, a dramatic increase occurred in prevalence from 0.1 to 5.3% in men, but little change in women was noted (5.4 to 5.6%). In Tuasivi, the increases were 2.3 to 7.0% in men and 4.4 to 7.5% in women. In combined survey areas, increases were observed in the age-standardized prevalence of obesity and mean levels of total cholesterol, fasting triglycerides, and uric acid between surveys as well as a reduction in the prevalence of smoking. CONCLUSIONS: This is the first study using standardized methods to show a dramatic increase in the prevalence of NIDDM in a developing Pacific island population, and it indicates the importance of maintaining and expanding preventive programs for NIDDM and related lifestyle diseases in these populations.

Activities of Daily Living↗
PubMed1995

High prevalence of diabetic retinopathy and nephropathy in Polynesians of Western Samoa.

OBJECTIVE: To determine the prevalence of diabetic retinopathy and nephropathy retinopathy and nephropathy and to define associated risk factors in Polynesian Western Samoans with non-insulin-dependent diabetes mellitus (NIDDM) or impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: A 1991 population-based study in Samoan adults (ages 25-74 years) included a 75-g oral glucose tolerance test, anthropometric measurements, and blood pressure recordings. Subjects with NIDDM or IGT had 45-degree stereo photographs taken (n = 263) (three standard fields of the right eye), and retinopathy was graded in comparison with Airlie House photographs. First-morning urine samples (n = 304) were also collected from these subjects and from a subsample with normal glucose tolerance. Urinary albumin concentration (UAC) was measured by radioimmunoassay: microalbuminuria was defined as UAC of 30-299 micrograms/ml; and macroalbuminuria among subjects with Proliferative diabetic retinopathy was found in 4.5% of known diabetic subjects. The prevalence of elevated UAC was 15.0% in subjects with IGT, 26.0% in newly diagnosed diabetes subjects, and 23.4% in known diabetes subjects. For all diabetic subjects (n = 162), the factors independently associated with diabetic retinopathy (logistic regression) were duration of diabetes, fasting plasma glucose, and body mass index (inversely). Duration of diabetes, serum triglyceride concentrations, and systolic blood pressure were independently associated with elevated UAC in all diabetic subjects (n = 138), and fasting plasma glucose had borderline significance. CONCLUSIONS: Diabetic retinopathy and albuminuria are common in Polynesian Western Samoans. Duration of diabetes and level of glycemia were the most important associated factors. These data underline the need for cost-effective programs for the detection and early treatment of diabetes in Western Samoa and other developing populations with high susceptibility to NIDDM.

Adult↗
PubMed1982

Eosinophilic radiculomyeloencephalitis: an angiostrongyliasis outbreak in American Samoa related to ingestion of Achatina fulica snails.

For the first time in American Samoa an outbreak of eosinophilic radiculomyeloencephalitis was related to eating giant African snails (Achatina fulica) infected with Angiostrongylus cantonensis. Among 24 Korean fisherman sharing the same infective meal, 16 who ate raw or partially cooked snails became ill; five who ate boiled snails and three who ate none remained well. The ensuing illnesses began within 1-6 days, persisted up to 10 weeks, and were characterized by both peripheral blood and spinal fluid eosinophilia, severe pains, weakness and hyporeflexia of the legs, and dysfunction of the bladder and bowels. Eight patients also had transient hypertension and/or lethargy, and three became comatose. One man died 17 days after eating the infected snails, and maturing larvae of A. cantonensis were found in his spinal cord. Enzyme-linked immunosorbent assay titers for antigens of A. cantonensis were elevated to 1:64 or greater (mean 1:128) in all 10 patients tested. Treatment with thiabendazole had no appreciable effect on the clinical course of the illness.

Adolescent↗
PubMed1985

Acute hemorrhagic conjunctivitis caused by enterovirus type 70: an epidemic in American Samoa.

From December 1981 to February 1982, an estimated 22,000 cases of acute hemorrhagic conjunctivitis (AHC) caused by enterovirus type 70 (EV 70) occurred among Samoan and non-Samoan residents of American Samoa. The overall attack rate was estimated to be 68%. Samoans of all ages resident in traditional housing and of large family size were at greatest risk of acquiring AHC, while non-Samoan adults resident in western style housing were at lowest risk. Epidemiologic aspects of AHC acquisition were also different for the Samoan and non-Samoan communities; index cases in Samoan households were frequently young adults, whereas index cases in non-Samoan households were commonly school age children, suggesting a role for school transmission in non-Samoans only. In this outbreak, subclinical AHC was rare; of 50 asymptomatic members of affected households, only 3 had neutralizing antibody to EV 70 (all with titers of 1:10). Investigation documented the highly contagious nature of AHC caused by EV 70, and the ease with which epidemic transmission may develop under conditions of crowding and frequent interpersonal contact.

Acute Disease↗
PubMed1980

Blood pressure studies in rural and urban Western Samoa.

Blood pressure was measured in the rural and urban male and female Polynesian populations of Western Samoa to determine if differences existed in mean blood pressures or in the prevalence of hypertension between these groups. It was found that, in the urban population, both males and females had higher mean blood pressures and approximately double the prevalence of hypertension found in their rural counterparts. There was an age-related rise in mean blood pressure and in the prevalence of hypertension in all groups. Approximately half of the difference in mean blood pressure and hypertension prevalence between rural and urban groups appeared to be due to difference in adiposity. Age and body mass index were significantly and independently correlated with systolic and diastolic blood pressure in each group. The prevalence of hypertension was greater in obese subjects.

Adult↗
PubMed1984

Medicine in western Samoa.

This article describes the geographical, historical, economic and cultural background of Western Samoa. It explores the present medical problems and those likely to occur in the future, and draws attention to the medical manpower needs of a developing Pacific nation.

Culture↗
PubMed1990

Incidence of antibodies against human immunodeficiency virus, human T-cell lymphotropic virus type 1, hepatitis B virus, hemorrhagic fever with renal syndrome virus and Chlamydia in Tonga and western Samoa.

Among the populations of Tonga and Western Samoa, serum antibodies against human immunodeficiency virus or hemorrhagic fever with renal syndrome virus were not detected (0/904 and 0/192). No serum samples were considered to be positive for antibody against human T-cell lymphotropic virus type 1 (0/527). Hepatitis B antigen and antibody were found in 4% (8/192) and 47% (90/192), respectively. Chlamydia trachomatis IgG and C. psittaci IgG antibodies were detected in 39% (75/192) and 47% (91/192), respectively. The possibilities of the spread of human immunodeficiency virus and hemorrhagic fever with renal syndrome virus on the islands when the viruses invade from abroad were discussed.

Adolescent↗