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An analysis of the work content of the physician-specialist at Apia General Hospital, Western Samoa, over a 12-month period in 1973-74 is described. Respiratory infections, rheumatic heart disease, hypertension, diabetes, peptic ulcer, and various forms of liver disease were encountered most commonly.
Three species of Freycinetia (Pandanaceae) (F. reineckei, F. storkii, and F. hombronii) were tested for oviposition preference of Ochlerotatus samoanus, a vector of filariasis in Samoa. Laboratory tests indicated that F. reineckei was preferred by this mosquito for oviposition. Eggs were preferentially deposited on a peeled or a moist dried leaf. The percentage hatch was highest when eggs were kept moist for longer than 4 days before submersion. Hatching was complete in less than 6 h. These studies allowed us to successfully rear Oc. samoanus in the laboratory, facilitating future studies on the biology and control of this important vector.
This study examines the importance of remittances from emigrants to the economies of Pacific island states. The author considers two basic questions: "Are there enough island-born or island-linked people in the labor forces of industrialized countries to generate a given level of remittances to the island states?...[and] Will those who are able to sustain the flow be willing to? In this paper I examine the case of remittance flows between New Zealand and Western Samoa."
A survey of peptic ulcer disease in Western Samoa is described. As compared with New Zealand experience, an unusually high prevalence of peptic ulceration is documented. A remarkable and significant variation in the geographic distribution of cases is reported. Regions of high prevalence were significantly associated with disease onset at an earlier age and with increased frequency of a family history of ulcer disease. It is concluded that this genetic predisposition is unlikely to sufficiently account for the regional localisation of cases observed and environmental causes are under study.
Among microfilaria (mf) carriers of subperiodic bancroftian filariasis in Samoa, the low-density level of microfilaraemia was defined as 1-20 mf/ml, and the occurrence of low-density carriers (90 in the present study) was analysed by age, sex, and village in relation to the microfilarial prevalence rate. The low-density carriers were more numerous among those under 20 years and over 60 years old than in other age groups. The ratio of low-density carriers to the total of mf-positive subjects in a village decreased as the prevalence rate of Wuchereria bancrofti in the village increased.The epidemiological significance of low-density carriers was assessed in connection with the infectivity of vector mosquitos (Aedes polynesiensis) produced by them, the possible change of these carriers to carriers of a higher density, and the production of new low-density carriers by diethylcarbamazine citrate (DEC-C) treatment. The mosquito infectivity produced by the low-density carriers accounted for only 2.16% of the total infectivity produced by all the carriers, suggesting that these carriers are of minor importance in the transmission of filariasis. The change of microfilarial count over time among untreated mf-positive subjects was not remarkable during a 60-252-day observation period. However, the low-density carrier group showed a mean increase of 36%, the younger such carriers (under 30 years old) showing a 132% increase. The production of low-density carriers by DEC-C single-dose treatment (6 mg/kg body weight) was not as great as expected.
Treatment of subperiodic bancroftian filariasis, which is endemic in Samoa, with diethylcarbamazine citrate (DEC-C) in single doses of 4 mg/kg, 6 mg/kg, and 8 mg/kg body weight was evaluated using the nuclepore filtration method (with 1 ml blood) and compared in terms of efficacy against the microfilariae (mf) and side-reactions produced. The 6 mg/kg single-dose treatment assessed at six months showed that the effect of DEC-C to eliminate microfilariae was closely associated with the pre-treatment microfilarial level. The treatment cured nearly 60% of the low-density carriers with </=20 mf/ml but only about 10% of the carriers with >/=501 mf/ml. However, the percentage decrease in the microfilarial count, which averaged 89.3%, did not seem to differ greatly according to the level of the pre-treatment count. The age group 20-29 years showed a poorer response to the treatment compared with the other age groups. When the different dosage regimens (4 mg/kg, 6 mg/kg and 8 mg/kg) were compared at 6 and 12 months after treatment, the 6 mg/kg regimen was found to be more effective than the 4 mg/kg regimen in reducing the microfilarial count, and it produced fewer adverse reactions than the 8 mg/kg regimen. The comparison between the annual single-dose treatment at 6 mg/kg and the six-monthly two doses/year treatment at the same dosage (total 12 mg/kg/year) showed that the latter had little advantage over the former, thus indicating the effectiveness of the single-dose treatment for longer than six months.
In the years 1910/13 two endemic infections of the conjunctiva were found in Samoa in addition to ocular manifestations of filiariosis. One of these infections was obviously trachoma, the other an acute micrococcus catarrhalis conjunctivitis by diplococcus samoensis.
The frequency distribution of log plasma glucose concentrations in certain populations show two distinct subgroups--a non-diabetic group and a hyperglycaemic group--when suitable methods of distributional analysis are used. These two groups show up as a double peak (bimodality) in the best-fit frequency distributions of log plasma glucose, and the separation or cut-off point where the two curves intersect, gives an indication of the plasma glucose level at which diabetes could be diagnosed. Venous plasma glucose concentrations 2 hr after a 75 g oral glucose load were determined in the urban Polynesian population of Western Samoa, in subjects aged 20 yr and over. Bimodality was evident in subjects over 35 yr of age in both sexes, but for the younger age groups the frequency distribution of log plasma glucose follows the usual unimodal Gaussian curve. The data show that among these Polynesians, as with Pimas and Nauruans, the frequency distribution of log plasma glucose concentrations can be used to separate the population into normal and hyperglycaemic groups.
A study of the effect of obesity on glucose tolerance in a Polynesian population (Western Samoa) has not shown a consistent relationship between the two. Although there was a trend for increasing age-standardized prevalence of impaired glucose tolerance and diabetes mellitus with increasing body mass index in males, no such trend was observed in females. The impressive differences in prevalence of abnormal glucose tolerance between rural and urban groups was altered little by adjusting for differences in distribution of body mass index. Environmental factors, such as diet, physical activity, and stress, acting independently of adiposity must have contributed significantly to the observed rural/urban differences in prevalence of abnormal glucose tolerance in Western Samoans.
OBJECTIVE: To evaluate anthropometric, haemodynamic and biochemical risk markers for coronary heart disease (CHD) in the Polynesian population of Western Samoa in a case-control study of 43 cases of CHD compared with 90 age- (mean 53 years) and sex-matched controls. METHODS: Cases were identified on the basis of a 12-lead electrocardiogram and clinical history. RESULTS: More than 60% of the participants had a body mass index > or =30 kg/m2 and nearly 80% had central obesity. Both diabetes mellitus (17%) and impaired glucose tolerance (9%) were also common in this population. Nineteen per cent of the population were hypertensive and both antihypertensive therapy (21 versus 1%, P<0.001, risk 23.6) and hypertension (35 versus 11%, P<0.01, risk 4.3) were significantly more common among cases than they were among controls. In addition, the plasma high-density lipoprotein cholesterol level was lower (1.00+/-0.09 versus 1.24+/-0.05 mmol/l, P<0.05) and the plasma urate level was higher (0.42+/-0.02 versus 0.37+/-0.01 mmol/l, P<0.05) in the female cases than they were in their respective controls. Low-density lipoprotein (LDL) particle sizing did not reveal an excess of small LDL particles to be a feature of CHD cases, but more than 70% both of cases and of controls had multiple LDL species. The response of the triglyceride level to a fat-rich meal was the same for CHD cases and controls. CONCLUSION: The population studied had a high prevalence of several risk factors for CHD, including obesity and non-insulin-dependent diabetes mellitus; however, the most prominent factor relating to CHD within the community was the presence of hypertension.
The author hypothesizes that the underreporting of mental illness in Tutuila, American Samoa, is a direct result of the social system, which provides a means of "curing" emotional disorder by family group process and shamanistic ritual, by making the disorder less disruptive, and by absolving the affected individual of personal guilt.
AIM: To investigate simultaneous outbreaks of Shigella sonnei gastroenteritis occurring in February 2001 at a health camp for socially deprived children and an elderly care facility. METHODS: Those with symptoms were interviewed using a standardised questionnaire. Cases were defined as having at least three loose stools over a 24 hour period and stool samples requested. A case-control study investigating routes of transmission was performed at the health camp. Environmental investigations of food safety and hygiene were conducted at each facility. RESULTS: At the camp, 15 (37%) students and 15 (28%) staff met case criteria. Contact with human faeces (OR 4.0; 95% confidence interval 1.0-16.3; p = 0.05) and, for staff, eating camp food (OR 6.9; 1.0-5.0; p = 0.06) were shown to be independent risk factors for illness. At the elderly care facility, four (19%) residents and four (25%) staff met case criteria. Molecular subtyping confirmed that the outbreaks were related to each other and to other cases in travellers returning from Samoa to Auckland and other New Zealand cities over a four month period. CONCLUSION: Molecular subtyping is of considerable use in communicable disease investigation, providing strong evidence for links between outbreaks. With expanded technological capability, New Zealand could perform routine molecular subtyping of selected organisms to improve the detection and the investigation of regional and inter-regional outbreaks of infection.
Filariasis surveys made during 1962-63 in 5 villages in American Samoa among persons over 5 years of age gave an elephantiasis rate of 3.4%, a microfilarial rate of 26% and a median microfilarial rate (MfD(50)) of 29. These rates were somewhat higher than those found in surveys made in the same villages among villagers of the same ages some 20 years previously. A mass treatment programme with diethylcarbamazine was then decided on.Preliminary treatment with a single total regimen of 72 mg of the drug per kg of body weight, given in 12 doses of 6 mg/kg, was administered in several villages over a period of 6 months. Among villagers of all ages at the end of 3 years, the microfilarial rate was 7.3% and the MfD(50) value was 2. These results appeared to be inadequate for a successful control programme and a periodic mass treatment project of 2 or more regimens of 72 mg/kg to be administered every 2 years was instituted on the Island of Tutuila, to be continued until considered no longer necessary.Surveys made 2 years after the second mass treatment in the villages of Amouli, Amanave, Onenoa, Tula, Alao, Utumea and Alofau, in which 1407 persons were examined, showed that 3 villages were negative for microfilariae, that the average microfilarial rate in all 7 villages was 0.4% and that the MfD(50) was 1. These villages were also negative in intensive mosquito surveys for infective-stage larvae of Wuchereria bancrofti. It is suggested that interruption of transmission has been observed in the 3 villages negative for both microfilariae and infective-stage larvae and that, if favourable surveys continue, eradication programmes should be established.
A pilot study was carried out to determine the nature of Polynesian liver disease by a study of blood donors and liver biopsy material from natives in Samoa, Tonga and Auckland, New Zealand. The data is suggestive that the Hepatitis B carrier state and hepatoma are greater in Polynesians than in Europeans. One familial hepatoma in two Maori brothers at ages of 11 and 13 years are reported.
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Data from a Samoan menstruation study suggest that lactation, even intensive on-demand lactation, does not inhibit menstruation or conception. This paper explores the applied and theoretical implications of continuing to accept lactation as a universally effective fertility control mechanism. Such thinking can have disastrous implications for family planning programs, and it keeps us from challenging long-held assumptions about lactation's role in population growth in early populations.
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