Poster Presentations

Dr. Janine Paynter & Dr. Fiona Langridge

The University of Auckland

Dr Janine Paynter is a Senior Research Fellow in the Department of General Practice & Primary Healthcare in the School of Population Health at Waipapa Taumata Rau, University of Auckland. Her research on tobacco displays and youth uptake of smoking supported advocacy that led to removal of tobacco displays in New Zealand. Thus, Janine has experience in the process of distilling research into action. Since 2014, Janine has worked as part of a research team that has had a focus on maternal and infant health and well-being. Janine has also made a substantial analytical contribution to quantitative epidemiological work published in The Lancet and to quantitative work assessing equity in immunisation coverage and health of migrant children and babies. Her areas of expertise include vaccine safety and effectiveness, public health, tobacco control, observational studies, and large datasets. Her areas of specialty also include: research design, data management, policy analysis, review of research.

Dr. Fiona Langridge is a child health researcher, clinician and advocate. She has experience in global health for children, specifically the Pacific region. She is currently a Cure Kids research fellow with the University of Auckland on the Fiji Oxygen Project and also has involvement in child protection research in Tonga. She has worked as a paediatric physiotherapist and developmental coordinator with children and communities in Aotearoa, New Zealand and the United Kingdom. Her research has included: Climate change and mental wellbeing – impacts on Pacific peoples, Infantcare practice in the Pacific and Neurodevelopmental outcomes related to alcohol exposure in the Growing Up in New Zealand study. Her areas of expertise are: global child health, Pacific child health, community engagement, resilience and wellbeing in children, and child protection.

Janine Paynter,1 Fiona Langridge,2 Maryann Heather,3 Amio Ikihele,4 Teuila Percival,2 Luam Ghebreab,1 Vili Nosa3
1General Practise and Primary Healthcare, FMHS, University of Auckland
2Paediatrics: Child and Youth Health, FMHS, University of Auckland
3Pacific Health, FMHS, University of Auckland
4Moana Connect

Background
Sudden unexpected death in infancy (SUDI) is a broad term that describes the initially unexplained death of an infant under the age of one. There are key risk factors that have been identified for SUDI including a baby sleeping on their front, maternal smoking, not being breastfed. Despite a relatively low rate of infant mortality, Aotearoa New Zealand carries one of the highest rates of SUDI, with disproportionate impact for Pacific infants. This study aimed to explore the infant care practices and factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Māori, and Niuean mothers in New Zealand, in order to inform evidence based interventions for reducing the incidence of SUDI for Pacific families and their children.

Methods
Analysis comprised of data from 1089 Samoan, Tongan, Cook Islands Māori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariate logistic regression analysis were conducted, controlling for sociodemographic factors to explore the relationship with other risk factors associated with SUDI.

Results
Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines in regards to what position they slept their infant in. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing.

Conclusion
The impact of SUDI on Pacific infant may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic and cultural worldviews, and languages. Despite the need for a more targeted response there has been little research to provide evidence for effective interventions to improve rates of SUDI for our Pasifika communities in Aotearoa New Zealand.

Associate Professor Stephen Howie & Dr. Eric Rafai

The University of Auckland

Associate Professor Stephen Howie is a graduate of the University of Auckland School of Medicine and completed specialist paediatric training in New Zealand, becoming a Fellow of the Royal Australasian College of Physicians. He worked for over a decade at the UK Medical Research Council’s unit in The Gambia, West Africa, latterly as its Theme Leader for Child Survival. He holds a PhD in clinical epidemiology from the London School of Hygiene and Tropical Medicine. His research, teaching, clinical practice and leadership focus is on the prevention and treatment of high-morbidity, high-mortality, child health conditions, including pneumonia, diarrhoea, vaccine-preventable and other infections, nutritional problems and maternal & newborn illness. His emphasis is on furthering effective partnerships to positively impact child health. He serves on a number of international child health-related groups. He is currently Associate Professor of Paediatrics at the University of Auckland in Auckland, New Zealand

Employment: Based at the Ministry of Health, Headquarters as the Head of Research, Innovation, Data analysis & management and ICT. Has worked in the Ministry for the past 20+ years in several positions in Public Health and a registered Public Health Specialist with the Fiji Medical & Dental Council

A member of the Fiji Medical Council and Chair of the Board of Management for Fiji Medical & Dental Council. Chair of the National Antimicrobial Resistance Committee (NARC). Previous chair of regional initiatives with WHO and SPC.

Qualifications: 1995 MBBS graduate of the Fiji School of Medicine (USP). Masters in Public Health (Queensland University of Technology 2008), Masters Degree in Infectious disease (University of Western Australia, 2011). Postgraduate diploma in Public sector management, 2015 (USP) and currently pursuing a Masters of Commerce in Entrepreneurship and Business management (FNU).

Publications: 1st primary author publication in 1997 and co-authored several publications since (google scholar).

Awards: Recipient of the Australian Leadership Awards in 2011

Personal: Married with four children and resides in Sigatoka, Fiji.

An innovative model of partnership for impact through country-led research and action: the Fiji Oxygen Project

 

Eric Rafai,1 Stephen Howie,2 Sainimere Boladuadua,2 Fiona Langridge,2 Shanjivan Padarath,3 Gyanendra Prasad,4 Nico Tillon,4 Tara Satyanand,4 Donald Wilson,3 Luke Nasedra,1

1Ministry of Health and Medical Services, Fiji, 2Paediatrics: Child and Youth Health; The University of Auckland, 3Fiji National University, Fiji, 4Cure Kids, New Zealand and Fiji.

 

 

Background

Conventional models of international health research and development frequently struggle to achieve their intended impact, being mired by the reality and perception of external self-interest and power imbalance.  Universities and aid donors, with their KPIs, fall foul of this routinely, leaving a legacy of suppressed fury. These models and entrenched systems are being challenged, with new approaches seeking to bring stated aspirations for partnership closer to reality.

 

Approach

An unconventional model has been applied to the Fiji Oxygen Project, built on a relationship of trust between government (Fiji MHMS), a research institution (University of Auckland) and a child health NGO (Cure Kids). This started with the need of MHMS for access to life-saving oxygen, and a pooling of expertise, resources and power. Successful pilot work was established, within a broadening partnership, followed by external substantial government aid funding from NZ and Australia, with the aim of sustainable health system strengthening.

 

Results

The project was able to scale up, during the COVID pandemic, with five components: 1) establishment of a dedicated oxygen team within the health system;  2) procurement and deployment of oxygen supplies across Fiji;  3) training for clinical and technical staff; 4) evidence to support effective management of oxygen, and 5) development of a national oxygen policy to facilitate sustainability of oxygen access.

 

From three initial pilot sites, all health facilities in Fiji have been positively impacted and the trust within, and effectiveness of the project, have resulted in it being regarded within MHMS as a model for partnership.

 

Conclusion 

This model, working at the nexus of health systems, research and development, has resulted in trusted partnership, local ownership and impact. External partners have reframed their metrics of success to align with local priorities, helping their organisations progress towards aligning their aspirations and institutional systems.

Amio Matenga Ikihele

Moana Connect

Amio is the General Manager – Community & Innovations.  Before working for Moana Research, she was the Innovations Lead for TAHA Maternal and Child Health Service and was instrumental in developing a smartphone application and website to support pregnancy and parenting for Pacific (Tapuaki), Maori and teen mothers.  Amio currently leads DIGIFALE (www.digifale.co.nz) which is an intergenerational digital literacy programme that provides the necessary access, connectivity, and skills required to improve digital health equity. 

Amio is also a registered nurse who has completed her Master of Health Science gaining first class honours, exploring the perceptions of sexual health and sources of sexual health information among NZ-born Niuean adolescent females living in Auckland. She has extensive teaching experience coming from Manukau Institute of Technology teaching in the undergraduate Bachelor of Nursing, Bachelor of Nursing Pacific and Pacific community health work programmes. Her research expertise in sexual health and digital innovations has seen Amio serve on various advisory groups which include the NZ Telelehealth Leadership Forum, SparkHealth, Health Navigator NZ Trust, The Village Collective, Pacific Nurses Section (NZNO), and Tau Nosi Niue (Niue Nurses Association NZ). 

Amio is currently a PhD candidate with the University of Auckland. The topic of her research – Digital health equity through a Pacific lens: Niue women and cardiovascular disease as a case study. 

Dr. Ellaine Ete-Rasch

Immunisation Advisory Centre

Ellaine has recently completed a PhD in Nursing from the University of Wellington and was a recipient of a Pacific Health Research PhD Scholarship from the Health Research Council of New Zealand. Ellaine’s research on the persistent high rates of ambulatory sensitive hospitalisations of Pacific children was drawn upon her previous study on skin infections of Pacific children to further her research on the health of Pacific children in New Zealand.
Ellaine has an extensive background in child health and primary health care nursing and is currently a Nurse Educator for IMAC on the Covid-19 Pacific Health Corridor project.

Background: purpose of the study/ the study’s objective
Ambulatory sensitive hospitalisations (ASH) are indicators of quality health care received in primary health care settings and reducing childhood ASH is a health priority in NZ. The persistent high rates of ASH for Pacific children in NZ has provided a more contextual and a better perspective of the burden of poor health experienced by Pacific children for many years.

Despite reducing ASH being a health priority in NZ, there is lack of research study to decipher the knowledge and understanding from parents’ perspectives on what contributes to these types of hospital admissions and solutions to reduce them.

Approach: the methods, framework or approach used
A qualitative multi-method design informed by a Community-Based Participatory Research (CBPR) approach was utilised. The research involved establishing a partnership between parents, nurses, and the researcher (myself) to yield knowledge to better understand Pacific children’s hospital admissions that are considered preventable. The study involved four sequential phases which involved establishing an Advisory Group of Pacific Nurses, group meetings and interviews with parents.

Results: a summary of the results or outcomes
Of the 31 potential participants referred, 25 children were eligible. Children’s primary reasons for hospital admissions were, Respiratory (n=9), Skin health (n=8), Oral health (n=4), Other (n=4). Multiple factors contributed to children’s hospital admissions. Significant findings were centered on parents’ limited knowledge on children’s health conditions, lack of confidence voicing their concerns and inadequate support by health workers. Health workforce and health literacy are critical contributing factors. 67

Conclusion: the significance of the findings or outcomes
The collective experiences and perspectives from Pacific nurses and parents of Pacific children provides valuable insights of small and large interventions that, if addressed, has the potential to make a positive impact on the lives of Pacific children and reduce ASH rates by Pacific children.

Dr. Elizabeth Holt

Eisdell Moore Centre 

The University of Auckland 

Elizabeth (Aotearoa/Tonga) is a public health researcher and New Zealand-trained physiotherapist. Her work draws on her research expertise in Public/Population Health and her clinical background. As such, her work is informed by a range of methodologies, including Pacific, ecological and biomedical frameworks and is underpinned by values of health equity and social justice.
Elizabeth is the Pacific Research Advisor/ Research Fellow for the Eisdell Moore Centre for Hearing and Balance Research (University of Auckland). She works with the PENTAG group and World Health Organization to progress ear and hearing health services and workforce development in the Pacific region and for Pasifika populations in Aotearoa New Zealand.

Authors/Presenters & Institutions/Organisations/Groups:
Dr Elizabeth Holt (presenter), Dr Joan Leung, Louise Dickinson, Professor Randall Morton, Dr Alehandrea Manuel, Associate Professor Alain Vandal, Professor Suzanne Purdy
Body of Abstract
Background: purpose of the study/ the study’s objectives
Our previous research has shown an unmet need to identify and manage hearing loss and middle ear disease in young children in South Auckland. A large study of >450 “asymptomatic” pre-schoolers showed over 20% with hearing loss. Pasifika and Māori children were especially at risk. A proposal was made to bridge the gap between newborn hearing screening and the four-year-old ‘before school’ hearing screening by conducting three ear and hearing tests on 3-year-olds within early childhood centres. The purpose of the research is to help facilitate earlier detection of significant ear and hearing problems to enable timely treatment and improve hearing and developmental outcomes.
Approach: the methods, framework or approach used
Of the 61 children in the pilot study, 23 were referred for formal audiology and/or Ear, Nose, Throat (ENT) review. The testing process in early childhood centres was efficient and feasible, but of the 23 children who were referred, 12 were lost to follow-up. A qualitative research study was undertaken to interview families of children who did not pass the hearing screening to learn more about the experiences of those whose children could attend audiology/ENT and those who did not receive follow-up services. Goals of this phase were to investigate barriers for families successfully navigating the current public health system.
Results: a summary of the results or outcomes
Preliminary data from the qualitative interviews will be presented. Families had a range of experiences, both positive and negative associated with their engagement with audiology and ENT services. A number of barriers to access were identified, including the location of the services and the challenges of the clinic being hospital-based.
Conclusion: the significance of the findings or outcomes
The next phase of this research will involve establishing a stake-holder group to discuss methods to identify and remove barriers to equitable hearing healthcare. Our group is committed to working alongside other Pasifika and Māori community-based groups in health equity, child health, and wellbeing.

Maria Casale

Massey University

Maria Casale has recently completed her PhD investigating Māori and Pasifika infant nutrition at Massey University. She is a NZ Registered Dietitian, and has a special interest in the health and wellbeing of Māori and Pasifika whānau. Maria plans to continue her research in this area, with a focus on decolonising through kai.

Complementary Feeding Practices of Māori and Pasifika infants in Aotearoa

Authors:
Maria Casale1, Kathryn Beck 1, Cathryn Conlon 1, Lisa Te Morenga 2, Jillian Haszard 3, Anne-Louise Heath 4#, Rachael Taylor 5#, Pamela von Hurst 1*
1 Affiliation 1; School of Sport Exercise and Nutrition, Massey University, Auckland, New Zealand, m.casale@massey.ac.nz, c.conlon@massey.ac.nz, k.l.Beck@massey.ac.nz, p.r.vonhurst@massey.ac.nz
2 Affiliation 2; Research Centre for Hauora and Health, Massey University, Wellington, New Zealand, l.temorenga@massey.ac.nz
3 Affiliation 3; Biostatistics Centre, University of Otago, Dunedin, New Zealand. jill.haszard@otago.ac.nz
4 Affiliation 4; Department of Human Nutrition, University of Otago, Dunedin, New Zealand 9054, anne-louise.heath@otago.ac.nz
5 Affiliation 5; Department of Medicine, University of Otago, Dunedin, New Zealand, rachael.taylor@otago.ac.nz
* Correspondence: p.r.vonhurst@massey.ac.nz; Tel.: +61 +6492136657
# Joint Principal Investigators

Background: Timing of complementary food (CF) introduction, feeding methods (baby-led weaning (BLW), traditional spoon-feeding (TSF)), baby-food pouch use, and characteristics of first foods can impact healthy infant growth and development. Māori and Pasifika infants in Aotearoa bear a disproportionate burden of nutrition-related disease, yet little is known about current complementary feeding practices for these groups.
Aim: To describe complementary feeding practices and first food characteristics amongst Māori and Pasifika infants in Aotearoa.
Methods: Feeding practices of infants aged 7.0–10.0 months were determined by questionnaire. Ethnicity was reported as total response. Frequency of pouch use and BLW were estimated with 95% confidence intervals.
Results: Of 175 infants, over half of Māori and Pasifika introduced CF around six months of age (56.5% of Māori, 62.2% of Pasifika). BLW prevalence was 29.2% for Māori and 17.1% for Pasifika. Pouches were used by 89.3% of Māori and 85.4% of Pasifika. Of those ‘always’ or ‘frequently’ fed pouches, 27.1% of Māori and 25% of Pasifika ‘always’ or ‘mostly’ sucked from the nozzle. Vegetables and pureed food were the most common first food and texture offered for both groups. At six months, 55% of Māori and 63% of Pasifika had red meat, and 57% of Māori and 56% of Pasifika had iron-fortified baby rice. Age-inappropriate drinks were given to 18% of Māori and 21% of Pasifika infants, and 9.1% of Māori and 20.7% of Pasifika respondents reported offering traditional cultural foods.
Conclusion: These findings provide insight into complementary feeding practices that can impact our most vulnerable infants. The high use of pouches alongside some infants feeding from the nozzle indicates that culturally appropriate messaging should be developed for the safe use of these products. Additionally, Māori- and Pasifika-centred approaches are needed to strengthen infant feeding practices to support the healthy growth of our next generation.

Lois Chu Ling

Moana Connect

Lois is a Project Co-ordinator at Moana Connect. Some of her projects revolve around Pacific Child Health such as The PEDS Study focused on Reducing Inequities for Pacific Children in Developmental Surveillance in the Well Child Tamariki Ora Program. Other projects with the Moana Learning team aims to disseminate and translate research through publications, workshops and online platforms.

 

Her family are originally from Sāmoa and come from the villages of Tanugāmanono, Sapunaoa, Manono, Saipipi and Lano.

 

Lois is passionate about advocating for the health and well-being of Pacific people through evidence-based research.

Exploring Samoan and Tongan parents and caregivers’ perception of child development and the Parental Evaluation of Developmental Status (PEDS) screening tool 

 

Lois Chu Ling*1, Mary Roberts2, Dr Seini Taufa2, Coventry Manavahetau3, Jacinta Fa’alili-Fidow2, Dr Teuila Percival2, Dr Alison Leversha4 

1 Presenting author’s affiliation: Moana Connect, 2 Co-author’s affiliation: Moana Connect, 3 Co-author’s affiliation: University of Auckland, 4 Co-author’s affiliation: Starship Hospital Auckland 

 

Background: 

The Well Child Tamariki Ora Programme (WCTO) is a free universal health service designed to identify developmental concerns so early intervention can maximise outcomes. There is concern the mandated developmental surveillance tool, the Parental Evaluation of Developmental Status (PEDS), is not identifying a significant proportion of children, especially Māori and Pacific children, with developmental delays therefore potentially increasing inequity. The aim of this study was to explore Pacific parents and caregivers understanding and views of child development and their lived experiences with PEDS. 

 

Methods: 

We undertook qualitative research using the Kakala Research Framework and Talanoa. A total of 12 Samoan and 12 Tongan families participated. 

 

Results: 

Pacific parents emphasised holistic child development and the influences and environmental factors particularly culture, multi-generational homes, and churches. These were important for their child’s development and language, physical, spiritual, and emotional health, and instilling a strong sense of culture and identity. The assessment process and PEDS were found to be deficit-based and not culturally appropriate. We identified tensions between the formal process of developmental and behavioural assessment and that of empowering Pacific parents in their own beliefs, understanding and care of their own children.  

 

Conclusion: 

Our research highlights the need for culturally appropriate, strength-based and holistic approaches for the development of the child. Understanding the tools’ purpose and seeking culturally-grounded approaches that also highlight a child’s strengths, is integral to developmental assessment that ensures a positive and empowering framework for Pacific children to thrive. This tension can be addressed by shifting the balance on both sides of the equation – empowering parents to participate and understand the assessment process and for experts and clinicians to reassess their own paradigms of successful children’s development.