Applied Epidemiology- Evaluating the Impact of the Implementation of Fiji's Clinical Guidelines for Diagnosis and Management of Leptospirosis in the Central Division

Abstract

Thesis Abstract for the Intention to Submit I commenced my Master of Philosophy (Master in Applied Epidemiology (MAE)) with my field placement at the Fiji Centre for Disease Control (Fiji CDC) in 2023, with the intention to complete by December of 2024. In this thesis I present the projects completed, my experience, and the completion of my core competencies during my placement. Chapter one provides an introduction to the thesis. Chapter two, describes my evaluation of a surveillance system. I evaluated the Early Warning Alert and Response Surveillance (EWARS) system for Suspected Leptospirosis Syndrome (SLS)in Fiji, from March 2022 to March 2023. SLS data from EWARS database and Laboratory data from the National Public Health Laboratory database were compared and analysed using Spearman's coefficient A strong correlation was shown to exist between SLS reports and laboratory-confirmed cases for the study period at National and in three divisions with correlation of 0.9. Participants in the survey were well-versed in EWARS and the recent changes. More training and feedback were highlighted by participants to further improve reporting. Chapter three describes my participation in an outbreak. The outbreak was a foodborne one in the Western Division. This outbreak included 433 people who had consumed prepared meals at a hotel and developed gastrointestinal symptoms within a matter of hours. As part of the investigating team, the 10 steps of outbreak investigation were followed We used relative risk (RR) analysis to identify exposure and outcomes. A RR of 353.3 indicated a common food source that had been consumed which resulted in the outbreak. Chapter four describes my data analysis. I conducted a retrospective analysis of Leptospirosis Microagglutination Test (MAT) results from 2018-2023.Laboratory data was obtained and a univariate analysis was conducted to identify the demographics details of tested samples. Multivariate analysis was then used to compare the different leptospirosis serovars by gender, age group, year and division. Leptospira Australis was found to be the most dominant serovar during the study period and was associated with reservoirs such as cattle and pigs. Chapter five describes my epidemiological research project. This was based on analysing the impact of Fiji's Clinical Management of Leptospirosis Guidelines 2016 and their implementation. An online survey was developed and delivered using REDCAP and focal group discussions were utilised using a Strengths Weaknesses Opportunities and Threats (SWOT) approach. The data were analysed thematically into five main areas. The results will contribute to the Fiji Ministry of Health review of the Leptospirosis guidelines and provide evidence-based recommendations to strengthen its implementation for healthcare workers. Chapters six and seven describe my teaching experiences and additional public health activities. These include introducing my MAE cohort to my field placement at Fiji CDC and describing how the public health systems in Fiji operate; the development of a research proposal for Japanese Encephalitis Virus preparedness Strategies in Fiji and teaching the 2024 first-year MAE cohort about Public Health systems at a regional level. Chapter 8 is a culmination of all work related experiences during my field placement, the lessons learnt and its application to my MAE program, including literature reviews, abstract writing, lessons from the field, conference and workshop presentations and my presentation at the Australian Communicable disease and Immunisation Conference (CDIC) in 2024.This work not only satisfies the competencies of the MAE program but will also continue to inform routine public health activities undertaken at Fiji CDC. Show more