Fijian participation in health research: analysis of Medline publications 1965-2002

Abstract

The driving force of health research in the Pacific has been the expatriates. The common practice has been that health professionals from developed countries come and do research, without much involvement by local experts, take the data off shore to analyze and publish elsewhere, without benefiting the researched communities.

Objectives: this paper examines the participation of Fijians in health research publications on Fiji; identifies the most researched health areas; and discusses the implications for health priorities and research capacity development in Fiji.

Methods: Medline published papers were used as database using "Fiji" as the search word. Two hundred and ninety-eight (298) health-related publications were retrieved from July 1965 to April 2002. Direct and indirect interviews were conducted for the identification of authors. Reviewing abstracts and full-textpapers were performed for the ascertainment of studied subjects of papers.

Results: The 298 papers identified include 275 (92.3%) descriptive studies (including community/population surveys, case series and cross-sectional studies); four (1.3%) case-control studies; eight (2.7%) cohort studies and 11 (3.7%) unknown-type studies. There were no randomized-controlled trials (RCT) or community intervention trials (CIT). Turning to authorship, there were more expatriates (82.3%) than local researchers (17.7%) out of a total 815 authors. There were fewer Fijians who had been sole and first authors (12.5% and 13.5%, respectively), and a significant difference between the proportion of non-Fijians to have contributed as sole and first author compared to that of Fijians (c2=6.4, df=1; p=0.01). Among the Fijian authors, males contributed five times more than females. Indo-Fijians (58%) participated more than indigenous Fijians (40%). Indigenous Fijian females contributed significantly more than Indo-Fijian females (c2=4.77; df=1; p=0.02). The majority of the authors (70.4%) were in the forties and fifties age groups. The staff from the Fiji School of Medicine (FSM) contributed only 12.9% to the total Fijian authorships. The remaining Fijian authors were affiliated with the Fiji Ministry of Health (MoH), the University of the South Pacific (USP) and other Fiji Government entities. The most researched areas were Non-communicable Diseases (13.4%), Infectious Diseases (11.4%), Health Services (10.4%), Nutrition and Dietetics (9.1%), and Mental Health (7.0%). The least researched areas were Cancer (2.3%), Gerontology (2.0%), Biochemistry (1.7%), Traumatology (1.7%) and Dermatology (1.3%). Only 31 (16.6%) out of 187 journals with papers about Fiji were available in the FSM Library. There was a significant increase of health publications over the studied period (r=0.502; 0.001<p<0.01), and, although the level of Fijian authorships was low, the proportion has been gradually increasing against declining non-Fijian authorships over time (r=0.32; 0.01<p<0.05).

Conclusions: This study provides evidence of expatriate dominance in health research in Fiji using Medline publications as an approximation of research participation. Participatory discrepancies among local health professionals have been identified with possible contributing factors. The trend of papers published over the past 37 years; their availability, accessibility to local readers and their subjects relevance to country health priorities were documented.

Discussion: This study strongly suggests a need for participatory health research by the Fijians. It also emphasizes the ongoing demand for research capacity building and development among local health professionals. Among other discussions on the findings, attentions were drawn to considering for more rational research areas that are relevant to country health priorities.