Discussion
There is not much variation in the seasonal fluctuation of the average maximum and the minimum temperature for Fiji during the study period. The pattern would show clear evidence of climate change if the study range were at least thirty years to see any changes to the temperature. The temperature trend confirms the findings of the temperature in the Pacific is gradually increasing, but over a more extended period. The average temperature increase across the Pacific is only 0.9 degrees for the last 60 years from 1961 to 2011, and the average increase for Fiji was 0.25 degrees Celsius during this period \cite{RN4738}. It shows that the temperature is increasing, but is not seen in a short time span of ten years but over a longer time span.
The rainfall trend was at its peak during parts of 2007, 2008 and twice in 2012. The rainfall trend peaks were consistent with the La Nina cycle occurring in the same period. There were robust La Nina recorded for the 2007/2008 season and also a moderate La Nina for the 20011/2012 season \citep{RN4828}. The humidity trend for the study period is similar to the maximum and the minimum temperatures. It was strange as increase humidity was expected due to the high rainfall levels recorded during the study period.
In 2011 the average maximum and minimum temperature were stationary, the rainfall levels increased in the first half of the year and decreased in the second half, and the trend remained stagnant. However, all the indicator of malnutrition (underweight, growth faltering, severe malnutrition and anaemia) were decreasing in the first half of the year and increased sharply in the second half of the year. Therefore there is very little evidence to suggest that the decrease in the prevalence of malnutrition is related to whether or climate variables. In the 2011 Budget address, the Finance Minister announced that in 2010 government for the first time in Fiji's history was introducing food vouchers to those on the welfare scheme which included single mothers without employment, widows, and the elderly \cite{RN4844}. \citep{RN4845} in their study stated that many of the developing countries are establishing food safety nets through the food assistance programs (FAP) to those at risk of malnutrition and global estimates by the World Bank state that 115 million people annually benefit from food assistance programs. In the 2011 budget announcement, additional funds were added to the nation employment centre to train and mobilise five hundred Fijians into the workforce \cite{RN4844}. The continued funding to the centre signifies that the centre was achieving its aims and objectives in preparing Fijians for employment and could be one of the reasons for the increase in employment in 2011. In 2011 the Fiji Bureau of Statistics recorded that the number of people with employment increased as compared to the previous year. The number of waged earners employed increased by 979 and the number of salaried workers increased by 3972 \cite{RN4769}. A study by \citep{RN4711} in urban Africa noted that wasting in children is influenced by the monthly financial status of the family. \citep{RN4848} stated that better income at the household level leads to families spending more on food, paying for adequate and wholesome water supply and good health care. However, they argued that income growth alone not be strong enough to reduce malnutrition, as there are other avenues such as nutritional programs, micronutrients supplements and community behaviour change scheme. \citep{RN4772} conducted a study from twelve countries on household consumption and GDP with child malnutrition and found that at household levels and the cross country continued growth leads to the reduction in malnutrition. It projected that countries with a growth rate of 2.5% per year could reduce malnutrition (low weight for age) by 27%. These are the social factors that contributed to the decrease in malnutrition trend during the first half of 2011.
In 2011, the prevalence trend of indicators of malnutrition started to increase rapidly towards the end of the year. As similar to above no unusual weather or climate patterns were happening to indicate the sudden increase in malnutrition. In 2011 the Fijian GDP decreased by 0.3% \cite{RN1355}, even though it is a small decrease it has an effect on the economy and trickles down to the household level. As stated by \citep{RN4772} growth rate is vital in reducing malnutrition especially for low weight for age classified as underweight in this study. The Fijian government also increased Value Added Tax from 12.5% to 15% in 2011, an increase of 2.5%\cite{RN4844}. The increase in VAT lead to the increase in most of the food items consumed by Fijians. The Consumer Council of Fiji released a media statement in August of 2011 stating that food prices continue to increase in Fiji. The price for essential food items such as sugar and butter increased by 18% and 52.1% respectively. The cost of sugar increased due to the lack of supply from Fiji Sugar Corporation who is now importing sugar from Thailand to meet the demand. The Consumer Council also highlighted in October of 2011, that liquid milk was out of stock in most of the major supermarkets, and they were calling on the suppliers to meet the public demand as most of the milk in Fiji is imported\cite{RN4851,RN4850}. The results of a study by \citep{RN796} on child malnutrition and spikes in food prices in India between 2006 to 2009 revealed that food consumption of children reduced significantly across the entire population. There were variations across the different income groups, but nutritional risks were more amongst low-income children. Sudden food price increases make it difficult for families to adjust, crumbling their purchasing power, minimising their calorie and nutritional intake and it is driving more people into hunger \citep{RN4856}. The high food prices increase the risk of hidden hunger a term used to people suffering from micronutrient deficiency as it usually takes time and shows when it is severe. Hidden hunger happens when people do not have access to micronutrient-rich foods, fruits, vegetables, meat which are either expensive to purchase or are not available locally \cite{RN4856}.
In 2012 the prevalence of the indicators of malnutrition (underweight, growth faltering, severe malnutrition and anaemia) continued to increase until the middle of the year and then it came down to 2013, where it decreased further or became stagnant for some of this indicators. Our findings showed that rainfall trend was high between 2007 and 2008 and in 2012. High rainfall occurred at the beginning of the year during the rainy season, but these peaks were above average rainfall levels. A strong La Nina occurred between 2007 and 2008 and a moderate La Nina in 2012 which are responsible for the above average rainfalls. As a result, two significant floods affected Fiji in the first quarter of 2012. The first floods occurred from 21st January to 12th February affecting the western parts of the main island. The flood caused significant damages to the affected areas of more than 178,000 people and costing the Fijian government FJ $50.4 million \cite{RN4814}. A tropical depression TD17F caused the second flooding in the early hours of the 30th March also affecting the western parts of the main island. It was the second flood to hit this area in less than a month. The floods affected 150,000 people including 3,000 farmers, the costs of damages were FJ $71.2 million dollars \cite{RN4815}. The prevalence of the indicators of malnutrition (underweight, severe malnutrition and anaemia) were the highest recorded in 2012 than at any time during the study period. Our study findings showed that the increase in the prevalence of indicators of malnutrition (underweight, severe malnutrition and anaemia) was compounded by episodes high rainfall and flooding replicates the findings of \citep{RN4796} that there was a significant relationship between seasonal rainfall and child stunting. It also supported \citep{RN4793} findings that children exposed to two floods are three times more likely to be severely wasted than children not exposed to floods and twice more likely than those exposed to only one flood. \cite{RN626} in their study on the effect of weather variables on child, undernutrition found that variation in rainfall increases moderate stunting in different geographical zones of Ethiopia. The warming of the world due to anthropogenic climate change has caused much variability in the weather, and the increasing temperature is increasing the intensity of extreme weather events such as rainfall and cyclones. The second flooding was due to a tropical depression confirms to the study by \citep{RN4837,RN4838} that warming will intensify rainfall events associated with cyclones. The Fijian newspapers were publishing stories of flooded and damaged roads in the main centres and also in the rural areas, making it inaccessible. The Nadi International Airport was closed for four days due to the inaccessibility of the roads as tourists cannot access their hotel due to the severity of the flood \cite{RN4858}. Accessibility is essential as it connected people to relief and to medical service which is essential to the health of the vulnerable population which includes children, the elderly and the disabled. Studies conducted in Jamaica and Iran showed that the availability and the accessibility of medical facilities to mothers and children significantly dropped malnutrition \cite{RN1,RN4713}
In the second half of 2012, the prevalence of indicators of malnutrition (underweight, growth faltering, severe malnutrition and anaemia) decreased at almost the same rate of increase at the beginning of the year. The prevalence of malnutrition decreased subsequently after the disaster. The collaboration and partnership of international aid, the private sector, NGO's and civil society working together in the relief efforts was one of the reasons for the sudden decline in malnutrition. Australia, New Zealand and other countries assisted in the relief efforts and supported the mechanism on the ground to efficiently carry out the relief efforts. The government also waived two months land rentals on all crown leases \cite{RN4814}. The Ministry of Agriculture distributed seedlings, cuttings and assisted in the land preparation and the government has distributed more than FJ $1 million in food rations both the floods \cite{RN4860}. The prevalence of malnutrition after floods in Bangladesh is similar to Fiji as it also subsequent decreases after the floods. They requested assistance from the IMF and adjusted the economy, and they made food, drinking water, medicines and shelter available to the poor \citep{RN4859}. The government also increased funding to the WAF to improve and provide safe and consistent water supply to the Fijian people \cite{RN4861}. A study in Brazil by \citep{RN4716} found that having access to piped water supply reduced the risk of stunting. \citep{RN1363} in their study after adjusting for confounder has found that water and sanitation are significantly associated with stunting. \citep{RN1361} found that children living in homes with adequate water and sanitation had 17% more chances of improved stunting than those living without it.
In 2013 the prevalence of underweight, growth faltering and severe malnutrition decreased and became stagnant while the prevalence of anaemia started to decrease. The decrease in malnutrition in 2013, is that the country's Gross Domestic Product (GDP) has increased by 2.5% in 2013 \cite{RN4769}. \citep{RN4865} found that the prevalence of underweight in children and the growth in the GDP is compelling than for stunting, where a 10% growth in GDP will have 7% decrease in underweight. The growth in the GDP on nutrition is a combination of improved household resources, better infrastructure, and better nutrition services. However, anaemia decreases at a measured rate where the 10% growth in GDP will only have a decrease in child anaemia by 2.4%. The government in 2013 introduced the national pension scheme where people above 70 years receive monthly pensions. The introduction of the poverty benefit scheme, where a maximum of four people in the same household can receive assistance and food voucher. The government introduced the care and protection allowance for single mothers, deserted spouses, widows and prisoners dependents \cite{RN4866}. These are social protection programs introduced or supported by the government through increased funding in 2013. According to \citep{RN4846} social protection programs are usually used to target to improve the standard of living and not on nutrition, even though the primary aim is minimising poverty it usually results in enhanced food security, health and education.
The prevalence trends of underweight, growth faltering, severe malnutrition and anaemia, in general, were showing that Fiji Indian children were having high prevalence rate, followed by the I-Taukei children and then the children of other races. The National Nutrition Survey further discovers that the introduction of supplementary foods to the two ethnic groups vary a lot. More Fiji Indian babies are given additional foods before six months and from six months to two years more supplementary foods are given to I-Taukei babies. Most of the Fiji Indian babies are still given milk until 12 months and the reason given is that milk is a customary diet in a Fiji Indian traditional diet and not as an I-Taukei traditional diet \cite{RN1193}. Nutritional status differs in different ethnic groups due to dietary patterns, lifestyle, cultural and religious beliefs and socio-economic status \citep{RN1340}. Dietary intake and an ethnic study conducted in Malaysia found that differences in sociocultural in regards to food preferences caused differences in their dietary behaviour\citep{RN1342}. Fiji is a multi-ethnic country with the majority of the population native Fijians called the I- Taukei and the other dominant group are Fijians of Indian descents while the other races are other Pacific Islanders, Asians, and other minority races.
Conclusion
Malnutrition is a complex and multidimensional health issue and there are many factors that are associated with it. In this paper, climate change is happening in Fiji but at a slower pace as seen in the temperature trend. However, the slightest increase in temperature causes variability to the already fragile climate due to the climate phenomenon such as the South Pacific Convergence Zone, the El Nino Southern Oscillation and the Intertropical Convergence Zone affecting the Pacific. There is no clear linkage between the effect of climate change on the prevalence of malnutrition in Fiji, as there are many social factors that cause the increase and the decrease in malnutrition. However, increase in rainfall intensity, frequency and episodes of flooding due to climate change compounds the increasing prevalence of malnutrition in Fiji.