Marshall Islands Research Articles

Time trends and advances in the management of global, regional, and national diabetes in adolescents and young adults aged 10–24 years, 1990–2021: analysis for the global burden of disease study 2021

BackgroundEstimation of global diabetes burden in adolescents and young adults (10–24 years) from 1990 to 2021.MethodsData were extracted from the 2021 Global Burden of Disease Study. Joinpoint regression analysis was employed to examine trends over the past 30 years, frontier analysis identified regions with potential for improvement, and the slope index of inequality and the relative concentration index were used to assess health inequalities.ResultsFrom 1990 to 2021, the age-standardized prevalence rates (ASPR) and age-standardized disability-adjusted life years rates (ASDR) of diabetes in adolescents and young adults increased globally, while age-standardized death rates (ASMR) remained stable. Oceania bore the highest burden regionally, East Asia experienced the fastest rise in ASPR and ASDR, and High-income Asia Pacific saw the most significant decrease in ASMR. Among 204 countries, Marshall Island and Hait reported the highest ASPR, ASDR, and ASMR in 2021. Health inequality analysis confirmed that the burden was concentrated in countries with lower Socio-Demographic Index (SDI). Frontier analysis showed that ASMR and ASDR were negatively correlated with SDI, with Yemen and Honduras, which have lower socio-demographic indices, exhibiting more smaller overall differences from frontier boundaries.ConclusionsThe analysis revealed a sharp increase in the global ASPR and ASDR of diabetes in adolescents and young adults. Additionally, the disease burden is typically concentrated in countries with lower SDI, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of diabetes in this demographic.

Prediction on Yellowfin Tuna (Thunnus albacares) Fishing Ground in Waters Near the Marshall Islands Based on SMOTETomek‐RF

ABSTRACTThis study monitored 37 longliners fishing in waters near the Marshall Islands from 2020 to 2022 by Liancheng Overseas Fishery (Shenzhen) Co., Ltd.'s operation management system. This study developed nine predictive models on the relationship between catch per unit effort (CPUE) data for yellowfin tuna (Thunnus albacares) and the environmental data. The environmental data integrate 48 variables, including eddy kinetic energy, chlorophyll a concentration, sea surface height, and additional measures of vertical oceanic conditions, alongside spatiotemporal parameters (year, month, day, longitude, and latitude). This study employed four spatial resolutions (0.25° × 0.25°, 0.5° × 0.5°, 1° × 1°, and 2° × 2°) to develop nine predictive models: KNN, RF, GBDT, CART, LightGBM, XGBoost, CatBoost, AdaBoost, and Stacking (RF, KNN, GBDT, and LR). These models, with a daily time resolution, were trained using 75% of the data and tested with the remaining 25%. The optimal spatial resolution and model were determined through a comprehensive comparison of model evaluation metrics across these spatial resolutions. The SMOTETomek algorithm was then applied to resample 75% of the data at the optimal spatial resolution, forming a new training dataset. This dataset was used to refine the model, subsequently tested with the remaining 25% of the data. Results indicated that (1) the optimal spatial resolution is 0.25° × 0.25° and the optimal model is RF; (2) the SMOTETomek algorithm enhances the model's predictive performance; and (3) the developed SMK‐RF model, exhibiting Acc and AUC values of 76.73% and 82.47%, respectively, accurately predicts the central fishing grounds for yellowfin tuna, consisting closely with actual fishing activity.

Creative Practice and Pedagogy with the Marshall Islands: Navigating a Critical Call-and-Response

Creative Practice and Pedagogy with the Marshall Islands: Navigating a Critical Call-and-Response

A new parasite discovery in Micronesia: eggs of the nematode Toxocara canis at archaeological sites on Ebon Atoll, Marshall Islands extend the known dog presence by c.600 years

ABSTRACTLittle is known of helminth parasites in Micronesia in archaeological contexts. This study presents a parasitological analysis of soil and sediment samples from Ebon Atoll in the Marshall Islands, eastern Micronesia. Microscopic eggs of the dog (Canis lupus familiaris) nematode Toxocara canis, which could have adversely affected the health of local people as well as their dogs, were found at two sites, in one example in habitation layers dated to 1830–1625 calBP (95% CI), extending the date for the known presence of dogs in the Marshall Islands by at least 600 years. This study represents the first confirmed evidence of pre‐European helminth parasites in Micronesia. As similar Melanesian and Polynesian studies have previously been reported, the study also completes the initial, pre‐contact helminth record for the three main island regions of Oceania.

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol

IntroductionThe Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families. MethodsThe purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study. SummaryThis study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial

Abstract Aims/hypothesis We conducted the largest and longest clinical trial comparing a whole-food, plant-based intervention with standard medical care (SMC) in individuals with type 2 diabetes. Methods We randomised (parallel-arm; computerised 1:1 randomisation ratio) 169 adults aged 18–75 years with type 2 diabetes in the Marshall Islands to an intensive whole-food, plant-based intervention with moderate exercise (PB+Ex) or SMC for 24 weeks. The PB+Ex intervention included 12 weeks of meals, exercise sessions and group classes. Primary outcomes were glycaemic control (HbA1c, glucose, insulin and HOMA-IR) and glucose-lowering medication use. Secondary outcomes included lipids, blood pressure, heart rate and C-reactive protein. Only lab analysts were blinded. Results Compared with SMC (n=90 randomised; n=70 analysed), the PB+Ex (n=79 randomised; n=66 analysed) intervention decreased HbA1c by an additional 14 mmol/mol (1.3%) at week 12 (−22 vs −7 mmol/mol [−2.0% vs −0.7%]; p<0.0001) and 8 mmol/mol (0.7%) at week 24 (−16 vs −8 mmol/mol [−1.4% vs −0.7%]; p=0.01). Concomitantly, 63% of medicated PB+Ex participants reduced their glucose-lowering medications (vs 24%; p=0.006), and 23% of PB+Ex participants with a baseline HbA1c <75 mmol/mol (<9%) achieved remission. Additionally, the PB+Ex intervention reduced weight (−2.7 kg; p<0.0001), C-reactive protein (−11 nmol/l; p=0.005) and cardiovascular medication use compared with SMC. At intermediate timepoints, it improved glucose, insulin, HOMA-IR, cholesterol, triglycerides and heart rate, but not at week 24. Conclusions/interpretation A whole-food, plant-based lifestyle intervention was more effective for improving glycaemic control than SMC. It also reduced the need for diabetes and cardiovascular medications and induced diabetes remission in some participants. Therefore, it is an effective, evidence-based lifestyle option for individuals with type 2 diabetes. Trial registration ClinicalTrials.gov NCT03862963 Funding This research was funded by the Department of the Army (W81XWH-05-1-0547). CJH received support through a National Institutes of Health Predoctoral T32 Obesity Fellowship (T32 HL105349). Graphical Abstract

New Compact of Free Association Agreements with Micronesia, the Marshall Islands, and Palau Approved by Congress

New Compact of Free Association Agreements with Micronesia, the Marshall Islands, and Palau Approved by Congress

아태지역 ODA사업 지원을 위한 대상국 선정 및 지원 사업 연구

Purpose: This study aimed t o e stablish strategies for strengthening t ransport networks in the Asia-Pacific region and select countries for support to improve port and logistics infrastructure. Research design, data, and methodology: Cluster analysis was used to select the target countries for support. The analysis was based on 15 variables, including GDP, economic growth, population, import and export growth, tariff rates, import tax rates, and container volumes, derived from literature studies of 53 UN ESCAP member countries. Cluster analysis was performed using a primary cluster analysis utilizing the quantitative variables and a secondary cluster analysis with qualitative variables. Results: The analysis identified 10 countries (Kiribati, Maldives, Marshall Islands, Nauru, Palau, Samoa, Tonga, Tuvalu, Vanuatu, and Vanuatu) as candidates for support. For each of the 10 selected countries, 10 support projects were proposed, considering the current status of shipping and ports in the country and national infrastructure development plans. Conclusions: The smooth progress of a project requires a consideration of the form and type of ODA support, support port facilities that can handle various cargo, and propose solutions to the problem of volume generation.

Attack and Decay

This essay theorizes about nuclear militarism in the Pacific—specifically, US nuclear militarism in the Marshall Islands—by tracing the critical musicological term resonance, or the deep, full, reverberant vibrational connections that disrupt modern constructs of spatiotemporal presence. Resonance refers to the amplification of a (sound) system through the matching of a frequency with an external system, shifting perceptual magnitude through connection of two separate systems that share some vibrational quality. I use the term resonance in these literal and metaphorical ways to examine how, in the aftermath of the United States’ many attacks on the Marshall Islands—nuclear, experimental, sociocultural—that created radiogenic decay as well as broader systemic decay for the Indigenous communities, the United States’ culture of silence and secrecy around nuclear testing disabled the resonance of Marshallese appeals for nuclear justice, thus promulgating such decay. Focusing on what I call “radiation songs” and nuclear commemoration, I explore how vocal resonance moves across generations as Marshallese navigate militarized currents and remember other forms of navigation or wayfinding, such as oceanic outrigger canoe–based navigation that, like singing, brings more-than-human communities together.

Practices of Informing and Consenting in Indigenous Communities: The Case of The Marshall Islands

The 1979 Belmont Report established the guiding principles of informed consent. The 2007 United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) pointed out several problems in the meaning of these principles, and in how they were operationalised in small, indigenous communities. The Belmont Report originated in a developed economy, and was taken forward by researchers in individualist societies more than collectivist societies. But in the 21st century, with cross-cultural work a routine element of academic research, these issues have greater salience. UNDRIP focuses on the local meanings of concepts such as respect, informed, consent and privacy. It privileges local cultural norms, meanings and practices in the processes of gaining consent, and foregrounds the need for selecting culturally appropriate processes of consulting, comprehending, and withdrawing. This paper uses examples from the Republic of the Marshall Islands (RMI) to explore these issues, and make recommendations for social science researchers in navigating cross-cultural dimensions of informing, respect, privacy and consent.

Republic of the Marshall Islands

Republic of the Marshall Islands

Testing as the Blindspot of Nuclear Nonuse

Pacific activists’ proclamation that nuclear testing is nuclear use poses a challenge to the notion of nuclear nonuse in the discipline of International Relations (IR). While addressing such a challenge, this article reveals a disciplinary blind spot regarding nuclear testing that disqualifies testing from nuclear use. I argue that IR discussions of nuclear nonuse—exemplified by Scott Sagan and Kenneth N. Waltz’s debates on nuclear deterrence and Nina Tannenwald’s nuclear taboo framework—are part of the colonial knowledge production that dismisses the political agency and humanity of colonized people. This article then argues that nuclear testing is a form of nuclear use, specifically, the colonial use of nuclear weapons, by developing a postcolonial reinterpretation of nuclear testing in the case of US nuclear weapon tests in the Marshall Islands (1946–58).

Annual phenology and migration routes to breeding grounds in western-central North Pacific sei whales

The sei whale (Balaenoptera borealis) is an important species among baleen whales in the North Pacific and plays a significant role in the ecosystem. Despite the importance of this species, information regarding its migration patterns and breeding locations remains limited. To enhance the understanding of the phenology of North Pacific sei whales, we deployed satellite-monitored tags on these whales in the western and central North Pacific from 2017 to 2023. We fitted 55 sei whale tracks to a state-space model to describe the whales’ seasonal movements at feeding grounds and their migratory behavior. The whales typically leave their feeding grounds between November and December, with migration pathways extending from off Japan to the west of the Hawaiian Islands. These southward transits converge in the waters of the Marshall Islands and north of Micronesia between 20° N and 7° N, which appear to be breeding grounds. After a brief stay at these breeding grounds, the whales migrate northward from January to February, reaching their feeding grounds around 30°N by March. To the best of our knowledge, this is the first study to present the phenology of feeding and breeding seasons and the migration pattern of North Pacific sei whales.

Review of the Newly Established amictus-Subgroup of the Genus Leptocoris (Hemiptera: Heteroptera: Rhopalidae), with the Description of a New Species from the Arabian Peninsula

Leptocoris arabicus new species (Hemiptera: Heteroptera: Rhopalidae: Serinethinae) is described based on 55 specimens of both sexes collected in various localities of southern Oman and southeastern Yemen; a hypothesis is proposed as to its host plant. The new species is close to Leptocoris amictus Germar, 1838 and to Leptocoris ruber Göllner-Scheiding, 1980, new status, due to the presence of a produced horned process along the posterior ventral margin of the genital capsule. It is distinguished from both by differences in colour pattern and morphology. An informal L. amictus species-subgroup is proposed to accommodate these three species within the Leptocoris hexophthalmus species-group sensu Göllner-Scheiding (1980). The following new faunistic records are also provided: L. amictus from Ethiopia, Mozambique and Zambia; L. ruber from Central African Republic. The occurrence of L. chevreuxi (Noualhier, 1893) in Oman is confirmed. The list of all available species-group names assigned to Leptocoris Hahn, 1833 (gender masculine) and their synonyms is compiled and the gender agreement is corrected in the species names when appropriate. The nomenclatural problem concerning Leptocoris living on Marshall Islands discovered by Kerzhner (2003) is discussed and the following corrections are provided: Leptocoris rufus rufus Hahn, 1833, new status = Leptocoris lariversi Usinger, 1952, new synonymy, and Leptocoris rufus isolatus (Distant, 1914) new status.

Mapping American innocence in the Pacific: Cold War empire, militarization and suburbanization at Kwajalein Atoll

ABSTRACT This article represents a historical and ethnographic reflection on the process of researching an active US military base in the Marshall Islands, while offering analysis of the spatial and cultural forms of suburbanization on the island that emerged during the Cold War. Kwajalein Island served as a support base for the nuclear testing campaign in the Northern Marshall Islands (1946–1958). At that campaign’s conclusion, the island was transformed into a segregated suburban missile installation that remains active today. By tracing my research process on the island, including discoveries of sources that helped me examine the importation of US racial signifiers marking the island’s social order, I offer an analysis on how the physical and cultural construction of this segregated suburban landscape on Kwajalein has helped support an exceptionalist narrative of US imperial innocence in the region.

Following the money: climate adaptation finance in the Marshall Islands

The significant body of research on the distribution of international finance for climate change adaptation shows that it is not well correlated to the vulnerability of countries. Vulnerability differs greatly within countries as well, yet very few studies examine subnational flows of adaptation finance. Here, we present evidence of the subnational allocation of international adaptation finance within the Republic of the Marshall Islands (RMI). The RMI is a highly salient case as it is a small island developing state comprised solely of low-lying atolls that is both in need of and a recipient of adaptation finance. We describe patterns of adaptation finance in the RMI between 2015 and 2019 based on analysis of a comprehensive government database of bilateral and multilateral aid projects. We find that flows of adaptation finance were heavily skewed towards a small number of large-scale civil works projects in urban areas funded by multilateral institutions. Rural areas attracted smaller scale projects funded largely by bilateral donors. The overall distribution of adaptation finance across islands is highly sporadic, with hotspots of activity and areas of neglect. Our results suggest the allocation of adaptation finance to the RMI is insufficient relative to needs, poorly coordinated, and fails to reach places where it is most needed.

From co-produced hegemony to coerced imperial governance

ABSTRACT This paper is inspired by recent analyses of the nature of imperial power that unbundle it from the modes of global governance performed by European rulers in the ‘Age of Empire’. While maintaining the defining features of the concept, it argues that today’s global Pax Americana is constituted by a variety of legal regulatory instruments that define the topography of an imperial regime through strategies of inclusion/exclusion that dilute the national and economic sovereignty of the targeted community or state. The argument is fleshed out by applying it as a grille de lecture to four existing case studies published by historians of science and technology, including my own. The regulatory systems they describe evolved from a classic metropolitan-periphery mode of colonial subordination (in the case of Hawaiʻi in the early twentieth century), through a US–UN brokered legal status of strategic trusteeship to legitimate the use of the Marshall islands to destructively test weapons after World War Two, to the use of export controls and other regulatory instruments to control the transnational flow of US-origin knowledge, know-how and technical data in the nuclear and commercial fields.

Hepatitis B virus infection on Kwajalein Atoll, Marshall Islands: a seroprevalence, knowledge and attitudes study.

A study was conducted to determine the seroprevalence of chronic hepatitis B virus (HBV) infection among children and their mothers on Kwajalein Atoll in the Marshall Islands two decades after routine vaccination was introduced in the 1990s. Mothers' knowledge and attitudes towards HBV disease and vaccination were also assessed. Results of a national seroprevalence survey conducted in 2016-2017 and antenatal records were used to determine the prevalence of HBV seropositivity in children aged 6-8years and their biological mothers. The associations between demographic, social and vaccination-related factors and seropositivity were explored using Fisher's exact tests. HBV seroprevalence was 0.3% in children and 6.8% in their mothers (during pregnancy). Coverage of timely HBV vaccination was 90.3% for the birth dose and was significantly associated with factors related to place of residence (P<0.001), place of birth (P<0.001) and number of antenatal visits (P<0.001). Maternal attitudes towards infant vaccination and antenatal screening were largely positive (95.8% and 96.7%, respectively) despite low vaccination rates (20.9%) among mothers. Knowledge levels were low for disease complications, treatment and transmission. Prevalence of HBV in children and mothers residing on Kwajalein Atoll in 2016-2017 was lower than the national average for the Marshall Islands. Timely birth dose administration appears to have been effective in preventing mother-to-child transmission of HBV in this setting and should be promoted in remote settings where antiviral therapy is not available. Provision of out-of-cold-chain HBV vaccines should be considered to improve access in remote settings.

Multi-country case study on school health policy and its implementation in relation to COVID-19 control in Micronesia Small Islands Developing States

IntroductionThe COVID-19 pandemic caused school closures and rises in mental illness and non-communicable disease among school children worldwide. The Pacific Small Islands Developing States (SIDS) were also affected, but school health activities, which can effectively reduce negative effects of COVID-19, were not widely implemented compared to other Asia-Pacific countries. This study examined current school health implementation and related policies at national, local, and school levels in the Micronesia SIDS according to phases of COVID-19 control.MethodsMulti-country case study targeted the Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau (ROP). These studies focused on school health implementation periods according to the PPR (Prevention, Preparedness, and Response) concept: Phase #1: prevention/preparedness, #2: early phase response, and #3: chronic phase response/recovery phase. Data were collected through policy document reviews that identified school health policies related to COVID-19 controls in the three phases and key informant interviews (KIIs) with 44 key informants (FSM, n = 14; RMI, n = 18; ROP, n = 12) whose work related to school health. The collected data were analyzed using content analysis methods according to the conceptual framework in this study.ResultsThis study identified three factors of school health implementation related to COVID-19 controls: promotion of decentralized education (FSM), implementation of COVID-19 controls in the school community (RMI), and disaster management for the protection of students including response to infectious disease (ROP). In Phase #1, no country had established a school health policy. In Phase #2, three enablers were identified in FSM and ROP, as reflected in COVID-19 controls by the education and health sectors. In Phase #3, RMI implemented COVID-19 controls in the school community. Documents on youth policy and disaster management in ROP were updated to reflect the chronic phase response and response to future public health crises.ConclusionsA decentralized education was instrumental in immediately implementing COVID-19 control measures in schools at national and local levels for coordination between education and health sectors. Despite each county’s multi-sectoral approach to engage COVID-19 controls in schools, local government organization requires strengthening and implementation of the formulated school health policy. In preparation for the next public health crisis, school health should be promoted that is integrated into both infection control and disaster management.

“We’re Taking Back the Narrative”. An Interview with Benetick Kabua Maddison, of the Marshallese Educational Initiative

This contribution features an interview with Benetick Kabua Maddison, the Executive Director of the Marshallese Educational Initiative (MEI), an NGO that aims to raise awareness of the effects of nuclear testing and climate change on the Republic of the Marshall Islands (RMI). The RMI was the site of 67 nuclear tests conducted by the United States between 1946 and 1958, which resulted in environmental degradation and health problems for the local population. The interview explores the current renegotiation of the Compact of Free Association (COFA), a treaty that governs the political and economic relationship between the RMI and the US. The interview also discusses the challenges and opportunities for the Marshallese community, the conflicting statements regarding the contamination of the RMI, and the prospects of a nuclear weapons ban and global solidarity to address the twin existential threats facing the RMI and the world.