South Tarawa Research Articles

A qualitative exploration of behavioral factors affecting mothers of malnourished children under 5 years old in Kiribati

Background: In Kiribati, malnutrition is the leading cause of death for children aged less than 5 years. The purpose of this study was to explore contributing behavioral factors among mothers of malnourished children under 5 years old in Kiribati. Methods: This qualitative study was conducted in an urban area of South Tarawa among mothers of malnourished children aged less than 5 years in 11 public health centers in 2016. The study included 9 focus group discussions, with a sub sample of 3 to 4 in each group, having a total of 35 participants. Using a semi-structured questionnaire, data was collected and thematic analysis was applied to analysis the data. Results: Seven main themes were identified including; knowledge, behaviors, perceived severity, perceived benefits to action, perceived barriers and cultural related issues. These encompassed a variety of reasons which could explain the malnutrition in children of those particular mothers. Conclusion: In order to tackle malnutrition in Kiribati, it is crucial to identify the main factors that are hindering this preventable disease. This study provides information essential to enhanced decision making, health care delivery planning and has policy implications for the improvement of quality of health care in Kiribati.

A qualitative exploration of factors affecting mothers of malnourished children under 5 years old in Kiribati.

Background: In Kiribati, malnutrition is the leading cause of death for children aged less than 5 years. The purpose of this study was to explore contributing factors among mothers of malnourished children under 5 years old in Kiribati. Methods: This qualitative study was conducted in an urban area of South Tarawa among mothers of malnourished children aged less than 5 years in 11 public health centers in 2016. The study included 9 focus group discussions, with a sub sample of 3 to 4 in each group, having a total of 35 participants. Using a semi-structured questionnaire, data was collected and thematic analysis was applied to analysis the data. Results: Seven main themes were identified including; knowledge, behaviors, perceived severity, perceived benefits to action, perceived barriers and cultural related issues. These encompassed a variety of reasons which could explain the malnutrition in children of those particular mothers. Conclusion: In order to tackle malnutrition in Kiribati, it is crucial to identify the main factors that are hindering this preventable disease. This study provides information essential to enhanced decision making, health care delivery planning and has policy implications for the improvement of quality of health care in Kiribati.

Quantitative estimates of dietary intake in households of South Tarawa, Kiribati.

Malnutrition is a public health problem especially among the Pacific Small Island developing nations. This study assessed malnutrition with dietary intakes in households of South Tarawa, Kiribati, a West Pacific Island Nation State. A cross-sectional community-based study design was used. One hundred and sixty-one households were selected from Betio, Bikenibeu and Teaorereke towns using a systematic random sampling method. About 35% each of the households was selected from Bikenebue and Besio while 30.4% was selected from Teaoraeke. Family (including children) dietary surveys including 24- hour dietary recall were administered to assess adequacy of nutrient intakes and dietary diversity using Household Diet Diversity Scores. A 3-day weighed food record was collected on a sub-sample. Data were analysed using FoodWorks Pro 8 for nutrient intake and Statistical Product for Service Solution (SPSS) version 21 for descriptive statistics. Sixty-one percent of the subjects had the lowest dietary diversity, 36.3% had a medium dietary diversity and only 2.7% had the highest dietary diversity. Based on the weighed food record results (n=29), male subjects of all age groups had adequate intakes of riboflavin, niacin, vitamin C, magnesium, iron and zinc, but had high intakes of protein and sodium; and low intakes of potassium and calcium. Female subjects had adequate intakes of vitamin C, iron, magnesium and zinc, but had high intakes of protein and sodium; and low intakes of potassium and calcium. Across all groups, 61% of the adult Kiribati population studied showed low dietary diversity, and a high prevalence of multiple micronutrient deficiencies.

Awareness and Characteristics of the Mothers of Malnourished Children Under 5 Years Old on South Tarawa, Kiribati in 2016: A Descriptive Study

Awareness and Characteristics of the Mothers of Malnourished Children Under 5 Years Old on South Tarawa, Kiribati in 2016: A Descriptive Study

Improving hepatitis B birth dose coverage through village health volunteer training and pregnant women education.

Hepatitis B is highly endemic in the Republic of Kiribati, while the coverage of timely birth dose vaccination, the primary method shown to prevent mother-to-child transmission of hepatitis B virus, was only 66% in 2014. Children born at home are especially at high risk, as they have limited access to timely birth dose (i.e. within 24 h) vaccination. To improve birth dose coverage, a project to improve linkages between village health volunteers and health workers and educate pregnant women on hepatitis B vaccination was carried out in 16 communities with low birth dose coverage in Kiribati from November 2014 to May 2015. After project completion, the coverage of timely birth dose administration increased significantly both in the densely populated capital region of South Tarawa (from 89% to 95%, p=0.001) and the Outer Islands (from 57% to 83%, p<0.001). The coverage of timely birth dose administration among infants born at home increased significantly from 70% to 84% in South Tarawa (p=0.001) and from 49% to 75% in the Outer Islands (p<0.001). Timely birth dose was associated with being born in a hospital, being born during the study period and caregivers having developed an antenatal birth dose plan. The project demonstrates a successful model for improving hepatitis B vaccine birth dose coverage that could be adopted in other areas in Kiribati as well as other similar settings.

Evaluation of health-related quality of life in patients with tuberculosis who completed treatment in Kiribati

ObjectiveTo examine the health-related quality of life (HRQoL) and related factors among patients with smear-positive and smear-negative pulmonary tuberculosis (TB) within 2 years after completion of directly observed treatment, short course (DOTS), and to compare their HRQoL with a comparison group of community-dwelling individuals without TB in South Tarawa, Kiribati.MethodsA cross-sectional questionnaire survey was conducted among 206 pulmonary TB patients who had completed DOTS and 214 individuals without TB, from July to September 2012. HRQoL was measured using the Short Form (36) Health Survey (SF-36).ResultsThe patients with TB had a statistically significantly higher physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 than the comparison group after adjustment for background characteristics. However, the differences did not exceed the 3-point threshold for clinically significant differences. Multiple liner regression showed that older age and presence of persistent symptoms after completion of DOTS were related to a lower PCS score in TB patients. Patients who were smear-positive before DOTS treatment had higher MCS scores than those who were smear-negative.ConclusionsOur results suggest the effectiveness of DOTS treatment. Health professionals can enhance HRQoL among posttreatment TB patients by managing their symptoms.

Barriers to contraceptive use in South Tarawa, Kiribati

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Improving access to family planning in the Pacific region has been slow, especially for those living in remote and rural areas. Pacific countries consistently report contraceptive prevalence rates well below the United Nations’ global averages for ‘less developed’ regions. The most recent data available on family planning usage in Kiribati from 2009 reported that the modern contraceptive prevalence rate was just 18.0% and total contraceptive prevalence rate just 22.3%.&lt;/p&gt;&lt;div&gt;&lt;p&gt;The aim of the study was to investigate knowledge and use of family planning and identify barriers to contraceptive uptake for men and women of reproductive age in South Tarawa, Kiribati, to inform future approaches aimed at increasing access to family planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A mixed methods approach was used. A community survey of men and women of reproductive age (15-49 years) (n=500) was carried out to identify current levels of knowledge, contraceptive use and barriers to use. Focus groups (n=4) of target populations (men 15-24, men 25-49, women 15-24, women 25-49) were undertaken and in-depth interviews (n=14) were conducted with health professionals and government officials to interpret survey results, further investigate barriers and generate ideas for improving service delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings:&lt;/strong&gt; Considerable barriers to family planning use were observed in the community survey and explored in the interviews and focus groups. They can be categorised into four thematic groups: disinterest in family planning; knowledge gaps; personal, family and social objections; and unsuitable service delivery.&lt;strong&gt;&lt;em&gt;&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;/div&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; A broad range of solutions were identified and fourteen service delivery recommendations were made for family planning service providers in South Tarawa. The recommendations may also hold relevance to other Pacific countries, however we encourage service providers to consider their country context before initiating any recommendations provided in this study. &lt;/p&gt;

Efficacy of Coral Sand for Removal of and Bacteriophage under Saturated Flow Conditions.

Knowledge of how effectively microbes are transported through porous media is useful for water resource/wastewater management. Despite much research having been done to characterize microbial contaminant transport through various sedimentary materials, very little study has been made on coral sand, such as constitutes the primary substrate of many Pacific atolls. We conducted a set of laboratory column experiments as a preliminary examination of how effective coral sand is at attenuating model pathogens J6-2 and MS2 bacteriophage (phage) under saturated flow conditions mildly representative of field conditions at the Bonriki freshwater lens, South Tarawa, Kiribati. The very poorly sorted gravelly sand coral substrate tested proved very effective at attenuating the bacterial tracer, and spatial removal rates of between 0.02 and 0.07 log cm were determined for J6-2. The ability to determine precise removal rates for MS2 phage was compromised by the use of a plastic apparatus, although the evidence weights toward coral sand being less effective at attenuating MS2 phage than it is . Further research is required to fully assess the ability of coral sand to remove pathogens and to explore how this medium could be engineered into cost-effective water/wastewater treatment solutions on Pacific atolls. The phage data from this work highlight the limitations of using plastic apparatus in experiments targeted at characterizing the fate and transport of viruses.

Sustainable artificial island concept for the Republic of Kiribati

Global warming and rising sea levels are increasingly causing major problems for low lying Pacific and Indian Ocean island nations. The Republic of Kiribati in the South Pacific is currently in a dire situation, and increasing levels of international aid will be required to maintain the population at its current standard of living. This paper describes a sustainable artificial island, designed for the inhabitants of South Tarawa, the capital island of the Republic of Kiribati. Design targets were to improve infrastructure, services and quality of life for the inhabitants, to increase island sustainability and to minimise construction costs. Transition to an artificial island is a feasible option with significant international support, and would enable survival for the population of South Tarawa with minimum disruption to their current lifestyle. Its construction and population would require a large leap of faith by both the financiers and the inhabitants, but it has the potential to provide a range of economic, social and environmental benefits both for the population and for the country.

Response to a large rotavirus outbreak on South Tarawa, Kiribati, 2013.

In July 2013, during annual independence celebrations in Kiribati, staff at Tungaru Central Hospital on South Tarawa reported an increase in children presenting with severe diarrhoea. This report describes the outbreak investigation, findings and response. After notification of the outbreak, all health facilities on South Tarawa began reporting cases of acute diarrhoea and/or vomiting through the early warning syndromic surveillance system on a daily basis. Community awareness was raised and the public was encouraged to present to a health facility if ill with acute gastroenteritis. Specimens were collected and sent for laboratory testing. Between 10 and 24 July 2013, 1118 cases of gastroenteritis were reported; 103 were hospitalized and six died. The median age of cases was one year (range: 0-68 years); 93.4% were aged less than five years. Rotavirus was identified in 81% of specimens tested. The outbreak response included enhanced surveillance, community education, clinical training and changes to in-hospital patient management for infection control. This outbreak was the largest diarrhoea outbreak in Kiribati in five years. Factors that may have contributed to the magnitude and severity of the outbreak included high household density, inadequate sanitation infrastructure and a mass gathering--all increasing the chance of transmission--as well as limited clinical response capacity. The current outbreak highlights the importance of clinical management to minimize severe dehydration and death. Rotavirus vaccination should be considered as an adjunct to other comprehensive enteric disease control measures as recommended by the World Health Organization.

Sustainably managing natural resources and the need for construction materials in Pacific island countries: The example of South Tarawa, Kiribati

AbstractThe growing demand for construction materials in South Tarawa, a remote atoll in the South Pacific, provides an example of the environmental and social challenges associated with the use of non‐renewable resources in the context of small island countries threatened by coastal erosion and climate change. In many small Pacific island countries, the availability of construction materials is limited, with the majority mined from beaches and coastal reefs in an unsustainable manner. Growing demand for construction aggregates is resulting in more widespread sand mining by communities along vulnerable sections of exposed beach and reefs. This has serious consequences for coastal erosion and impacts on reef ecosystem processes, consequences that cannot be easily managed. Construction materials are also in high demand for infrastructure projects which are financed in part with support from international development agencies and donors. This paper reviews the various challenges and risks that aggregate mining poses to reefs, fish, and the coastal health of South Tarawa and argues that the long term consequences from ad hoc beach/reef mining over large areas are likely to be far greater than the impacts associated with environmentally sustainable, organized extraction. The paper concludes with policy recommendations that are also relevant for neighbouring island countries facing similar challenges.

Exposure of atoll population to coastal erosion and flooding: a South Tarawa assessment, Kiribati

Atoll countries are particularly vulnerable to coastal hazards in the context of global change, which justifies the interest in population exposure assessments. This paper contributes to addressing this need by assessing the current exposure of the population of two areas of the South Tarawa Urban District (Tarawa Atoll, Republic of Kiribati) to coastal erosion and flooding. The assessment is based on data relating to island morphology (digital terrain models and shoreline change), land use (building extension and coastal works) and environmental changes reconstructed for the 1969–2008 period. The results highlight rapid changes in land use and significant differences in current population exposure to coastal erosion and flooding between and within study sites. Between 1969 and 2007–2008, the built area located less than 20 m from the reference shoreline has increased by a factor of 4.2 at Bairiki and by a factor of 32.2 at Eita–Bangantebure, enhancing population exposure given that land elevation is low (12.6 and 77.4 % 20 m from the coastline) and flooding (>1.5 m). Building exposure is higher at Eita–Bangantebure, where 71.3 % of the built area is currently not exposed (using the same criteria), but 17.1 % shows medium to very high levels of exposure, due to very low land elevation (22.3 % of the land area <1.5 m) and shoreline recession. The Eita–Bangantebure case study exemplifies the maladaptive trajectories of change that have been reported in other atoll countries.

Historical area and shoreline change of reef islands around Tarawa Atoll, Kiribati

Low-lying reef islands on atolls appear to be threatened by impacts of observed and anticipated sea-level rise. This study examines changes in shoreline position on the majority of reef islands on Tarawa Atoll, the capital of Kiribati. It investigates short-term reef-island area and shoreline change over 30 years determined by comparing 1968 and 1998 aerial photography using geographical information systems. Reef islands have substantially increased in size, gaining about 450 ha, driven largely by reclamations on urban South Tarawa, accounting for 360 ha (~80 % of the net change). Widespread erosion and high average accretion rates appear to be related to disjointed reclamations. In rural North Tarawa, most reef islands show stability, with localised changes in areas such as embayments, sand spits and beaches adjacent to, or facing, inter-island channels. Shoreline changes in North Tarawa are largely influenced by natural factors, whereas those in South Tarawa are predominantly affected by human factors and seasonal variability associated with El Nino—Southern Oscillation (ENSO). However, serious concerns are raised for the future of South Tarawa reef islands, as evidence shows that widespread erosion along the ocean and lagoon shorelines is primarily due to human activities and further encroachment onto the active beach will disrupt longshore sediment transport, increasing erosion and susceptibility of the reef islands to anticipated sea-level rise. Appropriate adaptation measures, such as incorporating coastal processes and seasonal variability associated with ENSO when designing coastal structures and developing appropriate management plans, are required, including prohibiting beach mining practices near settlements.

Land’s End

Land’s End

Homegardening as a panacea: A case study of South Tarawa

AbstractThe Republic of Kiribati is a small, highly infertile Pacific Island nation and is one of the most challenging locations to attempt to support dense urban populations. Kiribati, like other nations in the Pacific, faces an urban future where food insecurity, unemployment, waste management and malnutrition will become increasing issues. Homegardening is suggested as one way to address many of these problems. However, the most recent study on agriculture production in urban centres in Kiribati shows that, in general, intensive cultivation of homegardens is not a common practice. This disparity between theory and practice creates an opportunity to re‐examine homegardening in Kiribati and, more broadly, in the Pacific. This paper examines the practice of homegardening in urban centres in Kiribati and explores reasons why change has or has not occurred through interviews with homegardeners and government/donor representatives. Results show that homegardening has increased significantly in the past five years, largely because of the promotion of homegardens and organic composting systems by donor organisations. While findings further endorse homegardening as an excellent theoretical solution to many of the problems that confront urban settlements in Kiribati and the Pacific, it raises additional questions regarding the continuation of homegarden schemes beyond donor support programmes.

Water troubles in a Pacific atoll town

South Tarawa is a town on an isolated Pacific atoll of approximately 46,000 people, with absolute water scarcity, poor water safety and consequently water-related problems. It relies on shallow groundwater, with contributions from rainwater tanks and desalination. Due to a combination of factors such as small scale, limited human resources, system complexity, isolation and lack of financial resources, water management capacity is inadequate. Sustainability of groundwater resources is also uncertain and there are indications that groundwater has been extracted above the sustainable pumping rates. Social complexity is highlighted by the resistance from traditional landowners to the attempts to deal with the supply-side deficit through establishment of new infiltration galleries. In this paper, issues relating to water management in South Tarawa are reviewed. This follows on to an exploration of possible strategies to improve the existing situation. This research forms an empirical building block in the foundation of a larger study, aiming at developing a framework for strategic and adaptive small town water management. In particular, the larger study explores the options and viability of co-management of water and land resources in small scale urban areas as an alternative to traditional urban management approaches.

Shellfish gathering in Kiribati,Micronesia: Nutritional,microbiological, andtoxicological aspects

Shellfish gathering has received comparatively little attention in the anthropological literature. Yet, the contribution of shellfish to the diet of indigenous societies can be significant. Reef and lagoon gleaning activities in Kiribati, Micronesia illustrate the importance of this class of invertebrates, particularly on urban South Tarawa. Proximate composition of 24 bivalves and gastropods add to our knowledge of the nutritional value of tropical shellfish. Microbiological contamination remains a problem, however, notably among inshore shellfish collected from Tarawa Lagoon. Assays on one species of cowrie (Cypraea tigris) confirm its toxicological properties, as suggested by some informants. The future of shellfish resources in Kiribati will need to address the issue of open access associated with an erosion of customary marine tenure.

Solid Waste-level Rise on Atoll Nation States: A Less Publicised Environmental Issue in the Republic of Kiribati

The situation in urban South Tarawa Atoll, capital of the central Pacific nation of Kiribati (pron. Kir-i-bas), is just one example, although extreme, of the current solid waste crisis affecting many atoll nation states. Increased levels of development, an influx of imported consumer items and increasingly urbanised and overcrowded conditions have contributed to this crisis through modification of the traditional solid waste stream. Comparative analyses of various solid waste characterisation studies indicate recent quantitative and qualitative changes to the solid waste stream that, although significant, alone are of limited consequence. Rather, it is the inability of traditional waste disposal practices to adapt to the rapidity of change within the waste stream that has resulted in contamination of reef, lagoon and groundwater resources and also accounts for the almost ubiquitous presence of litter and indiscriminately dumped material. The security of traditional food and water harvesting activities has also been placed at risk, with subsequent repercussions for public health. Island Councils and Government Ministries are addressing the issue, with external assistance, but are inhibited by insufficient financial and human resources, low national priority, restrictions of atoll environments and traditional customs.

Self‐reliance in Kiribati: contrasting views of agricultural and fisheries production

Aid and remittances have long defined the economies of Pacific Island ‘micro states’ as part of the MIRAB approach to development. However, these sources of support now face an uncertain future. While recognizing that atoll nations, such as Kiribati, are constrained in terms of their agricultural potential, particularly on urban South Tarawa, there is still room for improvement of both traditional and exotic crop production to help reverse the trend of increasing imported food dependency and the rising incidence of nutritionally related non‐communicable diseases. By contrast, the inshore fisheries sector currently satisfies both subsistence and local commercial needs. This paper examines extant agricultural and nearshore fisheries activities on South Tarawa and analyzes the impact on health and nutrition and on the environment.

Freshwater Ostracoda from Tarawa, Kiribati: their implications for dispersal mechanisms

Abstract. Tarawa Atoll, Gilbert Islands (1° 30′N, 173° 00′E) is an isolated place, comparatively recently emergent – 2500 years bp and 2 – 3 m above present sea-level (Marshall &amp;amp; Jacobson, 1985). During the course of a study of the marine ostracods (Eagar, in press) it was noted that there are relatively few places where freshwater is visible on the surface of the atoll. This is not unusual, given the low precipitation (154 mm a−1) and the daytime temperatures of Tarawa (27–30°C). Five freshwater ponds on South Tarawa (Fig. 1) were examined and two species of Ostracoda were found: Cyprinotus cingalensis Brady, 1886 and Limnocythere notodonta Vávra, 1906. At Bairiki (locality A), a pond adjacent to the causeway linking Bairiki with Betio was sampled and yielded abundant Cyprinotus cingalensis. Other ponds were found at Ambo (Locality B) and Temaiku Bight (Localities C and D with two ponds). Only the pond (Locality B), an established babai pit (taro; Cyrtosperma chamissonis), adjacent to the roadside at Ambo yielded further specimens of the ostracod Limnocythere notodonta, although in low numbers.The question of how these species were introduced onto Tarawa Atoll is intriguing. C. cingalensis is known from Ceylon (Brady, 1886), Hawaii and the Sandwich Islands. The record by Vávra (1906) from Australia may be incorrect. Limnocythere notodonta was previously recorded only from Java (Vávra, 1906). Both species may have been distributed in the same way that Sars (e.g., Sars, 1896) transported species from different parts of the world to Norway to describe . . .