SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Two cases of extensive limb ulcers that had the clinical features of Mycobacterium ulcerans infection are described. This condition has not been described previously in the Central Pacific region. Both patients responded to radical debridement and skin grafting.
The aims of this project were: (1) to determine the extent to which infant hepatitis B immunisation is preventing chronic hepatitis B infection in children living in a sample of Pacific Island countries; and (2) to identify factors associated with the successful prevention of hepatitis B infection in these populations. A regional hepatitis B immunisation project which supplied hepatitis B vaccine to 10 Pacific Island countries began in 1995. Seroepidemiological surveys were conducted in Fiji, Kiribati, Tonga and Vanuatu in early 1998. These included immunised pre-school children and their biological mothers, and a historical control group of unimmunised students. Prevalence rates for hepatitis B surface antigen (HBsAg) in the populations of students, mothers and their pre-school children were respectively: Fiji: 6.9, 6.6, 0.7%; Kiribati: 27.4, 15.1, 3.8%; Tonga: 11.1, 18.6, 3.8%; Vanuatu: 16.3, 12.3, 3.0%; and for all four countries: 13.2, 12.5, 2.6%. Compared to the historical control group of students, the pre-school population had a much lower probability of HBsAg positivity (relative risk [RR]=0.19 [95%CI: 0.12-0.31]). Statistically significant differences in risk were apparent for all the countries: Fiji: RR=0.10; Kiribati: RR=0.14; Tonga: RR=0.34; Vanuatu: RR=0.19. This is equivalent to an overall program effectiveness of 81% (95%CI: 69-88%) in reducing chronic carriage. Also, the overall protective effectiveness against vertical hepatitis B transmission resulting in HBsAg positivity among children exposed to HBeAg positive and negative carrier mothers, was estimated to be 70%. By age 6 months, when all children should have had three vaccine doses, completed immunisation rates ranged from 22 (Fiji) to 84% (Vanuatu). Coverage of the first dose being given within 2 days of birth varied from 43% in Kiribati to 92% in Tonga. In conclusion hepatitis B immunisation of infants in these four countries is having a substantial beneficial effect in preventing chronic hepatitis B infection. Nevertheless, there is significant scope for further improving the timeliness of immunisation.
BACKGROUND: Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed. AIM: This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati. METHOD: Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for beta- and alpha-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography. RESULTS: Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19,086 microg beta-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques. CONCLUSIONS: These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.
Little is known about cancer epidemiology in Kiribati. Between November 1998 and December 1999, trained medical record abstractors visited 8 Micronesian jurisdictions including the Republic of Kiribati to review all available medical records in order to describe the epidemiology of cancer in Micronesia and to better understand the cancer data and control systems in each entity. The Republic of Kiribati has identified many prevalent preventable cancers. The lack of a robust cancer data tracking and surveillance system, as well as the lack of resources to institute a technologically and medically sustainable cancer control system was apparent. The implementation or existence of a national comprehensive cancer control strategic plan would facilitate greater identification, prevention, and treatment of cancer patients. The health sector and Government of Kiribati are working towards this end.
OBJECTIVES: To identify risk factors for xerophthalmia in the Republic of Kiribati. DESIGN: Case-control study. SETTING: The Republic of Kiribati. SUBJECTS: 666 xerophthalmic preschool children (cases) and 816 children without xerophthalmia (controls) from a population-based sample of 4619 children who participated in a xerophthalmia prevalence survey. MAIN OUTCOME MEASURES: Clinical signs of xerophthalmia (night blindness, Bitot's spots, corneal xerophthalmia and keratomalacia). RESULTS: Multivariable logistic regression models showed older age [1.35(1.24, 1.47)] [odds ratio (95% confidence interval)]; male sex [1.32(1.05, 1.67)]; recent diarrhea [1.45(1.10, 1.89)]; severe [3.82(2.73, 5.35)], moderate [3.55(2.04, 6.18)], and mild [3.07(2.33, 4.04)] protein-energy malnutrition; current breast-feeding [0.30(0.19, 0.46)]; higher frequency of consumption of carotenoid-containing fruits and vegetables [0.93(0.80, 0.96)]; and the presence of a Foundation for the Peoples of the South Pacific garden project [0.70(0.52, 0.93)] were each independently associated with xerophthalmia. A recent history of measles was associated with corneal xerophthalmia [7.73(1.78, 33.65)]. CONCLUSIONS: These data provide further evidence of the relationship between xerophthalmia and factors that may be amenable to intervention, and suggest that greater availability and consumption of provitamin A carotenoids is associated with decreased risk of xerophthalmia among preschool children.
From the Pacific Republic of Kiribati, 90/130 (69%) of hepatitis B-infected individuals carry antibodies to hepatitis delta virus. The prevalence of delta infection varied between geographically isolated subgroups in the population and delta antibodies were found more frequently in subjects over the age of 10. It is unlikely that delta superinfection in this population is associated with an acute hepatic illness. The prevalence of delta infection is the highest recorded from the Pacific region and thus migrants from Kiribati may have provided the source of infection in other population in this region.
"This paper presents an analysis of the 1985 census [of Kiribati] and compares projections made on the basis of that analysis with the 1990 enumeration. Comparison is made throughout with the estimates derived from [the] 1978 census." Information is provided on population growth and structure, child and adult mortality, marriage and first birth, and fertility.
Bimodality in the frequency distribution of plasma glucose 2 h after a 75-g oral glucose challenge has been demonstrated in only a few population groups, and the generalizability of the phenomenon remains unclear. Therefore, we have studied the distribution of 2-h glucose in 1813 Micronesians, aged 20 years and over, from an urbanized community of the Pacific Ocean Republic of Kiribati. The 2-h plasma glucose distributions were consistent with a mixture model comprising two lognormal components for age groups 30-39, 40-49 and 50+ years. The parameters of the mixture distribution were estimated by the method of maximum likelihood. The prevalence of non-insulin-dependent diabetes mellitus was 7.3% as defined by World Health Organization diagnostic criteria, and 4.7% when defined according to age-specific optimal cut-off values based on the minimization of the total number of misclassified individuals. Assuming that the fitted mixture distribution for each age group was the true plasma glucose distribution, the sensitivity and specificity of the World Health Organization diagnostic criteria and the age-specific optimal cut-off values were determined. Higher sensitivity with relatively little impairment of specificity resulted with the use of the former criteria. The prevalence of non-insulin-dependent diabetes mellitus increased with age as did the mean and standard deviation of the lower lognormal glucose component ("nondiabetics"). However, the mean and standard deviation of the "diabetic' upper component remained relatively constant and varied little with age.(ABSTRACT TRUNCATED AT 250 WORDS)
Vitamin A status was assessed clinically and by conjunctival impression cytology in a selected group under seven years of age in the Republic of Kiribati. A total of 230 children were studied. Of 185 with readable histology, 14.6% were clinically and histologically abnormal; 19.5% were clinically abnormal but histologically normal; and 15.7% were clinically normal and histologically abnormal. The remainder (50.3%) were clinically and histologically normal. There was a significant correlation between clinical disease and histology (P < 0.001). The prevalence of the disease in males was 45.8% and 26.3% in females. The risk of deficiency appeared to increase with advancing age. There was no significant difference between the two villages studied.
The seroepidemiology of hepatitis B was studied in Kiribati (formerly the Gilbert Islands). Six hundred and two (98%) of the population studied showed evidence of current or previous infection. The prevalence of hepatitis B surface antigen was 31% (188/615) and of the e antigen was 9% (58/615). Infection was acquired early in life, and the prevalence of both antigens declined with age. The rates of infection were similar in all age groups examined (0-70) including early childhood. Both hepatitis B surface antigen and e antigen were detected in exudates from tropical ulcers, which may be a source of environmental hepatitis B. Concordance of antigen presence was higher in pairs of siblings than in mother-child pairs. All Gilbertese children should receive hepatitis B vaccine at birth or soon after if the long term consequences of hepatitis B infection are to be minimised.
A population-based survey of 2938 subjects has demonstrated a high prevalence of non-insulin-dependent diabetes (NIDDM) in the Micronesian population of Kiribati (formerly the Gilbert Islands). This finding provides further support for evidence from Nauru, Guam, and the Marshall Islands that Micronesians are particularly susceptible to NIDDM. The age-standardized prevalence was over twice as high in an urban, as compared with a rural, sample (9.1 versus 3.0 in men, 8.7 versus 3.3 in women). To test the a priori hypotheses that obesity, reduced physical activity, and a nontraditional diet are associated with NIDDM, indices of these factors were compared in rural and urban subjects. The rural population was found to be leaner, to have a higher estimate of habitual physical activity, and to have a lower percentage of daily energy intake derived from imported foods. Further analysis demonstrated that obesity alone was insufficient to explain the rural-urban difference in prevalence of NIDDM. The multiple logistic regression model demonstrated a significant association between the prevalence of NIDDM and both obesity and urbanization in men. In women, obesity, physical inactivity, and urbanization were all associated with increased prevalence of NIDDM.
Subjects with impaired glucose tolerance have been shown to have a higher risk for subsequent diabetes and increased susceptibility to atherosclerosis. Data obtained from a cross-sectional medical survey in Kiribati in 1981 have been studied for evidence as to whether impaired glucose tolerance is a truly separate category of glucose intolerance. Subjects in the impaired glucose tolerance category were compared to both normal and diabetic subjects with respect to the mean values of certain variables including plasma glucose, body mass index, plasma cholesterol, plasma triglycerides, and systolic blood pressure. Differences between impaired glucose tolerant and normal subjects, and between impaired glucose tolerant and diabetic subjects were assessed. The most important differences between groups occurred with respect to plasma glucose concentration, body mass index, and plasma lipids. The results of this study provide further support for the validity of the impaired glucose tolerance category.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Attendances over a one-year period at the sole dispensary on a coral atoll (population 2411) have been studied. The patterns of presenting illnesses for those under five years old and those over five years old were studied, and analyses made of usage of the dispensary in relation to distance. Under-5s have disease incidences some four and a half to five and a half times those of over fives, but the apparent detrimental effect of distance is less in the under-fives. The skills required in the management of presenting illnesses are analysed in relation to those available--village health worker, trained nurse, doctor--and most were considered manageable by a nurse or village health worker. The latter appeared to be under-utilized and possible reasons for this are discussed.
The equatorial Pacific Ocean atoll islands of Kiritimati and Teraina encompass great physical, chemical and biological variability within extreme lacustrine environments. Surveys of lake chemistry and sediments revealed both intra- and inter-island variability. A survey of more than 100 lakes on Kiritimati found salinities from nearly fresh to 150 ppt with the highest values occurring within the isolated, inland portions of the island away from the influence of groundwater or extreme tides. Dissolved oxygen (DO) and pH values also showed considerable variability with a less regular spatial pattern, but were both generally inversely related to salinity. Series of lakes, progressively more isolated from marine communication, present a modern analog to the chemical and morphologic evolution of presently isolated basins. Sediments on both islands consist of interbedded red and green silt, possibly degraded bacterial mat, overlying white, mineralogenic silt precipitate. Variability may be indicative of shifts in climatological parameters such as the El Niño Southern Oscillation (ENSO) or the Pacific Intertropical Convergence Zone (ITCZ).
Explore the source record for details and available documents.