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Health

Health indicators are gradually improving in Kiribati. However, Kiribati has low life expectancy, the highest under five mortality rate in the Pacific and a high incidence of nutrition related diseases.

Poverty, overcrowding and the adoption of Western style diets have negative health consequences in Kiribati.

Kiribati has a shortage of trained medical personnel.

Most health services are free in Kiribati.

Offering quality and cost effective health services is difficult in Kiribati due to the geographical dispersity. Quality health services to the outer island is a major challenge.

Acute respiratory infections, wounds and sores, diarrhoeal diseases, cardiovascular disease and liver disease are the leading causes of death in Kiribati.

Malnutrition of the general population in Kiribati is a challenge.

Life expectancy in Kiribati is approximately 60 years.

Obesity among the adult population is a major health issue.

Dysentery and filariasis (a tropical disease caused by the presence of filarial worms) are a problem.

Health System and Infrastructure

Kiribati has a lack of hospital facilities, trained doctors and nurses. Kiribati has approximately 85 health centres and clinics on the Outer Islands and a referral hospital and clinics on South Tarawa. The facilities that do exist are often basic. Many clinics are staffed by foreign doctors (such as Cuban doctors) with the Kiribati Government paying for salaries and accommodation.

Most health services are free but some (such as dental, x-ray and laboratory services) are charged. This free healthcare system enables poor families to access basic health services.

There is an approved drug list and only these medicines can be prescribed.

The South Tarawa hospital only provides a limited set of services. Serious cases are referred overseas. Due to high referral costs overseas treatment is rationed by a committee of doctors and only those with a good prognosis are sent overseas.

Remoteness often make timely access to quality treatment and medicines difficult.

Infant Mortality

Infant mortality in Kiribati is more than five times higher than in Australia and is the highest in the western Pacific.

Perinatal conditions, diarrhoeal diseases and pneumonia are the main causes of infant mortality.

One of the major causes of infant mortality in Kiribati are water borne and faeces related illnesses causing many babies to die from chronic diarrhoea.

This is the result of the poor water supply and sanitation.

As children are over represented among the poor Kiribati's economic situation can impact infant mortality.

Early weaning of babies and the high cost of baby formula resulting in inappropriate choice of feedings (such as the use of condensed or "sunshine" milk) exacerbate infant malnutrition and mortality. The situation is often made worse because unhygienic water is used to prepare the infant feed.

These days there is no good reason for children to die from diarrhoea in Kiribati.

One reason these readily preventable deaths continue in Kiribati is the delay in rehydration. Diarrhoea is such a common problem in children (and the adult population) in Kiribati than mothers considered it unavoidable and "normal" therefore delayed treatment. Education is important in this area to prevent further infant deaths.

Many local people do not understand the benefits of oral rehydration therapy. The role of oral rehydration therapy is to prevent the child from dehydrating while the disease runs its course. Because it does not stop diarrhoea many locals think that the medicine is not working and do not see the benefit of taking it. Education is needed to clear this misconception within the community.

Improved water quality and sanitation are also important in reducing the incidence of fatal diarrhoea.

Nutrition Related Diseases

Many people in Kiribati have adopted Western diets. Westernisation of the Kiribati diet has increased the incidence of noncommunicable diseases such as diabetes, obesity, gout, hypertension, coronary heart disease, stroke, and cancers. These diseases are now prevalent in Kiribati.

The changing lifestyles associated with urbanisation is damaging health in Kiribati as it fosters a food dependency.

Foreign aid and private remittances negatively impact local food producing/collecting activities and in turn general health. Rather than obtaining local food, most food is imported.

Much of the food imported into Kiribati is nutritionally inferior and often low quality. These imported nutritionally inferior foods include low-fibre bread and rice, refined sugar, tinned meats and soft drinks.

Many families buy nutritionally inferior food to minimise spending.

A decline of traditional crop production had caused problems for maintaining a balanced diet.

Nutrition problems in children can result from repeated bouts of diarrhoea or heavy worm infestation. But often the cause is children eating unhealthy or having inadequate food.

There is a trend towards vitamin and mineral deficiency. Iron deficiency (anaemia), Vitamin A deficiency (eye problems) and Vitamin B deficiency are serious health issues and are causes for concern.

Night blindness caused by malnutrition (especially a lack of Vitamin A) is a chronic problem in Kiribati. Babies often do not receive adequate Vitamin A. Inadequate Vitamin A also results in dry eye (xerophthalmia). Dry eyes and night blindness mostly affect children.

Fishing provides the bulk of protein for the Kiribati people. Despite the wide availability of local fish and marine products protein deficiency regularly occurs with women and children. Meat protein is more difficult and expensive to obtain in Kiribati.

Land shortages in Kiribati discourage local food production resulting in poor diets from imported food high in fat, sodium, and sugar.

Diarrhoea and food poisoning affect almost everyone but especially children.

Ciguatera poisoning and the handling of fish after capture cause serious health risks in Kiribati. Many people in Kiribati prefer ungutted fish due to aesthetics and flavour but do not understand the relationship of gut and gill bacteria to spoilage. The problem of spoilage is exacerbated by extremely limited ice supplies.

Communicable Disease

Tuberculosis, leprosy, and other communicable diseases are prevalent in Kiribati.

Other frequent occurring diseases in Kiribati are diphtheria, whooping cough, tetanus, measles and polio. These diseases are preventable and vaccinations are available and a vaccination program exists. There have been few reported outbreaks of vaccine preventable diseases in Kiribati. Kiribati may now possibly be poliomyelitis free.

The Kiribati Tuberculoses Control Program does have high detection and cure rates.

Sexually transmitted infections are a major concern due to community lack of awareness, complacency and gender related discrimination.

The prevalence of human immunodeficiency virus ("HIV") and Acquired Immunodeficiency Syndrome ("AIDS") is a growing problem in Kiribati. Without proper education and appropriate medications the possibility of additional cases is inevitable.

Oral Healthcare

In Kiribati poor oral health is a common problem.

Many people suffer tooth decay or gum disease resulting in toothache.

Much of the oral care problem is the result of the lack of community awareness and education.

Smoking and Alcohol

Tobacco smoking is common in Kiribati. Kiribati has one of the highest prevalences of smoking in the world.

Alcohol and smoking-related diseases are increasing.

Alcohol consumption among young people in Kiribati is a major problem.

Excessive alcohol consumption is commonly linked to road traffic accidents and domestic violence.

Drink driving and alcohol related injury is common in Kiribati and often leads to death or hospitalisation.

Community awareness and education are critical in reversing this trend.

Water Supply

It is a major challenge to maintain the purity of Kiribati's water supply.

Groundwater contamination is associated with a higher incidence of diarrhoeal diseases.

Families often bury their dead in their yards and near wells. Due to the water lens being near these burial sites the dead readily contaminate the water supply.

The risk of a cholera epidemic is always present.

Because diarrhoea is so common in Kiribati many people do not associate it with illness.

It is estimated that the majority of people in Kiribati are outdoor defecators and this contributes to the contamination of the water supply.

Outdoor defecation is not entirely the result of a lack of other options. However, sometimes it is because of necessity. Extensive education is needed in this area to explain the dangers of outdoor defecation and to remove any necessity for outdoor defecation to occur.