Communicable and noncommunicable diseases, health risk factors and transition
A number of environmental factors are increasing the risk of communicable diseases in Kiribati. High-density housing and overcrowding in urban areas, such as South Tarawa, is facilitating the transmission of infectious diseases. For instance, tuberculosis incidence in Kiribati has now surpassed that of other Pacific island countries, and most reported cases (70% in 2005) are found in the urban settlement of Betio in South Tarawa. Other health indicators suggest that the health status of people living in South Tarawa is now worse that of people living in the Outer Islands. In the 2005 Census, for example, the infant mortality rate in South Tarawa was higher than that in the Outer Islands.
Inadequate water supplies, unsafe drinking water, variable standards of personal hygiene, poor food handling and storage, and poor sanitation are all contributing to the high number of cases of diarrhoeal, respiratory, eye and skin infections. Diarrhoeal diseases and respiratory infections are major causes of mortality among children.
There is a high prevalence of STIs, with a surveillance study in 2004 showing that approximately 15% of pregnant women were infected. HIV was first confirmed in Kiribati in 1991 and the number of people infected continues to rise. As of the end of 2006, Kiribati had a cumulative total of 50 HIV/AIDS cases, of whom 24 are known to have died. Since 2006, seven people living with HIV have been enrolled in a care and treatment programme. One has since died.
Kiribati achieved leprosy elimination status in 2000, but has since reverted to pre-elimination status.
Data suggest that the prevalence of noncommunicable diseases is increasing. Smoking is a significant risk factor contributing to noncommunicable diseases. Around 70% of males between the ages of 30 and 54 are regular smokers, compared with less than 50% of the adult female population, while 32% of young males aged 15-19 smoke (2005 census). The gift of tobacco (Mweaka) remains closely tied to spiritual beliefs in the Outer Islands and in urban areas a gift of tobacco is still considered polite.
Economic development and modernization has increased reliance on imported, processed food, such as rice and noodles, and on motorized transport. These changes, together with a strong tradition of feasting, have led to overnutrition and reduced activity in adults, increasing the risk of noncommunicable disease. Draft results from the 2004-2005 STEPs survey show approximately 20% of the adult population have diabetes, and diseases of the circulatory system are now the second leading cause of mortality.
Kiribati faces a double-edged health problem related to diet and nutrition: overnutrition in adults and undernutrition in children. Although nationally representative nutrition data are scarce, infant mortality and routine health facility data suggest undernutrition and vitamin and mineral deficiencies are major contributing factors to under-five mortality. Draft results of a STEPs survey in 2004-2005 showed an anaemia prevalence of 17% for non-pregnant women and 22% among women aged 15-24. Vitamin A deficiency was highly prevalent in an assessment in 1989. Morbidity due to diarrhoeal disease and pneumonia among children suggests vitamin A deficiency remains a public health problem.
In the late 1990s, the infection rate for chronic hepatitis B was 27.4% among students aged 10-13 years, increasing the burden of chronic liver disease and cancer. The introduction of hepatitis B vaccination in 2002 will reduce this burden of disease in the future.
Outbreaks of communicable diseases
Anecdotal reports of outbreaks of diarrhoea are common, but few official reports are available. No outbreak of a vaccine-preventable disease has been reported since 2004.
Leading causes of mortality and morbidity
The causes of mortality and morbidity remained fairly consistent between 2002 and 2005. Acute respiratory infections and diarrhoeal diseases are the two major causes of morbidity and are among the five leading causes of mortality. There has been an increase in reported cases of respiratory disease and eye infection since 2002.
The leading causes of mortality and morbidity reported from health facilities in 2005 were:
There have been increases in mortality from diseases of the circulatory system, respiratory system and cancers. Perinatal conditions are still a leading cause of mortality for infants.
Maternal, child and infant diseases
Maternal health is improving. Approximately 90% of all births are now attended by trained health personnel and the total fertility rate has declined, falling from 4.5 in 1995 to 3.5 in 2005. The maternal mortality ratio, based on hospital records, is now 158 per 100 000 live births (2005 Census Report), a significant reduction from the previously reported ratio and consistent with (a) the reduction in the total fertility rate, and (b) the continued high percentage of women attended by trained staff.
Infant mortality has also improved over the last decade. The infant mortality rate was estimated at 52 per 1000 live births in the 2005 census, significantly lower than the 67 reported in 1995, but still high compared with many other Pacific island counties. Perinatal conditions, diarrhoeal diseases and pneumonia are the main causes of infant mortality and morbidity. Malnutrition, iron and vitamin A deficiency, and worm infestation among children are contributing factors.
An expanded immunization programme, introduced in the early 1980s, and supplementary measles campaigns in 1997 and 1998 have resulted in few reported outbreaks of vaccine-preventable diseases. Kiribati was declared polio-free in 2002.
Burden of disease
Kiribati faces a double burden of disease, with high mortality and morbidity from both communicable and noncommunicable diseases.
Data on the burden of disease caused by injury, disability and mental health are scarce. A recent national survey on disabilities found 3840 people with 4358 disabilities. Physical disabilities accounted for 32% of all disabilities; blindness and vision impairment 27%; deafness and hearing impairment 23%; and intellectual disability, epilepsy or psychiatric illness approximately 17 %. Twenty three per cent of disabilities are in the under-20 age group. The number of these disabilities that are due to birth injuries and childhood infections is unknown.
Data on consumption of alcohol and its impact on the burden of disease are also very limited, but alcohol consumption among young people is seen as a “common social problem faced by society”. Excessive alcohol consumption is commonly linked with road traffic accidents and domestic violence.