ministry of health and medical services, kiribati annual report, 2011

annualreport

2011

Kiribati

3Kiribati • Annual Report • 2011

Ministry of Health and M

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Contents

Preface �� 4

Key points – Kiribati’s health 2011 �� 5

1. Introduction �� 7

2. The health of I-Kiribati – an overview �� 11

3. Determinants: keys to prevention ��19

4. Health across the life stages �� 35

5. Health services �� 45

6. Methods and definitions �� 59

7.Annexes ��61

4 Kiribati • Annual Report • 2011

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Preface

Mauri, the Ministry of Health and Medical Services is happy to present the first Annual Report produced for over ten years now. The Health Information Unit, who is responsible for the production of this report, stores much data in the system that has never been analysed. In this year, 2012, expertise from the University of Queensland, Brisbane, has assisted the Ministry of Health and Medical Services in Kiribati to produce this report. The Ministry would like to thank the head of the University of Queensland for allowing staff from the Ministry to come over and work in their office and finish the report with the assistance from their expertise.

The main purpose of this report is to assess the status of our population’s health. It is also going to serve the need from health donors on any kind of information they might need. In addition, the Ministry of Health and Medical Services required this report to assess its performance towards the health status of the population, and to better or improve its future plans and budget. There is no doubt that this report will help improve plans for the future. This report also plays a crucial role in documenting all information from past years that never been documented�

The Ministry of Health and Medical Services wishes to give its sincere gratitude to the team at the Health Information Systems Knowledge Hub, University of Queensland, for their assistance in producing this report, alongside our Senior Health Information Officer, Mr Teanibuaka Tabunga:

Professor Alan Lopez

Nicola Hodge

Fallon Horstmann

Michael Buttsworth

Jillian Ridley.

Also words of thanks to the team from the Australian Bureau of Statistics, and the Working Committee of the Pacific Health Information Network for your great support. Last, but not the least to the staff of the Health Information Units in Nawerewere for their assistance from home.

Without your individual support, this report would have never been done. But your great commitment is indicated in the completion of this report, and it is one way of many to help improve Health Information Systems

in Pacific Island Countries, and the Ministry of Health and Medical Services is thankful for this.

Finally, to Mr Tabunga’s mentor, Nicola Hodge, for her great support and advice: many thanks for the fantastic lessons; they have given our health information staff a new understanding of statistics.

Dr Kautu TenauaMinister of Health & Medical Services

Mr Elliot AliPermanent Secretary

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Kiribati • Annual Report • 2011

Key points – Kiribati’s health 2011

This section presents selected key findings from the report�

Table 1 Main indicators, 2011

Indicator Males Females Both sexes

Total population 51,002 52,464 103,466

Percent of population living in South Tarawa 23.3 25 48.3

Percent of population less than 15 years of age 37 35 36

Percent of population aged 15-24 21 20 21

Percent of population aged 25-59 37 39 38

Percent of population older than 60 years of age 5 6 5

Crude birth rate (per 1,000 people) - - 28.7

Crude death rate (per 1,000 people) 5.4 3.9 4.6

Infant mortality rate (per 1,000 births) - 34

Under-five mortality rate (per 1,000 births) - 47.3

Life expectancy at birth (years) 70 80.1 75.1

Fertility rate - 2.7 -

Source: National Statistics Preliminary Census 2010; Health Information Unit, MHMS 2011

General

Life expectancy and death

• The crude death rate in 2011 was 4.6 deaths per 1,000 people

• Life expectancy in Kiribati is currently 80 years for females and 70 for males

• The total fertility rate in Kiribati was 2.7 per female in 2010. The rate is lower than those of neighbouring Pacific Island Countries and Territories

• The leading causes of death in 2011 were digestive (8.7%) and cardiovascular (8.5%) diseases

Diseases

• 28.1% of the adult population is estimated to have diabetes

• In 2011, 12.3% of the new cases seen at clinics were for acute respiratory infections


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Health risks

• 61.3% of the adult population are ‘current smokers’, and of these, 59% smoke daily

• 25.5% of the adult population consumed alcohol in the past 12 months (in the year leading up to 2006)

• 50.1% of the population have low-levels of physical activity each week

• 99.3% of the population consume less than five servings of fruit and vegetables per day

• 17.3% of the population have high blood pressure

• 27.7% of the population have high blood cholesterol

Babies and children

• There were 2,971 births in 2011, which is approximately eight babies born per day

• The infant mortality rate is 34 deaths per 1,000 live births

• The under-five mortality rate is 47 deaths per 1,000 live births

• These rates have not increased or decreased significantly over the past 20 years

• Kiribati is currently not on track for achieving Millennium Development Goal 4 (Reduce child mortality)

Health services

• Approximately 29,000 people visit an outpatient clinic each month

• Over 700 pregnant women are seen by antenatal clinics each month

• Just under 10,000 home visits were conducted by public health nurses in 2011, the majority for treating sick patients, followed by care for infants under-one

• In 2011, under 700 patients were referred to Tungaru Central Hospital from the outer islands, the majority by plane

• There is an increasing number of patients registered at hypertension and diabetes clinics each year

• In 2011, 30,000 patients were registered with a hypertension clinic, and 24,000 with a diabetes clinic

• There are four Main Hospitals: Betio Hospital, Tarawa Central Hospital (TCH), Southern Kiribati Hospital (SKH), and Kiritimati Hosptal

• There are 34 Health Centres (eight in South Tarawa, four in Betio, and 22 from Outer Islands)

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1. Introduction

How....

• good is the health of people living in Kiribati?

• does it vary between the different islands?

What...• things influence health?

• is being done to improve health, and how well is that working?

These are the big questions behind the Annual Report 2011, the first report of its kind produced by the Ministry of Health and Medical Services in over ten years. As a report to the nation, the Annual Report 2011 brings together the latest available national statistics compiled by the Ministry of Health from many data sources. Its target readers are interested members of the public, clinicians, researchers, students, policy makers and government.

We can see from this report that there are some answers to these questions. The health of I-Kiribati is generally good, is improving (in some areas), and compares well with other countries in the Pacific.

But the ‘simple’ big-picture answers have a complex background. They depend on many statistics that are derived from a large amount of data compiled by many people throughout Kiribati and its extended health system. Contributors include people working in hospitals and other health facilities, in research agencies, in government health departments, and in special health registries.

Ultimately, it is all people from Kiribati who contribute to this report because there would be no data without them. Through them we also learn about the exceptions to the generally good news. These exceptions include the high infant mortality and under-five mortality rates, which have not reduced for over 20 years. Young males are also dying at much higher rates than young females, mostly from accidents and other external causes of injuries. Non-communicable diseases are a growing concern in the Pacific, and many people are already suffering from conditions such as diabetes.

This first chapter begins by discussing what health is, why health information is important and presenting a brief picture of Kiribati today.

1.1 Understanding health

What is health?

Ideas continue to change about what it means to be healthy or unhealthy. One view focuses mostly on the individual and emphasises the presence or absence of disease or sickness. Another view of health includes a wide range of social and economic risk and protective factors, along with various aspects of wellbeing. This report is based on an idea of health as described by the Australian Institute of Health and Welfare (AIHW); that it is:

An important part of wellbeing, of how people feel and function; that it contributes to social and economic wellbeing; that it is not simply the absence of illness or injury, and there are degrees of good and bad health; and that health should be seen in a broad social context. Overall, it can be said that healthy people feel and function well in body and mind and are in a condition to do so for as long as possible.1

A framework

This report is based on a conceptual framework of health, as shown in Figure 1. It shows that levels of health and wellbeing (‘how good is Kiribati’s health?) depend on two forces: determinants (‘what things influence health?’) and interventions and their resources (‘what is being done to improve health?’).

There are many determinants of health and they interact in complex ways. They include behaviours such as smoking, diet and physical activity, and much broader factors such as our social and environmental background. Interventions can range from personal services to treat us when we are sick, to prevention campaigns aimed at determinants�

1 Australian Institute of Health and Welfare (AIHW). 2010. Australia’s’ health 2010. Australia’s health series no. 12. Cat no. AUS 122. Canberra: AIHW


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Determinants Health and wellbeing Resources

Biomedical and genetic factors

Health behaviours

Socioeconomic factors

Environmental factors

Life expectancy, mortality

Subjective health

Functioning, disability

Illness, disease, injury

Human

Material

Financial

Research

Evaluation

Monitoring

Surveillance

Technology

Other information

Interventions

Prevention and health promotion

Treatment and care

Rehabilitation

Figure 1 Conceptual framework of health2


1.2 Health information

What is a health information system, and why is it important?

Health information systems (HIS), defined by the World Health Organization as integrated efforts to ‘collect, process, report and use health information and knowledge to influence policy making, programme action and research’, are essential to the effective functioning of health systems worldwide.3 Routine HIS, such as those operated through health information departments or national statistics offices, provide information on risk factors associated with disease, mortality and morbidity, health service coverage, and health system resources.4

Governments rely on the information provided to them from HIS for the production of high-quality, user-friendly statistical information on the health status of the community; the use and need of health services;

3 AbouZahr C and A Commar. 2008. Neglected Health Systems Research: Health Information Systems. Alliance for Health Policy and Systems Research: World Health Organization

4 Lewin S, Oxman A, Lavis J, Fretheim A, Marti S and Munabi-Babigumira S. 2010. Chapter 11: Fidning and using evidence about local conditions. In A Oxman, J Lavis, S Lewin and A Fretheim (eds.), pp 164-183, SUPPORT Tools for Evidence-Informed Policymaking. Report Number 4, 2010. Norwegian Knowledge Centre for the Health Services: Oslo

formulating, monitoring and evaluating health policies; and measuring progress made in the provision of health services.5 HIS can also identify health problems; help to form effective health policies; respond to public health emergencies; select, implement and evaluate interventions; and allocate resources.6

Collecting, analysing and sharing health information is a difficult process that requires a clear understanding of its underlying components and how these components interact. The Health Metrics Network provides a conceptual representation of the six components and standards of a HIS:

1. HIS resources – such as appropriately trained staff, finance, logistics support and context-specific technologies. These resources (or inputs) must be situated within the broader legislative, regulatory and planning framework of a country

5 World Health Organization Regional Office for the Western Pacific Region (WPRO). 2003. Chapter 5: Data quality of statistical reports. In Improving Data Quality: A guide for developing countries, pp 54-67. World Health Organization: Geneva

6 Pappaioanou M, Malison M, Wilkins K, Otto B, Goodman R, Churchill R, White M and Thacker S. 2003. Strengthening capacity in developing countries for evidence based public health: The data for decision making project. Social Science and Medicine 57(10): 1925-1937

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2. Indicators – the basis of a HIS strategic plan must include a core set of indicators and related targets that can provide a picture of the determinants of health, health system condition, and the status of population health

3. Data sources – such as civil and vital registration (births, deaths and cause-of-death), censuses and surveys, medical records, service records and financial and resource tracking

4. Data management – includes data collection, storage, quality, flow, processing, compilation and analysis

5. Information products – the transformation of data into information and therefore into a tool for evidence-based decision-making that will lead to improved health

6. Dissemination and use – increasing the value of health information by making it accessible to decision-makers and providing incentives for the use of health information.7

7 Health Metrics Network (HMN). 2008. Framework and Standards for Country Health Information Systems, 2nd Edition. World Health Organization: Geneva

Components and standards of a Health Information System

HIS resources

Indicators

Data sources

Data management

Information products

Dissemination and use

OUTPUTSDissemination

and Use

OUTPUTSInformation Products

PROCESSESData

Management

PROCESSESData Sources

PROCESSESIndicators

INPUTSHIS Resources

Figure 2 Components and standards of a health information system7


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1.3 Kiribati health systemThe government of Kiribati is the main provider of health services in the country. As of 2011, government health facilities included four main hospitals (Betio Hospital, Tungaru Central Hospital, Kiribati Southern Hospital and Kiritimati Hospital), 34 health centres operated by Medical Assistants from South Tarawa, Betio and outer islands, and 66 Clinics manned by Public Health Nurses.

There are six other health care providers that also report to the Health Information Unit, including the Integrated Management of Children’s Illness (IMCI) clinic, Gynaecology clinic, Diabetic clinic, Kiribati Family Health Association (KFHA), Reproductive Health Development and Adolescent Health Development.

Kiribati is comprised of 33 atoll islands divided among three island groups; the Gilbert Islands, the Phoenix Islands and the Line Islands. Of the 33 islands of Kiribati, 24 are inhabited. There are no private health care providers. All heath care services are provided free to all Kiribati residents by the Government and there is very minimal out-of-pocket spending for health.

In 2009, the Government spent approximately 16.5% of its total recurrent budget on health, taking the second largest share next to education. In addition to the recurrent budget, significant amounts of resources from external sources contribute to financing health services and activities through the government’s Development Fund and through other channels such as non-governmental organizations (NGOs).

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2. The health of I-Kiribati – an overview

How....

• healthy are the people of Kiribati?

• does Kiribati compare with other countries?

• is this changing over time?

This chapter describes Kiribati’s health using general measures of health status, for example, life expectancy, birth and death rates, and chronic disease prevalence. The population is considered as a whole, with some key differences highlighted for people living on remote and outer islands.

2.1 Kiribati’s changing populationTo understand a population’s health, it is useful to start with its demographic features: the size of a population, the ratio of males to females, its age structure, and how these characteristics are changing. These features are an important aspect of health monitoring, as they reflect past health events and also provide insight into the current and future health of the population.

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Births Vs Deaths Rates by Years

Crude Death Rate

Crude Birth Rate

Figure 3 Birth and death rates by year. Source: MHMS, Health Information Unit 2011

Other helpful insights come from statistics about fertility, mortality and life expectancy. Birth and death rates are major drivers of a population’s age structure, whereas life expectancy summarises the outlook on life based on current mortality patterns. Migration also contributes to changes in the size, structure and health of the population.

Population growth

The bar graph below shows the crude death rates and the crude births rates. It highlights a very important message that more babies are born than people died every year. Again the number of deaths still remains unchanged for the last 20 years whereas the births of babies started to increase from the year 2010 and 2011. The birth rates in 2011 are worrisome because comparing with baseline births during the past 20 years the births remains around 20 births per 1000. In 2006 the number of births increases to 25 births per 1000, then decrease 2007, 2008 and 2009. Again the decreasing could have to do with missing of data. Hence, 2010 and 2011 the births again increase.


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Age and sex structure

The estimated resident population of Kiribati in 2010 was 103,466, having grown by 11.8% since the last census in 2005. Since 1990, the population has increased by 43 percent. Overall, natural increase (that is, the number of births exceeding the number of deaths) has stayed the same over the past 20 years. The average rate of natural increase is 1.6 percent.

Figure 4 (below) indicates that the population of Kiribati is young and still growing. It also indicates that there are more females in the older age groups than males (from about age 25 upwards), due to the higher mortality rates among young males.

The 2010 census (tables provided in annexes at the end of the report) shows that 48.3% of the total population resides in South Tarawa, with the remaining population living on the different outer islands. The Ministry of Health and Medical Services will have to plan to make

sure that the health services are efficient and adequate to the public, especially those living on remote outer islands.

8.00 6.00 4.00 2.00 0.00 2.00 4.00 6.00 8.00

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Age

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Age structure of the I-Kiribati population, 2010

Females

Males

Figure 4 Population pyramid. Source: National Statistics Preliminary Census, 2010

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Fertility

Two different measures are commonly used to describe trends and patterns in fertility: the number of children born to each female, and the age of mothers giving birth.

Total fertility rate

The total fertility rate (TFR) is a summary measure used to describe the number of children a female could expect to give birth to during her lifetime, if she experience the current age-specific fertility rates throughout her childbearing life.

The TFR in Kiribati was 2.7 per female in 2010. The rate is lower than those of neighbouring Pacific Island Countries and Territories�

Mortality

Data on death and its causes are important measures of a population’s health. Examining trends and patterns in mortality can help explain changes and differences in health status, evaluate health strategies, and guide planning and policy making. Cause-specific mortality provides further insight into the events contributing to deaths, and changes in the pattern of these causes reflects changes in behaviours, exposures, and social and environmental circumstances as well as the effects of medical and technological advances.

Table 2 (below) shows that Kiribati continues to have high infant mortality, especially among males. Mortality declines in childhood and adolesence (five to 19 years of age), before increasing steadily and peaking in the 70 years and over age group.

Of concern is the high number of young boys (aged five to 19) and men (20 to 29) dying, compared to girls and women of the same age.

Table 2 Deaths by age and sex, 2011. Source: MHMS, Health Information Unit, 2011

2011 Males Females Sex ratio

Age Number Rate Number Rate Crude Rate ratio

Less than 5 75 1070.2 57 836.1 132 128.0

5 – 19 years 10 56.9 4 24.1 250 236.4

20-29 years 24 257.1 10 104.3 240 246.5

30-39 years 15 248.9 13 200.2 115 124.3

40-49 years 37 673.7 23 386.7 161 174.2

50-59 years 42 1307.6 32 869.3 131 150.4

60-69 years 34 2183.7 20 1025.1 170 213.0

70 and over 42 5269.8 43 3136.4 98 168.0

Total 279 547.0 202 385.0 138 142.1

Note: of the 494 deaths in 2011, only 481 deaths had data on age and/or gender recorded


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Trends

There were 494 deaths recorded by the Health Information Unit in Kiribati in 2011. Figure 5 shows the national total number of deaths from the year 1991 to 2011. It includes all ages and both sexes. The downfall in 2009 on the number of deaths is the outcome of the missing data during this year. This is when the reporting tool was renewed.

However, looking at the graphs it tells us that the number of deaths for the past 20 years until the 2011 is stable. An average of 4.7 per 1000 people die in Kiribati per year.

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National Number of Deaths by year - 1991 - 2011

Number of Deaths Three year moving average

Figure 5 Number of deaths (absolute and three-year moving average) by year. Source: MHMS, Health Information Unit, 2011

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Table 3 Crude death rate by year. Source: MHMS, Health Information Unit, 2011

Year Total number of deaths Crude Death Rate / 1000

1991 413 4.0

1992 536 5.2

1993 547 5.3

1994 421 4.1

1995 453 4.4

1996 416 4.0

1997 442 4.3

1998 465 4.5

1999 445 4.3

2000 526 5.1

2001 500 4.8

2002 509 4.9

2003 444 4.3

2004 508 4.9

2005 609 5.9

2006 619 6.0

2007 482 4.7

2008 512 4.9

2009 338 3.3

2010 599 5.8

2011 494 4.8

The table above indicates the number of deaths from 1991 to 2011. The total population used is from the preliminary census in 2010 from the national statistical office. The crude death rate (number of deaths per 1000 people) peaks in 2005 and 2006. The low number of deaths recorded in 2009 (338) is likely due to the change in reporting forms that year, which resulted in missing data�

2.2 Causes of deathThis section provides an overview of the leading causes of death in Kiribati. Cause-of-death statistics are usually based on the underlying cause, which is the disease or injury that initiated the train of events leading directly to an individual’s death – in other words, the condition believed to be the primary cause-of-death. Any other

condition or event that is not the underlying cause, but is still considered to contribute to the death, is known as an associated cause�

Leading causes of death

For the population as a whole, the top 10 causes presented here have been listed as specific causes rather than at the broader International Classification of Diseases (ICD) chapter level. Information on cancer deaths, for example, have been provided by individual cancer type rather than for cancer overall.

The top 10 causes of death were responsible for 64% of all deaths in 2011. The leading cause-of-death was ‘other digestive diseases’. ‘Other cardiovascular diseases’ is second, followed by cerebrovascular diseases and lower respiratory infections.


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Table 4 Leading underlying specific causes of death, all ages, 2011. Source: MHMS, Health Information Unit, 2011

RankAll ages, both sexes

Cause of death Number of deaths

% of all deaths

1 Ill-defined diseases 80 16.6

2 Other digestive diseases 42 8.7

3 Other cardiovascular diseases 41 8.5

4 Cerebrovascular diseases 33 6.9

5 Lower respiratory infections 30 6.2

6 Diabetes mellitus 26 5.4

7 Diarrhoeal diseases 17 3.5

7 Other infectious diseases 17 3.5

9 Endocrine diseases 16 3.3

10 Protein-energy malnutrition 14 2.9Total leading causes 316 64.0All deaths 494 100.00

Major causes of death by life stage

The statistics for various age groups are provided here at the broad ICD chapter level, rather than at the specific disease level, to give a better picture of the broad distribution of causes of death. Overall, the relative contribution of different underlying causes-of-death varies with age. For infants, the main cause-of-death for both males and females relates to conditions originating in the perinatal period. Infectious and parasitic diseases; endocrine, nutritional and metabolic diseases; and diseases of the respiratory system are the main causes of death for children aged 1-14 years. For young adults, the main cause-of-death differs for males (external causes) and females (neoplasm’s). As people age, diseases of the circulatory and digestive system cause more deaths. Ill-defined conditions account for a higher proportion of assigned causes-of-death as people age; representing 45.5% of all deaths for females aged over 85 years; and 32.7% of all deaths for males aged 65-84.

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Table 5 Leading underlying broad cause-of-death by age group, 2011. Source: MHMS, Health Information Unit

Age group #Males

#Females

Cause-of-death % of deaths Cause-of-death % of

deaths

Infants

(<1 year)1 Conditions originating in the

perinatal period 62.3 1Conditions originating in the perinatal period 65.1

2 Endocrine, nutritional and metabolic diseases 11.3 2 Endocrine, nutritional and metabolic

diseases 11.6

2 Ill-defined conditions 11.3 3 Diseases of the respiratory system 9.3

4 Infectious and parasitic diseases 7.5 4 Infectious and parasitic diseases 7.0

1-141

Endocrine, nutritional and metabolic diseases 25.8 1

Infectious and parasitic diseases23.5

2 Infectious and parasitic diseases 22.6 1 Endocrine, nutritional and metabolic diseases 23.5

3 Diseases of the respiratory system 12.9 1 Diseases of the respiratory system 23.5

4 External causes of morbidity and mortality 9.7 4 Diseases of the circulatory system 11.8

15-241

External causes of morbidity and mortality 43.8 1

Neoplasm’s (cancer)33.3

2 Diseases of the digestive system 31.3 2 Infectious and parasitic diseases 16.7

3Infectious and parasitic diseases

6.32 Endocrine, nutritional and metabolic

diseases 16.7

2

Diseases of the circulatory system

16.73 Diseases of the circulatory system 6.3

3 Diseases of the respiratory system 6.3

3 Ill-defined conditions 6.3

25-44 1 Diseases of the circulatory system 21.3 1 Diseases of the digestive system 30.0

1 Diseases of the digestive system 21.3 2 Diseases of the circulatory system 16.7

1 Ill-defined conditions 21.3 3 Ill-defined conditions 13.3

4 Infectious and parasitic diseases 10.6 4 Diseases of the genitourinary system 10.0

45-64 1 Diseases of the circulatory system 40.0 1 Diseases of the circulatory system 20.0

2 Ill-defined conditions 17.7 2 Endocrine, nutritional and metabolic diseases 18.0

3 Endocrine, nutritional and metabolic diseases 12.7 2 Diseases of the digestive system 18.0

4 Diseases of the digestive system 8.9 4 Neoplasm’s (cancer) 12.0

65-84 1 Ill-defined conditions 32.7 1 Diseases of the circulatory system 26.02 Diseases of the circulatory system 21.2 2 Ill-defined conditions 23.9

3 Endocrine, nutritional and metabolic diseases 11.5 3 Diseases of the respiratory system 15.2

3 Diseases of the respiratory system 11.5 4 Infectious and parasitic diseases 8.785 and over 1

Diseases of the skin and subcutaneous tissue 100.0 1

Ill-defined conditions45.5

- 2 Diseases of the circulatory system 18.2- 2 Diseases of the respiratory system 18.2- 4 Infectious and parasitic diseases 9.1

Note: Broad causes of death refer to ICD-10 Chapter-level headings

Percent of deaths are calculated within each age and sex group


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3. Determinants: keys to prevention

Many things can affect how healthy we are. They range from society-wide influences right down to highly individual factors such as blood pressure and genetic makeup – they also include the health care we receive. This chapter focuses on these various influences, which are known as health determinants because they help determine how likely we are to stay healthy or become ill or injured.

3.1 What are health determinants?A person’s health and wellbeing has many aspects. They result from the relationship between social, environmental, socioeconomic, biological and lifestyle factors, nearly all of which can be affected (to some extent) by health care and other interventions.

It is important to note that some determinants are positive in their effects on health and others are

negative. A high daily intake of fruit and vegetables, for example, or being vaccinated against disease are known as protective factors.

Things that increase our risk of ill health are known as risk factors. Examples include behaviours such as smoking or being physically inactive.

Measuring and monitoring determinants helps to explain trends in health. This information can then be used to help understand why some groups have poorer health than others, and to develop and evaluate policies and interventions to prevent disease and promote health.

Table 6 Relationship between selected chronic diseases (conditions) and risk factors (determinants)8

Risk factorCondition

COPD(a) CHD(b) Depression Type 2 diabetes Stroke

BehaviouralTobacco smoking a a a

Physical inactivity a a a a

Alcohol misuse a a a

Poor nutrition a a a

aBiomedical

Obesity a a a a

High blood pressure a a

High blood cholesterol a a

(a). COPD Chronic obstructive pulmonary disease

(b). CHD Coronary heart disease (also known as ischaemic heart disease)



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3.2 Health behavioursMany things can influence a person’s health-related behaviours. A person’s knowledge, attitudes and beliefs may make a particular behaviour more or less likely. Further, behaviours may be affected by the presence of disease or disability.

Changing health behaviours is a primary goal of health promotion, which often operates at a population level. Other population health interventions such as legislation, regulation or price control may make it harder for people to continue with unhealthy behaviours.

Ultimately, individuals make their own choices about health-related behaviours based on this mix of determinants, interventions and other influences, and consequently have more power to change their own behaviours than many of the other determinants discussed in this chapter.

The following sections describe the levels, patterns and trends of the health-related behaviours that have been shown to have a major influence on health.

Tobacco smoking

Tobacco smoking is a major risk factor for coronary heart disease, stroke, peripheral vascular disease, cancer and a variety of other diseases and conditions. The usual measure of population smoking rates is ‘daily’ smoking (those who smoke any tobacco product every day), as this reflects the pattern of smoking most harmful to health.

Estimates from the latest STEPS Report (see Box 1) show that in 2006, 61.3% of the population were ‘current smokers’9 and among current smokers, 59.0% smoked daily. Males were more likely to be daily smokers (74.0%) than females (45.4%). The mean age people started smoking was 19.1 years; men started smoking at a marginally younger age than women (18.2 and 20.5 years, respectively).

9 Current smokers are defined as those who had smoked any tobacco product (such as cigarettes, cigars or rolled tobacco) in the past 12 months

Box 1: WHO STEPwise Approach to Surveillance of Risk Factors for NCDs (STEPS Report)

The STEPS Report is a WHO surveillance tool for chronic disease risk factors and chronic disease-specific morbidity and mortality to be used at the national level. To date, 106 countries and territories throughout the world have used the WHO national STEPS tool.

The STEPS approach gathers information on key risk factors in a representative sample of the population using interviews and questionnaires, obtaining simple physical measurements, and collecting blood samples for biochemical assessment. The data gathered enables Governments to put emphasis in the right place when planning and implementing activities to reduce NCD risk factors. National STEPS results can also be used to evaluate the impact of NCD interventions, monitor national trends and judge a country’s overall performance by comparing results with other countries.

Data used in the Kiribati STEPS Report are based on a national representative population-wide sample of I-Kiribati. The survey was carried out in South Tarawa and four outer islands (Butaritari, Makin, Onotoa and Beru) from May 2004 to September 2006. A total of 1,755 individuals (response rate 88%) participated in the survey.

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Figure 6 Prevalence of ‘current smokers’ in Kiribati and selected Pacific Island Countries and Territories, 2009. Source: STEPS Report, WPRO

Alcohol consumption

Excessive alcohol consumption is a major risk factor for a variety of health problems such as stroke, coronary heart disease, high blood pressure, some cancers, and pancreatitis.10 It also contributes to motor vehicle accidents, drowning, homicides and falls. Measuring the health risks posed by different levels and patterns of drinking is complex and informed by a large body of research.


The STEPS Report shows that 25.5% of the I-Kiribati adult population had consumed alcohol in the past 12 months (defined as ‘current drinkers’). The survey shows that heavy drinking is more common among I-Kiribati men than women. Overall, greater proportions of males in all age groups drank six or more standard drinks per drinking day, with the highest proportion found in the 25-34 years age group (Table 7).

Table 7 Number of standard drinks per day among current drinkers by age group, 2004-200611

Age group (years)

Males Females

Total (N)

% one drink

% two-three drinks

% four-five drinks

% six or more drinks

Total (N)

% one drink

% two-three drinks

% four-five drinks

% six or more drinks

25-34 94 -- 1.1 11.7 87.2 17 -- 5.9 29.4 64.7

35-44 80 2.5 2.5 15.0 80.0 10 20.0 20.0 20.0 40.0

45-54 65 -- 6.2 12.3 81.5 15 6.7 33.3 26.7 33.3

55-64 25 -- 8.0 20.0 72.0 4 25.0 25.0 -- 50.025-64 264 0.7 2.8 13.3 83.1 46 7.5 16.9 24.9 50.7

11 World Health Organization Western Pacific Region (WPRO). 2009. Kiribati NCD Risk Factors: STEPS Report. Fiji: Excellence Fiji Ltd


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Figure 7 Prevalence of ‘current drinkers in Kiribati and selected Pacific Island Countries and Territories, 2009. Source: STEPS Report, WPRO

Physical inactivity

Physical inactivity is linked to poor health, including many chronic conditions and injuries, excess body weight and low bone-mineral density. Conversely, regular physical activity is associated with maintaining good health, and is important in helping to prevent the onset of some chronic diseases. It helps with better maintenance and control of certain conditions such as arthritis and Type 2 diabetes; and for those who have experienced heart attacks, physical activity can improve recovery and reduce the likelihood of further cardiovascular events.12 Participating in regular physical activity, in conjunction with a healthy diet, helps to maintain a healthy body weight and reduce body fat, helping to prevent or eliminate obesity.

National guidelines from Australia for physical activity, for both adults and children, provide recommendations about how much physical activity should be undertaken to gain a health benefit (see Box 2). The latest data about physical activity also come from the 2004-2006 STEPS Report, which included questions about how often (frequency) and how long (duration) people were engaged in three domains of physical activity: during recreation or leisure time, work, and transport


in a typical week. In the work and leisure domains, respondents were asked how many days per week and how many hours/minutes per day they participate in moderate- and vigorous-intensity activities. In the transport domain, respondents were asked how often and how long they either walk and/or cycle to and from places.

Box 2: National Physical Activity Guidelines for Australians12

The National Physical Activity Guidelines for Australians are guidelines for adults and recommend at least 30 minutes of moderate-intensity physical activity on most, preferably all, days of the week. The recommendations for children and adolescents advise at least 60 minutes of moderate to vigorous activity every day and no more than two hours of screen-time activity each day.

Examples of moderate-intensity activity are brisk walking, swimming, doubles tennis and medium-paced cycling. More vigorous physical activity includes jogging and active sports like football and rugby.

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Levels of physical activity

The survey found that 50.1% of I-Kiribati reported low-level total physical activity, that is, engaged in physical activities of less than 600 MET (metabolic equivalent) minutes per week.13 A greater proportion of women (57.3%) undertook low-level of physical activity compared to men (41.8%). Conversely, a higher proportion of men

13 600 MET minutes per week equals 30 minutes of moderate-intensity physical activity for five days per week, or 20 minutes of vigorous activity for three days per week

reported high-level of total physical activity compared to women (30.1% and 16.6% respectively) (Table 8). Overall, most physical activity in Kiribati was undertaken as part of work, and to a lesser extent, as part of transport. Leisure-time physical activity contributed to very little of the total time spent in physical activity.

Table 8 Categories of total physical activity by age group14

Age group (years)

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Total (N)

% Low % Moderate % High Total

(N) % Low % Moderate % High

25-34 147 39.5 28.6 32.0 216 54.2 25.5 20.4

35-44 165 36.4 33.3 30.3 231 59.3 27.3 13.4

45-54 149 49.7 20.1 30.2 179 61.5 25.1 13.4

55-64 81 50.6 25.9 23.5 120 55.0 26.7 18.325-64 542 41.8 28.1 30.1 746 57.3 26.1 16.6

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Figure 8 Prevalence of ‘low level physical activity’ in Kiribati and selected Pacific Island Countries and Territories, 2009. Source: STEPS Report, WPRO



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Dietary behaviours

The food we eat plays a major role in our health and wellbeing. The dietary guidelines for Australians provide guidance on healthy food choices and lifestyle patterns that promote good nutrition and health. The guidelines have a clear emphasis on enjoying a wide variety of nutritious foods from the five food groups: 1) vegetables and legumes; 2) fruit; 3) cereals; 4) dairy; and 5) meat or meat alternatives. They also recommend that care should be taken to limit saturated fat and restrict total fat intake, to choose foods low in salt and to limit sugar intake�

Fruit and vegetable consumption

In the STEPS Survey, eating behaviours were assessed by asking respondents how many days they consumed

fruit and vegetables in a typical week, and how many servings of each that they consumed on one of those days. The survey showed that average consumption of fruit and vegetables among I-Kiribati was well below the recommended levels. The mean number of days per week fruit and vegetables were consumed on were 1.5 and 1.9 days respectively. When fruit and vegetables were consumed, the self-reported mean number of combined fruit and vegetable servings was 0.8 serves. The overall prevalence of those consuming less than five combined servings of fruit and vegetables per day was 99.3%.

Box: How much is a serve?

By convention, a serve of fruit is 150g and a serve of vegetables is 75g. The table below sets out some examples of everyday fruit and vegetables in terms of a ‘serve’.

Fruit

1 medium apple, orange or banana

2 items of small fruit, such as apricots or plums

1 cup of canned fruit

½ cup of fruit juice

Vegetables

1 medium potato, ½ medium sweet potato

1 cup of salad vegetables

½ cup tomatoes, capsicum or cucumber

½ cup spinach, cabbage or broccoli

Table 9 Mean number of combined servings of fruit and vegetables consumed per day of the week15

Age group (years)

Males Females Total

Total (N) Mean number of servings Total (N) Mean number of

servings Total (N) Mean number of servings

25-34 158 0.9 218 0.7 376 0.8

35-44 177 0.7 233 0.8 410 0.8

45-54 159 0.7 180 0.7 339 0.7

55-64 85 0.7 119 0.7 204 0.725-64 578 0.8 750 0.8 1,329 0.8


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Figure 9 Proportion of people who consumed less than five combined servings of fruit and vegetables per day of the week. Source: STEPS Report, WPRO

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Figure 10 Prevalence of adults consuming less than five servings of fruit and vegetables in Kiribati and selected Pacific Island Countries and Territories, 2009. Source: STEPS Reports, WPRO


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3.3 Biomedical factorsUnlike behaviours and other determinants discussed earlier in this chapter, biomedical factors represent actual bodily states. Biomedical factors such as high blood pressure and high blood cholesterol can be regarded as relatively ‘downstream’ in the process of causing ill health. They carry relatively direct and specific risks for health, and they are often influenced by behavioural factors, which are in turn influenced by other ‘upstream’ determinants.

Health behaviours tend to interact with each other and influence a variety of biomedical factors. Both physical activity and diet, for example, can affect body weight, blood pressure and blood cholesterol. They can each do this independently, or, with greater effect, they can act together. Further, behavioural and biomedical risk factors tend to increase each other’s effects when they occur together in an individual.

Note that several of the biomedical risk factors discussed here are often highly interrelated in causing disease. Excess body weight, high blood pressure and high blood cholesterol, for example, can all contribute to the risk of heart disease and amplify each other’s effects if they occur together. In addition, obesity can in itself contribute to high blood pressure and high blood cholesterol.

Body weight

There are health problems associated with being either underweight or having excess weight (overweight and obesity) (see Box 3 for definitions). Being significantly underweight may lead to malnutrition and a range of health problems such as osteoporosis and the inability to fight infections. As Table 10 shows, measurements in the 2004-2006 STEPS Survey suggest that 81.5% of the population is overweight, and from this group, 50.6% is considered obese. Females were more likely to be overweight or obese than males.

Although underweight can be a serious risk to health, the material presented here focuses on excess body weight, as the scale of this problem is markedly greater than that of underweight.

Excess weight, especially obesity, is a risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk

of developing these conditions. In addition, being overweight can hamper the ability to control or manage chronic disorders.

Rates of overweight and obesity are high in Kiribati and overseas. The WHO has estimated that by 2015 there will be 2.3 billion adults who are overweight, and more than 700 million who will be obese.16 Once considered a problem only in developed countries, obesity is now an increasing concern in developing countries, where problems associated with it often exist along with the effects of under-nutrition.

Box 3: Classifying body weight

Body mass index (BMI) and waist circumference are the two main measures used for monitoring body weight. The BMI assesses people’s weight in relation to their height, and is more commonly used in surveys than the waist circumference. The BMI is calculated by dividing a person’s weight in kilograms by the square of their height in metres (kg/m2).

The standard classification of BMI recommended by the World Health Organization for adults is based on the association between BMI and illness and mortality and is as follows:

• Underweight: BMI < 18.5

• Healthy weight: BMI ≥ 18.5 and BMI <25

• Overweight but not obese: BMI ≥ 25 and BMI < 30

• Obese: BMI ≥ 30.3

This classification may not be suitable for all ethnic groups and it is unsuitable for children, so should be used with caution.

For adults, a waist circumference of 94cm or more in males and 80cm or more in females indicates increased risk. A waist circumference of 102cm or more in males and 88cm or more in females indicates substantially increased risk. This classification is not applicable to people aged under 18 years and the cut-off points may not be suitable for all ethnic groups.

16 World Health Organization (WHO). 2006. Obesity and overweight. Fact sheet no. 311. Geneva: WHO

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Excess weight arises through an energy imbalance over a sustained period. Although many factors may influence a person’s weight, weight gain is essentially due to the energy intake from the diet being greater than the energy expended. Energy expenditure occurs in three ways: basal metabolism (that is, the energy used to maintain vital body processes), thermic processes (that is, the energy taken to digest and absorb food), and physical activity. Physical activity is the most variable component of energy expenditure, and the only component a person has any direct control over. In a normally active person, physical activity contributes about 20% to daily energy expenditure.17


Table 10 Body mass index based on measured data, by age and sex, persons aged 25-64 (percent)18

Sex and BMIAge group (years)

25-34 35-44 45-54 55-64 Total 25-64

MalesUnderweight -- 0.5 0.6 -- 0.3

Normal 24.7 19.0 20.1 20.7 21.6

Overweight 37.6 33.7 35.4 42.5 36.5

Obese 37.7 46.7 43.9 36.8 41.7Total males 100.0 99.9 100.0 100.0 100.1Females

Underweight 0.5 0.4 -- 2.4 0.6

Normal 14.0 13.8 12.6 23.2 14.8

Overweight 24.2 27.2 27.0 24.8 25.7

Obese 61.4 58.6 60.4 49.6 58.9Total females 100.1 100.0 100.0 100.0 100.0


In the 2004-2006 STEPS Survey, the majority of adults (81.5%) has a body mass index (BMI) (based on measured data) that indicated they were overweight or obese. A larger proportion of females than males were overweight or obese (84.5% compared with 78.2%).


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A person’s waist circumference can be used to measure what is known as abdominal obesity. Waist circumference is regarded as an important independent risk factor for Type 2 diabetes and the risk increases with increasing waist circumference. In 2004-2006, all age groups for both genders (except for 25-34 year-old males), were at an increased risk of ill health due to high waist circumference measurements. While mean waist circumference increased with age among males, the pattern was more stable with females, peaking in the 45-54 year-old age group.

Table 11 Mean waist circumference (cm) and risk level by gender and age group19

Age group (years)

Males Females

Mean (cm) Risk level Mean (cm) Risk level25-34 91.4 -- 96.8 Substantially increased

35-44 95.8 Increased 96.9 Substantially increased

45-54 95.5 Increased 99.3 Substantially increased

55-64 96.9 Increased 96.4 Substantially increased25-64 94.2 Increased 97.3 Substantially increased


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Figure 11 Prevalence of ‘overweight’ and ‘obese’ in Kiribati and selected Pacific Island Countries and Territories, 2009. Source: STEPS Report, WPRO

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Blood pressure

High blood pressure (often referred to as hypertension; see Box 4) is a major risk factor for coronary heart disease, stroke, heart failure and chronic kidney disease. Studies have shown that the lower the blood pressure, the lower the risk of cardiovascular disease, chronic kidney disease and death.20 When high blood pressure is controlled, the risk is reduced, but not necessarily to the levels of unaffected people.21

Worldwide, high blood pressure has been found to be responsible for more deaths and disease than any other biomedical risk factor.22 Major causes of high blood pressure include diet (particularly a high salt intake), obesity, excessive alcohol consumption and insufficient physical activity. Attention to health determinants such as body weight, physical activity and nutrition plays an important role in maintaining healthy blood pressure.

Despite the definition of high blood pressure, blood pressure is a continuum with no threshold level of risk as it rises. Starting from quite low levels, as blood pressure increases so does the risk of stroke, heart attack and heart failure. This means that, for people’s usual, day-to-day blood pressure, the lower the better. This is true with rare exceptions.

20 National Health Foundation of Australia (NHFA). 2009. Position statement: build environment and walking. Melbourne: NHFA

21 World Health Organization – International Society of Hypertension (WHO-ISH). 1999. 1999 World Health Organization – International Society of Hypertension statement on management of hypertension. Journal of Hypertension 21: 1983-92

22 Lopez et al. 2006. Global and regional burden of diseases and risk factors, 2001: systematic analysis of population health data. Lancet 367: 1747-57

Box 4: High blood pressure

Blood pressure represents the forces on the wall of the arteries, and is written as systolic/diastolic (for example 120/80 mmHg, stated as ‘120 over 80’). Systolic blood pressure reflects the maximum pressure in the arteries when the heart muscle contracts to pump blood; diastolic blood pressure reflects the minimum pressure in the arteries when the heart muscle relaxes before the next contraction.

There is a continuous relationship between blood pressure levels and cardiovascular disease risk. This makes the definition of high blood pressure somewhat arbitrary. The World Health Organization and STEPS Survey define ‘high blood pressure’ as:

• Systolic blood pressure of 140 mmHg or more, or

• Diastolic blood pressure of 90 mmHg or more, or

• Receiving medication for blood pressure.

As part of the STEPS Survey, all survey participants had their blood pressure measured. Participants were also asked if they had their blood pressure measured in the last 12 months, within the last one to five years or longer, whether they had ever been told in the last 12 months by a health worker that they had high blood pressure, and if they were currently receiving any medical treatment for high blood pressure.

The survey found an estimated 17.3% of I-Kiribati had high blood pressure. While raised blood pressure increased with age, this condition was more common among men than women.


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Figure 12 Proportion of adults with high blood pressure (SBP ≥ 140 and/or DBP ≥90 mmHg or currently on medication for high blood pressure) by gender and age group. Source: STEPS Report, WPRO, 2009

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Figure 13 Prevalence of adults with high blood pressure in Kiribati and selected other Pacific Island Countries and Territories, 2009. Source: STEPS Report, WPRO, 2009

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Blood cholesterol

High blood cholesterol (see Box 5) is a major risk factor for coronary heart disease and ischaemic stroke. It is a basic cause of plaque, the process by which the blood vessels that supply the heart and certain other parts of the body become clogged.

For most people, saturated fat in the diet is the main factor that raises blood cholesterol levels. Genetic factors can also affect blood cholesterol, severely in some individuals. Physical activity and diet play an important role in maintaining a healthy blood cholesterol level.

Box 5: High blood cholesterol

Cholesterol is a fatty substance produced by the liver and carried by the blood to the rest of the body. Its natural function is to provide material for cell walls and for steroid hormones. If levels in the blood are too high, this can lead to artery-clogging plaques that can bring on heart attacks, angina or stroke. The risk of heart disease increases steadily from a low base with increasing blood cholesterol levels.

For the STEPS Report, levels of ‘high’ blood cholesterol are based on a total cholesterol level of 5.0 mmol/L or more�

The STEPS Survey estimated that 27.7% of the population of I-Kiribati had elevated blood cholesterol levels. There was a higher proportion of females (30.6%) with elevated cholesterol as compared to males (23.8%). The prevalence of high blood cholesterol increased with age to a peak for females aged 45-54 years. Among males, the prevalence increased dramatically in the 35-44 age group, before declining again in the older age groups (Figure 14).

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Figure 14 Proportion of I-Kiribati adults with raised total blood cholesterol (≥ 5.0 mmol/L) by gender and age group24



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Blood glucose

Every cell in the body depends on glucose for energy. Insulin is a hormone that helps regulate the movement of glucose from the bloodstream and into the cells. Changes in the production and action of insulin can affect glucose regulation.23

Impaired glucose regulation is the metabolic state between normal glucose regulation and failed regulation. Failed glucose regulation is known as diabetes. There are two categories of impaired glucose regulation: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). IFG and IGT are risk factors for the future development of diabetes and cardiovascular disease.

The 2004-2006 STEPS Survey measured levels of fasting blood glucose among adults. It found that the overall prevalence of diabetes (defined as raised fasting blood glucose levels) among I-Kiribati aged 25-64 was 28.1%.

The prevalence of diabetes increases with age across both genders (Figure 15). For males, a substantial and significant increase in diabetes occurs between the age of 35-44 years and 45-54 years, from 27.7% to 49.6% respectively. For females, diabetes prevalence almost doubles between 25-34 and 35-44 years. The prevalence rate peaks for both genders in the oldest age group.


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Figure 15 Prevalence of diabetes by gender and age group (raised blood glucose or currently on medication for diabetes and/or diagnosed with diabetes). Source: STEPS Report, WPRO, 2009

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Figure 16 Prevalence of diabetes in Kiribati and selected other Pacific Island Countries and Territories, 2009. Source: STEPS Reports, WPRO, 2009


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4. Health across the life stages

Health can be discussed in many ways, and this chapter presents a ‘life stages’ view of the health of the I-Kiribati people. It covers a range of age groups, from babies (and their mothers), through to early childhood and adolescent stages to the ‘working years’ and finally to those aged 65 years and over.

Why take this life stage perspective? First, several of these age groups are already a long established focus of the health system. For example, there are specialist health professionals and services dedicated to expectant mothers and childbirth, to infants and other children, and to the elderly. This chapter should be of special interest to those professionals.

Second, this approach can help to lay out a whole-of-life story that is difficult to obtain in other ways. It can be seen that some health problems are largely confined to certain age groups but a range of problems—such as injury—run throughout life and only their prominence varies with age. Also, many problems may only become pronounced in older ages but their seeds begin in childhood with factors such as smoking, poor diet and obesity. Information such as this provides a long-range view that is important for health planning.

4.1 How does health vary with age?Most aspects of health vary with age, with problems usually increasing over the life stages. As shown in Figure 17, deaths rates increase markedly with age. The exception is in the infant group (aged under one year) where death rates are much higher than for children overall. After infancy and childhood, the death rate drops dramatically; progressively increasing after 10-14 years�

The leading causes of death also vary with age, reflecting different exposure to environmental factors and to the underlying ageing processes. For example, the most common causes of death for infants are conditions originating in the perinatal period. Children and young people (aged 1-14 years) most commonly die of endocrine and nutritional diseases (including malnutrition) and infectious and parasitic diseases. In the young adult age group (15-24 years) the main cause-of-death differs markedly for males and females: for males their primary cause-of-death is external causes (including accidents), while in 2011 the primary cause-of-death for females was neoplasm’s (cancer). From age 25 and above, the leading cause-of-death is diseases of the digestive and circulatory system. For more information see Table 5.


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Figure 17 Age distribution of reported deaths. Source: MHMS, Health Information Unit, 2011

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Births

In 2011, there were 2971 births reported to the Health Information Unit, an average of eight babies born per day. These births included 1187 live births, one stillbirth and one IUD. Another 1725 births had incomplete or no data relating to birth status (if the baby was born dead or alive) and 57 were incorrectly recorded. Over the last 20 years, the number of births fluctuated between 1611 and 2971 per year (see Figure 19).

4.2 Mothers and babies

Maternal mortality

Figure 18 shows the maternal mortality ratio (MMR) in Kiribati since 1991. The MMR is the number of maternal deaths divided by the number of live births, multiplied by 100,000. It reflects the risk faced by women in relation to each pregnancy. In 2010 and 2011 there were two maternal deaths recroded each year, which produces a MMR of 33 deaths per 100,000 live births. Apart from the peak in 2004, the MMR has remained relatively low since 1991.

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Figure 18 Maternal mortality ratio, 1991-2011. Source: MHMS, Health Information Unit, 2011


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Figure 19 Total number of births by year. Source: MHMS, Health Information Unit, 2011

The overall trend of the graph shows an increasing number of births from the year 1991 to 2011 and this is worrying if compared with the limited number of resources and the high rate of unemployment.

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Figure 20 Births by location, 1991-2011. Source: MHMS, Health Information Unit, 2011

Figure 20 shows the number of births in Tungaru Central Hospital (TCH) is increasing. In the years 1991 to 1999 the number of births in TCH increased, while deliveries on the outer islands decreased. This graph indicates that more women are being referred to TCH for delivery, either through referral by a doctor or nurse, or self-referral to the hospital.


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Birth weight

A key indicator of infant health is the proportion of babies with low birth weight. This is because these babies have a greater risk of poor health and dying, require a longer period of hospitalisation after birth and are more likely to develop significant disabilities. For babies, a ‘low birth weight’ means less than 2,500 grams, ‘very low birth weight’ means less than 1,500 grams and ‘extremely low birth weight’ means less than 1,000 grams.

The graph of low birth weight by year from 1991 – 2006 shows the number of babies born with low birth weight appears to be decreasing (Figure 21). From the year 2006 we can’t say if the number of low birth weight babies is continuing to get lower or increasing, since this when most of data are incomplete. However data from 2011 seem to be similar with data from 2005, indicating that the number of babies born with low birth weight has been decreasing steadily.

Figure 21 Total fertility rate, selected countries, 2010. Source: WHO World Indicator Compendium, 2010

Fertility rate

The total fertility rate, which is the number of babies per female, was 2.7 in 2010. Kiribati’s rate is lower than those of neighbouring Pacific Island Countries and Territories. The world average is 2.5 babies per female.25

Sex

On average, there is an equal number of male and female babies born each year in Kiribati. In 2010, male births accounted for 44.7% of total births. However, 1245 births did not have the sex of the babies recorded (Annexes: Table 6).

25 World Bank. 2009. Available at www.data.worldbank.org

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Figure 22 Birth weight of babies, 1992-2011. Source: MHMS, Health Information Unit, 2011


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Perinatal mortality

Perinatal deaths are those that occur in the period shortly before or after birth. The three years 2009 to 2011 show the average number of perinatal deaths is over 20 cases every year, which is quite a lot. In 2009, 50% of perinatal deaths were male infants and 50% female. There is an increase in deaths in 2010, but more females than males. The total number of perinatal deaths decreased in 2011. However, there is no clear trend to tell whether the perinatal mortality is increasing or decreasing.

Figure 23 Perinatal deaths. Source: MHMS, Health Information Unit, 2011

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4.3 Infants and children

Under-five mortality

In the last 20 years, the under-five mortality seems to have slightly decreased. During 1991 to 2005, the average number of deaths per year is 145, which is a bit high for the country of a small population. In the years 2006 to 2009, there is a dramatic decrease in mortality; however, this was when the reporting tools changed, and this is likely the reason why the number of under-five deaths decreased. In 2010 and 2011, the number comes back again to over 100 deaths per year.

The achievement for the millennium development goals is to reduce under-five mortality by two-thirds. Under-five mortality is gradually decreasing. The question is: are we going to achieve the millennium development target? The Ministry of Health & Medical Services done quite well in the last 20 years, but more work still needed to reach the target in 2015.

Figure 24 Number of under-five deaths by year, Kiribati, 1991-2011. Source: MHMS, Health Information Unit, 2011

The under-five mortality rate represents the number of children dying per year, for every 1,000 live births in that same year. As shown in Figure 25, there is a steep downfall in the year 2006 and this again could be related to revision of the reporting tools that year. In the years 2010 and 2011 the death starts to come up again to the usual number of death every year.


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Year Deaths < 1yr

Infant Mortality Rate

Deaths 1 - 4 yrs

1-4yrs Mortality Rate

Deaths < 5yrs

Child Mortality

RateLive Births

1991 88 48.9 46 25.6 134 74.5 1799

1992 135 71.0 57 30.0 192 101.0 1901

1993 135 60.8 68 30.6 203 91.4 2222

1994 86 49.3 36 20.6 122 69.9 1746

1995 102 55.6 42 22.9 144 78.5 1835

1996 106 46.0 42 18.2 148 64.3 2302

1997 112 50.6 42 19.0 154 69.5 2215

1998 90 41.2 42 19.2 132 60.5 2183

1999 57 25.9 51 23.1 108 49.0 2204

2000 93 57.7 62 38.5 155 96.2 1611

2001 93 46.8 51 25.7 144 72.4 1988

2002 88 44.9 40 20.4 128 65.3 1961

2003 88 48.8 49 27.2 137 76.0 1803

2004 87 46.7 40 21.5 127 68.1 1864

2005 110 48.0 65 28.4 175 76.4 2290

2006 21 8.0 51 19.5 72 27.5 2617

2007 3 1.4 42 20.3 45 21.7 2072

2008 3 1.5 38 18.6 41 20.1 2043

2009 36 20.6 25 14.3 61 34.8 1751

2010 65 27.3 41 17.2 106 44.5 2380

2011 104 35 39 13.1 143 48.1 2971

Table 12 Mortality rates for infants and children, 1991-2011. Source: MHMS, Health Information Unit, 2011

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Under 5 mortality rates by years per 1000

infant Mortality Rate

Child Mortality Rate

< 5 yrs Mortality Rate

Figure 25 Child mortality rates by year. Source: MHMS, Health Information Unit, 2011

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The second one is lower respiratory infection: nine percent of under-fives died of lower respiratory infection followed by diarrhoeal diseases, which is 8.2%. Ill-defined diseases are the reporting error where diagnosis not labelled or the forms of the patients filled incompletely. This is also a challenge that needed to be addressed. After the ill-defined diseases are Endocrine disorders at 7.5%, with non-specific type indicated in this cause. Other infectious diseases are 3.7% followed by other digestive diseases. The least common causes include iron deficiency anaemia, leukaemia, other respiratory disease, transport accident and drowning.

Malnutrition

Figure 26 shows the number of malnutrition cases is increasing for the three years of 2009 to 2011. The graph supports the number one leading cause-of-death for children under-five years is protein energy malnutrition. With the increasing number of malnutrition cases and also malnutrition being the number one leading cause-of-death among children under-five, there is a need to look into this problem.

Table 13 Leading causes of death. Source: MHMS, Health Information Unit

Leading causes of death, both sexes combined, 0-4 yrs

Both sexes Number of deaths % total 0-4yr

1 Protein-energy malnutrition 14 10.4



3 Ill-defined diseases (ICD10 R00-R99) 11 8.2

5 Endocrine disorders 10 7.5



8 Iron deficiency Anaemia 1 0.7

8 Leukaemia 1 0.7

8 Other respiratory diseases 1 0.7

8 Transport accidents* 1 0.7

8 Drowning 1 0.7

Figure 25 also shows the infant mortality rate. The infant mortality rate is the number of deaths per year of babies aged less than one year, in relation to the total number of live births for the same year. From the years 1991 to 2005, the infant mortality rate was gradually decreasing. There is a down fall from the years 2005 to 2008. This again is to do with lost data during these years and the other reason was when the reporting tool was renewed. The overall picture of the infant mortality rate is decreasing and this is the outcome of the public health nurses and their medical assistances.

Leading causes of death

Table 13 shows the most common causes of death in the year 2011. The table is done by using WHO system where all deaths coding of diseases entered and automatically calculating the rankings of deaths by their causes.

The number one leading cause-of-death in 2011 for children under-five years is protein-energy malnutrition. Protein-energy malnutrition (or protein calorie malnutrition) refers to a form of malnutrition where there is inadequate protein intake, and 10.4% of children under-five years died of protein-energy malnutrition.


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Figure 26 Malnutrition cases by year. Source: MHMS, Health Information Unit, 2011

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Health Information System

s Knowledge Hub

5. Health services

This chapter presents an overview of health services in Kiribati, which are grouped into five broad categories: clinical services, immunisation, family planning, Tungaru Central Hospital visits and chronic disease visits.

5.1 Clinical servicesClinical services are defined as outpatient, antenatal, and postnatal services, child health care for infants under one and children aged one to four years, and the MCH services. On average over 29,000 people visit clinics for outpatient services every month. This equals over 1,000 people every day visiting the outpatient clinics.

Most health centres and clinics are manned by only one staff nurse, particularly on the outer islands. If the standard ratio of nurse to patient is 1:6, then looking at the number of outpatient visits is overwhelming. The Ministry needs to further look into this and decide other possible ways to avoid the loading of one staff on each island and particularly inside the wards.

Figure 27 Number of visits to outpatient clinics by month, 2011. Source: MHMS, Health Information Unit

Figure 27 shows visits to health clinics from all islands in Kiribati. There was a high number of visits in March, and this could be the result of an outbreak around the month where more people regularly visited the clinics.

Comparing the number of first visits against re-visits, more people visit clinics for their first time to get assistance from nurses in the clinics. Overall, the number of people visiting clinics every month for 2011 is more than 29,000. This is approximately over 1,000 people seen by nurses and doctors every day. The number of re-visits in July is 16.2%, which is the highest proportion compared with other months.


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Nurse aides provided services to over a thousand people every month in 2011. Nurse aides are paid by the council on every island and play an active role in providing health care services to the public.

Vitamin A coverage

Vitamin A is a group of compounds that play an important role in vision, bone growth, reproduction, cell division, and cell differentiation (in which a cell becomes part of the brain, muscle, lungs, blood, or other specialized tissue). Vitamin A helps regulate the immune system, which helps prevent or fight off infections by making white blood cells that destroy harmful bacteria and viruses. Vitamin A also may help lymphocytes (a type of white blood cell) fight infections more effectively.

Antenatal and postnatal services

Antenatal services are provided by all public health nurses within and outside the hospital. The graph (Figure 28) shows most pregnant women come back for these services. This can be seen in the re-visit figures, which show most pregnant women regularly come back every month for their antenatal clinic visits. On average, over 700 pregnant women attend the antenatal clinics every month. Everyday approximately over 25 pregnant women are seen by each clinic. This number is quite high since the antenatal clinics are done once a week.

Maternal and child health care services

Figure 29 indicates the number of services provided by nurse aides in the clinics. The main jobs performed by nurse aides include basic procedures like dressings, scaling of children, census, vital observation taking, and helping the nurse staff to carry out other programs and services.

Figure 28 Antenatal visits by month, 2011. Source: MHMS, Health Information Unit, 2011

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363 2085

4888

2656

14524

77 448 793 554 0

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8000

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14000

16000

2009 2010 2011

No.

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Vitamin A Distribution for Years & Age Groups

6 to <=12 mths

1 - <=6 yr

Mothers Postpartum

Figure 30 Vitamin A distribution by age. Source: MHMS, Health Information Unit, 2011

Since Kiribati is a country with high infant and child mortality, it is necessary to carry out Vitamin A prophylaxis to help reduce illness. Figure 30 shows an increasing coverage of Vitamin A prophylaxis for children, however more work is needed on coverage for mothers.

0200400600800

100012001400160018002000

Num

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its

Months

Clinical Service provided by Nurse aides - 2011

MCH aides Re-Visit

MCH aides 1st Visit

Figure 29 Number of visits by nurse aids per month, 2011. Source: MHMS, Health Information Unit, 2011


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Home visits

Home visits done by all the public health nurses are shown in Figure 31. Most visits are done to sick patients in their homes. There were more than 5,000 visits to treat sick patients in their homes There were about 3,000 home visits done by the public health nurses to provide child health care services to children under 1 year old. The service includes vaccinations and health educations.

On average, over 35 home vists are made each day throughout Kiribati. The number seems good, and it indicates that all nurses and Medical Assistance are doing well in their home visits activities.

Antenatal and postnatal care services visit done by public health nurses was less than 2,000 visits in 2011.

Child health care services

Child health care services involve all services offered to children under-one year of age, particularly immunization and children’s illness. Throughout the months from January to December the average number of first visits is around 25 percent. This indicates a high number of children are coming back to the services to receive follow-up care, such as their booster immunisations.

The very high number of revisits in March (19173) is most likely a data error problem. Data entry officers can make an error while entering and this could lead to the poor quality of the data and this was always the problem.

Looking at the table for the year 2011 total number of visits is 34,639, shows that the most mothers are visited clinics more often to seek help from the nurses or medical assistances.

Table 14 Child health care visits, 2011. Source: MHMS, Health Information Unit, 2011

Child Health - under 1 - 2011

1st visit Revisit Total visit % 1st visit % Revisit

Jan 403 1112 1515 26.6 73.4

Feb 361 1195 1556 23.2 76.8

Mar 392 19173 19565 2.0 98.0

Apr 330 973 1303 25.3 74.7

May 413 1055 1468 28.1 71.9

Jun 348 833 1181 29.5 70.5

Jul 356 735 1091 32.6 67.4

Aug 426 1073 1499 28.4 71.6

Sep 373 1393 1766 21.1 78.9

Oct 426 768 1194 35.7 64.3

Nov 304 1002 1306 23.3 76.7

Dec 289 906 1195 24.2 75.8

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64%

20%

91%

4%

114% 113% 106%

111% 109% 103%

90%

0%

20%

40%

60%

80%

100%

120%

140%

Cove

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Vaccines

National Immunization Coverage - 2011

Figure 31 National immunisation coverage, 2011. Source: MHMS, Health Information Unit 2011

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Sick Patientstreated

Familyplanning

Antenatal Postnatal Child health -under 1

Child Health- 1 to 4 yr

Num

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Health Services provided

Total Number of Home Visits - 2011

Figure 30 Home visits by service provided, 2011. Source: MHMS, Health Information Unit, 2011

Immunisation

The national immunization coverage in 2011 seems great. Pentavalent 1, 2, &3 reached over 100% coverage in 2011. OPV 1, OPV 2 and OPV 3 also reached over 100% coverage. Measles and Rubella vaccination is 90% coverage. BCG is 91% and Hepatitis B is 84% coverage. This is the national coverage of Kiribati, and shows very great results after the hard work done by all public health nurses and medical assistances.


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Immunisation coverage by year

Figure 33 shows national immunization coverage between 1980 and 2011, which has been increasing. The trend of the immunization coverage is encouraging as there is an increasing number of less than 1 year old child been immunized throughout the years. However, there are some vaccines with zero coverage. This is because some vaccines are new and just initiated during the years 2009 upwards.

The immunization program is done by medical assistants and public health nurses on all islands throughout Kiribati. Most Initial immunization doses were done by nurses in the obstetric wards.

Figure 32 represents the immunization coverage by districts, where most districts comprises of four islands. Northern and Banaba district reached 85% coverage in total average. The islands include Abaiang, Butaritari, Makin Marakei islands. The Southern districts reached 83% coverage and the islands include, Arorae, Beru, Nikunau and Tamana. Betio only district reached 80% coverage. Central districts reached 81% coverage and the islands include Abemama, Kuria, Aranuka, & Maiana. South-West districts reached over 100% coverage and the islands include Nonouti, Onotoa, Tab–North and Tab–South.

Linnix district coverage is very low (31%) and this district needs to be looked into it issues and challenges. It is understandable that the Linnix islands are very far but more needs to be done to improve coverage. Considering this kind of coverage is very low, children from the Linnix districts may be very prone to outbreaks or preventable diseases�

85% 83% 80% 81%

139%

92%

31%

0%20%40%60%80%

100%120%140%160%

Cove

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Districts

Immunization District Average Coverage - 2011

Figure 32 Immunisation coverage by districts. Source: MHMS, Health Information Unit, 2011

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0

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011

Cove

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Year

National Immunization Coverage by year

Hib 3

MCV

Polio 3

TT2 + (PAB)

Figure 34 Immunisation coverage by year, Hib 3, MCV, Polio 3 and TT2 + (PAB). Source: WHO/UNICEF estimate 2008; MHMS, Health Information Unit, 2011

0

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1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011

Cove

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Year

National Immunization Coverage by year

BCG

DPT 1

DPT 3

Hep B3

Figure 33 Immunisation coverage by year, BCG, DPT 1, DPT 3 and Hep B3. Source: MHMS, Health Information Unit, 2011


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0.010.020.030.040.050.060.070.080.090.0

Neo-gyon Eugynon Microlute Microgynon Depo Provera

Perc

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Methods

Family Planning Coverage - 2011

Continuers from last month New Clients Transfer in

Restart Discontinuers Transfer out

Lost contact

Figure 35 Family planning coverage. Source: MHMS, Health Information Unit, 2011

Family planning

The graph below shows family planning methods used in 2011. The majority of women use Depo Provera, with a high number of continuing users month-to-month, and also high numbers of new clients using this method.

the most popular methods used by women beside Depo-provera is Jadell. 94.7% of the women are using Jadell. Only 2.5% using norplant, likewise with IUCD. Majority of women in the year 2011 used this Jadell method where only a few using other methods. Since other methods are not popular by the women to use, the Ministry will need to look into this and probably order more Jadell or promote the use of other methods.

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NorplantInserted

NorplantRemoved

IUCD Inserted IUCD Removed Jadell Inserted Jadell Removed

No.

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Methods Used & Removed - 2011

Figure 36 Methods used and removed. Source: MHMS, Health Information Unit, 2011


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Figure 39 shows the total number of patients referred to the main hospital on South Tarawa. The three years presented show more females are referred than males. The new hospital on Tabiteuea North is planned to take a number of referrals to help reduce the burden on the main hospital, however the graphs indicate referrals to Tungaru Central Hospital haven't decreased much yet.

Figure 38 indicates the number of referrals from outer islands to Tungaru Central Hospital by month from 2009 to 2011. Every month, over 50 patients are referred to Tungaru Central Hospital on South Tarawa from all outer islands. These referrals are quite a lot and the Ministry needs to look into this.

570

775

657

0100200300400500600700800900

2009 2010 2011

No.

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refe

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Years

Total Number of Referrals to TCH- 2011

Figure 37 Referrals to Tungaru Central Hospital. Source: MHMS, Health Information Unit, 2011

Tungaru Central Hospital

Figure 37 represents the number of referrals from outer island to Tungaru Central Hospital on South Tarawa. On average, over 660 pateints were referred each year between 2009 and 2011. The Ministry covers the costs of transport, rations, foods and drinks while patients stay in the hospital. This is one of the biggest expenses made by the government, since everything provided to the public is for free. However, it is not only patients that are entitled to meals and rations, but their caretakers as well. The Ministry of Health has been trying its best to tackle this problem but this still exists.

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Figure 39 Referrals to TCH by gender. Source: MHMS, Health Information Unit, 2011

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60

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100

120

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Total No.of Referral Cases 2009 - 2011

Figure 38 Referrals by month, 2009-2011. Source: MHMS, Health Information Unit, 2011

Male


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The above graph shows the majority of referrals are by plane. The Ministry of Health and Medical Services pay for these air fares, which are believed to be one of the major expenses of this Ministry.

Figure 40 Total number of referrals by transport type. Source: MHMS, Health Information Unit, 2011

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Plane

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Chronic diseases

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Registered Pts 1st & Revist Registered Pts 1st & Revist Registered Pts 1st & Revist

2009 2010 2011

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Hypertension & Diabetes Patient visit by Years

Hypertension Diabetes

Figure 41 Hypertension and diabetes case visits by year. Source: MHMS, Health Information Unit, 2011

The above graph shows the registered cases and number of visits for hypertension and diabetes cases. Every year the number of hypertension and diabetes cases have increased, but hypertension is more common. Looking at the first visit and this is when they first registered, the numbers are very high. What worrisome is the revisit for treatment or regular check-ups. The graph shows that the visit number of revisits are very low. In 2009 only 23.9 percent of registered patients attended a clinic for a revisit. In 2010, this increased to 30 percent and by 2011 it had increased to 38 percent. The graph also shows that the revisit attendance is very poor but is increasing. However, it is obvious that it quite a large number of patients do not turn up for regular checks and medications and this could be a reason for the high mortality in heart diseases.


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Under-five mortality rate (probability of dying by age five per 1,000 live births)

The probability of a child born in a specific year or period dying before reaching the age of five, if subject to age-specific mortality rates of that period. The under-five mortality rate as defined here is strictly speaking not a rate (i.e. the number of deaths divided by the number of population at risk during a certain period of time) but a probability of death derived from a life table and expressed as rate per 1000 live births).

Under-five mortality rate measures child survival. It also reflects the social, economic and environmental conditions in which children (and others in society) live, including their health care.

Maternal mortality ratio (per 100,000 live births)

The maternal mortality ration (MMR) is the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, per 100,000 live births, for a specified year.

Effects of rounding

Entries in columns and rows of tables may not add to the totals shown, because of rounding. Unless otherwise stated, derived values are calculated using unrounded numbers�

Classification of diseases

ICD-10 is used.

Presenting dates and time spans

Periods based on full calendar years (1 January to 31 December) are written as, for example, 2011 for one year. When there are two or more calendar years in the period, the first and final years are written in full. For example, 2009-2009 is a two calendar-year span, and 2007-2009 covers three calendar years.

Details of methods used in particular sections of the report are included in the text and boxes, and in footnotes to figures and tables. Some general methods are also described here.

Annual population growth rate (%)

Average exponential rate of annual growth of the population over a given period.

Crude death rate

The crude (i.e. unadjusted) number of deaths per 100,000 (or 1,000) people in a population over a specified time period (usually one year).

Crude death rates are impacted by age distribution, and most countries will eventually show a rise in the overall death rate (as the population ages).

Crude birth rate

The average number of births during a year per 100,000 (or 1,000) people in a population.

A country’s birth rate is usually the dominant factor in determining the rate of population growth.

Life expectancy at birth

The average number of years that a newborn could expect to live, if he or she were to pass through life exposed to the sex- and age-specific death rates prevailing at the time of his or her birth, for a specific year, in a given country, territory or geographic area.

Life expectancy at birth reflects the overall mortality level of a population. It summarises the mortality pattern that prevails across all age groups – children, adolescents, adults and the elderly.

Total fertility rate (per woman)

The average number of children a hypothetical cohort of women would have at the end of their reproductive period if they were subject during their whole lives to the fertility rates of a given period and if they were not subject to mortality. It is expressed as children per woman.

6. Methods and definitions

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Symbols

% Percent

g Gram

> More than

< Less than

≥ More than or equal to

≤ Less than or equal to


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Preliminary Census Results 2010

Total Population 2010

Age Groups Female Male Total % Female % Male % Total Population

0-4 6817 7008 13825 6.6 6.8 13.4

5-9 5313 5779 11092 5.1 5.6 10.7

10-14 6059 6199 12258 5.9 6.0 11.8

15-19 5245 5596 10841 5.1 5.4 10.5

20-24 5165 5239 10404 5.0 5.1 10.1

25-29 4420 4095 8515 4.3 4.0 8.2

30-34 3532 3287 6819 3.4 3.2 6.6

35-39 2961 2740 5701 2.9 2.6 5.5

40-44 3191 2947 6138 3.1 2.8 5.9

45-49 2757 2545 5302 2.7 2.5 5.1

50-54 2117 1840 3957 2.0 1.8 3.8

55-59 1564 1372 2936 1.5 1.3 2.8

60-64 1067 911 1978 1.0 0.9 1.9

65-69 884 646 1530 0.9 0.6 1.5

70-74 684 435 1119 0.7 0.4 1.1

75+ 687 362 1049 0.7 0.3 1.0

not stated 1 1 2 0.0 0.0 0.0

Total 103,466

Source: National Statistics Office, 2011

7. Annexes

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Population by gender and age, 2010

Age Males Females Total % male % female % Total

0-4 yrs 7008 6817 13825 6.77 6.59 13.36

5-9 yrs 5779 5313 11092 5.59 5.14 10.72

10-14 yrs 6199 6059 12258 5.99 5.86 11.85

15-19 yrs 5596 5245 10841 5.41 5.07 10.48

20-24 yrs 5239 5165 10404 5.06 4.99 10.06

25-29 yrs 4095 4420 8515 3.96 4.27 8.23

30-34 yrs 3287 3532 6819 3.18 3.41 6.59

35-39 yrs 2740 2961 5701 2.65 2.86 5.51

40-44 yrs 2947 3191 6138 2.85 3.08 5.93

45-49 yrs 2545 2757 5302 2.46 2.66 5.12

50-54 yrs 1840 2117 3957 1.78 2.05 3.82

55-59 yrs 1372 1564 2936 1.33 1.51 2.84

60-64 yrs 911 1067 1978 0.88 1.03 1.91

65-69 yrs 646 884 1530 0.62 0.85 1.48

70-74 yrs 435 684 1119 0.42 0.66 1.08

75+ yrs 362 687 1049 0.35 0.66 1.01

Not stated 1 1 2 0.00 0.00 0.00

Total 51002 52464 103466 49.29 50.71 100.00



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Population by gender and island, 2010

Island Preliminary Data by Gender, for 2010 Census

Island Male Female 2010 %

Banaba 117 94 211 0.2

Makin 910 903 1813 1.8

Butaritari 2288 2119 4407 4.3

Marakei 1341 1397 2738 2.6

Abaiang 2822 2849 5671 5.5

North Tarawa 3045 3079 6124 5.9

South Tarawa 24104 25906 50010 48.3

Maiana 1001 1032 2033 2.0

Kuria 515 471 986 1.0

Aranuka 520 537 1057 1.0

Abemama 1684 1677 3361 3.2

Nonouti 1297 1301 2598 2.5

Tab North 1762 1931 3693 3.6

Tab South 680 624 1304 1.3

Onotoa 724 737 1461 1.4

Beru 1055 1041 2096 2.0

Nikunau 1003 904 1907 1.8

Tamana 587 624 1211 1.2

Arorae 621 651 1272 1.2

Teeraina 914 787 1701 1.6

Tabuaeran 1019 971 1990 1.9

Kiritimati 2976 2815 5791 5.6

Kanton 17 14 31 0.0

Total 51002 52464 103466 100.0

Source: National Statistics Office

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20 Leading Causes-of-deaths, all ages, 2011

20 leading causes of death, all ages

Both sexes Number of deaths % total

1 Ill-defined diseases (ICD10 R00-R99) 80 16.6


3 Other cardiovascular diseases 41 8.5

4 Cerebrovascular disease 33 6.9


6 Diabetes mellitus 26 5.4



9 Endocrine disorders 16 3.3

10 Protein-energy malnutrition 14 2.9

11 Tuberculosis 9 1.9

12 Chronic obstructive pulmonary disease 8 1.7

13 Iron deficiency Anaemia 6 1.2

13 Cervix uteri cancer 6 1.2

13 Hypertensive disease 6 1.2

13 Self-inflicted injuries 6 1.2

17 Ischaemic heart disease 5 1.0

17 Peptic ulcer 5 1.0

19 Breast cancer 4 0.8

19 Other neuropsychiatric disorders 4 0.8

19 Skin diseases 4 0.8

Source: MHMS, Health Information Unit, 2011


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Population Statistics

Population by year

Year Total population

% change (per census)

% change (1990-2010)

Average annual growth rate (%)

1990 72335 N/A - N/A

1995 77658 7.4 - 1.5

2000 84494 8.8 - 1.8

2005 92533 9.5 - 1.9

2010 103466 11.8 43 2.4

Population by year and gender

Year Total population Males Females

1990 72335 35770 36565

1995 77658 38478 39180

2000 84494 41646 42848

2005 92533 45612 46921

2010 103466 51002 52464

Population by age group and gender, 2005 and 2010

Census Percent of population

2005 <15 yrs 15-24 yrs 25-59 yrs 60+yrs Total %

Males 38 21 36 5 100

Females 36 20 38 6 100

Total 37 21 37 5 100

2010 <15 yrs 15-24 yrs 25-59 yrs 60+yrs Total %

Males 37 21 37 5 100

Females 35 20 39 6 100

Total 36 21 38 5 100


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Crude birth rate, death rate, and rate of natural increase

Year Crude Death Rate

Crude Birth Rate

Natural Increase Rate

1991 4.0 17.4 1.3

1992 5.2 18.4 1�31993 5.3 21.5 1�61994 4.1 16.9 1.3

1995 4.4 17.7 1.3

1996 4.0 22.2 1.8

1997 4.3 21.4 1.7

1998 4.5 21.1 1.7

1999 4.3 21.3 1.7

2000 5.1 15.6 1

2001 4.8 19.2 1.4

2002 4.9 19.0 1.4

2003 4.3 17.4 1.3

2004 4.9 18.0 1.3

2005 5.9 22.1 1.6

2006 6.0 25.3 1.9

2007 4.7 20.0 1.5

2008 4.9 19.7 1.5

2009 3.3 16.9 1.4

2010 5.8 23.0 1.7

2011 4.8 28.7 2.4



Min

istry

of H

ealth

and

Med

ical S

ervi

ces

Vaccination Coverage by Islands

IslandsHepB

(<24 hrs)HepB

(≥24 hrs)BCG

Failed BCG (no scar)

PENTA 1

PENTA 2

PENTA 3

OPV 1 OPV 2 OPV 3 MR 1

Banaba 0% 0% 80% 0% 100% 60% 220% 80% 80% 120% 220%Makin 22% 24% 97% 17% 125% 120% 98% 124% 95% 85% 92%Butaritari 74% 22% 101% 2% 128% 132% 126% 112% 117% 108% 90%Marakei 18% 67% 90% 0% 145% 142% 114% 130% 126% 96% 102%Abaiang 25% 47% 71% 9% 96% 95% 83% 99% 93% 104% 66%Nth.Tarawa 26% 55% 78% 1% 101% 93% 81% 90% 80% 80% 70%Sth.Tarawa 128% 10% 140% 2% 120% 120% 114% 118% 119% 112% 96%Betio 14% 9% 26% 6% 121% 118% 117% 120% 121% 116% 108%Maiana 0% 19% 64% 0% 99% 89% 84% 85% 86% 72% 78%Abemama 87% 1% 97% 3% 128% 129% 137% 118% 129% 128% 125%Kuria 57% 0% 67% 5% 119% 162% 181% 95% 119% 129% 100%Aranuka 6% 33% 47% 0% 122% 106% 58% 119% 100% 86% 75%Nonouti 25% 67% 92% 3% 116% 108% 100% 107% 99% 96% 76%Tabiteuea.Nth 25% 15% 91% 0% 138% 143% 144% 133% 138% 138% 117%Tabiteuea.Sth 160% 0% 180% 33% 253% 247% 260% 247% 253% 260% 87%Onotoa 179% 7% 186% 7% 300% 271% 236% 264% 293% 207% 229%Beru 44% 22% 67% 11% 115% 104% 85% 119% 93% 81% 0%Nikunau 39% 32% 80% 2% 117% 102% 102% 122% 102% 110% 85%Tamana 200% 0% 233% 0% 211% 244% 178% 211% 233% 178% 100%Arorae 63% 4% 54% 0% 71% 71% 88% 54% 67% 88% 79%Teeraina 10% 0% 24% 1% 30% 42% 35% 47% 38% 24% 18%Tabuaeran 0% 49% 69% 14% 69% 58% 31% 69% 37% 17% 31%Kiritimati 53% 2% 63% 1% 74% 76% 72% 78% 76% 73% 73%Kanton 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Vaccinnation Coverage by Islands - 2011


69


edical Services


Clinical Services

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecOutpatients 28564 31620 38931 29376 32993 31656 22369 31945 28570 28332 26854 27520Antenatal 244 226 289 230 233 254 193 260 242 246 224 211Postnatal 120 127 138 148 160 151 181 215 166 148 133 117Child health - under 1 403 361 392 330 413 348 356 426 373 426 304 289Child health - 1 to 4 yr 210 267 642 506 377 243 297 310 310 319 214 184MCH aides 776 1033 1280 813 865 608 452 680 650 1001 1112 1046



1ST VISIT

RE-VISITS

TOTAL

Clinical Services - 2011



Min

istry

of H

ealth

and

Med

ical S

ervi

ces

Births by Gender and Year

Gender and Data Gaps Proportions

Years F % F M % M (blank) % Blank Grand Total

1991 886 49.2 913 50.8 1799

1992 896 47.1 1005 52.9 1901

1993 1047 47.1 1175 52.9 2222

1994 887 50.8 859 49.2 `

1995 885 48.2 950 51.8 1835

1996 1142 49.6 1160 50.4 2302

1997 1102 49.8 1113 50.2 2215

1998 1121 51.4 1062 48.6 2183

1999 1148 52.1 1056 47.9 2204

2000 796 49.4 815 50.6 1611

2001 951 47.8 1037 52.2 1988

2002 982 50.1 979 49.9 1961

2003 934 51.8 869 48.2 1803

2004 951 51.0 913 49.0 1864

2005 1156 50.5 1125 49.1 9 0.4 2290

2006 1351 51.6 1258 48.1 8 0.3 2617

2007 1080 52.1 990 47.8 2 0.1 2072

2008 1062 52.0 962 47.1 19 0.9 2043

2009 498 28.4 434 24.8 819 46.8 1751

2010 628 26.4 507 21.3 1245 52.3 2380

2011 1501 50.5 1431 48.2 14 0.5 2971


71


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Natio

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Sour

ce: M

HMS,

Hea

lth In

form

ation

Uni

t, 20

11


Min

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of H

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and

Med

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ervi

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Natio

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Rep

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Sour

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HMS,

Hea

lth In

form

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Uni

t, 20

11

73


edical Services


Natio

nal M

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dity

Rep

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2010

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Sour

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form

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Uni

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11


Min

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of H

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1071

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2845

1676

1654

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3278

4342

1379

1642

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4

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110

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2258

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5635

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412

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612

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Men

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5859

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Nig

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112

119

159

115

146

129

108

132

113

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Tine

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255

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191

195

254

205

176

278

232

237

261

256

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266

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Sour

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form

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Uni

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11

75


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Natio

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No

Pneu

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4825

3664

1160

4829

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5438

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7714

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ARI -

Pne

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518

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3553

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817

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410

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117

138

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Men

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318

286

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956

1029

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1464

1758

381

402

151

213

112

208

9346

STI (

7)0

04

19

1596

107

8249

62

45

380

Acut

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ver,

No

Rash

(8)

1927

1850

3879

3760

2648

2419

2651

2820

698

835

354

381

302

360

2488

4

Acut

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7111

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495

8363

8238

3614

1814

1284

3

Diab

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(10)

12

57

65

195

259

189

295

9913

534

5512

87

Hype

rten

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(11)

00

00

311

188

252

171

213

8792

4052

1109

Men

tal I

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410

25

428

1711

145

20

110

6

Fish

Poi

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3)0

131

3873

6617

117

451

4617

189

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4

Nig

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14)

36

4270

309

221

356

228

5648

2419

1610

1408

Tine

a Co

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1211

5353

215

204

666

696

240

240

129

112

5762

2750

Tine

a Ve

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6)42

5795

107

222

245

723

724

229

212

112

102

5963

2992

Oth

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17)

5137

5163

1382

013

521

1637

617

498

5944

467

643

1903

919

587

9050

9663

6352

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962

1218

931

870

3015

125

563

2629

771

978

8193

723

173

2425

511

043

1187

880

2111

049

3823

66

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ce: M

HMS,

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lth In

form

ation

Uni

t, 20

11

Kiribati annual report

ministry of health and medical services, kiribati annual report, 2011

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