Geographical Locations - Marshall Islands

• (Statistical) Number of Inhabitants per Doctor: 2,217
• CIA - World Factbook: Marshall Islands

Organisations and Networks

UN and Multinational

• WHO - Environmental Burden of Disease: Country Profile – Marshall Islands
• WHO Regional Office for the Western Pacific (WPRO) in Manila (Philippines)

Government

Non-Government

• Roots: Resource & Development - a community organisation, the main objective is " to provide technical services that would lead toward improved living for people at risk due to diabling or threatening situations. The Center will take a proactive role in its primary objective of strengthening the extended family unit"
• Youth to Youth in Health - health promotion for youth, community-based program with strong peer-group component

Academic Institutions

• College of the Marshall Islands

National Policy and Related Documents

Reports, Guidelines, and Projects

• Estimation of the Baseline Number of Cancers Among Marshallese and the Number of Cancers Attributable to Exposure to Fallout from Nuclear Weapons Testing Conducted in the Marshall Islands
  "From 1946 through 1958, 66 nuclear weapons tests, in seven series, were carried out by the United States at Bikini and Enewetak Atolls in the Marshall Islands. The total explosive yield of the tests was approximately 100 Mt (equivalent to 100 million tons of TNT). Radioactive debris dispersed through the atmosphere was generally blown by the predominantly easterly winds towards the open ocean west of the Marshall Islands, though various historical reports indicate that radioactive debris from a number of tests traveled in other directions including north, east, southeast and southwest directions. … To date, there has not been an epidemiologic study of the Marshallese to estimate the total numbers of cancers and other serious illnesses resulting from exposure to radioactive fallout. It is possible, however, to develop estimates of the number of baseline cancers and radiation related cancers based on estimated doses and the large body of published cancer risk data derived from studies of various other irradiated populations. Estimation of diseases other than cancer is more problematic, although such diseases would likely occur in the more heavily-exposed population subsets. However, baseline morbidity and mortality data, as well as radiation-related risk data, are less developed than those for cancer, and would require access to expertise and data not readily available at the National Cancer Institute." [Prepared by the Division of Cancer Epidemiology and Genetics National Cancer Institute, National Institutes of Health, Department of Health and Human Services, for thr [US] Senate Committee on Energy and Natural Resources, September, 2004]
• Marshallese Diabetic Health Improvement Pilot Project in Ebeye
  Objectives: Translation and implementation of a diabetes mellitus type 2 educational curriculum in Ebeye, an island within the Republic of Marshall Islands, and a preliminary evaluation of improvements in health outcomes. Methods: Ebeye Public Health Clinic Health Educators held a series of hourly diabetes mellitus type 2 educational sessions with 17 Marshallese participants, based on a curriculum previously used with a group of Marshallese diabetics in Hawaii, focusing on diet, exercise, medications, and insulin administration. Baseline and six month data was collected on surrogate markers of health status. Results: After 6 months, statistically significant improvements were seen in the percentage of participants with blood pressure < 130/80 mmHg and weight loss of at least 10 pounds since their last visit. Minor trends toward improvement were observed in participation with; statin treatment, self monitoring of blood glucose goals set, and nutritional counseling. Discussion: Some markers of diabetic health improvement were observed in this preliminary translational study, and similar studies in other Pacific areas are being planned. [author abstract] [Californian Journal of Health Promotion 2009, Volume 7]
• Measles outbreak in the Republic of the Marshall Islands, 2003
  Background: Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989–2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12–23 months varied widely (52–94%) between 1990 and 2000. Methods: RMI is a Pacific island nation (1999 population: 50 840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. Results: Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1000 infants). Among cases aged 1–14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation: Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. ‘Islands’ of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage. [author abstract] [International Journal of Epidemiology 2006; 35: 299–306]
• Micronesian staple foods and the "yellow varieties message"
  "The great shift from traditional foods to rice and other imported highly processed and fatty foods has been followed by serious problems of nutritionally-related diseases in the Federated States of Micronesia, Marshall Islands, and Kiribati. For all three countries there are now serious emerging problems of Vitamin A deficiency (VAD), and chronic diseases, including diabetes, heart disease, cancer. Programs to promote leafy green vegetables met with limited success (they were not previously eaten). There are many varieties of the major staple foods: banana, giant swamp taro, breadfruit and pandanus. A systematic multiple-methodological participatory assessment of the nutrient content of samples of these revealed a great range of nutrient content and that those varieties with a deeper yellow flesh coloration are carotenoid-rich." [Biodiversity International]
• UNGASS 2008 Country Progress Report – Republic of the Marshall Islands
  "The Republic of the Marshall Islands (RMI) is located in the Central Pacific Ocean, and is comprised of twenty-nine scattered and remote atolls in the Eastern Ratak (Sunrise) and the Western Ralik (Sunset) chains. There exist approximately 1225 islands and islets in the Marshall Islands none of which are above ten feet in elevation above sea level. The land area is less than 0.01% of the total surface area, with the total land area being less than 180 square kilometers scattered over two million square kilometers of ocean. The Marshall Islands has a unique geography, which is a challenge to delivery of basic health services. Transportation, electricity and communication are limited by the isolated nature of many of the islands and atolls. The Republic of Marshall Islands, Ministry of Health (MOH) is proposing a new organizational structure that will consist of three Bureaus. The Bureau of Majuro Hospital which will cater for a population of 23,678, the Bureau of Ebeye for Kwajalein will service a population of 10.902 while the Bureau of Outer Island Health Services will cater for 14,817. It is planned that the new structure will have a positive impact on the improvement of health care delivery services including HIV AIDS and STIs for the RMI." [UNAIDS, 2008 (Reporting period: January 2006–December 2007)]
• Vitamin A Deficiency, Iron Deficiency, and Anemia Among Preschool Children in the Republic of the Marshall Islands
  Objective: We investigated the co-occurrence of vitamin A deficiency, iron deficiency, and anemia among young children in the Republic of the Marshall Islands. Methods: Hemoglobin, serum retinol, and serum ferritin were assessed in the Republic of the Marshall Islands Vitamin A Deficiency Study, a community-based survey that involved 919 children ages 1 to 5 y. Results: The proportion of children with vitamin A deficiency (serum retinol concentrations < 0.70 μM/L) was 59.9%. The prevalences of anemia (hemoglobin < 110 g/L), iron deficiency (serum ferritin < 12 μg/L), and iron deficiency anemia (iron deficiency and anemia) were 36.4%, 53.5%, and 23.8%, respectively. The proportion of children who had co-occurrence of vitamin A and iron deficiencies was 33.2%. The mean ages of children with and without vitamin A deficiency were 3.2 ± 1.4 and 2.9 ± 1.5 y, respectively (P < 0.01), and the mean ages of those with and without iron deficiency were 2.7 ± 1.3 and 3.5 ± 1.4 y, respectively (P < 0.0001). Conclusions: Children in the Republic of the Marshall Islands, ages 1 to 5 y, are at high risk of anemia, vitamin A deficiency, and iron deficiency, and one-third of these children had the co-occurrence of vitamin A and iron deficiencies. Further investigation is needed to identify risk factors and evaluate interventions to address vitamin A and iron deficiencies among children. [author abstract] [Nutrition 2003; 19: 405-408]

Educational Resources

• Bikini Atoll - located in the central Pacific, and is one of a number of atolls in the Republic of the Marshall Islands. It is perhaps best known for its role in a series of nuclear tests conducted by the United States in the 1940s and 1950s. The site provides information concerning the public health and environmental issues of this history. If you want to know what nuclear power is all about, visit this "hot site", highly recommended.
• CDC - Travel Information: Australia and the South Pacific
• RMI Online: Internet Guide to the Marshall Islands - this service is provided by the Embassy of the Marshall Islands in Washington, D.C.; it contains the best information on the island we could find.
• Marshalls: Digital Micronesia
• World Encyclopedia of Political Systems: Marshall Islands