Comprehensive analysis of antimicrobial resistance in the Southwest Indian Ocean: focus on WHO critical and high priority pathogens.

The spread of antimicrobial resistance (AMR) is a major global concern, and the islands of the Southwest Indian Ocean (SWIO) are not exempt from this phenomenon. As strategic crossroads between Southern Africa and the Indian subcontinent, these islands are constantly threatened by the importation of multidrug-resistant bacteria from these regions. In this systematic review, our aim was to assess the epidemiological situation of AMR in humans in the SWIO islands, focusing on bacterial species listed as priority by the World Health Organization. Specifically, we examined Enterobacterales, Acinetobacter spp., Pseudomonas spp. resistant to carbapenems, and Enterococcus spp. resistant to vancomycin. Our main objectives were to map the distribution of these resistant bacteria in the SWIO islands and identify the genes involved in their resistance mechanisms. We conducted literature review focusing on Comoros, Madagascar, Maldives, Mauritius, Mayotte, Reunion Island, Seychelles, Sri Lanka, and Zanzibar. Our findings revealed a growing interest in the investigation of these pathogens and provided evidence of their active circulation in many of the territories investigated. However, we also identified disparities in terms of data availability between the targeted bacteria and among the different territories, emphasizing the need to strengthen collaborative efforts to establish an efficient regional surveillance network.

Community perspectives on the magnitude of Xeroderma pigmentosum and care-seeking practices in Micheweni district, Pemba: a mixed-methods cross-sectional study.

OBJECTIVES: To determine the community's perception on the magnitude of Xeroderma pigmentosum (XP) disease and healthcare-seeking practices in Micheweni, Pemba in response to the public widespread information on the increased burden of the disease. DESIGN: Mixed-methods cross-sectional study. SETTING: Micheweni district, Pemba. PARTICIPANTS: 211 male and female adults in the household survey, three caretakers/parents of patients with XP in the case study, 20 key community leaders/influential people and health workers in in-depth interviews and 50 community members and other leaders in six focus groups. RESULTS: This study has revealed that XP disease exists in few families of which some of them have more than one child affected. The record review showed that there were a total of 17 patients who were diagnosed with the disease for the past 3 years, however only 10 were alive during the time of the survey. Findings from the community members revealed that several patients were believed to have XP disease and perceived causes include inheritance, food types, beliefs and other sociocultural practices. Stigma and discrimination were reported by caretakers and religious leaders. However, some cases believed to be XP were identified as other skin conditions when clinical examination was performed by the team of our researchers. There is a great confusion about XP and other skin diseases. CONCLUSION: The study has shown that XP affects only few families, hence termed as concentrated rather than a generalised disease. Due to the rareness of the disease, majority of people in the district are unaware of the disease, hence confusing it with other skin conditions. There is a need for the government in collaboration with other stakeholders to provide educational programme to community members about the disease to address the misconception about the magnitude of the disease.

The evolutionary history of three Baracoffea species from western Madagascar revealed by chloroplast and nuclear genomes.

The wild species of the Coffea genus present a very wide morphological, genetic, and biochemical diversity. Wild species are recognized more resistant to diseases, pests, and environmental variations than the two species currently cultivated worldwide: C. arabica (Arabica) and C. canephora (Robusta). Consequently, wild species are now considered as a crucial resource for adapting cultivated coffee trees to climate change. Within the Coffea genus, 79 wild species are native to the Indian Ocean islands of Comoros, Mayotte, Mauritius, Réunion and Madagascar, out of a total of 141 taxa worldwide. Among them, a group of 9 species called "Baracoffea" are particularly atypical in their morphology and adaptation to the sandy soils of the dry deciduous forests of western Madagascar. Here, we have attempted to shed light on the evolutionary history of three Baracoffea species: C. ambongensis, C. boinensis and C. bissetiae by analyzing their chloroplast and nuclear genomes. We assembled the complete chloroplast genomes de novo and extracted 28,800 SNP (Single Nucleotide Polymorphism) markers from the nuclear genomes. These data were used for phylogenetic analysis of Baracoffea with Coffea species from Madagascar and Africa. Our new data support the monophyletic origin of Baracoffea within the Coffea of Madagascar, but also reveal a divergence with a sister clade of four species: C. augagneurii, C. ratsimamangae, C. pervilleana and C. Mcphersonii (also called C. vohemarensis), belonging to the Subterminal botanical series and living in dry or humid forests of northern Madagascar. Based on a bioclimatic analysis, our work suggests that Baracoffea may have diverged from a group of Malagasy Coffea from northern Madagascar and adapted to the specific dry climate and low rainfall of western Madagascar. The genomic data generated in the course of this work will contribute to the understanding of the adaptation mechanisms of these particularly singular species.

Foraging and the importance of knowledge in Pemba, Tanzania: implications for childhood evolution.

Childhood is a period of life unique to humans. Childhood may have evolved through the need to acquire knowledge and subsistence skills. In an effort to understand the functional significance of childhood, previous research examined increases with age in returns to foraging across food resources. Such increases could be due to changes in knowledge, or other factors such as body size or strength. Here, we attempt to unpack these age-related changes. First, we estimate age-specific foraging returns for two resources. We then develop nonlinear structural equation models to evaluate the relative importance of ecological knowledge, grip strength and height in a population of part-time children foragers on Pemba island, Tanzania. We use anthropometric measures (height, strength, n = 250), estimates of ecological knowledge (n = 93) and behavioural observations for 63 individuals across 370 foraging trips. We find slower increases in foraging returns with age for trap hunting than for shellfish collection. We do not detect any effect of individual knowledge on foraging returns, potentially linked to information sharing within foraging parties. Producing accurate estimates of the distinct contribution of specific traits to an individual's foraging performance constitutes a key step in evaluating different hypotheses for the emergence of childhood.

The interdependence of relational and material wealth inequality in Pemba, Zanzibar.

The extent of inequality in material wealth across different types of societies is well established. Less clear, however, is how material wealth is associated with relational wealth, and the implications of such associations for material wealth inequality. Theory and evidence suggest that material wealth both guides, and is patterned by, relational wealth. While existing comparative studies typically assume complementarity between different types of wealth, such associations may differ for distinct kinds of relational wealth. Here, we first review the literature to identify how and why different forms of relational wealth may align. We then turn to an analysis of household-level social networks (food sharing, gender-specific friendship and gender-specific co-working networks) and material wealth data from a rural community in Pemba, Zanzibar. We find that (i) the materially wealthy have most relational ties, (ii) the associations between relational and material wealth-as well as relational wealth more generally-are patterned by gender differences, and (iii) different forms of relational wealth have similar structural properties and are closely aligned. More broadly, we show how examining the patterning of distinct types of relational wealth provides insights into how and why inequality in material wealth remains muted in a community undergoing rapid economic change. This article is part of the theme issue 'Evolutionary ecology of inequality'.

Enhancing pre-school teachers' competence in managing pediatric injuries in Pemba Island, Zanzibar.

BACKGROUND: Safe and healthy learning environment in pre-schools has received increased attention in promoting the well-being of pre-school children. However, pediatric injuries have remained one of the leading causes of childhood morbidity and mortality around the globe. Empowering pre-school teachers with first aid competencies have been identified as being of potential strategy against pediatric health burdens of problem. This study tested the effect of established pediatric first aid training on pre-school teachers' knowledge, attitude, and intention to practice first aid management to pre-school children in Zanzibar.  METHODS: Uncontrolled quasi-experimental design with a quantitative research approach was conducted in Teachers' Resource Centers among 120 preschool teachers at Pemba Island, Zanzibar. First aid training was facilitated based on the prescribed guidelines and standards of materials adapted from the American Academy of Pediatrics and implemented. The intervention was preceded by a baseline assessment using structured questionnaires adopted from previous studies that served as the main data collection tool. RESULTS: Participants' mean age was 32 years ± 6.2 with 84.2% of the sample being females. Given the training, post-test findings demonstrated a significant increase (p < 0.01) in participants' first aid management scores with mean differences of M = 15.08 ± 5.34 (Knowledge), M = 26.99 ± 6.587 (Attitude), and (M = 4.76 ± 0.648 (Intentional practice). CONCLUSION: The established pediatric first aid training can enhance the spectrum of managing pediatric injuries among preschool teachers in Zanzibar. Ongoing public health services opportunities should be structured within teachers' continuous learning against pediatric injuries in Zanzibar-Tanzania.

Fine-scale-mapping of Schistosoma haematobium infections at the school and community levels and intermediate host snail abundance in the north of Pemba Island: baseline cross-sectional survey findings before the onset of a 3-year intervention study.

BACKGROUND: Schistosomiasis elimination has gained renewed priority in the WHO guidance documents published in 2020 and 2022. The SchistoBreak project, implemented in Pemba, Tanzania between 2020 and 2024, aims to assess new tools and strategies for shifting from elimination as a public health problem towards interruption of transmission. Here we report our baseline findings and discuss implications for future interventions. METHODS: In 2020, human water contact sites (HWCSs) in the study area were geolocated and snail surveys were conducted. A parasitological and questionnaire cross-sectional baseline survey was implemented in 20 communities and their 16 primary schools between November 2020 and February 2021. Urine samples were collected at the school and household levels from individuals aged ≥ 4 years. Schistosoma haematobium infection was detected by urine filtration microscopy. Snail, parasitological and questionnaire-derived data were analyzed descriptively, spatially and with generalized estimated equation models. RESULTS: The intermediate host snail Bulinus globosus was detected in 19.8% (33/167) of HWCSs. The overall S. haematobium prevalence was 1.2% (26/2196) in school-aged children and 0.8% (31/3893) in community members, with 0.2% (4/2196) and 0.1% (3/3893) heavy-intensity infections, respectively. Children who studied < 1 km away from HWCSs with B. globosus had significantly higher odds for a S. haematobium infection than those attending a school located > 2 km away (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 2.3-11.1). Individuals living in a house located < 1 km away from HWCSs with B. globosus had higher odds than those residing in > 2 km distance (OR: 18.0; 95% CI: 2.9-111.0). Self-reported praziquantel treatment coverage was 83.2% (2015/2423) in schoolchildren in the mass drug administration (MDA) conducted in August 2020. Coverage among adult community members was 59.9% (574/958), but only 34.8% (333/958) took praziquantel correctly. CONCLUSIONS: While the S. haematobium prevalence is very low in Pemba, there are many HWCSs with B. globosus situated close to schools or houses that pose a considerable risk of recrudescence. To maintain and accelerate the progress towards interruption of transmission, targeted and cost-effective interventions that are accepted by the community are needed; for example, snail control plus focal MDA, or test-and-treat in schools and households near infested waterbodies.

Internal relocation as a relevant and feasible adaptation strategy in Rangiroa Atoll, French Polynesia.

Atoll islands face increasing coastal risks (coastal erosion and marine flooding) due to climate change, especially sea-level rise. To face increasing coastal risks, various adaptation options are considered by atoll countries and territories, including in particular hard protection (preferred option to date), Nature-based Solutions (increasingly used) and island raising (considered a longer-term solution and a potential alternative to international migration, e.g. in the Maldives). Internal relocation within the same atoll island or atoll, which refers to long-term community movement from one threatened island area or island to a safer island area or island, has previously been disregarded by scholars as a potentially relevant climate adaptation strategy. However, in low-lying coastal areas, it offers real potential to address the dual context of increasing climate risks and the shrinking of the solution space. This paper assesses the potential of internal relocation for atolls by applying to Rangiroa Atoll, French Polynesia, Central Pacific, a two-fold assessment framework questioning its physical relevance (are some islands high enough to host settlements in the future?) and its societal feasibility (are the political-institutional and socio-economic conditions in place? Are people willing to relocate?). The findings show that internal relocation is both relevant and feasible on Rangiroa Atoll and should therefore serve as a pillar to develop robust in situ adaptation pathways in this atoll.

Historical Malaria Epidemics on Previously Non-Endemic Indo-Pacific Islands.

Islands without prior malaria have on occasion had severe epidemics after its initial introduction, the most infamous example being the Indian Ocean island of Mauritius in 1867. The historical record was examined to see if additional examples of malaria epidemics on Indo-Pacific islands, which were originally non-malarious had been documented. The late nineteenth century depopulation of Polynesian outliers such as Ontong Java has largely been blamed on malaria. Similar but less well-documented instances exist with both the Western Islands, Papua New Guinea, and Rennell in the Solomon Islands. Specific instances of malaria introduction to Grand Comoros and Aldabra Island in the Seychelles occurred by the early twentieth century. In some cases, the epidemics were caused by changes in anopheline vectors while in others new human populations carrying parasites were the important ecological change. It is, however, remarkable how rarely major malaria epidemics have occurred on Indo-Pacific islands.

Awareness Status of Schistosomiasis among School-Aged Students in Two Schools on Pemba Island, Zanzibar: A Cross-Sectional Study.

Schistosomiasis elimination has been set as a target in the Neglected Tropical Disease Roadmap of 2021 to 2030. The present study assessed the level of understanding, awareness and behaviors of schistosomiasis among students in Zanzibar and explored the influencing factors as the basis for reliable suggestions for the follow-up policy on schistosomiasis prevention and control. A Knowledge, Attitude and Practices (KAP) survey on students' perceptions of schistosomiasis was conducted on students from grades 4−9 at two selected schools on Pemba, Zanzibar, from May through September in 2021. A total of 217 valid participants responded to the questionnaires. T-test and chi-squared tests were used to examine the association between the dependent and explanatory variables. Multiple linear regressions were used to analyze the influencing factors of KAP. The findings indicated a lack of knowledge about schistosomiasis among the participants. Although respondents were aware of the risks of infection, they continued to engage in high-risk activities. Age, family size and presence of hematuria were found as contributing factors. Elder students performed better on knowledge (p = 0.02) and attitude (p < 0.01) scores, and students with a smaller family received higher attitude scores (p = 0.04). Practice was significantly correlated with gender (p < 0.01) and hematuria (p < 0.01). Several kinds of health education should be adopted to raise students' basic knowledge of schistosomiasis. It is also critical to make the community aware regarding schistosomiasis. Future efforts for the prevention and control of schistosomiasis should employ an integrated strategy combining communities with schools to encourage behavioral change.

Independent evolution of intermediate bill widths in a seabird clade.

Interspecific introgression can occur between species that evolve rapidly within an adaptive radiation. Pachyptila petrels differ in bill size and are characterised by incomplete reproductive isolation, leading to interspecific gene flow. Salvin's prion (Pachyptila salvini), whose bill width is intermediate between broad-billed (P. vittata) and Antarctic (P. desolata) prions, evolved through homoploid hybrid speciation. MacGillivray's prion (P. macgillivrayi), known from a single population on St Paul (Indian Ocean), has a bill width intermediate between salvini and vittata and could also be the product of interspecies introgression or hybrid speciation. Recently, another prion population phenotypically similar to macgillivrayi was discovered on Gough (Atlantic Ocean), where it breeds 3 months later than vittata. The similarity in bill width between the medium-billed birds on Gough and macgillivrayi suggest that they could be closely related. In this study, we used genetic and morphological data to infer the phylogenetic position and evolutionary history of P. macgillivrayi and the Gough medium-billed prion relative other Pachyptila taxa, to determine whether species with medium bill widths evolved through common ancestry or convergence. We found that Gough medium-billed prions belong to the same evolutionary lineage as macgillivrayi, representing a new population of MacGillivray's prion that originated through a colonisation event from St Paul. We show that macgillivrayi's medium bill width evolved through divergence (genetic drift) and independently from that of salvini, which evolved through hybridisation (gene flow). This represents the independent convergence towards a similarly medium-billed phenotype. The newly discovered MacGillivray's prion population on Gough is of utmost conservation relevance, as the relict macgillivrayi population in the Indian Ocean is very small.

Are doctors protected enough during COVID-19 in South Asia?

BACKGROUND: The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places physicians in South Asia at high risk of contracting the infection. Accordingly, we conducted this study to provide an updated account of physician deaths in South Asia during the COVID-19 pandemic and to analyze and compare the different characteristics associated with physician mortality amongst the countries of the region. METHODS: We performed a cross-sectional study by using published news reports on the websites of news agencies from 9 selected countries in South Asia. Our study included only those physicians and doctors who died after contracting COVID-19 from their respective workplaces. All available data about the country of origin, type of, sex, age, medical or surgical specialty, and date of death were included. RESULTS: The total number of physician deaths reported due to COVID-19 in our study was 170, with half (87/170, 51%) of the deaths reported from Iran. Male physician deaths were reported to be 145 (145/170 = 85%). Internal Medicine (58.43%) was the most severely affected sub-specialty. The highest physician mortality rate in the general population recorded in Afghanistan (27/1000 deaths). General physicians from India [OR = 11.00(95% CI = 1.06-114.08), p = 0.045] and public sector medical practitioners from Pakistan [aOR = 4.52 (95% CI = 1.18-17.33), p = 0.028] were showing significant mortality when compared with other regions in multivariate logistic regression. CONCLUSION: An increased number of physician deaths, owing to COVID-19, has been shown in South Asia. This could be due to decreased personal protective equipment and the poor health care management systems of the countries in the region to combat the pandemic. Future studies should provide detailed information of characteristics associated with physician mortalities along with the main complications arising due to the virus.

Interrogating and Reflecting on Disability Prevalence Data Collected Using the Washington Group Tools: Results from Population-Based Surveys in Cameroon, Guatemala, India, Maldives, Nepal, Turkey and Vanuatu.

The Washington Group (WG) tools capture self-reported functional limitations, ranging from 6 domains in the Short Set (SS) to 11 in the Extended Set (ESF). Prevalence estimates can vary considerably on account of differences between modules and the different applications of them. We compare prevalence estimates by WG module, threshold, application and domain to explore these nuances and consider whether alternative combinations of questions may be valuable in reduced sets. We conducted secondary analyses of seven population-based surveys (analyses restricted to adults 18+) in Low- and Middle-Income Countries that used the WG tools. The prevalence estimates using the SS standard threshold (a lot of difficulty or higher in one or more domain) varied between 3.2% (95% Confidence Interval 2.9-3.6) in Vanuatu to 14.1% (12.2-16.2) in Turkey. The prevalence was higher using the ESF than the SS, and much higher (5 to 10-fold) using a wider threshold of "some" or greater difficulty. Two of the SS domains (communication, self-care) identified few additional individuals with functional limitations. An alternative SS replacing these domains with the psychosocial domains of anxiety and depression would identify more participants with functional limitations for the same number of items. The WG tools are valuable for collecting harmonised population data on disability. It is important that the impact on prevalence of use of different modules, thresholds and applications is recognised. An alternative SS may capture a greater proportion of people with functional domains without increasing the number of items.

Finding of a two-headed green turtle embryo during nest monitoring in Baa Atoll, Maldives.

Green sea turtles are one of the two species of marine turtles known to nest in the Maldives. The prevalent time of nesting seems to be inconsistent throughout the island nation. In this study, sea turtle nesting activity was monitored on the island of Coco Palm Dhuni Kolhu in Baa Atoll over a period of 12 months. A total of 13 nests were confirmed with a median hatching success rate of 89.58% as ascertained by nest excavation. In one of the nests, a severely deformed hatchling with polycephaly, an opening in the neck area and a lordotic spine was found, and we investigated in detail with radiographic images and a necropsy. Our findings support the importance of consistent nesting activity and nest monitoring efforts in the country as a basis for conservation efforts.

Clinical Features of Acute Chikungunya Virus Infection in Children and Adults during an Outbreak in the Maldives.

The chikungunya virus is an arthritogenic arbovirus that has re-emerged in many tropical and subtropical regions, causing explosive outbreaks. This re-emergence is due to a genomic polymorphism that has increased the vector susceptibility of the virus. The majority of those infected with chikungunya virus exhibit symptoms of fever, rash, and debilitating polyarthralgia or arthritis. Symptoms can persist for weeks, and patients can relapse months later. Fatalities are rare, but individuals of extreme age can develop severe infection. Here, we describe the 2019 outbreak, the second-largest since the virus re-emerged in the Maldives after the 2004 Indian Ocean epidemic, in which a total of 1,470 cases were reported to the Health Ministry. Sixty-seven patients presenting at the main referral tertiary care hospital in the Maldives capital with acute undifferentiated illness were recruited following a negative dengue serology. A novel point-of-care antigen kit was used to screen suspected cases, 50 of which were subsequently confirmed using real-time reverse transcription-polymerase chain reaction. We describe the genotype and polymorphism of Maldives chikungunya virus using phylogenetic analysis. All isolates were consistent with the East Central South African genotype of the Indian Ocean lineage, with a specific E1-K211E mutation. In addition, we explored the clinical and laboratory manifestations of acute chikungunya in children and adults, of which severe infection was found in some children, whereas arthritis primarily occurred in adults. Arthritides in adults occurred irrespective of underlying comorbidities and were associated with the degree of viremia.

Exposure of pelagic seabirds to Toxoplasma gondii in the Western Indian Ocean points to an open sea dispersal of this terrestrial parasite.

Toxoplasma gondii is a protozoan parasite that uses felids as definitive hosts and warm-blooded animals as intermediate hosts. While the dispersal of T. gondii infectious oocysts from land to coastal waters has been well documented, transmission routes to pelagic species remain puzzling. We used the modified agglutination test (MAT titre ≥ 10) to detect antibodies against T. gondii in sera collected from 1014 pelagic seabirds belonging to 10 species. Sampling was carried out on eight islands of the Western Indian Ocean: Reunion and Juan de Nova (colonized by cats), Cousin, Cousine, Aride, Bird, Europa and Tromelin islands (cat-free). Antibodies against T. gondii were found in all islands and all species but the great frigatebird. The overall seroprevalence was 16.8% [95% CI: 14.5%-19.1%] but significantly varied according to species, islands and age-classes. The low antibody levels (MAT titres = 10 or 25) detected in one shearwater and three red-footed booby chicks most likely resulted from maternal antibody transfer. In adults, exposure to soils contaminated by locally deposited oocysts may explain the detection of antibodies in both wedge-tailed shearwaters on Reunion Island and sooty terns on Juan de Nova. However, 144 adults breeding on cat-free islands also tested positive. In the Seychelles, there was a significant decrease in T. gondii prevalence associated with greater distances to cat populations for species that sometimes rest on the shore, i.e. terns and noddies. This suggests that oocysts carried by marine currents could be deposited on shore tens of kilometres from their initial deposition point and that the number of deposited oocysts decreases with distance from the nearest cat population. The consumption of fishes from the families Mullidae, Carangidae, Clupeidae and Engraulidae, previously described as T. gondii oocyst-carriers (i.e. paratenic hosts), could also explain the exposure of terns, noddies, boobies and tropicbirds to T. gondii. Our detection of antibodies against T. gondii in seabirds that fish in the high sea, have no contact with locally contaminated soils but frequent the shores and/or consume paratenic hosts supports the hypothesis of an open-sea dispersal of T. gondii oocysts by oceanic currents and/or fish.

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries.

This analysis of surveys from six low- and middle-income countries (LMICs) aimed to (i) estimate the prevalence of disability among older adults and (ii) compare experiences and participation in key life areas among older people with and without disabilities which may show vulnerability during the COVID-19 pandemic. Data were analysed from district-level or national surveys in Cameroon, Guatemala, Haiti, India, Nepal and the Maldives, which across the six databases totalled 3499 participants aged 60 years and above including 691 people with disabilities. Disability was common among adults 60+, ranging from 9.7% (8.0-11.8) in Nepal to 39.2% in India (95% CI 34.1-44.5%). Mobility was the most commonly reported functional difficulty. In each setting, older people with disabilities were significantly less likely to be working and reported greater participation restrictions and environmental barriers in key life areas compared to people in the same age categories without disabilities (p < 0.05). Disability is common in this population, and older people with disabilities may have greater difficulties participating in COVID-19 responses and have high economic vulnerabilities. It is imperative to prioritise the needs of older people with disabilities in the COVID-19 pandemic, including ensuring accessibility of both health services and the community in general.

Catastrophic loss of tropical seagrass habitats at the Cocos (Keeling) Islands due to multiple stressors.

Seagrass habitats at the Cocos (Keeling) Islands (CKI), a remote atoll in the Indian Ocean, have suffered a catastrophic decline over the last decade. Seagrass monitoring (1996-2020) in relation to dredging and coastal development works (2009 to 2011) provide a historical baseline, and document the decline of mixed tropical seagrass Thalassia hemprichii and macroalgal (predominantly Caulerpa spp.) beds over a decadal scale time series. Attribution of loss to coastal development is confounded by lagoon-wide die-off events in 2007, 2009 and 2012 and high air and water temperatures from 2009 to 2016, with evidence of broad scale changes, visible in satellite imagery between 2006 and 2018. We conclude that up to 80% of seagrass habitats in the CKI lagoon (~1200 ha) have been lost due to multiple stressors including episodic die-off events related to high temperatures and calm conditions, and loss due to sediment disturbance and increased turbidity. Grazing pressure from the resident green sea turtles (Chelonia mydas) may have also exacerbated the loss of seagrass, which in turn poses a dire threat to their ongoing health and survival. This study highlights the fragility of tropical seagrass habitats and the cascading effect of system imbalance as a result of anthropogenic pressures and climate drivers. Although small in comparison to global estimates, the loss of seagrass habitats at CKI could change the entire ecosystem of a remote atoll. Due to the significance of the Thalassia beds for coastal stability, as food for an isolated population of green sea turtles and as a fish nursery, rehabilitation efforts are warranted.