Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey.

Background: Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI. Methods: Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector. Findings: Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72). Interpretation: While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children. Funding: This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.

'Hybrid Survey' approach to non-communicable disease surveillance in the US-Affiliated Pacific Islands.

In 2010 the US-Affiliated Pacific Islands (USAPI) declared a regional state of health emergency due to the epidemic of non-communicable disease (NCD) and an NCD monitoring and surveillance framework was developed that includes adult NCD risk factor and disease prevalence indicators to be collected every 5 years using a population-based survey. On evaluation of existing data from adult population-based NCD surveys, it was found that there was a lack of valid, available and consistently collected data. Therefore, a new model was developed to combine various indicators and survey tools from different partner agencies into one survey. After the report was endorsed by local health leadership, a dissemination workshop was conducted. In 2015 (baseline for Hybrid Survey implementation), three out of nine jurisdictions (33.3%) had completed a population-based survey in the past 5 years. Four (44.4%) had no adult prevalence data at all, two (22.2%) had data sets from their surveys and four (44.4%) had at least two surveys ever collected that could be used for comparison. As of 2020, all nine jurisdictions have, or are in the process of completing an adult population-based survey. Eight (88.9%) have data sets from their surveys, and five (55.6%) have at least two surveys collected that can be used for comparison. This Hybrid Survey model has helped to improve adult NCD surveillance in the USAPI by more efficiently using limited resources. This model could be considered in other small island nations, or rural areas where adult NCD surveillance is challenging.

Diabetes Mellitus-related Foot Surgeries in the Republic of the Marshall Islands in Micronesia.

Diabetes Mellitus (DM) is the leading cause of morbidity and mortality in the Republic of the Marshall Islands (RMI), a small Pacific nation located in Micronesia (population 53,184). Although generally preventable, diabetic foot disease is among the most frequently reported complication of DM globally and in the RMI. Over 25% of people with DM globally will have at least one DM-related foot ulcer, which may require surgical intervention. The purpose of this study is to determine the incidence of DM-related foot surgeries at the Leroij Atama Zedkaia Majuro Hospital, the main tertiary referral centre for the RMI, and where 90% of all DM-related foot surgeries in the country are conducted. A retrospective review of surgical and clinical records at Majuro Hospital for the 12-month period January 2015 to December 2015 was conducted to determine the incidence and characteristics of DM-related foot surgeries (foot ulcer debridement or lower limb amputation [LLA]). DM-related foot surgery was the fourth most common surgical procedure conducted in the RMI during the 12-month period reviewed. Four percent of people with DM presenting to the Majuro Hospital during the review period required DM-related foot surgery. The incidence of DM-related major LLAs was 103 per 100,000 population. As age increased, so did the proportion of patients requiring DM-related foot surgery. Eighty six percent of those requiring surgery were 50 years and older, and the majority were male (54.6%). The incidence of DM-related foot surgeries in the RMI remains high by international standards. The study findings confirm the need to address the burden of DM in the RMI and support the country's NCD Crisis Action Plan.