View Article PDF

In the Solomon Islands, there was little clinical evidence of non-communicable diseases (NCDs) until the 1960s,1 but research conducted in the 1980s revealed that a substantial portion of adults were classified as suffering from obesity, diabetes or hypertension.2 On the other hand, mortality and morbidity by malaria, respiratory infections, diarrhoea and other infectious diseases, which had once been the main causes of deaths, have decreased due to improved hygienic conditions and health services.3,4In 2002, deaths due to communicable, maternal, perinatal and nutritional conditions were 254.8 per 100,000 population, while those due to NCDs were 363.9.5 Thus, although people are still under the double burden of both types of etiological diseases, the epidemiological transition has already been shifted toward higher prevalence of NCDs.On 2 April 2007, at 7:40 local time, a massive earthquake (Richter magnitude 8.1), the epicentre of which was 10 km deep and 45 km south-southeast of Gizo (the provincial capital of the Western Province), struck the country (Figure 1).6,7This earthquake and the related tsunami and landslides killed 52 people, wrecked 3150 houses and left behind an affected population of 24,059 in the Western and Choiseul Provinces.8 The greatest damage was inflicted upon the residents of the town and neighbouring semi-urban villages in Gizo Island, followed by coastal fishermen and horticulturalists on several small islands.In the devastated areas, people took refuge on mountain ridges, since houses and infrastructure, including water supply, hygiene and subsistence tools (e.g. fishing canoes and agricultural tools) were severely affected.9National, international and non-governmental efforts delivered relief goods and sufficient food, and tried to control disease incidences.8,10-12 While these efforts were successful in avoiding severe outbreaks of infectious diseases and shortage of food and drinking water, disease risks and dietary shortage remained an issue at the local level.In addition, during this time, the population experienced a lifestyle change; some of the residents became increasingly dependent on imported foods and cash economy because subsistence economy and local food production were interrupted. Therefore, this disaster could potentially be related to risks of communicable and nutritional conditions as well as NCDs. Figure 1. Locations of epicentre and study villages in the Western Province, Solomon Islands This study aimed to explore the type of health and nutritional problems that were likely to be prevalent during the recovery process from the 2007 earthquake in the Solomon Islands. Special attention was paid upon the effects of levels of damages, recovery and urbanisation. The research was conducted 2 years after the disaster. This time period was ideal to assess medium-term influences, since the adverse effects of the initial phase are usually treated by emergency relief operations. The effects remaining after withdrawal of intensive operations were little studied. A greater understanding of these effects is necessary for implementing or assessing long-term recovery action plans at the grass-root level. Methods Study areaOut of 53 deaths caused by the disaster, 33, including at least 29 Micronesians, occurred on Gizo Island, followed by 11 on Simbo. This study was conducted in August 2009 in the following four villages (Figure 1; Table 1) in the Western Province. Titiana village, where almost all houses were lost in the tsunami and all residents had evacuated to the top of a hill and built a camp; both original settlement and the camp were located at walking distances from the centre of the Gizo town (approximately 45 minutes on foot). During the study period, a portion of households had returned to the original settlement, but the majority was still living in the camp. Tapurai village, in the remote Simbo Island, had also been totally destroyed by the tsunami. All residents, except only for a couple of households, were living in a new settlement in Rupe, where subsistence gardens were located before the disaster. Mondo village in Ranongga Island had lost about half of the settlement due to landslides. The majority of the residents moved into an inner mountainous area and built a new settlement called Keigolo. Although this village was geographically remote from the town, the lifestyle was manifestly more modern than Tapurai, since it had been one of the biggest villages in the island before the disaster, and even after the disaster, it had received overseas aids for setting-up a clinic and rebuilding hygienic infrastructure. Olive village in New Georgia Island was affected by the quake but the sea level increased only slightly and did not change the settlement. Table 1 Characteristics of the study villages Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive Island Gizo Simbo Ranongga New Georgia Major effects Tsunami Tsunami Land slides Sea level rise Damage Severe Severe Severe Minimum Population 366 7 234 7 341 7 365a No. of deaths (% population) 13 (3.6%) 7 7 (3.0%) 7 2 (0.6%) 7 0 (0%)a Recovery stage Majority still live in campsite on a hill near the Gizo town* Building a new settlement without new infrastructure* Building a new settlement with new hygiene equipments in inner mountain* Same* Distance to the nearest town 1 km 38 km 34 km 32 km No. of participants (% Female) Infants (<5 years) Children (5-17 years) Adult (18-49 years) Elders (\u226550 years) Total 49 (44.9%) 81 (51.9%) 63 (77.8%) 17 (52.9%) 210 (58.1%) 21 (33.3%) 34 (58.8%) 53 (52.8%) 15 (60.0%) 123 (52.0%) 23 (39.1%) 52 (57.7%) 36 (77.8%) 24 (33.3%) 135 (55.6%) 27 (37.0%) 60 (40.0%) 36 (66.7%) 23 (52.2%) 146 (48.0%) No. of participating households 61 34 30 35 aSource: The authors\u2019 field observations; *At August 2009. We therefore assumed that Titiana represented a village severely damaged and located near the town, Tapurai represented a severely damaged remote village, Mondo represented a severely damaged, medium urban village and Olive represented a control village. It should be noted that almost all residents in Titiana were Micronesians who had migrated from the Gilbert Islands in 1960s,2 while those in the remaining three villages were indigenous Melanesians. Participants and interview surveyIn each village, all residents were invited to participate in the study; measurements were made for three days in Titiana and two days in Tapurai, Mondo and Olive. All participants who, based on their free will, agreed and provided informed consent were included in the study; the consent was obtained from a parent or a legal guardian in case of children less than 18 years of age. This study has been conducted in full accordance with the ethical principles of the World Medical Association Declaration of Helsinki (as amended by the 59th General Assembly in Seoul, 2008) and was approved by the University of Tokyo Ethics Committee, Japan, and the Solomon Islands National Health Research Ethics Committee. Every participant, or a parent or legal guardian in case of children, was asked to report the date of birth, settlement place and housing type; birth records were referred to in case of children to calculate their exact age in months. Every adult was asked to report on his\/her lifestyle by replying yes or no in the questionnaire. Health check-upsBody height was measured to the nearest 1 mm using a field anthropometer (TTM, Japan) and weight was recorded to the nearest 0.1 kg using a portable digital scale (Tanita model HD-654, Japan) according to a standard protocol.13 Height was measured only for participants of 5 years of age or older. Blood pressure of participants aged 18 years or older was measured using a blood pressure monitor (HEM-7051-HP, Omron, Japan); readings were obtained twice for every participant and averaged. For malaria active case detection, thick and thin blood films were collected by the finger prick method. All slides were taken to the Malaria Department of the National Gizo Hospital to be examined under a microscope; each slide was checked by at least two technicians. Malaria detection was also made with a rapid detection test using the ICT Malaria Combo Cassette Test (ICT Diagnostics, South Africa) on site. The blood obtained from the finger prick method was also used to measure haemoglobin A1c (HbA1c) and C-reactive protein (CRP) using NycoCard HbA1c (Axis Shield, Norway) and NycoCard CRP tests, respectively, and read using a NycoCard Reader II on site. HbA1c is a glycated haemoglobin that reflects plasma glucose concentration over the past two to three months and is an indicator of diabetes mellitus.14-16 CRP is a component of acute innate immunity that increases in concentration in response to a range of pathogenic agents and inflammation.17,18 Statistical analysesThe health indicators measured in this study were conceptually classified into (i) communicable and nutritional conditions and (ii) NCDs. Indicators for communicable and nutritional conditions included malaria infection (positive or negative), adult malnutrition (BMI < 18.5 kg\/m2), adult and child infection status (CRP \u2265 1.0 mg\/dL),18 child stunting (height-for-age z-score (HAZ) < \u22122), child underweight (weight-for-age z-score (WAZ) < \u22122) and child malnutrition (BMI-for-age z-score (BMIZ) < \u22122). Those for NCDs included adult overweight (BMI \u2265 25 kg\/m2), obesity (BMI \u2265 30 kg\/m2),19 hypertension (SBP \u2265 140 mmHg and\/or DBP \u2265 90 mmHg) and diabetes (HbA1c \u2265 6.5%).16 Standardisation of measures (i.e. z-score calculation) for children was performed based on the CDC\/WHO 1978 growth curves recommended by the WHO using Epi Info version 3.5 software (Centers for Disease Control and Prevention, Atlanta, USA). Associations between the villages and the health or life level indicators were tested using Fisher\u2019s exact test. Multiple logistic regression analyses were performed to detect the effects of villages, individual-level settlement and housing styles, age and gender on the health indicators; settlement was treated as an environmental factor, while ownership and style of housing as factors of socioeconomic status. In this study, a P value of less than 0.05 was considered to be statistically significant. All statistical analyses were performed using SAS 9.2 (SAS Institute, Cary, USA). Results Almost all participants from Tapurai and Mondo villages lived in settlements that were established after the disaster (Table 2); the majority of Titiana participants lived in a camp, but the remaining had returned to the old settlement. As opposed to 16.4% of participants from Titiana, only 6.7% and 2.9% of participants from Tapurai and Mondo, respectively, still lived in tents or temporary houses. Regarding subsistence activities, almost all households were engaged in horticulture (making traditional gardens) in Tapurai, Mondo and Olive villages compared to only 75.4% of the peri-urban Titiana village households. The proportion of Mondo households engaged in fishing was as low as that of households in the urban Titiana. The proportion of households having a running business and employment or remittance for cash income was high in Titiana and Olive. Table 2. Socioeconomic status of the participant households Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive No. of participating households 61 (100%) 34 (100%) 30 (100%) 35 (100%) Settlement style Living in old settlement Living in temporary camp site Living in new settlement 21 (34.4%) 40 (65.6%) - 1 (2.9%) - 33 (97.1%) 2 (6.7%) - 28 (93.3%) 100 (100%) - - House ownership Living in own house Living in a relative\/friend\u2019s house 59 (96.7%) 2 (3.3%) 29 (85.3%) 5 (14.7%) 26 (86.7%) 4 (13.3%) 34 (97.1%) 1 (2.9%) Housing style Tent\/temporary house Leaf house\/Western house 10 (16.4%) 51 (83.6%) 0 (0%) 34 (100%) 2 (6.7%) 28 (93.3%) 1 (2.9%) 34 (97.1%)

Summary

Abstract

Aim

The major causes of mortality and morbidity have changed from infectious diseases and malnutrition conditions to non-communicable diseases (NCDs) in Melanesian societies. However, a massive earthquake and its related changes might have disturbed the patterns. This study aimed to explore which health problems were likely to be prevalent during the recovery process from the 2 April 2007 earthquake in the Solomon Islands.

Method

Participants were recruited in Titiana, a severely damaged village located near a town; Tapurai, a severely damaged remote village; Mondo, a severely damaged, medium urban village; and Olive, a control village. Health indicators measured were classified into communicable and nutritional conditions (malaria, malnutrition, infection status and child growth) and NCDs (overweight/obesity, hypertension and diabetes).

Results

Titiana residents were more at risk of infectious conditions (C-reactive protein 2265 1 mg/dL) and obesity (BMI 2265 30 kg/m2). Tapurai and Mondo residents were at risks of infectious conditions and becoming overweight (BMI 2265 25 kg/m2), respectively. Titiana and Mondo residents complained about insufficient subsistence production.

Conclusion

The urban communities were found to be at risks of both communicable and NCDs. Controlling the urbanisation as well as providing continuous support against infectious conditions during the recovery process would be beneficial.

Author Information

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan; Hana Furusawa, Assistant Professor, Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Ricky Eddie, Chief Laboratory Officer, Gizo Hospital, Gizo, The Solomon Islands; Makiva Tuni, Deputy Director, Department of Health Promotion, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Freda Pitakaka, Chief Research Officer, National Health Training and Research Institute, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Shankar Aswani, Associate Professor, Department of Anthropology, University of California, Santa Barbara, California, USA

Acknowledgements

The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan (KAKENHI Grant-in-Aid) and United States National Science Foundation (NSF) financially supported this study. We are also grateful to the staff members of the Ministry of Health and Medical Services of the Solomon Islands, in particular Ms Josephine Watoto and Ms Connie Panisi. Lastly our sincere thanks to all the people of the villages studied

Correspondence

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan. Fax: +81 (0)75 7537834 and Shankar Aswani , Associate Professor, Department of Anthropology, University of California, Santa Barbara, CA 93106-3210, USA

Correspondence Email

furusawa@asafas.kyoto-u.ac.jp and aswani@anth.ucsb.edu

Competing Interests

None.

Page L, Damon A, Moellering RC. Antecedents of Cardiovascular Disease in Six Solomon Islands Societies. Circulation. 1974;49(6):1132-46.Eason RJ, Pada J, Wallace R, et al. Changing patterns of hypertension, diabetes, obesity and diet among Melanesians and Micronesians in the Solomon Islands. Med J Aust. 1987;146(9):465-73.Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204.Tanner M, de Savigny D. Malaria eradication back on the table. Bull World Health Organ. 2008 Feb;86(2):82.World Health Organization (WHO). Mortality and burden of disease estimates for WHO member states in 2002. Geneva: World Health Organization; 2002 [updated 2004 December; cited 2010 June 15]; Available from: http://www.who.int/healthinfo/global_burden_disease/en/index.html.United States Geological Survey (USGS). Magnitude 8.1 - Solomon Islands 2007 April 01 20:39:56 UTC. [updated 2007 April; cited 2010 June 15]. http://earthquake.usgs.gov/earthquakes/eqinthenews/2007/us2007aqbk/McAdoo B, Moore A, Baumwoll J. Indigenous knowledge and the near field population response during the 2007 Solomon Islands tsunami. Nat Hazards. 2009;48(1):73-82.Solomon Islands Government. Recovery Action Plan: Western and Choiseul Provinces Earthquake and Tsunami. Honiara: Solomon Islands Government; 2007.Furusawa T, Maki N, Suzuki S. Bacterial contamination of drinking water and nutritional quality of diet in the areas of the western Solomon Islands devastated by the April 2, 2007 earthquake/tsunami. Trop Med Health. 2008;36(2):65-74.United Nations Office for the Coordination of Humanitarian Affairs (OCHA). South Pacific Tsunami - April 2007 OCHA Situation Report No. 1-14. 2007 [updated 2007 April 12; cited 2010 June 15]; Available from: http://www.reliefweb.int/rw/RWB.NSF/db900SID/SHES-727MMM?OpenDocument.ReliefWeb. Solomon Islands tsunami-earthquake emergency programme: External situation report - 23 Apr 2007. 2007 [updated 2007 Apirl 23; cited 2010 June 15]. http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-72MC5K?OpenDocumentKastom Gaden Association. Western and Choiseul Province Earthquake and Tsunami Disaster: Rapid Assessment of Agriculture and Food Security. Kastom Gaden Association, Honiara; 2007 [updated 2007 April; cited 2010 June 15].http://www.acfid.asn.au/news-media/docs_news-items/ag-assesment-final.pdfWeiner JS, Lourie JA. Practical Human Biology. London: Academic Press; 1981.John WG. Haemoglobin A1c: analysis and standardisation. Clin Chem Lab Med. 2003 Sep;41(9):1199-212.American Diabetes Association. Living with diabetes. 2010 [cited 2010 June 15]. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/American Diabetes Association. Executive summary: standards of medical care in diabetes - 2009. Diabetes Care. 2009 Jan;32(Suppl 1):S6-12.McDade TW, Leonard WR, Burhop J, et al. Predictors of C-reactive protein in Tsimane' 2 to 15 year-olds in lowland Bolivia. Am J Phys Anthropol. 2005 Dec;128(4):906-13.McDade TW. Life history theory and the immune system: steps toward a human ecological immunology. Am J Phys Anthropol. 2003;122(Suppl 37):100-25.World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. World Health Organ Tech Rep Ser. 2000;894:1-253.Natsuhara K, Inaoka T, Umezaki M, et al. Cardiovascular risk factors of migrants in Port Moresby from the highlands and island villages, Papua New Guinea. Am J Hum Biol . 2000;12(5):655-64.Misch KA. Ischaemic heart disease in urbanized Papua New Guinea: An autopsy study. Cardiology. 1988;75(1):71-5.Parry J. Pacific islanders pay heavy price for abandoning traditional diet. Bull World Health Organ. 2010;88:484-5.Aswani S, Albert S, Sabetian A, Furusawa T. Customary management as precautionary and adaptive principles for protecting coral reefs in Oceania. Coral Reefs. 2007;26(4):1009-21.Furusawa T, Naka I, Yamauchi T, et al. The Q223R polymorphism in LEPR is associated with obesity in Pacific Islanders. Hum Genet. 2010;127(3):287-94.Schooneveldt M, Songer T, Zimmet P, Thoma K. Changing mortality patterns in Nauruans: an example of epidemiological transition. J Epidemiol Community Health. 1988 Mar;42(1):89-95.Aghababian RV, Teuscher J. Infectious diseases following major disasters. Ann Emerg Med. 1992 Apr;21(4):362-7.Binder S, Sanderson LM. The role of the epidemiologist in natural disasters. Ann Emerg Med. 1987 Sep;16(9):1081-4.Kumari R, Joshi PL, Lal S, Shah W. Management of malaria threat following tsunami in Andaman & Nicobar Islands, India and impact of altered environment created by tsunami on malaria situation of the islands. Acta Trop. 2009 Nov;112(2):204-11.Krishnamoorthy K, Jambulingam P, Natarajan R, et al. Altered environment and risk of malaria outbreak in South Andaman, Andaman & Nicobar Islands, India affected by tsunami disaster. Malar J. 2005;4:32.Zimmet P, Taylor R, Whitehouse S. Prevalence rates of impaired glucose tolerance and diabetes mellitus in various Pacific populations according to the new WHO criteria. Bull World Health Organ. 1982;60(2):279-82.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

In the Solomon Islands, there was little clinical evidence of non-communicable diseases (NCDs) until the 1960s,1 but research conducted in the 1980s revealed that a substantial portion of adults were classified as suffering from obesity, diabetes or hypertension.2 On the other hand, mortality and morbidity by malaria, respiratory infections, diarrhoea and other infectious diseases, which had once been the main causes of deaths, have decreased due to improved hygienic conditions and health services.3,4In 2002, deaths due to communicable, maternal, perinatal and nutritional conditions were 254.8 per 100,000 population, while those due to NCDs were 363.9.5 Thus, although people are still under the double burden of both types of etiological diseases, the epidemiological transition has already been shifted toward higher prevalence of NCDs.On 2 April 2007, at 7:40 local time, a massive earthquake (Richter magnitude 8.1), the epicentre of which was 10 km deep and 45 km south-southeast of Gizo (the provincial capital of the Western Province), struck the country (Figure 1).6,7This earthquake and the related tsunami and landslides killed 52 people, wrecked 3150 houses and left behind an affected population of 24,059 in the Western and Choiseul Provinces.8 The greatest damage was inflicted upon the residents of the town and neighbouring semi-urban villages in Gizo Island, followed by coastal fishermen and horticulturalists on several small islands.In the devastated areas, people took refuge on mountain ridges, since houses and infrastructure, including water supply, hygiene and subsistence tools (e.g. fishing canoes and agricultural tools) were severely affected.9National, international and non-governmental efforts delivered relief goods and sufficient food, and tried to control disease incidences.8,10-12 While these efforts were successful in avoiding severe outbreaks of infectious diseases and shortage of food and drinking water, disease risks and dietary shortage remained an issue at the local level.In addition, during this time, the population experienced a lifestyle change; some of the residents became increasingly dependent on imported foods and cash economy because subsistence economy and local food production were interrupted. Therefore, this disaster could potentially be related to risks of communicable and nutritional conditions as well as NCDs. Figure 1. Locations of epicentre and study villages in the Western Province, Solomon Islands This study aimed to explore the type of health and nutritional problems that were likely to be prevalent during the recovery process from the 2007 earthquake in the Solomon Islands. Special attention was paid upon the effects of levels of damages, recovery and urbanisation. The research was conducted 2 years after the disaster. This time period was ideal to assess medium-term influences, since the adverse effects of the initial phase are usually treated by emergency relief operations. The effects remaining after withdrawal of intensive operations were little studied. A greater understanding of these effects is necessary for implementing or assessing long-term recovery action plans at the grass-root level. Methods Study areaOut of 53 deaths caused by the disaster, 33, including at least 29 Micronesians, occurred on Gizo Island, followed by 11 on Simbo. This study was conducted in August 2009 in the following four villages (Figure 1; Table 1) in the Western Province. Titiana village, where almost all houses were lost in the tsunami and all residents had evacuated to the top of a hill and built a camp; both original settlement and the camp were located at walking distances from the centre of the Gizo town (approximately 45 minutes on foot). During the study period, a portion of households had returned to the original settlement, but the majority was still living in the camp. Tapurai village, in the remote Simbo Island, had also been totally destroyed by the tsunami. All residents, except only for a couple of households, were living in a new settlement in Rupe, where subsistence gardens were located before the disaster. Mondo village in Ranongga Island had lost about half of the settlement due to landslides. The majority of the residents moved into an inner mountainous area and built a new settlement called Keigolo. Although this village was geographically remote from the town, the lifestyle was manifestly more modern than Tapurai, since it had been one of the biggest villages in the island before the disaster, and even after the disaster, it had received overseas aids for setting-up a clinic and rebuilding hygienic infrastructure. Olive village in New Georgia Island was affected by the quake but the sea level increased only slightly and did not change the settlement. Table 1 Characteristics of the study villages Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive Island Gizo Simbo Ranongga New Georgia Major effects Tsunami Tsunami Land slides Sea level rise Damage Severe Severe Severe Minimum Population 366 7 234 7 341 7 365a No. of deaths (% population) 13 (3.6%) 7 7 (3.0%) 7 2 (0.6%) 7 0 (0%)a Recovery stage Majority still live in campsite on a hill near the Gizo town* Building a new settlement without new infrastructure* Building a new settlement with new hygiene equipments in inner mountain* Same* Distance to the nearest town 1 km 38 km 34 km 32 km No. of participants (% Female) Infants (<5 years) Children (5-17 years) Adult (18-49 years) Elders (\u226550 years) Total 49 (44.9%) 81 (51.9%) 63 (77.8%) 17 (52.9%) 210 (58.1%) 21 (33.3%) 34 (58.8%) 53 (52.8%) 15 (60.0%) 123 (52.0%) 23 (39.1%) 52 (57.7%) 36 (77.8%) 24 (33.3%) 135 (55.6%) 27 (37.0%) 60 (40.0%) 36 (66.7%) 23 (52.2%) 146 (48.0%) No. of participating households 61 34 30 35 aSource: The authors\u2019 field observations; *At August 2009. We therefore assumed that Titiana represented a village severely damaged and located near the town, Tapurai represented a severely damaged remote village, Mondo represented a severely damaged, medium urban village and Olive represented a control village. It should be noted that almost all residents in Titiana were Micronesians who had migrated from the Gilbert Islands in 1960s,2 while those in the remaining three villages were indigenous Melanesians. Participants and interview surveyIn each village, all residents were invited to participate in the study; measurements were made for three days in Titiana and two days in Tapurai, Mondo and Olive. All participants who, based on their free will, agreed and provided informed consent were included in the study; the consent was obtained from a parent or a legal guardian in case of children less than 18 years of age. This study has been conducted in full accordance with the ethical principles of the World Medical Association Declaration of Helsinki (as amended by the 59th General Assembly in Seoul, 2008) and was approved by the University of Tokyo Ethics Committee, Japan, and the Solomon Islands National Health Research Ethics Committee. Every participant, or a parent or legal guardian in case of children, was asked to report the date of birth, settlement place and housing type; birth records were referred to in case of children to calculate their exact age in months. Every adult was asked to report on his\/her lifestyle by replying yes or no in the questionnaire. Health check-upsBody height was measured to the nearest 1 mm using a field anthropometer (TTM, Japan) and weight was recorded to the nearest 0.1 kg using a portable digital scale (Tanita model HD-654, Japan) according to a standard protocol.13 Height was measured only for participants of 5 years of age or older. Blood pressure of participants aged 18 years or older was measured using a blood pressure monitor (HEM-7051-HP, Omron, Japan); readings were obtained twice for every participant and averaged. For malaria active case detection, thick and thin blood films were collected by the finger prick method. All slides were taken to the Malaria Department of the National Gizo Hospital to be examined under a microscope; each slide was checked by at least two technicians. Malaria detection was also made with a rapid detection test using the ICT Malaria Combo Cassette Test (ICT Diagnostics, South Africa) on site. The blood obtained from the finger prick method was also used to measure haemoglobin A1c (HbA1c) and C-reactive protein (CRP) using NycoCard HbA1c (Axis Shield, Norway) and NycoCard CRP tests, respectively, and read using a NycoCard Reader II on site. HbA1c is a glycated haemoglobin that reflects plasma glucose concentration over the past two to three months and is an indicator of diabetes mellitus.14-16 CRP is a component of acute innate immunity that increases in concentration in response to a range of pathogenic agents and inflammation.17,18 Statistical analysesThe health indicators measured in this study were conceptually classified into (i) communicable and nutritional conditions and (ii) NCDs. Indicators for communicable and nutritional conditions included malaria infection (positive or negative), adult malnutrition (BMI < 18.5 kg\/m2), adult and child infection status (CRP \u2265 1.0 mg\/dL),18 child stunting (height-for-age z-score (HAZ) < \u22122), child underweight (weight-for-age z-score (WAZ) < \u22122) and child malnutrition (BMI-for-age z-score (BMIZ) < \u22122). Those for NCDs included adult overweight (BMI \u2265 25 kg\/m2), obesity (BMI \u2265 30 kg\/m2),19 hypertension (SBP \u2265 140 mmHg and\/or DBP \u2265 90 mmHg) and diabetes (HbA1c \u2265 6.5%).16 Standardisation of measures (i.e. z-score calculation) for children was performed based on the CDC\/WHO 1978 growth curves recommended by the WHO using Epi Info version 3.5 software (Centers for Disease Control and Prevention, Atlanta, USA). Associations between the villages and the health or life level indicators were tested using Fisher\u2019s exact test. Multiple logistic regression analyses were performed to detect the effects of villages, individual-level settlement and housing styles, age and gender on the health indicators; settlement was treated as an environmental factor, while ownership and style of housing as factors of socioeconomic status. In this study, a P value of less than 0.05 was considered to be statistically significant. All statistical analyses were performed using SAS 9.2 (SAS Institute, Cary, USA). Results Almost all participants from Tapurai and Mondo villages lived in settlements that were established after the disaster (Table 2); the majority of Titiana participants lived in a camp, but the remaining had returned to the old settlement. As opposed to 16.4% of participants from Titiana, only 6.7% and 2.9% of participants from Tapurai and Mondo, respectively, still lived in tents or temporary houses. Regarding subsistence activities, almost all households were engaged in horticulture (making traditional gardens) in Tapurai, Mondo and Olive villages compared to only 75.4% of the peri-urban Titiana village households. The proportion of Mondo households engaged in fishing was as low as that of households in the urban Titiana. The proportion of households having a running business and employment or remittance for cash income was high in Titiana and Olive. Table 2. Socioeconomic status of the participant households Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive No. of participating households 61 (100%) 34 (100%) 30 (100%) 35 (100%) Settlement style Living in old settlement Living in temporary camp site Living in new settlement 21 (34.4%) 40 (65.6%) - 1 (2.9%) - 33 (97.1%) 2 (6.7%) - 28 (93.3%) 100 (100%) - - House ownership Living in own house Living in a relative\/friend\u2019s house 59 (96.7%) 2 (3.3%) 29 (85.3%) 5 (14.7%) 26 (86.7%) 4 (13.3%) 34 (97.1%) 1 (2.9%) Housing style Tent\/temporary house Leaf house\/Western house 10 (16.4%) 51 (83.6%) 0 (0%) 34 (100%) 2 (6.7%) 28 (93.3%) 1 (2.9%) 34 (97.1%)

Summary

Abstract

Aim

The major causes of mortality and morbidity have changed from infectious diseases and malnutrition conditions to non-communicable diseases (NCDs) in Melanesian societies. However, a massive earthquake and its related changes might have disturbed the patterns. This study aimed to explore which health problems were likely to be prevalent during the recovery process from the 2 April 2007 earthquake in the Solomon Islands.

Method

Participants were recruited in Titiana, a severely damaged village located near a town; Tapurai, a severely damaged remote village; Mondo, a severely damaged, medium urban village; and Olive, a control village. Health indicators measured were classified into communicable and nutritional conditions (malaria, malnutrition, infection status and child growth) and NCDs (overweight/obesity, hypertension and diabetes).

Results

Titiana residents were more at risk of infectious conditions (C-reactive protein 2265 1 mg/dL) and obesity (BMI 2265 30 kg/m2). Tapurai and Mondo residents were at risks of infectious conditions and becoming overweight (BMI 2265 25 kg/m2), respectively. Titiana and Mondo residents complained about insufficient subsistence production.

Conclusion

The urban communities were found to be at risks of both communicable and NCDs. Controlling the urbanisation as well as providing continuous support against infectious conditions during the recovery process would be beneficial.

Author Information

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan; Hana Furusawa, Assistant Professor, Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Ricky Eddie, Chief Laboratory Officer, Gizo Hospital, Gizo, The Solomon Islands; Makiva Tuni, Deputy Director, Department of Health Promotion, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Freda Pitakaka, Chief Research Officer, National Health Training and Research Institute, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Shankar Aswani, Associate Professor, Department of Anthropology, University of California, Santa Barbara, California, USA

Acknowledgements

The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan (KAKENHI Grant-in-Aid) and United States National Science Foundation (NSF) financially supported this study. We are also grateful to the staff members of the Ministry of Health and Medical Services of the Solomon Islands, in particular Ms Josephine Watoto and Ms Connie Panisi. Lastly our sincere thanks to all the people of the villages studied

Correspondence

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan. Fax: +81 (0)75 7537834 and Shankar Aswani , Associate Professor, Department of Anthropology, University of California, Santa Barbara, CA 93106-3210, USA

Correspondence Email

furusawa@asafas.kyoto-u.ac.jp and aswani@anth.ucsb.edu

Competing Interests

None.

Page L, Damon A, Moellering RC. Antecedents of Cardiovascular Disease in Six Solomon Islands Societies. Circulation. 1974;49(6):1132-46.Eason RJ, Pada J, Wallace R, et al. Changing patterns of hypertension, diabetes, obesity and diet among Melanesians and Micronesians in the Solomon Islands. Med J Aust. 1987;146(9):465-73.Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204.Tanner M, de Savigny D. Malaria eradication back on the table. Bull World Health Organ. 2008 Feb;86(2):82.World Health Organization (WHO). Mortality and burden of disease estimates for WHO member states in 2002. Geneva: World Health Organization; 2002 [updated 2004 December; cited 2010 June 15]; Available from: http://www.who.int/healthinfo/global_burden_disease/en/index.html.United States Geological Survey (USGS). Magnitude 8.1 - Solomon Islands 2007 April 01 20:39:56 UTC. [updated 2007 April; cited 2010 June 15]. http://earthquake.usgs.gov/earthquakes/eqinthenews/2007/us2007aqbk/McAdoo B, Moore A, Baumwoll J. Indigenous knowledge and the near field population response during the 2007 Solomon Islands tsunami. Nat Hazards. 2009;48(1):73-82.Solomon Islands Government. Recovery Action Plan: Western and Choiseul Provinces Earthquake and Tsunami. Honiara: Solomon Islands Government; 2007.Furusawa T, Maki N, Suzuki S. Bacterial contamination of drinking water and nutritional quality of diet in the areas of the western Solomon Islands devastated by the April 2, 2007 earthquake/tsunami. Trop Med Health. 2008;36(2):65-74.United Nations Office for the Coordination of Humanitarian Affairs (OCHA). South Pacific Tsunami - April 2007 OCHA Situation Report No. 1-14. 2007 [updated 2007 April 12; cited 2010 June 15]; Available from: http://www.reliefweb.int/rw/RWB.NSF/db900SID/SHES-727MMM?OpenDocument.ReliefWeb. Solomon Islands tsunami-earthquake emergency programme: External situation report - 23 Apr 2007. 2007 [updated 2007 Apirl 23; cited 2010 June 15]. http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-72MC5K?OpenDocumentKastom Gaden Association. Western and Choiseul Province Earthquake and Tsunami Disaster: Rapid Assessment of Agriculture and Food Security. Kastom Gaden Association, Honiara; 2007 [updated 2007 April; cited 2010 June 15].http://www.acfid.asn.au/news-media/docs_news-items/ag-assesment-final.pdfWeiner JS, Lourie JA. Practical Human Biology. London: Academic Press; 1981.John WG. Haemoglobin A1c: analysis and standardisation. Clin Chem Lab Med. 2003 Sep;41(9):1199-212.American Diabetes Association. Living with diabetes. 2010 [cited 2010 June 15]. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/American Diabetes Association. Executive summary: standards of medical care in diabetes - 2009. Diabetes Care. 2009 Jan;32(Suppl 1):S6-12.McDade TW, Leonard WR, Burhop J, et al. Predictors of C-reactive protein in Tsimane' 2 to 15 year-olds in lowland Bolivia. Am J Phys Anthropol. 2005 Dec;128(4):906-13.McDade TW. Life history theory and the immune system: steps toward a human ecological immunology. Am J Phys Anthropol. 2003;122(Suppl 37):100-25.World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. World Health Organ Tech Rep Ser. 2000;894:1-253.Natsuhara K, Inaoka T, Umezaki M, et al. Cardiovascular risk factors of migrants in Port Moresby from the highlands and island villages, Papua New Guinea. Am J Hum Biol . 2000;12(5):655-64.Misch KA. Ischaemic heart disease in urbanized Papua New Guinea: An autopsy study. Cardiology. 1988;75(1):71-5.Parry J. Pacific islanders pay heavy price for abandoning traditional diet. Bull World Health Organ. 2010;88:484-5.Aswani S, Albert S, Sabetian A, Furusawa T. Customary management as precautionary and adaptive principles for protecting coral reefs in Oceania. Coral Reefs. 2007;26(4):1009-21.Furusawa T, Naka I, Yamauchi T, et al. The Q223R polymorphism in LEPR is associated with obesity in Pacific Islanders. Hum Genet. 2010;127(3):287-94.Schooneveldt M, Songer T, Zimmet P, Thoma K. Changing mortality patterns in Nauruans: an example of epidemiological transition. J Epidemiol Community Health. 1988 Mar;42(1):89-95.Aghababian RV, Teuscher J. Infectious diseases following major disasters. Ann Emerg Med. 1992 Apr;21(4):362-7.Binder S, Sanderson LM. The role of the epidemiologist in natural disasters. Ann Emerg Med. 1987 Sep;16(9):1081-4.Kumari R, Joshi PL, Lal S, Shah W. Management of malaria threat following tsunami in Andaman & Nicobar Islands, India and impact of altered environment created by tsunami on malaria situation of the islands. Acta Trop. 2009 Nov;112(2):204-11.Krishnamoorthy K, Jambulingam P, Natarajan R, et al. Altered environment and risk of malaria outbreak in South Andaman, Andaman & Nicobar Islands, India affected by tsunami disaster. Malar J. 2005;4:32.Zimmet P, Taylor R, Whitehouse S. Prevalence rates of impaired glucose tolerance and diabetes mellitus in various Pacific populations according to the new WHO criteria. Bull World Health Organ. 1982;60(2):279-82.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

In the Solomon Islands, there was little clinical evidence of non-communicable diseases (NCDs) until the 1960s,1 but research conducted in the 1980s revealed that a substantial portion of adults were classified as suffering from obesity, diabetes or hypertension.2 On the other hand, mortality and morbidity by malaria, respiratory infections, diarrhoea and other infectious diseases, which had once been the main causes of deaths, have decreased due to improved hygienic conditions and health services.3,4In 2002, deaths due to communicable, maternal, perinatal and nutritional conditions were 254.8 per 100,000 population, while those due to NCDs were 363.9.5 Thus, although people are still under the double burden of both types of etiological diseases, the epidemiological transition has already been shifted toward higher prevalence of NCDs.On 2 April 2007, at 7:40 local time, a massive earthquake (Richter magnitude 8.1), the epicentre of which was 10 km deep and 45 km south-southeast of Gizo (the provincial capital of the Western Province), struck the country (Figure 1).6,7This earthquake and the related tsunami and landslides killed 52 people, wrecked 3150 houses and left behind an affected population of 24,059 in the Western and Choiseul Provinces.8 The greatest damage was inflicted upon the residents of the town and neighbouring semi-urban villages in Gizo Island, followed by coastal fishermen and horticulturalists on several small islands.In the devastated areas, people took refuge on mountain ridges, since houses and infrastructure, including water supply, hygiene and subsistence tools (e.g. fishing canoes and agricultural tools) were severely affected.9National, international and non-governmental efforts delivered relief goods and sufficient food, and tried to control disease incidences.8,10-12 While these efforts were successful in avoiding severe outbreaks of infectious diseases and shortage of food and drinking water, disease risks and dietary shortage remained an issue at the local level.In addition, during this time, the population experienced a lifestyle change; some of the residents became increasingly dependent on imported foods and cash economy because subsistence economy and local food production were interrupted. Therefore, this disaster could potentially be related to risks of communicable and nutritional conditions as well as NCDs. Figure 1. Locations of epicentre and study villages in the Western Province, Solomon Islands This study aimed to explore the type of health and nutritional problems that were likely to be prevalent during the recovery process from the 2007 earthquake in the Solomon Islands. Special attention was paid upon the effects of levels of damages, recovery and urbanisation. The research was conducted 2 years after the disaster. This time period was ideal to assess medium-term influences, since the adverse effects of the initial phase are usually treated by emergency relief operations. The effects remaining after withdrawal of intensive operations were little studied. A greater understanding of these effects is necessary for implementing or assessing long-term recovery action plans at the grass-root level. Methods Study areaOut of 53 deaths caused by the disaster, 33, including at least 29 Micronesians, occurred on Gizo Island, followed by 11 on Simbo. This study was conducted in August 2009 in the following four villages (Figure 1; Table 1) in the Western Province. Titiana village, where almost all houses were lost in the tsunami and all residents had evacuated to the top of a hill and built a camp; both original settlement and the camp were located at walking distances from the centre of the Gizo town (approximately 45 minutes on foot). During the study period, a portion of households had returned to the original settlement, but the majority was still living in the camp. Tapurai village, in the remote Simbo Island, had also been totally destroyed by the tsunami. All residents, except only for a couple of households, were living in a new settlement in Rupe, where subsistence gardens were located before the disaster. Mondo village in Ranongga Island had lost about half of the settlement due to landslides. The majority of the residents moved into an inner mountainous area and built a new settlement called Keigolo. Although this village was geographically remote from the town, the lifestyle was manifestly more modern than Tapurai, since it had been one of the biggest villages in the island before the disaster, and even after the disaster, it had received overseas aids for setting-up a clinic and rebuilding hygienic infrastructure. Olive village in New Georgia Island was affected by the quake but the sea level increased only slightly and did not change the settlement. Table 1 Characteristics of the study villages Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive Island Gizo Simbo Ranongga New Georgia Major effects Tsunami Tsunami Land slides Sea level rise Damage Severe Severe Severe Minimum Population 366 7 234 7 341 7 365a No. of deaths (% population) 13 (3.6%) 7 7 (3.0%) 7 2 (0.6%) 7 0 (0%)a Recovery stage Majority still live in campsite on a hill near the Gizo town* Building a new settlement without new infrastructure* Building a new settlement with new hygiene equipments in inner mountain* Same* Distance to the nearest town 1 km 38 km 34 km 32 km No. of participants (% Female) Infants (<5 years) Children (5-17 years) Adult (18-49 years) Elders (\u226550 years) Total 49 (44.9%) 81 (51.9%) 63 (77.8%) 17 (52.9%) 210 (58.1%) 21 (33.3%) 34 (58.8%) 53 (52.8%) 15 (60.0%) 123 (52.0%) 23 (39.1%) 52 (57.7%) 36 (77.8%) 24 (33.3%) 135 (55.6%) 27 (37.0%) 60 (40.0%) 36 (66.7%) 23 (52.2%) 146 (48.0%) No. of participating households 61 34 30 35 aSource: The authors\u2019 field observations; *At August 2009. We therefore assumed that Titiana represented a village severely damaged and located near the town, Tapurai represented a severely damaged remote village, Mondo represented a severely damaged, medium urban village and Olive represented a control village. It should be noted that almost all residents in Titiana were Micronesians who had migrated from the Gilbert Islands in 1960s,2 while those in the remaining three villages were indigenous Melanesians. Participants and interview surveyIn each village, all residents were invited to participate in the study; measurements were made for three days in Titiana and two days in Tapurai, Mondo and Olive. All participants who, based on their free will, agreed and provided informed consent were included in the study; the consent was obtained from a parent or a legal guardian in case of children less than 18 years of age. This study has been conducted in full accordance with the ethical principles of the World Medical Association Declaration of Helsinki (as amended by the 59th General Assembly in Seoul, 2008) and was approved by the University of Tokyo Ethics Committee, Japan, and the Solomon Islands National Health Research Ethics Committee. Every participant, or a parent or legal guardian in case of children, was asked to report the date of birth, settlement place and housing type; birth records were referred to in case of children to calculate their exact age in months. Every adult was asked to report on his\/her lifestyle by replying yes or no in the questionnaire. Health check-upsBody height was measured to the nearest 1 mm using a field anthropometer (TTM, Japan) and weight was recorded to the nearest 0.1 kg using a portable digital scale (Tanita model HD-654, Japan) according to a standard protocol.13 Height was measured only for participants of 5 years of age or older. Blood pressure of participants aged 18 years or older was measured using a blood pressure monitor (HEM-7051-HP, Omron, Japan); readings were obtained twice for every participant and averaged. For malaria active case detection, thick and thin blood films were collected by the finger prick method. All slides were taken to the Malaria Department of the National Gizo Hospital to be examined under a microscope; each slide was checked by at least two technicians. Malaria detection was also made with a rapid detection test using the ICT Malaria Combo Cassette Test (ICT Diagnostics, South Africa) on site. The blood obtained from the finger prick method was also used to measure haemoglobin A1c (HbA1c) and C-reactive protein (CRP) using NycoCard HbA1c (Axis Shield, Norway) and NycoCard CRP tests, respectively, and read using a NycoCard Reader II on site. HbA1c is a glycated haemoglobin that reflects plasma glucose concentration over the past two to three months and is an indicator of diabetes mellitus.14-16 CRP is a component of acute innate immunity that increases in concentration in response to a range of pathogenic agents and inflammation.17,18 Statistical analysesThe health indicators measured in this study were conceptually classified into (i) communicable and nutritional conditions and (ii) NCDs. Indicators for communicable and nutritional conditions included malaria infection (positive or negative), adult malnutrition (BMI < 18.5 kg\/m2), adult and child infection status (CRP \u2265 1.0 mg\/dL),18 child stunting (height-for-age z-score (HAZ) < \u22122), child underweight (weight-for-age z-score (WAZ) < \u22122) and child malnutrition (BMI-for-age z-score (BMIZ) < \u22122). Those for NCDs included adult overweight (BMI \u2265 25 kg\/m2), obesity (BMI \u2265 30 kg\/m2),19 hypertension (SBP \u2265 140 mmHg and\/or DBP \u2265 90 mmHg) and diabetes (HbA1c \u2265 6.5%).16 Standardisation of measures (i.e. z-score calculation) for children was performed based on the CDC\/WHO 1978 growth curves recommended by the WHO using Epi Info version 3.5 software (Centers for Disease Control and Prevention, Atlanta, USA). Associations between the villages and the health or life level indicators were tested using Fisher\u2019s exact test. Multiple logistic regression analyses were performed to detect the effects of villages, individual-level settlement and housing styles, age and gender on the health indicators; settlement was treated as an environmental factor, while ownership and style of housing as factors of socioeconomic status. In this study, a P value of less than 0.05 was considered to be statistically significant. All statistical analyses were performed using SAS 9.2 (SAS Institute, Cary, USA). Results Almost all participants from Tapurai and Mondo villages lived in settlements that were established after the disaster (Table 2); the majority of Titiana participants lived in a camp, but the remaining had returned to the old settlement. As opposed to 16.4% of participants from Titiana, only 6.7% and 2.9% of participants from Tapurai and Mondo, respectively, still lived in tents or temporary houses. Regarding subsistence activities, almost all households were engaged in horticulture (making traditional gardens) in Tapurai, Mondo and Olive villages compared to only 75.4% of the peri-urban Titiana village households. The proportion of Mondo households engaged in fishing was as low as that of households in the urban Titiana. The proportion of households having a running business and employment or remittance for cash income was high in Titiana and Olive. Table 2. Socioeconomic status of the participant households Village Titiana Tapurai (Rupe) Mondo (Keigolo) Olive No. of participating households 61 (100%) 34 (100%) 30 (100%) 35 (100%) Settlement style Living in old settlement Living in temporary camp site Living in new settlement 21 (34.4%) 40 (65.6%) - 1 (2.9%) - 33 (97.1%) 2 (6.7%) - 28 (93.3%) 100 (100%) - - House ownership Living in own house Living in a relative\/friend\u2019s house 59 (96.7%) 2 (3.3%) 29 (85.3%) 5 (14.7%) 26 (86.7%) 4 (13.3%) 34 (97.1%) 1 (2.9%) Housing style Tent\/temporary house Leaf house\/Western house 10 (16.4%) 51 (83.6%) 0 (0%) 34 (100%) 2 (6.7%) 28 (93.3%) 1 (2.9%) 34 (97.1%)

Summary

Abstract

Aim

The major causes of mortality and morbidity have changed from infectious diseases and malnutrition conditions to non-communicable diseases (NCDs) in Melanesian societies. However, a massive earthquake and its related changes might have disturbed the patterns. This study aimed to explore which health problems were likely to be prevalent during the recovery process from the 2 April 2007 earthquake in the Solomon Islands.

Method

Participants were recruited in Titiana, a severely damaged village located near a town; Tapurai, a severely damaged remote village; Mondo, a severely damaged, medium urban village; and Olive, a control village. Health indicators measured were classified into communicable and nutritional conditions (malaria, malnutrition, infection status and child growth) and NCDs (overweight/obesity, hypertension and diabetes).

Results

Titiana residents were more at risk of infectious conditions (C-reactive protein 2265 1 mg/dL) and obesity (BMI 2265 30 kg/m2). Tapurai and Mondo residents were at risks of infectious conditions and becoming overweight (BMI 2265 25 kg/m2), respectively. Titiana and Mondo residents complained about insufficient subsistence production.

Conclusion

The urban communities were found to be at risks of both communicable and NCDs. Controlling the urbanisation as well as providing continuous support against infectious conditions during the recovery process would be beneficial.

Author Information

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Kyoto, Japan; Hana Furusawa, Assistant Professor, Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Ricky Eddie, Chief Laboratory Officer, Gizo Hospital, Gizo, The Solomon Islands; Makiva Tuni, Deputy Director, Department of Health Promotion, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Freda Pitakaka, Chief Research Officer, National Health Training and Research Institute, Ministry of Health and Medical Services, Honiara, The Solomon Islands; Shankar Aswani, Associate Professor, Department of Anthropology, University of California, Santa Barbara, California, USA

Acknowledgements

The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan (KAKENHI Grant-in-Aid) and United States National Science Foundation (NSF) financially supported this study. We are also grateful to the staff members of the Ministry of Health and Medical Services of the Solomon Islands, in particular Ms Josephine Watoto and Ms Connie Panisi. Lastly our sincere thanks to all the people of the villages studied

Correspondence

Takuro Furusawa, Associate Professor, Graduate School of Asian and African Area Studies, Kyoto University, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan. Fax: +81 (0)75 7537834 and Shankar Aswani , Associate Professor, Department of Anthropology, University of California, Santa Barbara, CA 93106-3210, USA

Correspondence Email

furusawa@asafas.kyoto-u.ac.jp and aswani@anth.ucsb.edu

Competing Interests

None.

Page L, Damon A, Moellering RC. Antecedents of Cardiovascular Disease in Six Solomon Islands Societies. Circulation. 1974;49(6):1132-46.Eason RJ, Pada J, Wallace R, et al. Changing patterns of hypertension, diabetes, obesity and diet among Melanesians and Micronesians in the Solomon Islands. Med J Aust. 1987;146(9):465-73.Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81(3):197-204.Tanner M, de Savigny D. Malaria eradication back on the table. Bull World Health Organ. 2008 Feb;86(2):82.World Health Organization (WHO). Mortality and burden of disease estimates for WHO member states in 2002. Geneva: World Health Organization; 2002 [updated 2004 December; cited 2010 June 15]; Available from: http://www.who.int/healthinfo/global_burden_disease/en/index.html.United States Geological Survey (USGS). Magnitude 8.1 - Solomon Islands 2007 April 01 20:39:56 UTC. [updated 2007 April; cited 2010 June 15]. http://earthquake.usgs.gov/earthquakes/eqinthenews/2007/us2007aqbk/McAdoo B, Moore A, Baumwoll J. Indigenous knowledge and the near field population response during the 2007 Solomon Islands tsunami. Nat Hazards. 2009;48(1):73-82.Solomon Islands Government. Recovery Action Plan: Western and Choiseul Provinces Earthquake and Tsunami. Honiara: Solomon Islands Government; 2007.Furusawa T, Maki N, Suzuki S. Bacterial contamination of drinking water and nutritional quality of diet in the areas of the western Solomon Islands devastated by the April 2, 2007 earthquake/tsunami. Trop Med Health. 2008;36(2):65-74.United Nations Office for the Coordination of Humanitarian Affairs (OCHA). South Pacific Tsunami - April 2007 OCHA Situation Report No. 1-14. 2007 [updated 2007 April 12; cited 2010 June 15]; Available from: http://www.reliefweb.int/rw/RWB.NSF/db900SID/SHES-727MMM?OpenDocument.ReliefWeb. Solomon Islands tsunami-earthquake emergency programme: External situation report - 23 Apr 2007. 2007 [updated 2007 Apirl 23; cited 2010 June 15]. http://www.reliefweb.int/rw/RWB.NSF/db900SID/LSGZ-72MC5K?OpenDocumentKastom Gaden Association. Western and Choiseul Province Earthquake and Tsunami Disaster: Rapid Assessment of Agriculture and Food Security. Kastom Gaden Association, Honiara; 2007 [updated 2007 April; cited 2010 June 15].http://www.acfid.asn.au/news-media/docs_news-items/ag-assesment-final.pdfWeiner JS, Lourie JA. Practical Human Biology. London: Academic Press; 1981.John WG. Haemoglobin A1c: analysis and standardisation. Clin Chem Lab Med. 2003 Sep;41(9):1199-212.American Diabetes Association. Living with diabetes. 2010 [cited 2010 June 15]. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/American Diabetes Association. Executive summary: standards of medical care in diabetes - 2009. Diabetes Care. 2009 Jan;32(Suppl 1):S6-12.McDade TW, Leonard WR, Burhop J, et al. Predictors of C-reactive protein in Tsimane' 2 to 15 year-olds in lowland Bolivia. Am J Phys Anthropol. 2005 Dec;128(4):906-13.McDade TW. Life history theory and the immune system: steps toward a human ecological immunology. Am J Phys Anthropol. 2003;122(Suppl 37):100-25.World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. World Health Organ Tech Rep Ser. 2000;894:1-253.Natsuhara K, Inaoka T, Umezaki M, et al. Cardiovascular risk factors of migrants in Port Moresby from the highlands and island villages, Papua New Guinea. Am J Hum Biol . 2000;12(5):655-64.Misch KA. Ischaemic heart disease in urbanized Papua New Guinea: An autopsy study. Cardiology. 1988;75(1):71-5.Parry J. Pacific islanders pay heavy price for abandoning traditional diet. Bull World Health Organ. 2010;88:484-5.Aswani S, Albert S, Sabetian A, Furusawa T. Customary management as precautionary and adaptive principles for protecting coral reefs in Oceania. Coral Reefs. 2007;26(4):1009-21.Furusawa T, Naka I, Yamauchi T, et al. The Q223R polymorphism in LEPR is associated with obesity in Pacific Islanders. Hum Genet. 2010;127(3):287-94.Schooneveldt M, Songer T, Zimmet P, Thoma K. Changing mortality patterns in Nauruans: an example of epidemiological transition. J Epidemiol Community Health. 1988 Mar;42(1):89-95.Aghababian RV, Teuscher J. Infectious diseases following major disasters. Ann Emerg Med. 1992 Apr;21(4):362-7.Binder S, Sanderson LM. The role of the epidemiologist in natural disasters. Ann Emerg Med. 1987 Sep;16(9):1081-4.Kumari R, Joshi PL, Lal S, Shah W. Management of malaria threat following tsunami in Andaman & Nicobar Islands, India and impact of altered environment created by tsunami on malaria situation of the islands. Acta Trop. 2009 Nov;112(2):204-11.Krishnamoorthy K, Jambulingam P, Natarajan R, et al. Altered environment and risk of malaria outbreak in South Andaman, Andaman & Nicobar Islands, India affected by tsunami disaster. Malar J. 2005;4:32.Zimmet P, Taylor R, Whitehouse S. Prevalence rates of impaired glucose tolerance and diabetes mellitus in various Pacific populations according to the new WHO criteria. Bull World Health Organ. 1982;60(2):279-82.

Contact diana@nzma.org.nz
for the PDF of this article

Subscriber Content

The full contents of this pages only available to subscribers.

LOGINSUBSCRIBE