Kiribati - Combating malnutrition

Combating malnutrition

Humanitarian Services of the Church of Jesus Christ of Latter-Day Saints

"I am humbled by my opportunity to serve in BOTFL. It allowed me to think through complicated issues that face the world, and provided a clear example of the importance of fieldwork when addressing a problem. Additionally, it taught me to never underestimate what a small group can achieve, and opened my eyes to the possibilities of business as a force for good in the frontier." 

Bill Brunner, NDMBA '17


Comprised of 33 atolls in the middle of the Pacific Ocean, Kiribati is home to 107,000 people, half living on the capital island of Tarawa. The atolls are situated close to the equator spanning all four hemispheres.  Temperatures rarely stray outside of 80° F. Isolation, poverty, and threats associated with climate change and rising sea levels are the key challenges facing i-kiribati (the name for Kiribati citizens). The tragedy of malnutrition is the leading cause of death for under 5 year old children in Kiribati. 

What was the problem?

With malnutrition accounting for about 11% of 47-75 deaths per 1,000 live births (UNICEF, 2013), the World Health Organization (WHO) classifies malnutrition in Kiribati as a significant public health concern. The country has a very young population, over 50% under the age of 25.  Given its effects on cognitive and physical development, malnutrition poses a risk to future economic and social development. Partnering with the Humanitarian Services of the Church of Latter Day Saints, our objective was to develop innovative and pragmatic approaches to reduce child malnutrition. This was certainly a daunting task given complicating factors such as remoteness of Kiribati, its dependence on imported foods, especially subsidized rice, the overpopulation in Tarawa, poor sanitation practices, and a general lack of awareness on why healthy food consumption contributes to improved quality of life. 

What did we do?

Prior to our time in country, we thought the main issues were children were not getting the right nutrients in the first 1000 days.  Drivers of early malnutrition could be poor feeding practices, poor soil in Tarawa, which could not support the growth of vegetables, lack of accessibility to clean drinking water and poor sanitation.  Based on our research, we planned to evaluate ways to improve agricultural yields in the outer islands, and provide Ready to Use Therapeutic Foods for infants.  Further, Kiribati’s most plentiful natural resource was tuna, so perhaps a more vibrant fishing industry could be established.  
Once on the islands, our partners scheduled meetings with ministers, NGOs working in the agricultural and health sectors, and schools. Across multiple islands, we visited villages, interviewed families, negotiated with market women, talked to business owners, and lived with families - fishing, working, and preparing meals together. 

What was the turning point? 

During our first few days in country, we quickly realized that Kiribati did not lack NGO support. The government had gathered all the NGOs to coordinate programs on health: for example, UNICEF was partnering with the government to provide RUTFs, other organizations were instructing locals on WASH (water, sanitation and hygiene). Further, fishing with the locals, and visiting the airport made us realize the tuna fishing would be a long way off.  The run-way was not long enough to handle cargo planes; the distance to Australia would make sea transport prohibitive expensive. By our second week, though, we came to realize that Kiribati could sustain agriculture. Everything that was required for a balanced diet could grow on the island, specifically on Tarawa. We did not need to go to the outer islands to create commercial farms. The native plants- coconut, taro, pandanus, breadfruit, and other vegetables-cabbage, pumpkin, coupled with fish could provide the necessary nutrients.
So why were i-kiribati not healthier?   Why did malnutrition remain such a tragedy?  A very direct conversation with a UNICEF nurse and malnutrition expert gave us insight into this conundrum: many mothers lacked understanding on why giving healthy food to their children is important for their development.  Our subsequent home visits and interviews with students, market women and diabetic patients confirmed the nurse’s observations.  Many i-kiribati showed a general lack of awareness on why eating vegetables was important to their health. 

What was the recommendation?

We recommended that our LDS partner invest in three areas- agriculture, awareness, and execution. LDS owns a prized, unused plot of land in Tarawa.  We recommended that LDS partner closely with Taiwan Agricultural Technical Mission to develop a learning garden, where families can be taught best farming practices adapted to the Kiribati soil, introducing new agricultural technologies and the use of organic liquid fertilizer to improve yields. In addition to gardening lessons, we recommended that LDS host cooking lessons, with the help of dieticians, to teach families how to best incorporate the vegetables into the local diets. 
Regarding increasing awareness, we recommended that LDS host competitions in schools and communities to write jingles explaining the reasoning behind healthy living, which would air on the local radio (the main source of communication). Children learn a great deal from radio broadcasts. We also recommended that LDS leverage Facebook to post educational campaigns. 
Finally, given the rather slow governmental bureaucracy on the island, we recommended that LDS execute a pilot nutrition program through one of its greatest assets- the best high school in the country. This program would leverage the lunch lady model, which exists in all Kiribati schools, to ensure that the food sold on the school grounds contained the necessary balance of vegetables, protein and rice or noodles. This could serve as a model for other schools to adopt across the Pacific. 

What actually happened?

Our partner took each of the recommendation to heart and even suggested our team present them to to LDS Humanitarian Program leaders in Salt Lake City. The partner is currently developing plans to implement the learning garden and nutrition program in the high school.