Objectives & approach
Non-communicable diseases, especially diabetes and cardiovascular disease, have emerged as the leading causes of morbidity and mortality in the Marshall Islands. The national prevalence of diabetes is estimated at 21,49% by the International Diabetes Federation (Global Diabetes Atlas 5th edition). Nutritional transition has been very fast on the Islands and has resulted in widespread unhealthy lifestyle; this combined with a profound lack of knowledge among the general population and health care professionals about the consequences is the main driver for the rise in the burden of non-communicable diseases.
Diabetes is managed centrally at a small island hospital in the capital city Majuro (the legislative district of the Marshall Islands) which makes access to care limited. The widespread unhealthy lifestyle in combination with a lack of access to care indicates an urgent need to intervene when people are still young and more amenable to behaviour change rather than solely focus on curative services.
The aim of the project is to improve general health and address diabetes prevention through health promotion and healthy living in the Majuro and Ebeye islands of the Marshall Islands by educating school children and their parents with the hope to reduce the incidence of type 2 diabetes in the future.
The project is a collaboration between the Diabetes Wellness Center, the Ministry of Education (MoE) and the Ministry of Health (MoH).
The project is aimed at primary prevention through dietary and lifestyle changes and awareness-raising. The project seeks to integrate physical activity and healthy diet into the daily routines of school children and their parents.
Initially a new school health curriculum will be implemented and permanently integrated into the national curriculum in elementary and middle schools on the main islands of Majuro and Ebeye. Subsequently, the curriculum will be adopted in the remaining schools of the Marshall Islands. As part of the new curriculum children will be taught how to avoid the onset of diabetes and other "lifestyle-related" diseases. The tuition will focus on healthy cooking and diet as well as physical activity. Among other things, cook books will be distributed to the pupils. 85 teachers will receive training on how to apply the new curriculum. The schools will also be assisted in developing culturally appropriate exercise classes.
Healthy Cooking classes will be held with parents at the participating schools. It is anticipated that at least one parent per child will participate. Healthy Cooking classes will also be taught to people with diabetes at the Diabetes Wellness Center and to the general population at different community events.
In collaboration with the MoE and Majuro Middle School, the Diabetes Wellness Center will arrange rallies, school assemblies, physical fitness competitions and several other events. To support the efforts being done at the schools, a nationwide multi-media awareness campaign will be implemented, using posters, newspapers, TV and radio. It is intended to raise awareness of healthy living.
To assess the impact of the project, the teachers will administer a KAP-study to the children before and after the project to assess the impact on the children's level of knowledge, attitudes and practices with regard to healthy lifestyle and the risks of unhealthy living. The Diabetes Wellness Center will in addition measure project impact by assessing BMI and blood sugar levels of the target group at different stages of the project.
• Implementation of a new national school health curriculum
• Teaching materials produced
• 180 teachers instructed on how to use the revised health curriculum
• 2,900 school children between 7-14 years taught revised health curriculum
• 5,000 parents and caregivers reached through tuition activities
• 1,800 cook books with healthy recipies distributed to parents
• Exercise classes conducted for 1,800 children and 300 parents
• Basic information and healthy cooking classes conducted for 240 parents
• 33 radio public service spots produced
• 11 public service TV programmes produced
• 65,000 people on all islands reached through awareness activities
• Diabetes knowledge and behavoiur pre/post test conducted with 2,900 children