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Factors to consider in Micronesian food-based interventions: a case study of preventing vitamin A deficiency

Published online by Cambridge University Press:  02 January 2007

L Englberger*
Affiliation:
Australian Centre for International and Tropical Health and Nutrition, School of Population Health, University of Queensland, Brisbane, Australia PO Box 2299, Kolonia, Pohnpei, 96941, Federated States of Micronesia
GC Marks
Affiliation:
Australian Centre for International and Tropical Health and Nutrition, School of Population Health, University of Queensland, Brisbane, Australia
MH Fitzgerald
Affiliation:
School of Occupation and Leisure Studies, University of Sydney, Sydney, Australia
*
*Corresponding author: Email nutrition@mail.fm
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Abstract

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Background:

Many factors need to be considered in a food-based intervention. Vitamin A deficiency and chronic diseases, such as diabetes, heart disease and cancer, have become serious problems in the Federated States of Micronesia (FSM) following the decreased production and consumption of locally grown foods. However, agricultural and social conditions are still favourable for local food production.

Aim:

To identify key factors to consider in a Micronesian food-based intervention focusing on increased production and consumption of four major Micronesian staple foods: banana, breadfruit, giant swamp taro and pandanus.

Methods:

Ethnographic methods including key informant interviews and a literature review.

Results:

Pacific and Micronesian values, concepts of food and disease, and food classifications differ sharply from Western concepts. There are few FSM professionals with nutrition expertise. Traditional foods and food cultivars vary in nutrient content, consumption level, cost, availability, status, convenience in growing, storing and cooking, and organoleptic factors.

Conclusions:

A systematic consideration of the factors that relate to a food-based intervention is critical to its success. The evaluation of which food and cultivar of that food that might be most effectively promoted is also critical. Regional differences, for example FSM inter-island differences between the staple foods and cultivars, must be considered carefully. The evaluation framework presented here may be relevant to Pacific Island and other countries with similar foods where food-based interventions are being planned. An ethnographic approach was found to be essential in understanding the cultural context and in data collection and analysis.

Type
Research Article
Copyright
Copyright © CAB International 2004

References

1Auerbach, S. Report of Pohnpei Child Health Survey. Findings presented to the Federated States of Micronesia and Pohnpei State Department of Health Services. Palikir, Pohnpei: US Public Health Service and FSM Department of Health Service, 1994.Google Scholar
2Centers for Disease Control and Prevention. Vitamin A deficiency among children – Federated States of Micronesia, 2000. MMWR Morbidity and Mortality Weekly Report 2001; 50(24): 509–12.Google Scholar
3Lloyd-Puryear, M, Humphrey, JH, West, KP, Aniol, K, Mahoney, J, Keenum, DG. Vitamin A deficiency and anemia among Micronesian children. Nutrition Research 1989; 9: 1007–16.CrossRefGoogle Scholar
4Lloyd-Puryear, M, Mahoney, J, Humphrey, JH, Mahoney, F, Siren, N, Moorman, C, et al. Xerophthalmia, vitamin A deficiency in Micronesia: a state-wide survey in Chuuk. Nutrition Research 1991; 11: 1101–10.CrossRefGoogle Scholar
5Auerbach, S. Obesity, Hypertension, and Type II Diabetes Mellitus and the Non-communicable Diseases (NCD) Program in the Federated States of Micronesia. Report of activities carried out for the PHHS MINIGRANT & related activities. Pohnpei: FSM Department of Health, 1999.Google Scholar
6Coyne, T, Badcock, J, Taylor, R. The Effect of Urbanisation and Western Diet on the Health of Pacific Island Populations. SPC Technical Paper No. 186. Noumea, New Caledonia: South Pacific Commission, 1984.Google Scholar
7Coyne, T. Lifestyle Diseases in Pacific Communities. Noumea, New Caledonia: Secretariat of the Pacific Community, 2000.Google Scholar
8Shmulewitz, D, Auerbach, SB, Lehner, T, Blundell, ML, Winick, JD, Youngman, LD et al. Epidemiology and factor analysis of obesity, type II diabetes, hypertension, and dyslipidemia (syndrome X) on the island of Kosrae, Federated States of Micronesia. Human Heredity 2001; 51: 819.CrossRefGoogle ScholarPubMed
9McLaren, DS, Frigg, M. Sight and Life Manual on Vitamin A Deficiency Disorders. (VADD). 2nd ed. Basel, Switzerland: Task Force Sight and Life, 2001.Google Scholar
10Bertram, JS. Lectures presented at the 13th International Symposium on Carotenoids held in Honolulu, Hawaii, USA, 6–11 January 2002. Pure and Applied Chemistry 2002; 74(8): 1369–478.Google Scholar
11Ford, ES, Will, JC, Bowman, BA, Narayan, KM. Diabetes mellitus and serum carotenoids: findings from the Third National Health and Nutrition Examination Survey. American Journal of Epidemiology 1999; 149: 168–76.CrossRefGoogle ScholarPubMed
12Mares-Perlman, JA, Millen, AE, Ficek, TL, Hankinson, SE. The body of evidence to support a protective role for lutein and zeaxanthin in delaying chronic disease. Overview. Journal of Nutrition 2002; 132(3): 518S–24S.CrossRefGoogle ScholarPubMed
13World Cancer Research Fund. Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research, 1997.Google Scholar
14Englberger, L, Marks, GC, Fitzgerald, MH. Insights on food and nutrition in the Federated States of Micronesia: a review of the literature. Public Health Nutrition 2003; 6(1): 517.CrossRefGoogle ScholarPubMed
15Hezel, FX. The New Shape of Old Island Cultures: A Half Century of Social Change in Micronesia. Honolulu, HI: University of Hawaii Press, 2001.Google Scholar
16Raynor, B. Agroforestry Systems in Pohnpei – Practices and Strategies for Development. Pohnpei, Federated States of Micronesia. RAS/86/036 Field Document 4. FAO/UNDP South Pacific Forestry Development Programme, 1991.Google Scholar
17Rody, N. Consumerism in Micronesia. South Pacific Bulletin 1978; 28: 914.Google Scholar
18Englberger, L, Aalbersberg, W, Fitzgerald, MH, Marks, GC, Chand, K. Provitamin A carotenoid content and cultivar differences in edible pandanus fruit Pandanus tectorius. Journal of Food Composition and Analysis 2003; 16(2): 237–47.CrossRefGoogle Scholar
19Englberger, L, Aalbersberg, W, Ravi, P, Bonnin, E, Marks, GC, Fitzgerald, MH, et al. Further analyses on Micronesian banana, taro, breadfruit and other foods for provitamin A carotenoids and minerals. Journal of Food Composition and Analysis 2003; 16(2): 219–36.CrossRefGoogle Scholar
20Englberger, L, Schierle, J, Marks, GC, Fitzgerald, MH. Micronesian banana, taro, and other foods: newly recognized sources of provitamin A and other carotenoids. Journal of Food Composition and Analysis 2003; 16(1): 319.CrossRefGoogle Scholar
21Rodriguez-Amaya, DB. A Guide to Carotenoid Analysis in Foods. Washington, DC: ILSI Press, 1999.Google Scholar
22Englberger, L. A community and laboratory-based assessment of the natural food sources of vitamin A in the Federated States of Micronesia. PhD thesis, University of Queensland, Brisbane, Australia, 2003.Google Scholar
23Kuhnlein, HV, Pelto, GH, eds. Culture, Environment, and Food to Prevent Vitamin A Deficiency. Boston, MA: International Nutrition Foundation for Developing Countries, 1997.Google Scholar
24Blum, L, Pelto, PJ, Pelto, GH, Kuhnlein, HV. Community Assessment of Natural Food Sources of Vitamin A: Guidelines for an Ethnographic Protocol. Ottawa: International Development Research Centre, 1997.Google Scholar
25Fitzgerald, MH. Ethnography. In: Higgs, J, ed. Qualitative Research: Discourse on Methodologies. Sydney: Hampden Press, 1997; 4860.Google Scholar
26Miles, MB, Huberman, AM. Qualitative Data Analysis. 2nd ed. Thousand Oaks, CA: Sage Publications, 1994.Google Scholar
27Booth, SL, Sallis, JF, Ritenbaugh, C, Hill, JO, Birch, LL, Frank, LD, et al. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutrition Reviews 2001; 59(3): S2139.CrossRefGoogle ScholarPubMed
28Economos, CD, Brownson, RC, DeAngelis, MA, Novelli, P, Foerster, SB, Foreman, CT, et al. What lessons have been learned from other attempts to guide social change? Nutrition Reviews 2001; 59(3): S4056.CrossRefGoogle ScholarPubMed
29Green, LW, Kreuter, MW. Health Promotion Planning: An Educational and Environmental Approach, 2nd ed. Mountain View, CA: Mayfield Publishing Company, 1991.Google Scholar
30Iannotti, L, Gillespie, S. Successful Community Nutrition Programming: Lessons from Kenya, Tanzania, and Uganda. Washington, DC: United States Agency for International Development/Academy for Educational Development, 2002.Google Scholar
31Schultz, J. Nutrition education in the Pacific. Present status of noncommunicable disease in the Pacific: what next? In: Proceedings of SPC Regional Nutritionists Workshop, Auckland, New Zealand, 18–20 September 1999. Noumea, New Caledonia: Secretariat of the Pacific Community, 1999; 5660.Google Scholar
32Pollock, NJ. These Roots Remain: Food Habits in Islands of the Central and Eastern Pacific since Western Contact. Laie, HI: The Institute for Polynesian Studies, 1992.Google Scholar
33Finau, SA. Health care in the Pacific: who would bell the cat? Pacific Health Dialog 1994; 1(1): 4455.Google Scholar
34Rody, N. Empowerment as organizational policy in nutrition intervention programs: a case study from the Pacific Islands. Journal of Nutrition Education 1988; 20(3): 133–41.CrossRefGoogle Scholar
35Federated States of Micronesia. A Situation Analysis of Children and Women in the Federated States of Micronesia. Suva, Fiji: UNICEF Pacific, 1996.Google Scholar
36Fitzgerald, MH. Whisper of the Mother: From Menarche to Menopause among Women in Pohnpei. Westport, CT: Greenwood Publishing Group, Inc., 2001.Google Scholar
37Debunce, LA. Cultural changes in horticultural practices on the high island of Kosrae, Micronesia. PhD thesis, University of Oregon, Eugene, OR, 1996.Google Scholar
38Lewis, JL. Kusaiean Acculturation 1824–1948. Division of Land Management, Trust Territory of the Pacific Islands, reprint ed. Saipan, Mariana Islands: Pacific Science Board of the National Research Council, Coordinated Investigation of Micronesian Anthropology, 1967.Google Scholar
39South Pacific Commission. Rethinking Food Guidance in the Pacific: Workshop Report. Noumea, New Caledonia: South Pacific Commission, 1996.Google Scholar
40Barker, C. Review of the Family Food Production and Nutrition Project. Report prepared for the UNICEF Pacific Programme Office, Suva, Fiji, 21 July–30 September 1995. Suva, Fiji: UNICEF Pacific, 1996.Google Scholar
41Schoeffel, P, Bolabola, C, Ngirmidol, C. The UNICEF Family Food Production and Nutrition Project. Evaluation Report. Christchurch, New Zealand: DSIR Social Science, Ilam Research Centre, 1991.Google Scholar
42Thaman, RR. Foods and drinks for the 21st century in Fiji. Fiji Food and Nutrition Newsletter 1999; 24(4): 13.Google Scholar
43Jansen, AAJ. Report on a Field Visit to the Trust Territory of the Pacific Islands 16 February–2 March 1972. WPRO 5601 (TTPI). Manila: WHO Regional Office for the Western Pacific, 1972.Google Scholar
44Crocombe, R. The South Pacific. Suva, Fiji: University of the South Pacific, 2001.Google Scholar
45Demory, BGH. An illusion of surplus: the effect of status rivalry upon family consumption. PhD thesis, University of California, Berkeley, CA, 1976.Google Scholar
46Flear, J. Good intentions: good enough? Observations of the sociocultural aspects of health care delivery in Micronesia. Presented at the Institutes of Medicine Meeting, 18–19 April 1997. Saipan: Commonwealth of the Northern Mariana Islands, 1997.Google Scholar
47Ward, RL. Curing on Ponape: a medical ethnography. PhD thesis, Tulane University, New Orleans, LA, 1977.Google Scholar
48Pretrick, E. Guest editorial. Pacific Health Dialog 1994; 1(1): 45.Google Scholar
49Smitasiri, S, Attig, GA, Dhanamitta, S. Participatory action for nutrition education: social marketing vitamin A-rich foods in Thailand. Ecology of Food and Nutrition 1992; 28: 199210.CrossRefGoogle Scholar
50Malolo, M, Matenga-Smith, T, Hughes, R. The Staples We Eat. Noumea, New Caledonia: Secretariat of the Pacific Community, 1999.Google Scholar
51Tilfas, R, Tolenoa, A. Legends of Kosrae. Tofol, Kosrae: Curriculum Division, Kosrae Education Department, Kosrae State Government, 1993.Google Scholar
52Raynor, B, Lorens, A, Phillip, J. Traditional yam cultivation on Pohnpei, Eastern Caroline Islands, Micronesia. Economic Botany 1992; 46(1): 2533.CrossRefGoogle Scholar
53Bascom, WR. A Pacific Economy in Transition. Volume 22. Berkeley, CA: University of California Press, 1965.Google Scholar
54Malolo, M. Nutrition training: needs and priorities in the Pacific. Pacific Health Dialog 1997; 4(1): 166–71.Google Scholar
55Finau, SA, Finau, E, ‘Ofanoa, M. Research imperialism in Pacific health: the case of Tonga (1966–1977). Pacific Health Dialog 2000; 7(2): 109–14.Google Scholar
56Elymore, J, Elymore, A, Badcock, J, Bach, F, Terrell-Perica, S. The 1987/88 National Nutrition Survey of the Federated States of Micronesia. Technical report prepared for the Government and Department of Human Resources of the FSM. Noumea, New Caledonia: South Pacific Commission, 1989.Google Scholar
57Van der Haar, F. Vitamin A deficiency in Micronesia. Sight and Life Newsletter 2002; 3: 67–8.Google Scholar
58Englberger, L. Promotion of vitamin A-rich foods in Pohnpei, Federated States of Micronesia: was the 1999 campaign a success? Sight and Life Newsletter 2002; 2: 2832.Google Scholar
59Booth, SL, Johns, T, Kuhnlein, HV. Natural food sources of vitamin A and provitamin A. Food and Nutrition Bulletin 1992; 14(1): 619.CrossRefGoogle Scholar
60De Pee, S, Bloem, MW, Satoto, , Yip, R, Sukaton, A, Tjiong, R, et al. Impact of a social marketing campaign promoting dark-green leafy vegetables and eggs in central Java, Indonesia. International Journal for Vitamin and Nutrition Research 1998; 68(6): 389–98.Google ScholarPubMed
61Persson, V, Greiner, T, Bhagwat, IP, Gebre-Medhin, M. The Helen Keller International food frequency method may underestimate vitamin A intake where milk is a normal part of the young child diet. Ecology of Food and Nutrition 1999; 38: 5769.CrossRefGoogle Scholar
62Underwood, B. Dietary approaches to the control of vitamin A deficiency: an introduction and overview. Food and Nutrition Bulletin 2000; 21(2): 117–23.CrossRefGoogle Scholar