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At least 19 recordsLinked to original sources
PubMed2005

Sexual health behaviours among Pacific Island youth in Vanuatu, Tonga and the Federated States of Micronesia.

ISSUES ADDRESSED: This study was conducted to describe the sexual risk behaviours of youth within the Pacific Island nations of Vanuatu, Tonga and the Federated States of Micronesia. METHODS: General health behaviour surveys were conducted with youth aged 15-19 years and not attending school in the three countries. A sample of 390 Ni-Vanuatu youth from the Shefa Province, 934 youth from three island provinces of Tonga and 92 youth from Pohnpei, the main island of the four island states of the Federated States of Micronesia, were interviewed in gender-specific groups. Questions were asked about sexual behaviours that may contribute to unintended pregnancy or sexually transmitted infections (STIs). RESULTS: Moderate to high percentages of youth were sexually active (had a least one sexual partner) in the Pacific island nations of Vanuatu (49.7%), Tonga (35.5%) and the Federated States of Micronesia (76.1%). Young men were more likely to engage in sexually risky behaviour than young women. They were more likely to be sexually active, have had multiple sexual partners and have had sex when drunk or high. Of those sexually active, more young men than women in Vanuatu (36.1% compared with 30.6%) and Micronesia (54.2% compared with 50%) never used protection against STIs. However, of the sexually active Tongan youth, the proportion of females (61.1%) who reported never using protection against STIs was nearly double the proportion reported by Tongan males (32.2%). CONCLUSION: A high percentage of young people not attending school in the Pacific island nations of Vanuatu, Tonga and the Federated States of Micronesia are at risk of unintended pregnancy and STIs, including HIV, because of patterns of sexual risk behaviour.

Adolescent↗
PubMed2005

Sexually transmitted diseases and HIV/AIDS in Vanuatu: a cause for concern and action.

AIMS: This article argues that sexually transmitted infections (STIs) and HIV/AIDS in Vanuatu are a cause for concern and that a strong response is needed to stem an epidemic. METHODS: Three sources of data are used: studies and policy documents on STIs and HIV/AIDS in Vanuatu; analysis of reported STI cases from public health facilities; and key informant interviews with 14 policy stakeholders. RESULTS: In Port Vila (capital of Vanuatu), more than a quarter of the women attending antenatal clinics were positive for at least one STI. Although Vanuatu Ministry of Health (MoH) case records for gonorrhoea, genital ulceration, and syphilis show national prevalence rates have remained relatively constant between 1.2% and 2%, there is probably gross under-reporting because MoH data exclude trichomoniasis and chlamydiasis cases; surveillance systems are poor; and patient access to services is limited. High STI prevalence and several socioeconomic factors create a high-risk environment for the rapid spread of HIV/AIDS. DISCUSSION: The need for a strategic response in Vanuatu is pressing. Priorities for action include the scaling up of awareness programmes for young people, particularly girls, and the development of surveillance systems. Government capacity weaknesses mean the MoH should explore possible partnerships with the non-government organisation (NGO) sector and point to the need for international support to implement a new government Strategic Plan.

Adolescent↗
PubMedDate not supplied

Perinatal mortality 1982-2001 at Vila Central Hospital, Vanuatu.

OBJECTIVE: To determine the perinatal mortality at Vila Central Hospital (VCH) and thereby make an estimate of Vanuatu's perinatal mortality. METHODS: Labour floor and nursery records from VCH, Vanuatu's only tertiary referral hospital, were examined and collated for the period 1982-2001. Death certificate books were also examined. The perinatal mortality rate was calculated as the sum of stillbirths (infants = 20 weeks and/or = 500 g) and neonatal mortality (deaths <28 days). Premature infants were recorded for infants less than 37 weeks gestation and small-for-gestational-age for infants less than 2500 g. RESULTS: The mean perinatal mortality rate for the period was 27/1000, (range 15-36/1000). The mean stillbirth rate was 15/1000, (range 8-22/1000). The neonatal mortality was 12/1000, (range 4-18/1000). Premature babies accounted for 37/1000 births, (range 11-80/1000). Small-for-gestational-age infants were recorded in 45/1000 births, (range 16-83/1000). The mean twinning rate was 12/1000. Seven spontaneous triplets, two quadruplets and two pairs of siamese twins were born. Sepsis, meconium aspiration and birth asphyxia were the commonest causes of neonatal death. CONCLUSION: Accurate data collection is difficult in Vanuatu. There is the risk of under-ascertainment however, the figure of 27/1000 represents the current best possible estimate of perinatal mortality at VCH over the last 20 years. VCH is Vanuatu's premier hospital and it is likely that the national figure for perinatal mortality is higher, probably in the range of 37-39/1000. This places Vanuatu's perinatal mortality at a level 30 years or more behind Australia. These figures represent the largest account of hospital based perinatal data collected from any Pacific island nation.

Australia↗
PubMed1991

Prevalence of diabetes, hypertension and obesity at different levels of urbanisation in Vanuatu.

OBJECTIVE: To determine the prevalence of non-communicable disease, specifically hypertension, diabetes and obesity, amongst populations at different levels of urbanisation in Vanuatu, and to relate the frequency of these conditions to the modernisation of way of life. DESIGN: A cross-sectional population-based comparative study of indicative cluster samples. SETTING: Republic of Vanuatu (south-west Pacific). A relatively undeveloped malarious island country. PARTICIPANTS: Adult (aged greater than or equal to 20 years) Melanesian ni-Vanuatu of both sexes. An occupation-based (civil servants) urban sample (n = 623) and area-based semi-rural (n = 349) and rural (n = 397) samples were employed. Response rates were 78%-92%. INTERVENTIONS: Cases detected were referred for assessment and treatment by local medical staff. MAIN OUTCOME MEASURES: Body mass index, triceps skinfold thickness, blood pressure, plasma glucose (fasting and 2 hours after 75 g glucose), plasma cholesterol and triglyceride levels. RESULTS: Modernity scores confirmed that the three locations represented different levels of acculturation. Prevalences of non-communicable disease were relatively low compared to other Pacific Island communities and industrialised countries. These conditions were nevertheless more common in the urban sample and least common in the rural sample. Non-communicable disease correlated positively with modernity scores and negatively with physical activity scores. Obesity correlated with blood pressure in the urban sample, and there was indirect evidence (urine sodium concentration) of higher salt intake with modernisation. Mean plasma cholesterol levels were lowest in the rural group. CONCLUSIONS: Prevalences of non-communicable disease are relatively low in Vanuatu, although rural-urban differentials are present, and likely to increase with continued development. The evidence presented is consistent with non-communicable disease being related to the modernisation of way of life; specifically: decreased exercise, obesity, and dietary change. Preventive activities should commence now.

Adult↗
PubMed1999

High and variable frequencies of CYP2C19 mutations: medical consequences of poor drug metabolism in Vanuatu and other Pacific islands.

Cytochrome P450 (CYP) 2C19 is polymorphic with poor metabolizers representing 3-6% of Europeans and Africans, and 13-23% of Asians. Greater than 99% of the poor metabolizer alleles in Asian populations are defined by two single base pair mutations (CYP2C19*2 and CYP2C19*3). We have recently reported an unprecedentedly high prevalence (71%) of CYP2C19-related poor metabolizer genotype individuals and poor metabolism of proguanil on two malarious islands of Vanuatu in eastern Melanesia. To elucidate this further, a total of 5538 individuals from 24 populations on 16 different islands of Vanuatu were genotyped. Of these, 61% had a poor metabolizer genotype (*2/*2, *2/*3 or *3/*3) with substantial variation among the populations (38-79%). The overall frequencies of CYP2C19*1 (wild-type), CYP2C19*2, and CYP2C19*3 were 0.223, 0.633, and 0.144, respectively. A significant linear correlation was observed between heterozygosity and South latitude (r = 0.552, P < 0.05). The genotype frequencies of 21 of the 24 populations were consistent with Hardy-Weinberg expectations (P > 0.05). Comparisons of genetic, linguistic and geographical patterns among populations suggest that short range gene flow is largely responsible for the current distribution of CYP2C19 alleles in Vanuatu. Taken together with previous studies of nuclear genetic loci of Pacific island populations, these data predict that the poor metabolizer genotype is common throughout Polynesia and Micronesia and may be even more prevalent in western Melanesia than in Vanuatu. This suggests that the majority of Pacific Islanders metabolize a wide variety of clinically important drugs to a significantly lower degree than the average European.

Antimalarials↗
PubMed2000

The effectiveness of the infant hepatitis B immunisation program in Fiji, Kiribati, Tonga and Vanuatu.

The aims of this project were: (1) to determine the extent to which infant hepatitis B immunisation is preventing chronic hepatitis B infection in children living in a sample of Pacific Island countries; and (2) to identify factors associated with the successful prevention of hepatitis B infection in these populations. A regional hepatitis B immunisation project which supplied hepatitis B vaccine to 10 Pacific Island countries began in 1995. Seroepidemiological surveys were conducted in Fiji, Kiribati, Tonga and Vanuatu in early 1998. These included immunised pre-school children and their biological mothers, and a historical control group of unimmunised students. Prevalence rates for hepatitis B surface antigen (HBsAg) in the populations of students, mothers and their pre-school children were respectively: Fiji: 6.9, 6.6, 0.7%; Kiribati: 27.4, 15.1, 3.8%; Tonga: 11.1, 18.6, 3.8%; Vanuatu: 16.3, 12.3, 3.0%; and for all four countries: 13.2, 12.5, 2.6%. Compared to the historical control group of students, the pre-school population had a much lower probability of HBsAg positivity (relative risk [RR]=0.19 [95%CI: 0.12-0.31]). Statistically significant differences in risk were apparent for all the countries: Fiji: RR=0.10; Kiribati: RR=0.14; Tonga: RR=0.34; Vanuatu: RR=0.19. This is equivalent to an overall program effectiveness of 81% (95%CI: 69-88%) in reducing chronic carriage. Also, the overall protective effectiveness against vertical hepatitis B transmission resulting in HBsAg positivity among children exposed to HBeAg positive and negative carrier mothers, was estimated to be 70%. By age 6 months, when all children should have had three vaccine doses, completed immunisation rates ranged from 22 (Fiji) to 84% (Vanuatu). Coverage of the first dose being given within 2 days of birth varied from 43% in Kiribati to 92% in Tonga. In conclusion hepatitis B immunisation of infants in these four countries is having a substantial beneficial effect in preventing chronic hepatitis B infection. Nevertheless, there is significant scope for further improving the timeliness of immunisation.

Adolescent↗
PubMed2005

Associations between frequencies of a susceptible TNF-alpha promoter allele and protective alpha-thalassaemias and malaria parasite incidence in Vanuatu.

Tumour necrosis factor-alpha (TNF-alpha) is one of the key cytokines that influence the pathology of microbial infections. The genetic susceptibility to severe forms of falciparum malaria is differentially associated with TNF-alpha promoter gene polymorphisms (TNFP alleles). In a previous study, we identified a TNFP-allele characterized by a C to T transition at position -857 (TNFP-D allele) as a marker for susceptibility to cerebral malaria in Myanmar. The frequencies of TNFP alleles on six islands of Vanuatu, Melanesia (South-west Pacific) were estimated to investigate whether malaria selection pressure on this susceptibility marker has influenced its prevalence. Within the archipelago of Vanuatu there is a decreasing cline of parasite incidence from North to South. Of the four alleles of the TNFP gene detected in Vanuatu, the TNFP-D allele frequencies were inversely correlated with the parasite incidence of islands; TNFP-D varied from 0.55 on the island with the lowest parasite incidence to 0.26 on the island with the highest parasite incidence (r = -0.855, P = 0.03). We also observed a significant correlation between the frequencies of alpha-thalassaemia alleles, thought to protect against malaria and parasite incidence in the same populations. These data are consistent with a previously reported correspondence between the frequencies of glucose 6-phosphate dehydrogenase (G6PD) deficiency and parasite incidences on the islands of Vanuatu (Kaneko et al. 1998) and indicate that the degree of malaria endemicity has influenced the allele frequencies of at least three loci that confer both susceptibility (TNFP-D) and protection (alpha-thalassaemias and G6PD deficiency).

Alleles↗
PubMed2002

Population, public health and tubal ligation in Vanuatu.

The association between population growth and public health is often neglected. Between 1989 and 1999 Vanuatu's population grew by 30%. Unless this growth slows existing public health problems will worsen. To gain insight into family planning habits 111 ni-Vanuatu women undergoing tubal ligation were surveyed. 85% had 4, or more, children. Women resident on the outer islands had more children than those on the island containing the nation's capital. The implication is that ni-Vanuatu women perceive 4 children as desirable. With approximately half the population entering their reproductive years in the next decade this is too many to avoid a population explosion in Vanuatu. Public health campaigns must promote the benefits of a small family. Urgent education and widespread provision of effective family planning is required to avoid a future public health crisis. Aid donors need to be made aware of this as an absolute priority.

Adult↗
PubMed2007

Herpes simplex virus type 2 (HSV-2) infection in women attending an antenatal clinic in the South Pacific island nation of Vanuatu.

OBJECTIVE: The objective of this study was to estimate the prevalence and correlates of herpes simplex virus type 2 infection in women in an antenatal clinic in the South Pacific island nation of Vanuatu. STUDY DESIGN: A prevalence survey of sexually transmitted infections of pregnant women attending an antenatal clinic at Vila Central Hospital was conducted in 1999-2000. Serum samples were tested for HSV-1 and HSV-2 antibodies by enzyme-linked immunosorbent assay. Results for other sexually transmitted infections and demographic and obstetric variables were analyzed for their association with HSV-2 serostatus. RESULTS: HSV-2 serum antibody results were obtained on 535 women and HSV-1 results on 134. The seroprevalence of HSV-2 was 30% and HSV-1 was 100%. On multivariate analysis, the independent predictors of HSV-2 infection were age, marital status, and trichomoniasis. CONCLUSIONS: HSV-2 was common in this sample of sexually active women in Vanuatu. This is the first study of HSV in Vanuatu and one of very few studies in the Pacific region.

Adolescent↗
PubMedDate not supplied

A survey for the rare blood group antigen variants, En(a-), Gerbich negative and Duffy negative on Espiritu Santo, Vanuatu in the South Pacific.

The people of Vanuatu exhibit several different genetic red cell polymorphisms. Some of these, such as alpha thalassaemia, are thought to have reached a high frequency as a result of selection pressure by malaria. In this study three rare blood group antigen variants, En(a-), Gerbich negative and Duffy negative, which are thought to confer a protective effect against malaria were sought in a sample of 214 (187 in the case of Duffy) from Espiritu Santo, Vanuatu. No individuals bearing these rare variants were found. The original settlers in Vanuatu are thought to have migrated from Papua New Guinea some 5,000 years ago, so it is of interest to note that no individuals were found to be Gerbich negative despite a high frequency in Melanesians living on some coastal parts of Papua New Guinea.

Antigenic Variation↗
PubMed2003

Alternative medicine use at Vila Central Hospital Vanuatu: a survey of the use of 'custom medicine' in patients and staff.

A structured questionnaire was developed to assess the use of custom (traditional or herbal) medicine in 50 medical and 50 surgical inpatients and 50 staff at Vila Central Hospital, Vanuatu. Eighty-six per cent of those interviewed had used custom medicine at least once, 60% within the last year. Twenty-one medical patients (42%) had used custom medicine for their current problem, 12% whilst in hospital. Eighteen surgical patients (36%) had used custom medicine for their current problem, 6% whilst in hospital. Fourteen of the staff (28%) interviewed had used custom medicine within the last year. Sixty-nine per cent of interviewees stated that custom medicine had improved their condition. Whilst custom medicine use was common across all attained education levels, there was a trend for those with higher levels of education to use less custom medicine. The most common form of custom medicine was leaf tea, followed by leaf applications, cutting, magic, massage and chanting. The majority of these were made/prescribed by local 'Klevas' (custom doctors). The cost of the 'medicine' was often substantial, generally many times the cost of a day in hospital. These findings indicate a high prevalence of custom medicine use within Vanuatu. Clinicians must be alert to the possibility of their patients using custom medicine even whilst in hospital and the potential for custom medicine to contribute to the clinical problems. Late presentation of patients to hospital is common in Vanuatu, and the use of custom medicine is partially a contributing factor to this. It also poses questions as to patient confidence in health services.

Adult↗
PubMed1981

Scrub typhus in the Eastern Solomon Islands and Northern Vanuatu (New Hebrides).

Rickettsia tsutsugmushi has been isolated from Rattus rattus from Vanua Lava island in Northern Vanuatu (New Hebrides) and from R. exulans and Leptotrombidium akamushi on Ndende island in the Eastern Solomon Islands. The well-known vector mite L. deliense was found on Mota Lava and Vanua Lava in Vanuatu, but no isolation was made from pools of this mite. Serology confirms that R. tsutsugamushi infects humans in the Banks group of islands in Northern Vanuatu and that infection is much more widespread in the Solomon Islands than the limited isolations indicate.

Animals↗
PubMed1992

Skin infections in Tanna, Vanuatu in 1989.

Skin infections are an important health problem in Vanuatu and other Pacific island countries. In this study, 18,223 people, representing 90% of the population of the southern island of Tanna in Vanuatu, were examined. Scabies was found in 16% of those screened, with 24% of children under 10 years affected. Other skin infections were predominantly furuncles, abscesses, impetigo and cellulitis and were found in 12% overall and in 16% of children under 10 years of age. These infections were found to be more common in larger households and in the vicinity of the volcano Yasur. Strategies for prevention and management of skin infections in Vanuatu are discussed.

Adolescent↗
PubMed2005

Evaluation of the program to eliminate lymphatic filariasis in Vanuatu following two years of mass drug administration implementation: results and methodologic approach.

This report presents the results of the Vanuatu mid-term evaluation of the lymphatic filariasis elimination program being implemented countrywide. Vanuatu is one of the first countries to initiate this program as part of the Global Program for Elimination of Lymphatic Filariasis, based on a five-year annual mass drug administration (MDA) of albendazole and diethylcarbamazine and complemented in Vanuatu by extensive coverage with bed nets. This paper reports results of 561 persons tested at eight sentinel sites following two years of MDA. Coverage was 72% and bed net use was more than 70%. Antigen prevalence was reduced by 63% (from 22% to 8%) and prevalence of microfilaremia prevalence was reduced by 93% (from 12% to 0.8%). Results of surveys of health workers and the community are also reported, and the methodology used for this evaluation is discussed.

Adolescent↗
PubMed1994

Reducing perinatal mortality in Vila Central Hospital, Vanuatu.

This paper provides accurate figures and detailed analysis of the causes of perinatal mortality in the main referral hospital in Vanuatu in 1992, and discusses possible improvements in management. The perinatal mortality rate for the Vila Central Hospital area was 30.4 per 1000 births (with a stillbirth rate of 14 per 1000). These figures include mothers who presented for the first time in labour without any antenatal care, and cases of very low birthweight (less than 1 kg). These results were achieved with very low intervention rates. The commonest cause of death in Vanuatu was birth asphyxia, with prematurity, unexplained stillbirth and major congenital abnormality as the other main causes. Even though there is still scope for improvement, especially in the prevention of birth asphyxia, the perinatal mortality rate in Vanuatu compares favourably with that in other developing countries. Increased family planning uptake will be expected to lead to a reduction in perinatal mortality.

Asphyxia Neonatorum↗
PubMed2006

Recent Southeast Asian domestication and Lapita dispersal of sacred male pseudohermaphroditic "tuskers" and hairless pigs of Vanuatu.

Recent analyses of global pig populations revealed strict correlations between mtDNA phylogenies and geographic locations. An exception was the monophyletic "Pacific clade" (PC) of pigs not previously linked to any specific location. We examined mtDNA sequences of two varieties of Vanuatu sacred pigs, the male pseudohermaphroditic Narave from the island of Malo (n = 9) and the hairless Kapia from the island of Tanna (n = 9), as well as control pigs (n = 21) from the islands of Malo, Tanna, and Epi and compared them with GenBank sequences to determine (i) the distribution of PC and introduced domestic lineages within Vanuatu, (ii) relationship between the Narave and Kapia, and (iii) origin of the PC. All of the Narave share two PC mtDNA sequences, one of which matches the sequence of a Narave collected in 1927, consistent with an unbroken maternal descent of these intersex pigs from the original pigs brought to Vanuatu 3,200 years ago. One-third of the Kapia share a single PC lineage also found in the Narave. The remaining Kapia lineages are associated with recently introduced, globally distributed domestic breeds. The predominant Narave lineage is also shared with two wild boars from Vietnam. These data suggest that PC pigs were recently domesticated within Southeast Asia and dispersed during the human colonization of Remote Oceania associated with the Lapita cultural complex. More extensive sampling of Southeast Asian wild boar diversity may refine the location of Pacific pig domestication and potentially the proximate homeland of the Lapita cultural complex.

Animals↗
PubMed1994

Malaria treatment in Vanuatu: new national treatment guidelines.

In Vanuatu malaria is a major killer, especially of young children. As most deaths occur outside the hospital it is very important to have simple, clear guidelines on the management of patients with suspected malaria for the primary health care workers who treat the majority of cases. Despite the encouragement of early treatment, malaria was the major cause of death in children after the neonatal period in 1988. During 1989 and 1990 the treatment of malaria in Vanuatu was reviewed with the aim of trying to reduce the morbidity and mortality from the disease. New guidelines were included in the Vanuatu Health Workers' Manual, issued to all nurses, nurse practitioners and doctors in 1991. The major changes were the introduction of immediate slide microscopy, the use of a combination of chloroquine and sulphadoxine-pyrimethamine for Plasmodium falciparum malaria and for children under 5 years and pregnant women, the discontinuation of single-dose primaquine (previously given as a gametocytocidal agent), and the use of a loading dose of quinine. The constraints of the previous guidelines, the rationale for the changes and the expected improvements resulting from using the new treatments are discussed.

Adolescent↗
PubMedDate not supplied

Microfilarial periodicity of Wuchereria bancrofti in Vanuatu.

A study on the relationship between the microfilarial periodicity of Wuchereria bancrofti and vector biting activity was carried out in Penama province, Vanuatu from February to April 1999, to enable the design of a more efficient strategy to control filariasis transmission. The microfilarial periodicities of 22 W. bancrofti antigen-positive volunteers were studied. Microfilariae (mf) were counted every hour for 24 h for 6 volunteers and every hour for 12 h (from 18:00 to 06:00) for 16 volunteers. At the same time as the preparation of mf test slides, indoor human landing catches of the vector mosquito, Anopheles farauti, were conducted to assess the vector biting activity. The time of peak microfilaraemia was 01:32 and the microfilarial periodicity index was 112.3, confirming the nocturnal periodicity of Wuchereria bancrofti in Vanuatu. Nearly all (98.5%) of the mf appeared during the time periods when A. farauti were collected. The timing of vector biting activity corresponded to the time of mf circulation.

Adolescent↗