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Objective: To prevent importation of coronavirus disease 2019 (COVID-19) to Vanuatu, since March 2020, all travellers to the country have been required to complete a 14-day quarantine in a government-designated facility. A short message service (SMS, or “text message”) system was developed to collect information on symptoms of COVID-19 among travellers in quarantine. A trial within a cohort study was conducted among travellers arriving to Vanuatu by air from 27 October to 7 December 2020 to assess SMS acceptability, efficiency and utility and whether SMS-based health monitoring was as effective as in-person monitoring in identifying people with COVID-19 symptoms. Methods: Control group participants received standard monitoring (daily in-person visits) and participants in the intervention group received a daily SMS text requesting a response coded for symptom development. Differences between the two groups were determined using chi-squared tests. Results: Of the 495 eligible travellers, 423 participated; 170 were allocated to the control group and 253 to the intervention group. At least one return SMS text was received from 50% (107/212) of participants who were confirmed to have received an SMS text. Less than 2% (4/253) of the intervention group and 0% of the control group reported symptoms. Discussion: The SMS intervention had a high level of acceptability. SMS is a useful tool to monitor symptom development among people in quarantine and for broader public health programmes that require follow up.

Obesity prevalence has increased in low- and middle-income countries (LMICs) over the past several decades, with generally greater occurrence among adult females compared with males. Gendered variation in health behaviors, such as substance use, may play a role in how differences in obesity, body size, and composition manifest in association with sex. This study examines sex-moderated relationships of tobacco smoking and kava consumption with body composition and obesity among 301 Ni-Vanuatu (local self-identification meaning “of Vanuatu”) adults. Data collected included self-reported frequency of substance use as well as anthropometric measurements to assess body mass, composition, and obesity. Tobacco and kava use were associated with reduced measurements of body mass and adiposity in males, and kava use was associated with some elevated measurements of body mass and hip circumference in females. Kava use was also negatively associated with obesity based on waist-to-height ratio among males. These results have implications for evaluation and future research on substance control programs in this population.

The Pacific island nation of Vanuatu is vulnerable to emerging infectious diseases, including epidemics and pandemics; chronic food and water insecurity; and natural hazards, including cyclones, earthquakes, tsunamis, landslides and flooding. In March 2020, the World Health Organization characterized the outbreak of novel coronavirus disease 2019 (COVID-19) as a global pandemic. By the end of April 2020, Vanuatu had reported no confirmed cases of COVID-19. Data from several sources are collected in Vanuatu’s COVID-19 surveillance system to provide an overview of the situation, including data from case investigations and management, syndromic surveillance for influenza-like illness, hospital surveillance and laboratory surveillance. Review of data collected from January to the end of April 2020 suggests that there was no sustained increase in influenza-like illness in the community and no confirmed cases were identified. Lessons learnt from the early implementation of surveillance activities, the changing landscape of laboratory testing and pharmaceutical interventions, as well as the global experience, particularly in other Pacific island countries, will inform the refinement of COVID-19 surveillance activities in Vanuatu.

International borders to Vanuatu closed on 23 March 2020 due to the global COVID-19 pandemic. In May–July 2020, the Government of Vanuatu focused on the safe and timely return of citizens and residents while ensuring Vanuatu remained COVID-19 free. Under Phase 1 of repatriation, between 27 May and 23 June 2020, 1522 people arrived in the capital, Port Vila, and were placed in compulsory government-mandated 14-day quarantine in 15 hotels. Pre-arrival health operations included collection of repatriate information, quarantine facility assessments, training for personnel supporting the process, and tabletop and functional exercises with live scenario simulations. During quarantine, health monitoring, mental health assessments and psychosocial support were provided. All repatriates completed 14 days of quarantine. One person developed symptoms consistent with COVID-19 during quarantine but tested negative. Overall health operations were considered a success despite logistical and resource challenges. Lessons learnt were documented during a health sector after-action review held on 22 July 2020. Key recommendations for improvement were to obtain timely receipt of repatriate information before travel, limit the number of repatriates received and avoid the mixing of “travel cohorts”, ensure sufficient human resources are available to support operations while maintaining other essential services, establish a command and control structure for health operations, develop training packages and deliver them to all personnel supporting operations, and coordinate better with other sectors to ensure health aspects are considered. These recommendations were applied to further improve health operations for subsequent repatriation and quarantine, with Phase 2 commencing on 1 August 2020.

Natural disasters have major consequences for mental health in low- and middle-income countries. Symptoms are often more pronounced among women. We analyzed patterns and predictors of distress among pregnant and non-pregnant women 3-4 and 15-16 months after a cyclone in Vanuatu, a low- to middle-income country. Distress levels were high among both pregnant and non-pregnant women, although pregnant women showed lower longer-term symptoms. Low dietary diversity predicted greater distress, which could affect women even in villages with little cyclone damage.

Background Past studies show relationships between disaster-related displacement and adverse psychosocial health outcomes. The development of psychosocial interventions following displacement is thus increasingly prioritized. However, data from low- and middle-income countries (LMICs) are lacking. In October 2017, the population of Ambae Island in Vanuatu, a lower-middle income country, was temporarily displaced due to volcanic activity. We analyzed distress among adults displaced due to the event and differences based on the psychosocial support they received. Methods Data on experiences during displacement, distress and psychosocial support were collected from 443 adults 2–3 wk after repatriation to Ambae Island. Four support categories were identified: Healthcare professional, Traditional/community, Not available and Not wanted. We analyzed differences in distress by sex and group using one-way ANOVA and generalized linear models. Results Mean distress scores were higher among women (1.90, SD=0.97) than men (1.64, SD=0.98) (p Conclusions Women might be particularly vulnerable to distress during disaster-related displacement in LMICs, and those who report a lack of support might be at greater risk. Both healthcare professional and traditional networks provide important sources of support that are widely used and might help to ameliorate symptoms.

Poor maternal mental health during pregnancy is associated with adverse birth outcomes, including lower birthweight and gestational age. However, few studies assess both mental health and diet, which might have interactive effects. Furthermore, most studies are in high-income countries, though patterns might differ in low- and middle-income countries (LMICs). Objectives To analyze relationships between mental health and diet during pregnancy with birth outcomes in Vanuatu, a lower-middle income country. Methods We assessed negative emotional symptoms of depression, anxiety, and stress (referred to as "distress") and dietary diversity during pregnancy, and infant weight and gestational age at birth, among 187 women. We used multivariate linear regression to analyze independent and interactive relationships between distress, dietary diversity, and birth outcomes, controlling for sociodemographic and maternal health covariates. Results There were no direct linear relationships between dietary diversity or distress with infant birthweight or gestational age, and no curvilinear relationships between distress and infant outcomes. We observed interactive relationships between distress and dietary diversity on birthweight, explaining 2.1% of unique variance (P = .024). High levels of distress predicted lower birthweights among women with low dietary diversity. These relationships were not evident among women with moderate or high dietary diversity. Conclusions Relationships between mental health and diet might underlie inconsistencies in past studies of prenatal mental health and birthweight. Results highlight the importance of maternal mental health on birthweight in LMICs. Interactive relationships between mental health and diet might ultimately point to new intervention pathways to address the persistent problem of low birthweight in LMICs.

Non-communicable diseases are responsible for 63% of global deaths, with a higher burden in low- and middle-income countries. Hypertension is the leading cause of cardiovascular-disease-related deaths worldwide, and approximately 1.7 million deaths are directly attributable to excess salt intake annually. There has been little research conducted on the level of salt consumption amongst the population of Vanuatu. Based on data from other Pacific Island countries and knowledge of changing regional diets, it was predicted that salt intake would exceed the World Health Organization&rsquo, s (WHO) recommended maximum of 5 g per day. The current study aimed to provide Vanuatu with a preliminary baseline assessment of population salt intake on Efate Island. A cross-sectional survey collected demographic, clinical, and urine data from participants aged 18 to 69 years in rural and urban communities on Efate Island in October 2016 and February 2017. Mean salt intake was determined to be 7.2 (SD 2.3) g/day from spot urine samples, and 5.9 (SD 3.6) g/day from 24-h urine samples, both of which exceed the WHO recommended maximum. Based on the spot urine samples, males had significantly higher salt intake than females (7.8 g compared to 6.5 g, p &lt, 0.001) and almost 85% of the population consumed more than the WHO recommended maximum daily amount. A coordinated government strategy is recommended to reduce salt consumption, including fiscal policies, engagement with the food industry, and education and awareness-raising to promote behavior change.

In Vanuatu, mean salt intake exceeds the recommended maximum daily intake, and contributes to the high proportion of deaths attributable to cardiovascular diseases. Understanding salt-related knowledge, attitudes, and behaviors of the Vanuatu population can inform appropriate interventions. This cross-sectional study was conducted as part of the 2016&ndash, 2017 Vanuatu Salt Survey. In total, 753 participants aged between 18 and 69 years from rural and urban communities on the Island of Efate were included. Demographic and clinical data were collected and a salt-related knowledge, attitudes, and behaviors survey was administered. Knowledge relating to the need to reduce salt consumption was high, but reported behaviors did not reflect this knowledge. A total of 83% of participants agreed that too much salt could cause health problems, and 86% reported that it was &ldquo, very important&rdquo, to lower the amount of salt in the diet. However, more than two-thirds of the population reported always/often adding salt to food during cooking/meal preparation and at the table, and always/often consuming processed foods high in salt. Strategic, targeted, and sustained behavior change programs in parallel with interventions to change the food environment to facilitate healthier choices should be key components of a salt reduction program. Actions should implemented as part of a comprehensive strategy to prevent and control non-communicable diseases in Vanuatu.

Prenatal stress affects body composition in childhood and later in life. However, few studies assess body composition in infancy. Furthermore, most are in high-income countries and do not consider interactive or curvilinear relationships. We assessed distress and diet during pregnancy via questionnaires among 310 women in Vanuatu, a lower-middle income country. We measured body mass index (BMI) among 54 infants at 4&ndash, 12 months of age. We analyzed interactive relationships between prenatal distress and diet with BMI Z-scores, and curvilinear relationships between distress and BMI Z-scores. There were no direct linear or interactive relationships between prenatal distress or diet with BMI Z-scores. We observed curvilinear relationships between prenatal distress and BMI Z-scores (p = 0.008), explaining 13.3 percent of unique variance. Results highlight that relationships between prenatal stress and body composition are evident in infancy but might not be detected if only linear relationships are assessed. Analyses in more diverse samples might help to explain inconsistencies in past studies.

Maternal stress during pregnancy is associated with birth outcomes, including birthweight. Exposure to natural disasters during pregnancy provides a model to study these relationships. However, few studies assess both stress and diet, which might have interactive effects. Furthermore, most are conducted in high-income countries. Patterns might differ in low- and middle-income countries (LMICs).To study relationships between stress and diet during pregnancy, and infant birthweight, following a natural disaster in a lower-middle income country.In 2015, the island nation of Vanuatu suffered a Category 5 cyclone. Three months later, the authors assessed hardship due to the cyclone, distress, and dietary diversity among 900 women, including 187 pregnant women. Of these, 70 had birth records available. Multivariate linear regression was used to analyse relationships between cyclone exposure and infant birthweight among this sub-sample.Neither hardship nor dietary diversity predicted birthweight. Distress was a robust predictor, explaining 8.5% of variance (p = 0.012). There were no interactive relationships between distress and other exposure variables.Maternal distress following a natural disaster has important implications for maternal and child health. In LMICs, low birthweight remains a pressing public health concern. Distress during pregnancy might represent one underlying risk factor.

Objective The Republic of Vanuatu, similar to other South Pacific island nations, is undergoing a rapid health transition as a consequence of modernization. The pace of modernization is uneven across Vanuatu's 63 inhabited islands, resulting in differential impacts on overall body composition and prevalence of obesity among islands, and between men and women. In this study, we investigated (1) how modernization impacts body composition between adult male and female Melanesians living on four islands of varying economic development in Vanuatu, and (2) how body composition differs between adult Melanesians and Polynesians living on rural islands in Vanuatu. Methods Anthropometric measurements were taken on adult male and female Melanesians aged 18 years and older (n = 839) on the islands of Ambae (rural), Aneityum (rural with tourism), Nguna (rural with urban access), and Efate (urban) in Vanuatu, in addition to Polynesian adults on Futuna (rural). Results Mean measurements of body mass and fatness, and prevalence of obesity, were greatest on the most modernized islands in our sample, particularly among women. Additionally, differences between men and women became more pronounced on islands that were more modernized. Rural Polynesians on Futuna exhibited greater body mass, adiposity, and prevalence of obesity than rural Melanesians on Ambae. Conclusions We conclude that Vanuatu is undergoing an uneven and rapid health transition resulting in increased prevalence of obesity, and that women are at greatest risk for developing obesity-related chronic diseases in urbanized areas in Vanuatu. Am. J. Hum. Biol. 27:832–844, 2015. © 2015 Wiley Periodicals, Inc.

In addition to the widespread availability of packaged cigarettes, the inhabitants of island nations of the Southwest Pacific frequently smoke commercially available loose tobacco using manufactured rolling papers, as well as locally grown tobacco rolled in manufactured rolling paper or wrapped in leaves, copybook paper, and newspaper. In this study, Vanuatu men who smoked local tobacco rolled in leaves, copybook paper, or newspaper showed significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC ratios than men who smoked packaged cigarettes, store-bought tobacco rolled in manufactured rolling paper, or who smoked locally grown tobacco rolled in manufactured rolling papers. The addition of toxins from these unusual tobacco-wrapping media produces lung function deficits similar to the pattern noted among tobacco smokers who also inhale smoke from burning biomass. Thus, public health initiatives should consider including strategies addressing the use of wrapping media among smokers in South Pacific island societies.

There is insufficient data on sexually transmitted infections (STI) and related behaviours among key populations, including female sex workers (FSW), in the Pacific region. Using respondent driven sampling, we conducted an integrated bio-behavioural survey with FSW in Vanuatu (aged ≥18 years) to investigate risk behaviours associations with Chlamydia trachomatis (CT). Weighted population estimates and correlates of CT infection were calculated. Among 149 FSW, prevalence of CT was 36 % (95 % CI 26-48 %). Few FSW reported consistent condom use with recent transactional sex partners (TSP) (8 %; 95 % CI 2-13 %). CT infection was positively associated with increasing number of TSP (adjusted odds ratio [AOR] 1.1; 95 % CI 1.0-1.2) and group sex (AOR 2.9; 95 % CI 1.1-8.2). CT was negatively associated with increasing age of first sex (AOR 0.6; 95 % CI 0.5-0.9) and previous STI treatment (AOR 0.1; 95 % CI 0.0-0.4). A comprehensive public health strategy for prevention and treatment of STI among FSW, incorporating community empowerment strategies, FSW-targeted health services and periodic presumptive treatment, is urgently needed in Vanuatu.

The South Pacific archipelago of Vanuatu, like many developing countries, is currently experiencing a shift in disease burdens from infectious to chronic diseases with economic development. A rapid increase in obesity prevalence represents one component of this “health transition.” We sought to identify behaviors associated with measures of obesity in Vanuatu. We surveyed 534 adults from three islands varying in level of economic development. We measured height; weight; waist and hip circumferences; triceps, subscapular and suprailiac skinfolds; and percent body fat (%BF) by bioelectrical impedance. We assessed diet through 24-hour dietary recall and physical activity patterns using a survey. We calculated prevalence of obesity and central obesity based on multiple indicators (body mass index, %BF, waist circumference, and waist-to-height ratio), and analyzed differences among islands and associations with behavioral patterns. Obesity prevalence was lowest among rural and highest among suburban participants. Prevalence of central obesity was particularly high among women (up to 73.9%), even in rural areas (ranging from 14.7% to 41.2% depending on the measure used). Heavier reliance on animal protein and incorporation of Western foods in the diet – specifically, tinned fish and instant noodles – was significantly associated with increased obesity risk. Even in rural areas where diets and lifestyles remain largely traditional, modest incorporation of Western foods in the diet can contribute to increased risk of obesity. Early prevention efforts are thus particularly important during health transition. Where public health resources are limited, education about dietary change could be the best target for prevention.

To determine whether: (1) there is a secular increase in adult stature in Vanuatu, and (2) whether adult stature is positively associated with modernization in Vanuatu.This study reports on stature measurements collected on 650 adult (age 17 years) men and women from four islands of varying economic development in Vanuatu. Measurements were collected as part of the Vanuatu Health Transitions Research Project in 2007 and 2011.Stature increased significantly in adults born between the 1940s and 1960s in Vanuatu, before leveling off in those born between the 1970s and 1990s. Adults are significantly taller on Efate, the most modernized island in the study sample, than on the less economically developed islands.Modernization is likely associated with improvements in child growth in Vanuatu, as assessed by gains in adult stature.

Objective The Republic of Vanuatu, like many developing nations, is undergoing a rapid health transition. Our previous study identified several behavioral risk factors for the rising prevalence of obesity. Unexpectedly, daily time spent using television and radio was revealed as a protective factor for obesity in 2007. In this study, we sought to explore associations between ownership of consumer electronics (CE) and measures of adiposity in Vanuatu in 2011. Methods We surveyed 873 adults from five islands varying in level of economic development. Height, weight, and waist circumferences; triceps, subscapular, and suprailiac skinfolds; and percent body fat by bioelectrical impedance were measured. Ownership of eight types of CE, diet through 24-h dietary recall and leisure-time activity patterns were assessed using a questionnaire. Results Participants from more developed islands owned more types of CE, and revealed higher measures of adiposity on average as well as higher prevalence of obesity/central obesity. When controlling for demographic factors, and dietary and activity patterns, increased measures of adiposity and risk for obesity/central obesity were associated with ownership of cellphones, music players, televisions, video players, microwaves, and/or refrigerators. Positive correlations between CE ownership and measures of adiposity were mainly observed among men on the two most developed islands. Conclusions The results of this study indicate a possible role of CE use in the rising prevalence of obesity and the shift to a sedentary lifestyle in Vanuatu and many other modernizing regions, where prevention efforts including education on healthy use of CE are imperative.

ObjectiveRapid economic development and subsequent changes in lifestyle and disease burdens (‘health transition’) is associated with increasing prevalence of obesity among both adults and children. However, because of continued infectious diseases and undernutrition during the early stages of transition, monitoring childhood obesity has not been prioritized in many countries and the scope of the problem is unknown. Therefore we sought to characterize patterns of childhood overweight and obesity in an early transitional area, the South Pacific archipelago of Vanuatu.DesignWe completed an anthropometric survey among children from three islands with varying levels of economic development, from rural areas (where adult obesity prevalence is low) to urban areas (where adult obesity prevalence is high).SettingThe islands of Ambae (rural), Aneityum (rural with tourism) and Efate (urban).SubjectsBoys and girls (n 513) aged 6–17 years.ResultsHeight-, weight- and BMI-for-age did not vary among islands, and prevalence of overweight/obesity based on BMI was low. However, girls from Aneityum – a rural island where the tourism industry increased rapidly after malaria eradication – had increased central adiposity compared with girls from the other islands. This is contrary to adult patterns, which indicate higher obesity prevalence in urban areas. Multiple factors might contribute, including stunting, biological responses after malaria control, sleeping patterns, diet and physical activity levels.ConclusionsMeasures of central adiposity highlight an emerging obesity risk among girls in Vanuatu. The data highlight the synergistic relationship among infectious diseases, undernutrition and obesity during the early stages of health transition.

Health patterns are changing in developing countries; as diet and activity patterns change with economic development, chronic disease prevalence increases, which is a characteristic of health transition. The islands of Vanuatu (South Pacific) have varying rates of economic development and provide a natural experimental model of health transition. Objectives: To characterize behavioral changes associated with modernization. Methods: We surveyed 425 children and 559 adults on three islands varying in degree of economic development. We assessed diet (24-h dietary recall), physical activity (mode of transport, work activities, and recreation), substance use, and other behavioral patterns. Results: Spending patterns and access to Western foods followed modernization gradients in our sample, whereas occupational patterns and ownership of technological goods were poor markers of modernization. With increasing economic development, participants consumed more animal proteins and simple carbohydrates. Physical activity levels were high; most participants were active in gardening, and sports were popular, especially in urban areas. However, urban participants spent more time in sedentary recreation. Men's use of alcohol and tobacco increased with economic development, but we observed marked differences in substance use patterns between two rural islands—one with and one without tourism. Conclusions: Economic development in Vanuatu is accompanied by nutrition transition and increased sedentary recreation, although physical activity levels remain high. Differences in substance use patterns between rural islands with and without tourism indicate a need for more research in rural areas. These findings might inform research in other communities in the early stages of health transition. Am. J. Hum. Biol. 2011. © 2011Wiley-Liss, Inc.

The Republic of Vanuatu, similar to other South Pacific island nations, is undergoing a rapid health transition as a consequence of modernization. The pace of modernization is uneven across Vanuatu's 63 inhabited islands, resulting in differential impacts on overall body composition and prevalence of obesity among islands, and between men and women. In this study, we investigated (1) how modernization impacts body composition between adult male and female Melanesians living on four islands of varying economic development in Vanuatu, and (2) how body composition differs between adult Melanesians and Polynesians living on rural islands in Vanuatu.Anthropometric measurements were taken on adult male and female Melanesians aged 18 years and older (n = 839) on the islands of Ambae (rural), Aneityum (rural with tourism), Nguna (rural with urban access), and Efate (urban) in Vanuatu, in addition to Polynesian adults on Futuna (rural).Mean measurements of body mass and fatness, and prevalence of obesity, were greatest on the most modernized islands in our sample, particularly among women. Additionally, differences between men and women became more pronounced on islands that were more modernized. Rural Polynesians on Futuna exhibited greater body mass, adiposity, and prevalence of obesity than rural Melanesians on Ambae.We conclude that Vanuatu is undergoing an uneven and rapid health transition resulting in increased prevalence of obesity, and that women are at greatest risk for developing obesity-related chronic diseases in urbanized areas in Vanuatu.

Objective To determine whether: (1) there is a secular increase in adult stature in Vanuatu, and (2) whether adult stature is positively associated with modernization in Vanuatu. Methods This study reports on stature measurements collected on 650 adult (age > 17 years) men and women from four islands of varying economic development in Vanuatu. Measurements were collected as part of the Vanuatu Health Transitions Research Project in 2007 and 2011. Results Stature increased significantly in adults born between the 1940s and 1960s in Vanuatu, before leveling off in those born between the 1970s and 1990s. Adults are significantly taller on Efate, the most modernized island in the study sample, than on the less economically developed islands. Conclusions Modernization is likely associated with improvements in child growth in Vanuatu, as assessed by gains in adult stature.

Inequity in health-care delivery for those with mental illness is widespread throughout low- and middle-income countries. In the Pacific Island countries there are many barriers to addressing the growing mental health burden. In an effort to address this problem, the WHO is coordinating the Pacific Islands Mental Health Network involving 18 countries in the Pacific region with the financial support of New Zealand Aid (NZAid). JB and DP have developed and presented mental health training to health professionals, community leaders, and social service personnel in an environment in Vanuatu that is very different from that of their usual Australian-based general practices. They discuss evidence for their work, an outline of the programme, some difficulties working across different cultures, and the enthusiasm with which the training has been greeted. Vanuatu is now well on its way to addressing the inequity of access to mental health care with a culturally appropriate and self-sustaining mental health workforce.

Background Although the Republic of Vanuatu has improved maternal indicators, more needs to be done to improve equity among the poorest in the use of reproductive health services to expedite the progress towards the Millennium Development Goal 5(MDG 5) target. While large developing country studies provide evidence of a rich-poor gap in reproductive health services utilization, not much is written in terms of Pacific Islands. Thus, this study aims to examine the degree of inequality in utilization of reproductive health services in a nationally representative sample of Vanuatu households. Methods This paper used data from the 2007 Vanuatu Multiple Indicator Cluster Survey (MICS). The analyses were based on responses from 615 ever married women, living with at least one child below two years of age. Outcomes included antenatal care (ANC) and use of birth attendants at delivery, place of delivery, and counseling and testing for HIV/AIDS. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Results Findings revealed that the economic well-being status of the household to which women belong, played a crucial role in explaining the variation in service utilization. Inequality in utilization was found to be more pronounced between the poorest and richest groups within the wealth quintiles. In adjusted models, mothers in the richest bands of wealth were 5.50 (95% confidence interval [CI]: 1.34-22.47), 2.12 (95% CI: 1.02-3.42), 4.0 (95% CI 1.58-10.10), and 2.0 (95% CI 1.02-5.88) times more likely to have assisted delivery from medically trained personnel, have institutional deliveries, and have counseling and testing for HIV/AIDS. Conclusions Association between household wealth inequality and utilization of ANC and delivery assistance from medically trained personnel, institutional delivery, and counseling and testing for HIV/AIDS suggest that higher utilization of reproductive health care services in Vanuatu poor-rich inequalities need to be addressed. Reducing poverty and making services more available and accessible to the poor may be essential for improving overall reproductive health care utilization rate in Vanuatu.

We conducted studies in Vanuatu to evaluate potential screening and treatment strategies to assist with control of cervical cancer. In a pilot study of 496 women, visual inspection and cytology were evaluated as screening tests for detection of CIN 2 or worse (CIN2+), observed in 21 of 206 subjects biopsied on the basis of abnormal visual inspection or cytology. Sensitivity of visual inspection with Lugol's Iodine for detection of CIN2+ on biopsy was 0.63, specificity was 0.32, and the positive predictive value was 0.09. For HSIL cytology, sensitivity was 0.99, specificity was 0.77, and the positive predictive value was 0.88. HSIL cytology was significantly more sensitive and had a significantly higher PPV for CIN 2+ than visual inspection (p