10th November 2017, Volume 130 Number 1465

Fiona Catherine Langridge, Sione Vaioleti Hufanga, Malakai Mahunui ‘Ofanoa, Toakase Fakakovikaetau, Teuila Mary Percival, Cameron Charles Grant

The Millennium Development Goals have provided a focus for the global reporting of child health in recent decades1 by describing child population health using under-five year, neonatal and infant mortality…

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New Zealand is situated close to the Pacific Islands geographically and has a high Pacific population. Unfortunately, children living in these small but important Pacific nations have not received much attention in regards to their health status. In this paper, 85% of admissions to hospital in Tonga for primary school children were for injury and poisoning, non-respiratory infectious disease, respiratory conditions, abdominal/surgical conditions and dental disease. This information is helpful to inform healthcare priorities for Tonga and other similar countries.



To describe inpatient utilisation patterns for primary school aged children in Tonga.


We described admissions for children aged 5–11 years to the main hospital in Tonga from January 2009 to December 2013. Rates with 95% confidence intervals (CI) were compared using rate ratios (RR).


There were 1,816 admissions. The average annual admission rate was 20.2/1,000 (95% CI 19.3–21.1). Hospital admission rates were higher in younger than older children (5–7 versus 8–11 years, RR=1.28, 95% CI 1.18–1.41) and in boys than girls (RR=1.52, 95% CI 1.38–1.68). Injury and poisoning (28%), non-respiratory infectious diseases (19%), respiratory conditions (16%), abdominal/surgical conditions (13%) and dental (9%) were the most frequent admission reasons. A larger proportion of younger versus older children were hospitalised for dental (16% vs 1%, P<0.001) or respiratory conditions (18% vs 14%, P=0.02). A larger proportion of older children were hospitalised for abdominal/surgical conditions (15% vs 11%, P=0.008), other infectious diseases (21% vs 17%, P=0.04), other conditions (10% vs 6%, P<0.001) and cardiac conditions (2% vs 1%, P<0.001).


In children 5–11 years in Tonga, 85% of admissions were for five groups of conditions. These data inform priority areas for healthcare spending and enable comparisons over time and between different Pacific countries.

Author Information

Fiona Catherine Langridge, PhD Candidate, Departments of Pacific Health, Paediatrics: Child and Youth Health, The University of Auckland, Auckland; Sione Vaioleti Hufanga, Biostatistician, Biostatistics Department, Chief Information Officer, Ministry of Health, Tonga;
Malakai Mahunui ‘Ofanoa, Senior Lecturer, Departments of Pacific Health;
Toakase Fakakovikaetau, Paediatrician, Paediatrics Department, Vaiola Hospital, Nuku’alofa, Tonga; Teuila Mary Percival, Paediatrician and Senior Lecturer, Departments of Pacific Health;
Cameron Charles Grant, Paediatrician and Professor, Paediatrics: Child and Youth Health, The University of Auckland, Auckland, Starship Children’s Hospital, Auckland.


The authors would like to thank the Ministry of Health in Tonga. We acknowledge NZAID, The Oticon Foundation, NZOVRF and the Ranchhod Foundation for funding support. FL is supported by The University of Auckland Doctoral Scholarship. The authors have no competing interests to declare.


Fiona Langridge, Department of Pacific Health, Faculty of Medicine and Health Sciences, University of Auckland, Private Bag 92019, Auckland.

Correspondence Email


Competing Interests

Mrs Langridge reports grants from University of Auckland during the conduct of the study; grants from New Zealand Optometric Vision Research Foundation, grants from The Oticon Foundation, non-financial support from The Ranchhod Foundation, outside the submitted work. MO is part of the supervision team for this PhD candidate (main author).


  1. Duke T, Kado JH, Auto J, et al. Closing the gaps in child health in the Pacific: An achievable goal in the next 20 years. J Paediatr Child Health. 2015; 51:54–60. 
  2. Denno D. Global child health. Pediatr Rev. 2011; 32:e25–e38.
  3. United Nations. The sustainable development goal report 2016; New York: United Nations 2016. Available from: http://unstats.un.org/sdgs/report/2016/The%20Sustainable%20Development%20Goals%20Report%202016.pdf accessed 10 August 2017.
  4. Redmond G, Skattebol J, Saunders P, et al. Are the kids alright? Young Australians in their middle years: Final report of the Australian Child Wellbeing Project, Flinders University, University of New South Wales and Australian Council for Educational Research. Flinders University, University of New South Wales and Australian Council for Educational Research, 2016. Available from: http://australianchildwellbeing.com.au/sites/default/files/uploads/ACWP_Final_Report_2016_Full.pdf accessed 10 August 2017.
  5. Bryce J, Terreri N, Victora CG, et al. Countdown to 2015: tracking intervention coverage for child survival. Lancet. 2006; 368:1067–1076.
  6. Karadag B, Karakoc F, Ersu R, et al. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration. 2005; 72:233–238.
  7. Prescott SL, Pawankar R, Allen KJ, et al. A global survey of changing patterns of food allergy burden in children. World Allergy Organ J. 2013; 6:21.
  8. Thapar N, Sanderson IR. Diarrhoea in children: an interface between developing and developed countries. Lancet. 2004; 363:641–653.
  9. Wald A, Sigurdsson L. Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol. 2011; 25:19–27.
  10. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380:2095–2128.
  11. Jackson SL, Vann Jr WF, Kotch JB, et al. Impact of poor oral health on children’s school attendance and performance. Am J Public Health. 2011; 101:1900–1906.
  12. Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005; 83:661–669.
  13. Parker EJ, Jamieson LM, Broughton J, et al. The oral health of Indigenous children: A review of four nations. J Paediatr Child Health. 2010; 46:483–486.
  14. Gore FM, Bloem PJ, Patton GC, et al. Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet. 2011; 377:2093–2102.
  15. Asiegbu UV, Asiegbu OG, Onyire BN, et al. Assessment of gross malnutrition among primary school children using body mass index as an assessment tool in abakaliki metropolis of Ebonyi State, South-East Nigeria. Niger J Clin Pract. 2017; 20:693–699.
  16. Ukaegbe OC, Umedum NG, Chime EN, Orji FT. Assessment of common otolaryngological diseases among children in rural primary schools in south eastern Nigeria. Int J Pediatr Otorhinolaryngol. 2016; 89:169–172.
  17. Gharaibeh NS. Effects of indoor air pollution on lung function of primary school children in Jordan. Ann Trop Paediatr. 1996; 16:97–102.
  18. Odinaka KK, Nwolisa EC, Mbanefo F, et al. Prevalence and Pattern of Soil-Transmitted Helminthic Infection among Primary School Children in a Rural Community in Imo State, Nigeria. J Trop Med. 2015; 2015:349–439.
  19. Kombich JJ, Muchai PC, Tukei P, Borus PK. Rubella seroprevalence among primary and pre- primary school pupils at Moi’s Bridge location, Uasin Gishu District, Kenya. BMC Public Health 2009; 9:269.
  20. Klepp KI, Ndeki SS, Seha AM, et al. AIDS education for primary school children in Tanzania: an evaluation study. AIDS. 1994; 8:1157–1162.
  21. Gajanana A, Thenmozhi V, Samuel PP, Reuben R. A community-based study of subclinical flavivirus infections in children in an area of Tamil Nadu, India, where Japanese encephalitis is endemic. Bull World Health Organ. 1995; 73:237–244.
  22. Ayanniyi AA, Mahmoud AO, Olatunji FO. Causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Niger J Clin Pract. 2010; 13:248–253.
  23. Sarvamangala K, Koujalgi MB, Manjunath TP. Prevalence of anemia, morbidity and school absenteeism among lower primary school children of Davangere city. Indian J Public Health Res Dev. 2014; 5:220–225.
  24. Thapa KB, Okalidou A, Anastasiadou S. Teachers’ screening estimations of speech-language impairments in primary school children in Nepal. Int J Lang Commun Disord. 2016; 51:310–327.
  25. Rabbani MG, Hossain MM. Behaviour disorders in urban primary school children in Dhaka, Bangladesh. Public Health. 1999; 113:233–236.
  26. Narwaria YS, Saksena DN. Prevalence of dental fluorosis among primary school children in rural areas of Karera Block, Madhya Pradesh. Indian J Pediatr. 2013; 80:718–720.
  27. Percival T, Langridge F, Stowers L. Keeping promises, measuring results: implications for maternal and child health in the pacific. Health information Services Knowledge Hub working paper series. Queensland: School of Population Health, University of Queensland, AusAID. 2013 (26). Available from: http://www.researchgate.net/profile/Teuila_Percival/publication/237084244_Keeping_promises_measuring_results_the_Pacific_Maternal_and_Child_Health_Indicators_Project/links/00b4953c84c336c6da000000/Keeping-promises-measuring-results-the-Pacific-Maternal-and-Child-Health-Indicators-Project.pdf accessed 10 August 2017.
  28. Gray S, Lennon D, Anderson P, et al. Nurse-led school-based clinics for skin infections and rheumatic fever prevention: results from a pilot study in South Auckland. N Z Med J. 2013 Apr 19; 126:53–61.
  29. Lennon D, Stewart J, Farrell E, et al. School-based prevention of acute rheumatic fever: a group randomized trial in New Zealand. Pediatr Infect Dis J. 2009; 28:787–794.
  30. Anderson P, King J, Moss M, et al. Nurse-led school-based clinics for rheumatic fever prevention and skin infection management: evaluation of Mana Kidz programme in Counties Manukau. NZ Med J. 2016; 129:36–45.
  31. New Zealand Ministry of Health. Tagata Pasifika in New Zealand. 2014; Available at: http://www.health.govt.nz/our-work/populations/pacific-health/tagata-pasifika-new-zealand accessed 02/10, 2017.
  32. Morton SM, Atatoa Carr PE, Grant CC, et al. Cohort profile: growing up in New Zealand. Int J Epidemiol. 2013; 42(1):65–75.
  33. Tonga Department of Statistics. Census Statistics 2011. 2016; Available at: http://tonga.prism.spc.int/#population-statistics-including-administrative-information-and-statistical-tabulation-of-the-2011 accessed 5 November 2016.
  34. World Health Organisation. Tonga: A Country Profile. 2011. Available from: http://www.wpro.who.int/countries/ton/33TONpro2011_finaldraft.pdf accessed 10 August 2017.
  35. Russell FM, Fakakovi T, Paasi S, et al. Reduction of meningitis and impact on under-5 pneumonia after introducing the Hib vaccine in the Kingdom of Tonga. Ann Trop Paediatr. 2009; 29:111–117.
  36. Danielsson N, Fakakovikaetau T, Szegedi E. Improved immunization practices reduce childhood hepatitis B infection in Tonga. Vaccine. 2009; 27:4462–4467.
  37. Lutui F, Grant CC, Best E, et al. Invasive Pneumococcal Disease in Children in Tonga. Pediatr Infect Dis J. 2017; 36:239–240.
  38. Schultz J, Utter J, Mathews L, et al. The Pacific OPIC project (Obesity Prevention in Communities): action plans and interventions. Pac Health Dialog. 2007; 14:147–153.
  39. Swinburn B, Pryor J, McCabe M, et al. The Pacific OPIC project (Obesity Prevention in Communities)-objectives and designs. Pac Health Dialog. 2007; 14:139–146.
  40. Fotu K, Moodie M, Mavoa H, et al. Process evaluation of a community-based adolescent obesity prevention project in Tonga. BMC Public Health. 2011; 11:284.
  41. Finau SA, Taylor L. Rheumatic heart disease and school screening: Initiatives at an isolated hospital in Tonga. Med J Aust. 1988; 148:563–567.
  42. Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med. 2008; 5:411–417.
  43. Poole-Wilson PA, Seth S. Rheumatic fever: The potential advantages of technology. Nat Clin Pract Cardiovasc Med. 2008; 5:426–427.
  44. Foliaki S, Annesi-Maesano I, Daniel R, et al. Prevalence of symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: The International Study of Asthma and Allergies in Childhood (ISAAC). Allergy Eur J Allergy Clin Immunol. 2007; 62:259–264.
  45. Foliaki S, Fakakovikaetau T, D’Souza W, et al. Reduction in asthma morbidity following a community-based asthma self-management programme in Tonga. Int J Tuberc Lung Dis. 2009; 13:142–147.
  46. Hoffman MP, Cutress TW, Tomiki S. Prevalence of developmental defects of enamel in children in the Kingdom of Tonga. N Z Dent J. 1988; 84:7–10.
  47. Craig L, Adams J, Oben G, et al. The Health Status of Children and Young People in New Zealand. Dunedin: New Zealand Child and Youth Epidemiology Service, University of Otago; 2013. Available from: http://www.otago.ac.nz/nzcyes/otago086007.pdf accessed on 10 August 2017. 
  48. Jansen H, Johansson-Fua S, Hafoka-Blake B, ‘Ilolahia GR. National Study on Domestic Violence against Women in Tonga Nofo ‘a kainga. Kingdom of Tonga: Ma`a Fafine mo e Famili Inc. 2012. Available from: http://www.pacificwomen.org/wp-content/uploads/tonga-vaw-report-final-20121.pdf accessed 10 August 2017 
  49. McLean A. Corporal Punishment of Children in Tonga–A Violation of Constitutional Rights. Asia-Pacific Journal on Human Rights and the Law. 2014; 15:73–118.
  50. Smith BJ, Phongsavan P, Bampton D, et al. Intentional injury reported by young people in the Federated States of Micronesia, Kingdom of Tonga and Vanuatu. BMC Public Health. 2008; 8:145.
  51. Nair H, Simões EA, Rudan I, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet. 2013; 381:1380–1390.
  52. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1,160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013; 380:2163–2196.
  53. Morrongiello BA, Rennie H. Why do boys engage in more risk taking than girls? The role of attributions, beliefs, and risk appraisals. J Pediatr Psychol. 1998; 23:33–43.
  54. Walker CLF, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhoea. Lancet. 2013; 381:1405–1416.
  55. Zhong W, Finnie DM, Shah ND, et al. Effect of multiple chronic diseases on health care expenditures in childhood. J Prim Care Community Health. 2015 Jan;6:2–9.
  56. World Health Organisation. Tonga - 2010 Global School-based Student Health Survey. Kingdom of Tonga: World Health Organisation. 2012. Available from: http://www.who.int/chp/gshs/GSHS_Tonga_2010_Report.pdf?ua=1 accessed 10 August 2017.
  57. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:593–602.


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