High resilience of Pacific Island forests to a category- 5 cyclone

Assessing how forests respond to, and recuperate from, cyclones is critical to understanding forest dynamics and planning for the impacts of climate change. Projected increases in the intensity and frequency of severe cyclones can threaten both forests and forest-dependent communities. The Pacific Islands are subject to frequent low-intensity cyclones, but there is little information on the effects of high intensity cyclones, or on how forest stewardship practices may affect outcomes. We assess the resistance and resilience of forests in three community-stewarded sites on the island of Tanna, Vanuatu, to the wind-related effects of 2015 Category-5 Cyclone Pam, one of the most intense cyclones to make landfall globally. Drawing on transect data established pre-and post-cyclone, we (1) test whether windspeed and tree structural traits predict survival and damage intensity, and whether this varies across sites; (2) assess post-cyclone regeneration of canopy, ground cover, seedlings, and saplings, and how community composition shifts over time and across sites. In sites that sustained a direct hit, 88 % of trees were defoliated, 34 % sustained severe damage, and immediate mortality was 13 %. Initial mortality, but not severe damage, was lower in areas that received an indirect hit and had lower windspeed. Larger trees and those with lighter wood had a higher probability of uprooting and snapping, respectively. Canopy and ground cover regenerated within three years and seedling and sapling regeneration was widespread across life histories, from pioneer to mature forest species. Three species of non-native vines recruited post-cyclone but within 5 years had largely declined or disappeared with canopy closure. Tanna's historical cyclone frequency, combined with customary stewardship practices that actively maintain a diversity of species and multiplicity of regeneration pathways, are likely responsible for the island's resistance and resilience to an intense tropical cyclone.

Type 2 Diabetes Prevalence, Control and Management within Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu: A Scoping Review with a Systematic Approach

BACKGROUND

Type 2 diabetes (T2D) causes significant morbidity and is disproportionately prevalent in Pacific Island Countries (PICs). The socio-political demographics of PICs are rapidly changing, and health services must adapt to match the needs of their population.

OBJECTIVES

The objective of this study was to review the literature published within the last 15 years relating to T2D prevalence, control, and management, with a specific focus on targetable areas for future funding and research projects.

METHODS

This review was conducted using the PRISMA guidelines. Inclusion criteria were: discussion on T2D in the six PICs. Results were limited to those published between 1st January, 2006, and 27th July, 2023.

RESULTS

A total of 6,640 publications were retrieved, and 110 met the inclusion criteria. Nineteen additional studies were identified through hand-searching. T2D prevalence differed between countries but was predicted to increase in the coming decades, with projections of up to 31.2% by 2030 in Tonga. Factors associated with T2D varied between countries, including Indian-Fijian ethnicity in Fiji and tuberculosis in Kiribati. Control was generally poor, with high rates of undiagnosed diabetes and microvascular complications. Epidemiological data was limited in some cases, as was information describing the structure and function of diabetes services.

CONCLUSION

The prevalence, control, and management of T2D varied between Fiji, Kiribati, Samoa, the Solomon Islands, Tonga, and Vanuatu. Significant gaps remain in the data describing these domains; however, there are clearly targetable areas for future research and diabetes management programs.

The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study

Antimicrobial resistance (AMR) is included in the ten most urgent global public health threats. Global evidence suggests that antibiotics were over prescribed during the early waves of the COVID-19 pandemic, particularly in low- and middle-income countries. Inappropriate use of antibiotics drives the emergence and spread of antibiotic resistance. This study aimed to examine the impact of COVID-19 on Ni-Vanuatu health worker knowledge, beliefs, and practices (KBP) regarding antibiotic prescribing and awareness of antibacterial AMR. A mixed methods study was conducted using questionnaires and in-depth interviews in 2018 and 2022. A total of 49 respondents completed both baseline (2018) and follow-up (2022) questionnaires. Knowledge scores about prescribing improved between surveys, although health workers were less confident about some prescribing activities. Respondents identified barriers to optimal hand hygiene performance. More than three-quarters of respondents reported that COVID-19 influenced their prescribing practice and heightened their awareness of ABR: "more careful", "more aware", "stricter", and "need more community awareness". Recommendations include providing ongoing continuing professional development to improve knowledge, enhance skills, and maintain prescribing competency; formalising antibiotic stewardship and infection, prevention, and control (IPC) programmes to optimise prescribing and IPC practices; and raising community awareness about ABR to support more effective use of medications.

Diabetic Retinopathy Screening Using a Portable Retinal Camera in Vanuatu

Background and Objective

Proof-of-concept study to test the feasibility of using an all-in-one portable retinal camera for the screening of diabetic retinopathy in the Pacific Island of Vanuatu, which has a high rate of diabetes and its associated complications and a dearth of ophthalmologists.

Study Design/Materials and methods

From February 10, 2020, through February 28, 2020, 49 patients with diabetes mellitus from three islands in Vanuatu were recruited to participate in the study. Demographics, basic health data and retinal photography were obtained. A non-mydriatic, handheld camera was used (Volk Pictor Plus).

Results

Eleven participants (24%) had referral-warranted diabetic retinopathy. There was moderately high inter-rater reliability for our dependent variables: referral status (κ = 0.62, 95% CI 0.42-0.83), retinopathy severity (κ = 0.76, 95% CI 0.55-0.96), and clinically significant macular edema (κ = 0.50, 95% CI 0.25-0.74).

Conclusion

Our study confirms that portable handheld cameras can be used to obtain retinal images of sufficient quality for diabetic retinopathy screening even in resource limited environments like Vanuatu. Among this cohort, a relatively high (24%) prevalence of referral-warranted diabetic retinopathy was found in Vanuatu.

Adoption, Fostering, and Parental Absence in Vanuatu

Alloparenting, wherein people provide care to children who are not their biological offspring, is a key aspect of human child-rearing. In the Pacific, many children are adopted or fostered by custodial alloparents even when both biological parents are still alive. From a behavioral ecology perspective, such behaviors are puzzling: why parent someone else's child at your expense? Furthermore, little is known about how these arrangements are made in Pacific Islander societies today, who provides care, and what kinds of outcomes fostered children experience. A better understanding of these proximate factors may help reveal the ultimate drivers behind custodial alloparenting. Here, we report findings from a survey carried out with the caregivers of 282 children in rural areas of Vanuatu, an island nation in Melanesia. Most fostered and adopted children lived with relatives such as aunts, uncles, and grandparents (87.5%) rather than unrelated caregivers, with a strong preference for maternal kin. The most common reasons for these arrangements were that the parents had separated (16.7%), were engaging in labor migration (27.1%), or a combination of both (27.1%). Results for investment in children's education and their educational outcomes were mixed, although children removed from crisis situations did more poorly than children removed for aspirational reasons. Our findings suggest that custodial alloparenting helps families adapt to socioeconomic transitions and changing marriage practices. Outcomes may depend on a range of factors, such as the reason children were transferred out of the natal home to begin with.

"Road traffic injury could be minimized when individual road users take more responsibility for their safety and the safety of others": Perception of healthcare workers in Vanuatu

Introduction

Around 1.35 million deaths are caused by Road Traffic Injuries (RTIs) each year. This study aimed to explore the perceptions of Vanuatu's Health Care Workers (HCWs) regarding the existing preventative strategies for RTI.

Materials and methods

In 2020, this study used qualitative approaches to collect data from HCWs using Focus Group Discussions (FGDs). Study participants were self-identified Ni-Vanuatu HCWs who had been serving for more than 6 months in three main hospitals where the study was conducted and purposive sampling was used to gather the study participants. To guide the FGDs, a semi-structured open-ended questionnaire was created. Thematic analysis was used to processed the data obtained, based on predetermined themes that were based on theory while also enabling the data to determine new themes.

Result

From 5 FGDs with 22 HCWs who were emergency nurses, doctors and public health officers, data saturation was reached. The study yielded five main themes and sixteen subthemes. The relevance and trends of RTI, barriers to effective care, pre-hospital management capacity, barriers to pre-hospital care and addressing RTI were among the key subjects. The findings suggest that addressing health institutional leadership and resources will improve prevention of RTIs.

Conclusion

Prevention of RTIs is hindered by the lack of health institutional capacities in terms of leadership and resources that include emergency equipment, financial and trained human resources. The health sector should consider developing stronger leadership in road safety to be an essential part of its core business.

'They're not as MSM, they're a bufta': using the categories 'men who have sex with men' and 'transgender' as technologies in Vanuatu

In Vanuatu, the use of the terms such as 'men who have sex with men' (MSM) and 'transgender' has increased over the past decade. This paper draws on twenty months ethnographic research in Port Vila, the country's capital, to analyse what happens on the ground when MSM and transgender categories are taken up to identify people or to narrate the self. The focus is on who uses these terms, in what ways they are experienced, and what is rendered visible (or not) by their use. This research departs from approaches framing 'non-heteronormative' categories as related solely to gender and sexuality. It argues that MSM and transgender categories are used in various ways to refer not only to sexual practices and/or gender identity, but also to health risk behaviours, transactional sex and LGBT rights advocacy. The analysis offered suggests we view MSM and transgender categories as technologies that, depending on the interactional context, contribute to bureaucratic tasks or to maintaining or, on the contrary, changing established socio-political relations.

The challenges in protecting public health interests in multisectoral governance in the context of small island developing states: the case of tobacco control in Fiji and Vanuatu

BACKGROUND

The commercial determinants of health (CDoH) drive the rise of NCDs globally, and their regulation requires multisectoral governance. Despite existing recommendations to strengthen institutional structures, protecting public health interests can be challenging amidst industry interference and conflicting policy priorities, particularly in low and middle-income countries (LMICs) where the need for rapid economic development is pronounced. Small island developing states (SIDS) face even more challenges in regulating CDoH because their unique socioeconomic, political, and geographic vulnerabilities may weaken institutional conditions that could aid health sector actors in protecting health interests. This study aims to explore the institutional conditions that shape health sector actors' capability to protect public health interests in tobacco governance in Fiji and Vanuatu.

METHODS

We employed a qualitative, exploratory case study design. We applied the administrative process theory to inform data collection and analysis. Seventy interviews were completed in Fiji and Vanuatu from 2018 to 2019.

RESULTS

The findings show that the protection of health interests in tobacco governance were not supported by the institutional conditions in Fiji and Vanuatu. While the policy processes formally ensured a level playing field between actors, policies were often developed through informal mechanisms, and the safeguards to protect public interests from vested private interests were not implemented adequately. SIDS vulnerabilities and weak regulation of political parties contributed to the politicisation of government in both states, resulting in high-level government officials' questionable commitment to protect public health interests. The system of checks and balances usually embedded into democratic governments appeared to be muted, and policymakers had limited bureaucratic autonomy to elevate health interests in multisectoral policymaking amidst high-level government officials' frequent rotation. Finally, capacity constraints aggravated by SIDS vulnerabilities negatively impacted health sector actors' capability to analyse policy alternatives.

CONCLUSIONS

Health sector actors in Fiji and Vanuatu were not supported by institutional conditions that could help them protect public health interests in multisectoral governance to regulate CDoH originating from the tobacco industry. Institutional conditions in these states were shaped by SIDS vulnerabilities but could be improved by targeted capacity building, governance and political system strengthening.

Humanitarian aid and local responses: the aftermath of the rebuilding effort on Tongoa island, Vanuatu

Cyclone Pam swept through the archipelago of Vanuatu on 13-14 March 2015, with wind speeds exceeding those recorded anywhere in the South Pacific since the 1980s. Southern and central parts of the country were particularly affected. Material damage on Tongoa, one of the most afflicted islands, was extensive, but no deaths were reported. During the storm, villagers found shelter in their kitchen, in what is considered locally as a 'lifeboat'. The aftermath was managed and mitigated by international aid organisations. On Tongoa, this included a 'Shelter Cluster' programme, under which villagers were given house rebuilding kits. Elaborating upon extensive ethnographic investigations on site between 2011 and 2018, this paper explores and reveals the ways in which this aid generated confusion among the local population. In a larger context of regular disasters triggered by natural hazards, locals have found endogenous ways of dealing with such extreme climatic events, for the most part without any external assistance.

Challenges and opportunities in rapid disaster research: lessons from the field in New Mexico and Vanuatu

Rapid research is essential to assess impacts in communities affected by disasters, particularly those communities made "hard-to-reach" due to their active marginalization across history and in contemporary practices. In this article, we describe two rapid research projects developed to assess needs for and experiences of communities hard-hit by disasters. The first is a project on the COVID-19 pandemic in southern New Mexico (USA) that was developed to provide information to local agencies that are deploying programs to rebuild and revitalize marginalized communities. The second is a project on population displacement due to a volcanic eruption in Vanuatu, a lower-middle income country in the South Pacific, with mental and physical health outcomes data shared with the Vanuatu Ministry of Health. We describe the similar and unique challenges that arose doing rapid research in these two different contexts, the potential broader impacts of the research, and a synthesis of lessons learned. We discuss the challenges of rapidly changing rules and regulations, lack of baseline data, lack of survey instruments validated for specific populations and in local languages, limited availability of community partners, finding funding for rapid deployment of projects, rapidly training and working with research assistants, health and safety concerns of researchers and participants, and communicating with local and international partners. We also specifically discuss how we addressed our own personal challenges while also conducting time-intensive rapid research. In both studies, researchers shared results with governmental and non-governmental partners who may use the data to inform the design of their own relief programs. While different in context, type of disaster, and research strategy, our discussion of these projects provides insights into common lessons learned for working with communities at elevated risk for the worst outcomes during disasters, such as the need for flexibility, compromise, and good working relationships with community partners.

Antibiotic Consumption in Vanuatu before and during the COVID-19 Pandemic, 2018 to 2021: An Interrupted Time Series Analysis

The study objectives were to examine antibiotic consumption at Vila Central Hospital (VCH), Vanuatu between January 2018 and December 2021 and the influence of the COVID-19 pandemic on antibiotic consumption during this period. Data on antibiotic usage were obtained from the Pharmacy database. We used the WHO's Anatomical Therapeutic Classification/Defined Daily Dose (ATC/DDD) index, VCH's inpatient bed numbers and the hospital's catchment population to calculate monthly antibiotic consumption. The results were expressed as DDDs per 100 bed days for inpatients (DBDs) and DDDs per 1000 inhabitants per day for outpatients (DIDs). Interrupted time series (ITS) was used to assess the influence of COVID-19 by comparing data before (January 2018 to January 2020) and during (February 2020 to December 2021) the pandemic. Ten antibiotics were examined. In total, 226 DBDs and 266 DBDs were consumed before and during COVID-19 by inpatients, respectively with mean monthly consumption being significantly greater during COVID-19 than before the pandemic (2.66 (p = 0.009, 95% CI 0.71; 4.61)). Whilst outpatients consumed 102 DIDs and 92 DIDs before and during the pandemic, respectively, the difference was not statistically significant. Findings also indicated that outpatients consumed a significantly lower quantity of Watch antibiotics during COVID-19 than before the pandemic (0.066 (p = 0.002, 95% CI 0.03; 0.11)). The immediate impact of COVID-19 caused a reduction in both inpatient and outpatient mean monthly consumption by approximately 5% and 16%, respectively, and this was followed by an approximate 1% monthly increase until the end of the study. By mid-2021, consumption had returned to pre-pandemic levels.

Tracing innovation pathways behind fisheries co-management in Vanuatu

Co-management approaches have become a core part of coastal fisheries policy and planning practice in Vanuatu. With a long history of supporting community based fisheries management (CBFM), we trace its evolution in Vanuatu to understand how new structures and processes become adopted at scale. A theory of scaling for CBFM guides the analysis of regime shifts over time. We discuss planning for sustained spread under a national programme by categorising multiple drivers of change through three intervention pathways focussed, respectively, on developing (i) an enabling environment, (ii) institutional and individual capacity, and (iii) focussed innovative action in smaller targeted constituencies. Whilst we argue that local fisheries co-management institutions balance competing interests, and so differ amongst places, we also recognise the importance of connectivity and continuity. The realisation of a national programme therefore requires patchworks of siloed projects to be knitted together into coordinated programmatic approaches that strategically integrate activities.

Marine conservation in Vanuatu: Local conceptualisation and 'assemblage'

This article deals with the local conceptualisation of 'conservation' in the village Siviri in Vanuatu where villagers have established and maintain a small marine conservation area. Looking at villagers' motivations, the aim is to carve out the local conceptualisation and practice of 'conservation', to show what conservation is for the villagers. The theoretical framework is a combination of two approaches, namely 'assemblage' and 'world-making'. Conservation in Siviri is ontologically different from the concept of conservation used in Vanuatu national policy. It can be regarded as a creative engagement of villagers with their environment(s) to preserve the specific world-making assemblage consisting of humans and marine life for future generations.

Patterns of distress and psychosocial support 2 years post-displacement following a natural disaster in a lower middle income country

Background

Displacement due to natural disaster exposure is a major source of distress, and disproportionately affects people in low- and middle-income countries (LMICs). Public mental health resources following natural disasters and displacement are often limited in LMICs. In 2017, the population of one island in Vanuatu, a lower-middle income country, was displaced due to volcanic activity. Following the launch of a public mental health policy in 2009, psychosocial support interventions are increasingly available, providing an opportunity to assess relationships with distress following displacement.

Methods

440 people contributed data. We assessed distress using a local adaptation of the Impact of Event Scale-Revised, and types of psychosocial support available and received, including from health professionals, support groups, and traditional networks such as chiefs, traditional healers, and church leaders. We analyzed relationships between distress and psychosocial support, controlling for sociodemographic covariates.

Results

Professional and group support was reported available by 86.8-95.1% of participants. Traditional support networks were widely used, especially by men. Availability of professional support predicted lower distress among men (p < 0.001) and women (p = 0.015) ( η p 2 = 0.026-0.083). Consulting church leaders for psychosocial support was associated with higher distress among men (p = 0.026) and women (p = 0.023) ( η p 2 = 0.024-0.031). Use of professional and group support was lower than reported availability.

Discussion

Increased collaboration between professional and traditional support networks could help respond to mental health needs following natural disasters in LMICs with limited infrastructure. Providing training and resources to church leaders might be a specific target for improvement. Promoting use of available services represents a continued public health need.

Revision of Vanuatubasis Ober & Staniczek, 2009 (Odonata, Coenagrionidae), with description of seven new species

Vanuatubasis Ober & Staniczek, 2009 is an endemic genus of damselfly found on the island archipelago of Vanuatu. Previously only three species were assigned to the genus. Here, all known species of Vanuatubasis are formally described and treated, including the association of females for known species. The following new congeners are also described: V.discontinua sp. nov., V.evelynae sp. nov., V.insularivorum sp. nov., V.kapularum sp. nov., V.nunggoli sp. nov., V.rhomboides sp. nov., and V.xanthochroa sp. nov. from material collected across six different islands. An illustrated key to both males and females of all species within Vanuatubasis is provided as well as distributions for all known species.

Menstrual Health Experiences of People with Intellectual Disabilities and Their Caregivers during Vanuatu's Humanitarian Responses: A Qualitative Study

Attention to menstrual health in humanitarian responses is increasing, but evidence related to people with intellectual disabilities and their caregivers is absent. This study begins to address that. We applied purposive sampling to select 17 women and girls (aged 15-31) with intellectual disabilities, their 17 caregivers in SANMA province, Vanuatu, and seven key informants. We used in-depth interviews, PhotoVoice and ranking, and observation and analysed data thematically using Nvivo 12. We found that caregivers wished to maintain the person's safety and privacy, especially when menstruating, which reduced evacuation options. People with intellectual disabilities support requirements sometimes increased after emergencies. This meant caregivers were less able to work and recover from disasters. Caregivers requested the distribution of more reusable menstrual materials and a greater choice, including adult-sized diapers for menstruation and incontinence. Key informants noted that menstrual health interventions must always be delivered to people with intellectual disabilities and their caregivers so that menstrual health knowledge and practices exist before emergencies. We found that men and women supported people with intellectual disabilities' menstrual health, thus challenging gendered assumptions about caregiving. Efforts to achieve menstrual health for this population within disaster preparedness plans must be included. If not, families will fall further into poverty every time a disaster hits Vanuatu.

The genomic landscape of contemporary western Remote Oceanians

The Vanuatu archipelago served as a gateway to Remote Oceania during one of the most extensive human migrations to uninhabited lands ∼3,000 years ago. Ancient DNA studies suggest an initial settlement by East Asian-related peoples that was quickly followed by the arrival of Papuan-related populations, leading to a major population turnover. Yet there is uncertainty over the population processes and the sociocultural factors that have shaped the genomic diversity of ni-Vanuatu, who present nowadays among the world's highest linguistic and cultural diversity. Here, we report new genome-wide data for 1,433 contemporary ni-Vanuatu from 29 different islands, including 287 couples. We find that ni-Vanuatu derive their East Asian- and Papuan-related ancestry from the same source populations and descend from relatively synchronous, sex-biased admixture events that occurred ∼1,700-2,300 years ago, indicating a peopling history common to the whole archipelago. However, East Asian-related ancestry proportions differ markedly across islands, suggesting that the Papuan-related population turnover was geographically uneven. Furthermore, we detect Polynesian ancestry arriving ∼600-1,000 years ago to Central and South Vanuatu in both Polynesian-speaking and non-Polynesian-speaking populations. Last, we provide evidence for a tendency of spouses to carry similar genetic ancestry, when accounting for relatedness avoidance. The signal is not driven by strong genetic effects of specific loci or trait-associated variants, suggesting that it results instead from social assortative mating. Altogether, our findings provide an insight into both the genetic history of ni-Vanuatu populations and how sociocultural processes have shaped the diversity of their genomes.

Mathematical Modeling for Removing Border Entry and Quarantine Requirements for COVID-19, Vanuatu

The Pacific Island country of Vanuatu is considering strategies to remove border restrictions implemented during 2020 to prevent imported coronavirus disease. We performed mathematical modeling to estimate the number of infectious travelers who had different entry scenarios and testing strategies. Travel bubbles and testing on entry have the greatest importation risk reduction.

The perception of public transport drivers (PTDs) on preventing road traffic injury (RTIs) in Vanuatu: a qualitative study

Purpose

Road Traffic Injury (RTI) is major public health concern globally and is excessively affecting vulnerable road users in the pacific Island nations. This study aimed to explore and understand the perception of Public Transport Drivers (PTDs) on risk factors and the existing prevention strategy of RTI in Vanuatu.

Methods

This study employed qualitative methods that used 31 In-Depth Interviews (IDIs) to gather data from PTDs from 14 October to 30 November 2020. Purposive sampling was used to recruit PTDs from three main municipalities, Luganville, Port Vila and Lenakel. Semi-structured open-ended questionnaire were used to gather data. Interview data was transcribed and manual thematic analysis was performed to analysis the data.

Results

Data saturation was reach from interviewing 31 PTDs who were all male. Five main themes were generated from the study including the trend of RTI, the determinants of RTI, high-risk road users, traffic law enforcement and public education. The respondents perceived that the best measures for preventing RTI include community education, enforcement of road traffic control laws and addressing specific road infrastructure issues.

Conclusions

Changing driver behaviours, community education on road safety and enforcement of traffic laws are essential for preventing RTI in Vanuatu.

Perception of Law Enforcement Officers on Preventing Road Traffic Injury in Vanuatu: A Qualitative Study

Background: Road Traffic Injuries (RTIs) cause approximately 1. 35 million deaths annually, and is the leading cause of death among people between ages 5 and 29. Law Enforcement Officers (LEOs) deal with Road Traffic Collisions (RTCs) and have contact with RTI victims at a daily basis, they possess an excellent perspective on preventing RTI. This study aimed to explore LEOs perceptions on risk factors and preventive measures of RTI in Vanuatu. Methods: This study employed qualitative methods that used Focus Group Discussions (FGDs) to gather data from 25 LEOs between October 14th and November 30th, 2020. Self-identified Ni-Vanuatu LEOs who have been serving for over 6 months and residing at the study setting were included in this study. Purposive sampling was used to recruit study participants from three municipalities in Vanuatu. A semi-structured open ended questionnaire was designed to guide the FGDs. Data obtained were sorted out using thematic analysis processed with some preconceived themes based on theory, and also allowing the data to determine new themes. Results: Data saturation was reached from conducting 5 FGDs with 25 LEOs who were traffic officers and municipal wardens. Five main themes and sixteen subthemes were generated from the study. The main themes include driving and alcohol, the challenges to effective enforcement, barriers to effective care and support for RTI victims, measures for road traffic control and promoting road traffic safety. The respondents perceived that addressing resources issues and the legislations on road traffic control act and vehicle regulation act will enhance prevention of RTI. Conclusion: This study explored the risk factors of RTI and the barriers to effectively prevent RTI in Vanuatu. The study also generated suggestions of a combination of road traffic control measures that could be implemented to prevent RTI. Future research should look at effective strategies of preventing RTIs in resource deficit settings.

Water circulation and impact on water quality in the southwest of Efate Island, Vanuatu

In Small Island Developing States (SIDS), water pollution is not monitored or assessed frequently enough to fully understand the processes, impacts of water quality issues and what solutions are available This study investigated flushing time in Erakor lagoon and Port Vila Bay, Vanuatu using a numerical model developed in Delft3D. Microbial contamination by Escherichia coli was detected in multiple locations in the lagoon system with counts exceeding thresholds related to human health concerns. Modelling demonstrated a poor flushing time overall with a further decrease as the influence of waves and wind increased, especially in Vila Bay. Sea level rise resulted in an increase in flushing time downstream of the lagoon near the open sea, while with a decrease upstream and in Vila Bay. Based on these results, we recommend long-term continuous monitoring and identification of higher risks areas to prioritise decisions around wastewater management.

Transitional challenges faced by medical intern doctors (IDs) in Vanuatu: a qualitative study

The transition from being a medical student to a fully qualified registered doctor is a challenging time in the lives of intern doctors (IDs). Throughout those challenging times they face many challenges which significantly impact their professional lives as well as their transitional experience. This study aimed to identify the transitional challenges experienced by IDs in Vanuatu. This qualitative study was conducted using a phenomenological approach whereby data collection is done through semi-structured in-depth interviews. Ethical approval was obtained before the commencement of this study. Twenty-seven participants were IDs of Vila Central Hospital and Northern Provincial Hospital in Vanuatu who were either current IDs and had worked for more than 6 months or had completed internship within the past 2 years. The willing IDs were consented on paper before they participated in the interview. The interview data was then transcribed verbatim and interpreted thematically. The participating IDs in the study were between the ages of 27 and 36 years old. Twenty two were current interns while the remaining five had recently completed their internship and now working as registered doctors. Three subthemes were identified as challenges through thematic analysis in this study; intern's welfare not met; different medical training institution; and transitional shock. Those subthemes were later categorized. The study findings have identified that intern's welfare needs improvement along with diverse training medical schools, and the transitional internship encounters were significant challenges experienced by IDs. There is indeed a need for healthcare providers, medical leaders, and relevant stakeholders to recognize and address these challenges.

The effectiveness of legislative and voluntary strategies to prevent ocean plastic pollution: Lessons from the UK and South Pacific

The islands of the South Pacific contribute a fraction of the mis-managed plastics in the world's ocean, yet the region is one of the main recipients of its impacts. Based on expert interviews and a review of current strategies to prevent marine plastic pollution in six countries (Australia, New Zealand, Fiji, Tonga, Vanuatu, United Kingdom), this paper identifies several interventions - legislative, financial, voluntary - which governments, organisations and individuals can learn from. Both voluntary and statutory consumer-based behaviour change campaigns are well developed and somewhat successful in several countries. While sub-national policies do not inhibit progress, they are not optimal. Harmonisation across the territories of federal and devolved systems is beneficial, such as container return schemes, levies, and bans. Vanuatu has displayed high ambition, and the challenges in achieving this serve as a case study. A coordinated global strategy with associated legislation aimed at tackling plastic pollution is critical.

Polysubstance use among national samples of in-school adolescents in Tonga and Vanuatu

The study aimed to provide estimates on current polysubstance use among adolescents in Tonga and Vanuatu. Cross-sectional and national school health survey data were analyzed from 5028 adolescents (mean age 15.4 years) in Tonga and Vanuatu in 2016-2017. Polysubstance use was defined as currently using two or three substances of tobacco, alcohol, and cannabis. Results indicate that 72.9% of students reported zero current substance use, 14.5% single current substance use, and 12.6% current polysubstance use (2 or 3 types of substance use). In the adjusted multinational logistic regression analysis factors associated with current single and polysubstance included older adolescents (15-18 years or older), male sex, bullied, passive smoking, high psychological distress, and low peer support, whereby the associations with current polysubstance use were stronger than with current single substance use. In addition, parental tobacco use was associated with single substance use, and school truancy and frequent soft drink consumption (≥3 times/day) were associated with current polysubstance use, and high parental support was negatively associated with polysubstance use. More than one in ten of the participating students engaged in current polysubstance use. Several factors associated with current single and polysubstance use were found which can help in designing intervention strategies.

Fungi in soil and understory have coupled distribution patterns

Ecological processes that control fungal distribution are not well understood because many fungi can persist in a wide variety of dissimilar habitats which are seldom sampled simultaneously. Geographic range size is reflective of species’ resource usage, and for plants and animals, there is a robust positive correlation between niche-breadth and range-size. It remains unknown whether this pattern is true for fungi. To investigate the fungal niche breadth–range size relationship we identified habitat specialists and generalists from two habitats (plant leaves and soil) and asked whether habitat specialization influenced fungal biogeography. We sampled fungi from the soil and phylloplane of tropical forests in Vanuatu and used DNA metabarcoding of the fungal ITS1 region to examine rarity, range size, and habitat connectivity. Fungal communities from the soil and phylloplane are spatially autocorrelated and the spatial distribution of individual fungal OTU are coupled between habitats. Habitat breadth (generalist fungi) did not result in larger range sizes but did correlate positively with occurrence frequency. Fungi that were frequently found were also found in high abundance, a common observation in similar studies of plants and animals. Fungal abundance-occupancy relationships differed by habitat and habitat-specificity. Soil specialists were found to be locally abundant but restricted geographically. In contrast, phylloplane generalists were found to be abundant over a large range in multiple habitats. These results are discussed in the context of differences between habitat characteristics, stability and spatial distribution. Identifying factors that drive spatial variation is key to understanding the mechanisms that maintain biodiversity in forests.

Intimate partner violence and health outcomes experienced by women who are pregnant: a cross-sectional survey in Sanma Province, Vanuatu

Background

We aimed to describe the association between ni-Vanuatu women's experiences of violence perpetrated by their intimate partner (IPV) during pregnancy, and health outcomes, including self-reported general health, antenatal care attendance, psychological distress and suicidal thoughts/behaviours.

Methods

A cross-sectional survey of a consecutive cohort of women attending the antenatal clinic at Northern Provincial Hospital, Vanuatu from May to July 2019. Psychological, physical and sexual IPV were measured using the WHO Violence Against Women Instrument. Psychological distress was measured using the 20-item WHO Self-Reporting Questionnaire. Data were collected in confidential individual interviews with a trained local interviewer. Logistic regression models were used to investigate the relationship between IPV and health outcomes while controlling for confounding variables.

Findings

192 women contributed data, among whom 188 answered the questions about IPV. Of these, 80 women had experienced any form of IPV during the current pregnancy. Women who experienced IPV were more likely than those who did not to report poorer general health (aOR:2.97, 95%CI:1•42-6•22), higher levels of psychological distress (aOR:4.77, 95%CI:2•02-11.24) and suicidal thoughts (aOR:3•78, 95%CI:1•71–8.33) and/or behaviours (aOR:1.98, 95%CI:0•69–5.64) in the previous four weeks. Late antenatal attendance was widespread, but not related to IPV.

Interpretation

IPV perpetrated against women who are pregnant is a serious public health problem in Vanuatu and is related to worse antenatal physical and psychological health.

Funding

JF is supported by the Finkel Professorial Fellowship, funded by the Finkel Family Foundation; TT is supported by a Monash Strategic Bridging Fellowship. Monash University provided a student research grant to SMcK. Soroptimist International Gippsland provided a grant to fund small gifts for the participants.

Analysing the impact of trade agreements on national food environments: the case of Vanuatu

BACKGROUND

A large body of literature exists on trade liberalisation and the ways in which trade agreements can affect food systems. However, the systematic and objective monitoring of these and their impact on national food environments has been limited. Using a case study, this paper undertakes a systematic analysis of how Vanuatu's obligations under WTO agreements has impacted its food environment.

RESULTS

Data collection was guided by the INFORMAS trade monitoring framework's minimal approach and seven selected indicators outlined in three domains: trade in goods, trade in services and FDI, and policy space. Strong associations between trade liberalisation and imported foods, especially ultra-processed foods were evident in measured indicators as follows: (i) food trade with 32 WTO countries showing high levels of import volumes; (ii) a marked increase in 'less healthy' focus food imports namely fatty and other selected meat products, sugar, savoury snacks, ice-cream and edible ices and energy-dense beverages; (iii) actual and bound tariff rates impacting import trends of ice-cream and edible ices, bakery products and confectionary; and in other instances, a sharp increase in import of crisps, snacks and noodles despite tariff rates remaining unchanged from 2008 to 2019; (iv) policies regulating food marketing, composition, labelling and trade in the domestic space with relatively limited safeguard measures; (v) 49 foreign-owned food-related companies involved in food manufacturing and processing and the production of coffee, bakery products, confectionary, food preservatives, fish, local food products and meat, and the manufacturing, processing and packaging of palm oil, coconut oil, cooking oil, water, cordial juice, flavoured juices, soft drinks and alcoholic beverages. These were largely produced for local consumption; (vi) 32 domestic industries engaged in food and beverage production; and (vii) an assessment of WTO provisions relating to domestic policy space and governance showing that the current legal and regulatory environment for food in Vanuatu remains fragmented.

CONCLUSIONS

The analysis presented in this paper suggest that Vanuatu's commitments to WTO agreements do play an important role in shaping their food environment and the availability, nutritional quality, and accessibility of foods.

Factors Influencing the Distribution of Endemic Damselflies in Vanuatu

Simple Summary

Predicting the distribution of endemic insects is vital to continual study and conservation efforts. Here we used ecological niche models and pH data to determine which environmental factors may be influencing the distribution of a group of damselflies in Vanuatu. We tested the utility of niche models in this context and found pH to be a strong predictor for this genus.

Abstract

Vanuatubasis Ober and Staniczek is a genus of damselfly endemic to Vanuatu. Little is known about the distribution and general natural history of the genus. We present the results of 14 weeks of fieldwork in Vanuatu to provide a better understanding of the biology of this genus. Specifically, we tested ecological niche models to predict the presence of Vanuatubasis throughout the region and explored how water pH may play a role in their distribution and ecology. The results of this fieldwork refined our model and further predicted the presence of this genus on additional islands. We also found stream pH as a strong predictor for the presence of Vanuatubasis, with their presence in alkaline streams significantly higher (p < 0.001). The mean pH for those streams where the genus was collected was 8.44 (n = 53).

Assessing Women's Health Needs in the Underserved Island Communities of Vanuatu

INTRODUCTION

Vanuatu is a South Pacific island nation with limited resources and dispersed communities. Healthcare provision and population health data is lacking; and women have been an historically undervalued, underserved group. This needs assessment was completed by mothers in the area surrounding a health clinic in Vanuatu to better inform the clinic's service expansion.

METHODS

In a period of six weeks, 60 parous women, between 17 and 66 years old, were interviewed in their native language (Bislama). Participants provided verbal responses to 29 questions targeting family health needs and pregnancy experiences. The questionnaire was constructed from WHO and UNICEF surveys. Descriptive statistics were calculated.

RESULTS

Primary care complaints were the most common health concerns reported by participants. Few women (43.3%, 26/60) knew what a sexually transmitted infection was, and 38.3% (23/60) knew a place offering HIV testing. Thirty percent (18/60) never had a pelvic exam. During their last pregnancies, 98.3% (59/60) received prenatal care with a median of five visits and variable health education. Injectable (65.2%, 15/23) and oral contraception (21.7%, 5/23) were the most utilized family planning methods; one person used condoms (4.3%, 1/23). Eighty-seven percent (52/60) felt unsafe walking through their neighborhoods at night.

DISCUSSION

General knowledge and utilization of women's health resources were limited in this group. The community-based primary care setting could be an important site for future provision of women's health services. Future studies and interventions in family planning, sexual health, and prenatal care could aid this community.

Scale-Dependent Influences of Distance and Vegetation on the Composition of Aboveground and Belowground Tropical Fungal Communities

Fungi provide essential ecosystem services and engage in a variety of symbiotic relationships with trees. In this study, we investigate the spatial relationship of trees and fungi at a community level. We characterized the spatial dynamics for above- and belowground fungi using a series of forest monitoring plots, at nested spatial scales, located in the tropical South Pacific, in Vanuatu. Fungal communities from different habitats were sampled using metagenomic analysis of the nuclear ribosomal ITS1 region. Fungal communities exhibited strong distance-decay of similarity across our entire sampling range (3-110,000 m) and also at small spatial scales (< 50 m). Unexpectedly, this pattern was inverted at an intermediate scale (3.7-26 km). At large scales (80-110 km), belowground and aboveground fungal communities responded inversely to increasing geographic distance. Aboveground fungal community turnover (beta diversity) was best explained, at all scales, by geographic distance. In contrast, belowground fungal community turnover was best explained by geographic distance at small scales and tree community composition at large scales. Fungal communities from various habitats respond differently to the influences of habitat and geographic distance. At large geographic distances (80-110 km), community turnover for aboveground fungi is better explained by spatial distance, whereas community turnover for belowground fungi is better explained by plant community turnover. Future syntheses of spatial dynamics among fungal communities must explicitly consider geographic scale to appropriately contextualize community turnover.

Community Perceptions of the Determinants of Diabetes in Peri-Urban Vanuatu

Health promotion is a core component of the Pacific region's response to noncommunicable diseases (NCDs) prevention and control. However, while health promotion should build on and be informed by contextually specific norms and social discourse, there remains a paucity in research that seeks to understand how people in the Pacific region comprehend chronic conditions and their determinants. Based in peri-urban Vanuatu, this codesigned study utilized an open-ended survey to investigate community perceptions of factors contributing to the development of type 2 diabetes. Results demonstrate a complex picture of diabetes-specific health literacy, with 22 distinct causes identified by 308 respondents. Dietary factors were commonly acknowledged; however, dietary complexity was not well understood. Limited recognition of the role of tobacco and alcohol consumption in disease development was also noted. Overall, findings demonstrate mixed successes in NCD-related health promotion. Moving away from more universalized approaches commonly advocated by donors, this research identifies the need for locally designed and driven health promotion that focuses on more nuanced, culturally sensitive, and contextually grounded messaging.

Aquatic contaminants in Solomon Islands and Vanuatu: Evidence from passive samplers and Microtox toxicity assessment

Water Quality issues in many Pacific countries are rising, with the increase in coastal populations and associated urban runoff but management requires contamination issues in the aquatic environment to be identified and prioritised. In Vanuatu and Solomon Islands there are few laboratories and resources to assess for the presence or impact of complex chemical contaminants. The extent and impact of chemical contamination of the marine and coastal environment is poorly described. Passive chemical samplers were used to measure a range of aquatic pollutants around the capital cities, Honiara (Solomon Islands) and Port Vila (Vanuatu). We detected a range of chemicals indicative of agricultural and industrial contamination and a few sites had concerning concentrations of specific hydrocarbons and pesticides. The rapid ecotoxicology test, Microtox, indicated toxic impacts in rivers, coastal sites and urban drains This work provides new data on chemical contamination and possible impacts of that contamination for both countries. The techniques could be applied widely across the region to generate critical data for environmental management, guide monitoring efforts and measure the impact of policy or land-use changes.

A qualitative study of patient perspectives of diabetes and diabetic retinopathy services in Vanuatu

ISSUE ADDRESSED

Diabetes mellitus is an increasing global health problem, particularly in Vanuatu, where it poses a major health burden. There is paucity of information on how patients in Vanuatu perceive diabetes, diabetic retinopathy, access to services and management, health promotion and intervention services to alleviate the issues. This study aimed to explore the perceptions of diabetic patients in Vanuatu on these issues, to help inform the design of health promotion materials and community activities to empower people to self-manage and shape diabetic services that are integrated and people-centred.

METHODS

Qualitative Talanga and Kakala Pacific research methodologies were applied. Participants were diabetic patients from both urban locations and rural villages in Vanuatu. Data were collected from four (two male, two female) focus group interviews and thematically analysed.

RESULTS

There were 26 participants. System failures became apparent, including the inability of the health care services to meet the complex needs of patients with diabetes. The protective factors to reduce the risk and increasing incidence of diabetes and diabetic retinopathy included comprehensive village-based health promotion and community development programmes at the primary prevention level.

CONCLUSION

This study described patients' experiences of their diabetic care and identified key barriers and facilitators of service delivery pathways. SO WHAT?: Vanuatu needs to expand nationwide health promotion and education programmes on nutrition and exercise, food insecurity and access through trade agreements and provide well-trained nursing and medical specialists for early diagnosis and adequate management of diabetes that all people can access and afford.

Three Phases of Ancient Migration Shaped the Ancestry of Human Populations in Vanuatu

The archipelago of Vanuatu has been at the crossroads of human population movements in the Pacific for the past three millennia. To help address several open questions regarding the history of these movements, we generated genome-wide data for 11 ancient individuals from the island of Efate dating from its earliest settlement to the recent past, including five associated with the Chief Roi Mata's Domain World Heritage Area, and analyzed them in conjunction with 34 published ancient individuals from Vanuatu and elsewhere in Oceania, as well as present-day populations. Our results outline three distinct periods of population transformations. First, the four earliest individuals, from the Lapita-period site of Teouma, are concordant with eight previously described Lapita-associated individuals from Vanuatu and Tonga in having almost all of their ancestry from a "First Remote Oceanian" source related to East and Southeast Asians. Second, both the Papuan ancestry predominating in Vanuatu for the past 2,500 years and the smaller component of Papuan ancestry found in Polynesians can be modeled as deriving from a single source most likely originating in New Britain, suggesting that the movement of people carrying this ancestry to Remote Oceania closely followed that of the First Remote Oceanians in time and space. Third, the Chief Roi Mata's Domain individuals descend from a mixture of Vanuatu- and Polynesian-derived ancestry and are related to Polynesian-influenced communities today in central, but not southern, Vanuatu, demonstrating Polynesian genetic input in multiple groups with independent histories.

First marine litter survey on beaches in Solomon Islands and Vanuatu, South Pacific: Using OSPAR protocol to inform the development of national action plans to tackle land-based solid waste pollution

The increasing abundance of marine litter is impacting the environment, human health and economies in the South Pacific. Small Islands Developing States are particularly affected by marine litter, primarily due to insufficient waste management systems. For the first time, marine litter was quantified and characterised on 13 beaches in Solomon Islands and Vanuatu in the South Pacific region using the OSPAR beach litter monitoring guidelines. A total of 1053 (±1017) and 974 (±745) items of litter per 100 m beach were recorded in Solomon Islands and Vanuatu respectively. Litter composition and distribution show that the majority of the litter comes from local land-based sources and large quantities of fragments and single use plastics were found by cities and river mouths. Actions to reduce single use plastic, improve collection, reuse and recycling, together with outreach campaigns would reduce marine litter significantly in these countries. Furthermore, there is great potential to develop a more circular economy to manage the substantial quantities of recyclable items that were found stranded on the beaches.

Prospects and constraints of post-cyclone housing reconstruction in Vanuatu drawing from the experience of tropical cyclone Harold

Vanuatu is one of the countries in the world most at risk from natural hazards. This Pacific island country is frequently struck by ferocious tropical cyclones, such as Cyclone Harold in April 2020, causing massive devastation to the housing sector; nearly 21,000 houses were destroyed and damaged by the cyclone. Drawing from the literature and communications with local stakeholders, five main thematic aspects were analysed: nature of the impact of cyclones on housing; key challenges for post-cyclone housing reconstruction in Vanuatu; cyclone-resistant construction approaches; post-Harold housing reconstruction initiatives; and key opportunities. Of particular significance is the dilemma posed by traditional versus 'modern' approaches to design and construction for post-disaster reconstruction. There are many guidelines available for cyclone-resistant housing, but they face barriers to dissemination and application, and whether they are necessarily appropriate in the cultural context of Vanuatu is examined. Vanuatu faces a difficult situation in the aftermath of Cyclone Harold in the midst of the COVID-19 pandemic, and it can be expected that the reconstruction will be a protracted process.

Factors Associated with Smoking and Drinking among Early Adolescents in Vanuatu: A Cross-Sectional Study of Adolescents and Their Parents

This cross-sectional study determined whether various factors, such as parental behavior, attitude, and knowledge and sibling and peer behaviors, were associated with smoking and drinking among early adolescents in the Republic of Vanuatu. For this purpose, logistic regression analysis was used to determine the relative importance of the factors as well as the influences of the parents/guardians, siblings, and peers. The participants consisted of 157 seventh- and eighth-grade adolescents (mean age = 13.3 years; 52.2% girls), including their parents/guardians, from three public schools in Vanuatu. According to the results, the proportions of smokers and drinkers among the adolescents were 12.7% each, while the majority of the parents/guardians disapproved of underage smoking and drinking. In addition, peer influences (i.e., regularly smoking and/or drinking and offering tobacco and/or alcohol) was significantly associated with ever smoking and drinking, whereas parental and sibling influences did not have a significant impact on ever smoking and drinking. In sum, being given tobacco or alcohol from peers had the strongest association with ever smoking and drinking among the adolescents in this study. Thus, future school-based intervention programs should focus on enhancing early adolescents’ life skills, including the ability to resist offers of tobacco and/or alcohol from their peers.

Baseline assessment of coastal water quality, in Vanuatu, South Pacific: Insights gained from in-situ sampling

Nearshore deterioration of water quality in Pacific coastal waters is a growing problem, associated with increasing urban and industrial sewage discharges, and agricultural runoff. Published water quality studies in the Pacific region are limited in both number and scope, making it difficult to resolve the extent of the issue or quantify the variability of water quality across Pacific islands and countries. This study collected water quality measurements over three years in the coastal waters around the Island of Efate (Vanuatu) with majority of work carried out in Port Vila, its capital. Port Vila is the key urban centre for Vanuatu where the increasing population and pollution inputs are placing substantial pressure on the coastal environment. Highest concentrations of dissolved nutrients and suspended sediments were measured adjacent or near the urban drains that enter the coastal areas along the capital's seafront, highlighting many of the issues around anthropogenic inputs are linked to the increasing urbanisation in Port Vila Bay. We provide baseline data that explores variability of coastal water quality and these types of datasets for Pacific islands are a first step towards facilitating development of long-term monitoring programmes and informing coastal zone management decision making.

Occurrence and abundance of meso and microplastics in sediment, surface waters, and marine biota from the South Pacific region

Data on the occurrence and abundance of meso and microplastics for the South Pacific are limited and there is urgent need to fill this knowledge gap. The main aim of the study was to apply a rapid screening method, based on the fluorescence tagging of polymers using Nile red, to determine the concentration of meso and microplastics in biota, sediment and surface waters near the capital cities of Vanuatu and Solomon Islands. A spatial investigation was carried out for sediment, biota and water as well as a temporal assessment for sediment for two consecutive years (2017 and 2018). Accumulation zones for microplastics were identified supported by previous hydrodynamic models. Microplastics were detected for all environmental compartments investigated indicating their widespread presence for Vanuatu and Solomons Islands. This method was in alignment with previous recommendations that the Nile red method is a promising approach for the largescale mapping of microplastics in a monitoring context.

COVID-19 restrictions amidst cyclones and volcanoes: A rapid assessment of early impacts on livelihoods and food security in coastal communities in Vanuatu

Coastal communities in regions like the Pacific have been impacted by COVID-19 related public health measures that limit the movement of people, trade and access to resources. In disaster-prone countries, like Vanuatu, such measures add to existing pressures on coastal communities' adaptive capacity. To understand how coastal communities in Vanuatu were impacted in the immediate period after COVID-19 measures were placed, and how people responded to the changing circumstances, a rapid appraisal survey was carried out following a nationally declared state of emergency in March 2020. Results reveal changes in village population, loss of cash income, difficulties in accessing food and shifting pressures on particular resources and habitats. The findings provide insights into the ways local adaptive capacity to satisfy livelihood and food security needs differed among rural contexts. From this we argue that broad quantitative impact assessments are important in guiding strategic and longer term responses and adaptations, but that these are made more useful when complemented with qualitative insights on people and place in the short-term.

Cultural Variation in the Development of Beliefs About Conservation

Examining variation in reasoning about sustainability between diverse populations provides unique insight into how group norms surrounding resource conservation develop. Cultural institutions, such as religious organizations and formal schools, can mobilize communities to solve collective challenges associated with resource depletion. This study examined conservation beliefs in a Western industrialized (Austin, Texas, USA) and a non-Western, subsistence agricultural community (Tanna, Vanuatu) among children, adolescents, and adults (N = 171; n = 58 7-12-year-olds, n = 53 13-17-year-olds, and n = 60 18-68-year-olds). Participants endorsed or rejected four types of justifications for engaging in land and animal conservation: sustainability, moral, religious, or permissible. In both populations, participants endorsed sustainability justifications most frequently. Religious justifications increased with age in Tanna and decreased with age in Austin. Tannese participants were also more likely to endorse multiple justifications for conservation than Austin participants. Data across all justification types show a main effect of age in both communities; endorsement of conservation decreased with age in Austin, but increased with age in Tanna. Across age groups, participants were more likely to endorse the conservation of animals than land in Austin, yet equally as likely to endorse the conservation of land and animals in Tanna. Overall, these results reveal similarities and differences in the beliefs that support the conservation of natural resources across populations.

Scaring Nemo: Contrasting effects of observer presence on two anemonefish species

Behaviours of Clark's anemonefish Amphiprion clarkii and the dusky anemonefish Amphiprion melanopus were studied in Vanuatu. Six anemones and their resident fish were observed for typical behaviours (hiding, watching, roaming, inter-, and intraspecific behaviour) with and without the presence of a snorkelling observer. Observer presence had significant but contrasting effects on hiding behaviour in A. clarkii and A. melanopus. Bolder anemonefish species may be able to outcompete other species in areas with high human presence.

From community-based to locally led adaptation: Evidence from Vanuatu

The Green Climate Fund, donors, governments and non-governmental organisations, among others, are pouring vast amounts of financial and human capital into community-based adaptation across the developing world. The underlying premise is that the world's majority-who have the minority of financial capital-are living on the margins and are the most vulnerable and at risk from climate change. Such a reality, coupled with a deficit understanding of the majority world, is resulting in significant implications for how the 'adaptation industry' (those that fund, design and implement projects) go about their work. Drawing on research evaluating 15 community-based adaptation projects in Vanuatu we found that despite genuine attempts, projects invariably fell short of success, longevity and sustainability. We argue that the indifferent, albeit variable, success of most projects is attributable to the construction of the geographical scale of 'community-based' and the deficit view flowing down to the 'community' through hubris policy, funding guidelines and individual implementers. Our findings show that 'experts' are working in Pacific communities, conducting assessments that involve asking what 'community' needs are, going away to design projects, coming back and implementing projects, which communities are inevitably challenged to sustain once funding has ceased. We postulate that these limitations stem from such a formation of adaptation work that pejoratively fails to see Pacific Islanders in situ as the best litmus test of their own agendas, needs, aspirations and futures and in the best position to make decisions for themselves about what and how they might become more resilient. We claim from a growing body of evidence and new frontiers in research that, rather than adaptation being 'community-based', it needs to be 'locally led', not limited to 'communities', and should take place across different entry points and incorporate, as appropriate, elements of autonomous/Indigenous peoples ownership.

New names and status for Pacific spiny species of Solanum (Solanaceae, subgenus Leptostemonum Bitter; the Leptostemonum Clade)

Five new species of spiny solanums (Solanum subgenus Leptostemonum Bitter; the Leptostemonum Clade) are described from the islands of the Pacific. Two of the new species are from Fiji (S. pseudopedunculatum D.McClelland, sp. nov. and S. ratale D.McClelland, sp. nov.), two from New Caledonia (S. memoayanum D.McClelland, sp. nov. and S. semisucculentum D.McClelland, sp. nov.), one from Papua New Guinea (S. labyrinthinum D.McClelland, sp. nov.) and another from Vanuatu (S. vanuatuense D.McClelland, sp. nov.). A new status and combination is provided for the rare Hawaiian endemic S. caumii (F.Br.) D.McClelland, comb. et stat. nov. and a new type designated for S. peekelii Bitter of Papua New Guinea, for which a description is also provided. All species are illustrated with digitized herbarium specimens, mapped and have been assigned a preliminary conservation status using current IUCN guidelines. Details of all specimens examined are provided in a Suppl. materials 1: file SM1.

Vanuatu Psychiatry Mentorship Programme: a case illustrating cultural and clinical considerations

OBJECTIVES

The objectives of this article are to describe a case highlighting challenges in managing an acute psychiatric presentation, the process of mentorship and the significance of cultural matters influencing family engagement in Vanuatu.

METHOD

Case description.

RESULTS

This case highlights resourcing constraints facing a small mental health team in the Pacific, the clinical significance of the concept of tabu in a ni-Vanuatu context and the importance of family decision making processes in ni-Vanuatu culture.

CONCLUSION

A structured mentoring programme to foster mental health capacity development in Vanuatu can support psychiatric decision-making in complex cases, reflection on the role of culture in formulation and family engagement, and mutual learning.

Ocular Chlamydia trachomatis infection, anti-Pgp3 antibodies and conjunctival scarring in Vanuatu and Tarawa, Kiribati before antibiotic treatment for trachoma

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In Vanuatu, ocular Chlamydia infection prevalence is low; in Kiribati it is high.

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In Vanuatu, Pgp3 seroprevalence does not increase in childhood; in Kiribati it does.

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Conjunctival scarring is more common in adults in Kiribati than in Vanuatu.

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Trachomatous inflammation—follicular lacks specificity for ocular Chlamydia infection.

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Non-TF markers may help to determine need for interventions against active trachoma.

Introduction

In the peri-elimination setting, the positive predictive value of trachomatous inflammation–follicular (TF), the primary marker used to determine need for antibiotics for trachoma, is suboptimal. Here, three non-TF measures are used to compare two regions where TF prevalence exceeds the threshold for intervention, but where the Chlamydia trachomatis (Ct) prevalence is different.

Methods

Population prevalence of trachoma was measured in Vanuatu (n = 3470) and Kiribati (n = 2922). Dried blood spots (DBS) and conjunctival photographs were collected from every survey participant, and conjunctival swabs were collected from those aged 1–9 years. Individuals were tested for blood anti-Pgp3 antibodies, Ct DNA at the conjunctiva and severity of conjunctival scarring.

Results

The prevalence of TF in 1–9-year-olds was 16.5% in Vanuatu and 38.2% in Tarawa. 7% of people aged ≥1 year in Vanuatu had conjunctival scarring compared to 27% in Tarawa. The prevalence of ocular Ct infection in 1–9-year-olds was 1.5% in Vanuatu and 27.4% in Tarawa. The seroconversion rate amongst 1–9-year-old children in Vanuatu and Tarawa was 0.018 and 0.197 events per child per year, respectively.

Conclusions

Comparing Vanuatu to Tarawa demonstrates several markers that could be used to differentiate the trachoma status of populations in these (and other) locations.

The Vanuatu Psychiatry Mentorship Programme: supporting the development of a fledgling mental health service in the Pacific

OBJECTIVE

To describe the Vanuatu Psychiatry Mentorship Programme (VPMP) set up to support the sole mental health doctor and local nurses developing mental health service capacity in Vanuatu.

METHOD

Following a request from Vanuatu, the VPMP was set up under the auspices of the Faculty of Child and Adolescent Psychiatry of the Royal Australian and New Zealand College of Psychiatrists (the College) with three components: regular online supervision, yearly onsite visits and advice over the Internet on an as-required basis.

RESULTS

Onsite visits undertaken by three VPMP psychiatrists provided opportunities for mentoring and teaching activities related to clinical psychiatry, community liaison, social and ethical considerations and mental health policy matters. Online supervision sessions were initially hampered by technology difficulties. Ad hoc advice over the Internet allowed more rapid responses in complex acute psychiatry cases.

CONCLUSIONS

Structured mentoring programmes can play a role in supporting the development of mental health capacity in low-resourced Pacific nations. Such programmes are likely to be more useful for Pacific participants if they are flexible, ongoing, sustained by support from the College and reviewed regularly.

Betel Nut Use in Vanuatu: Investigating Opportunities to Reduce Harms to Health

Background: Betel nut chewing is a public health concern in the Asia-Pacific region and is an emerging issue in Vanuatu. Despite the significant health risks associated with betel nut chewing, few interventions have been undertaken to reduce its harm. Objectives: To investigate betel nut use in Vanuatu and to identify opportunities to reduce its harm and possible interventions, framing the responses using the World Health Organization's MPOWER tobacco control model. Method: Qualitative research design, in the form of semi-structured interviews with ten participants with expertise in health, agriculture, education or non-communicable disease in Port Vila, Vanuatu during June 2017. Recorded interviews were transcribed verbatim, and a general inductive approach was used to identify key themes. Results: Participants reported a recent increase in betel nut use in Vanuatu due to the influence from Papua New Guinea and the Solomon Islands. To reduce the harm of betel nut use in Vanuatu, participants suggested policies and strategies that aligned with the MPOWER framework that could be adopted for betel nut control, including restricting cultivation and sale of betel nut in Vanuatu and using radio and existing community networks to reach people with messages about the dangers of betel nut use. Conclusion: Betel nut use may be growing in popularity in Vanuatu, where there are potential policy options to minimize harm. The MPOWER model for tobacco control may be a useful framework to help the Vanuatu government to deliver a comprehensive approach to reducing harm from betel nut use.

Metapopulation Vicariance, Age of Island Taxa and Dispersal: A Case Study Using the Pacific Plant Genus Planchonella (Sapotaceae)

Oceanic islands originate from volcanism or tectonic activity without connections to continental landmasses, are colonized by organisms, and eventually vanish due to erosion and subsidence. Colonization of oceanic islands occurs through long-distance dispersals (LDDs) or metapopulation vicariance, the latter resulting in lineages being older than the islands they inhabit. If metapopulation vicariance is valid, island ages cannot be reliably used to provide maximum age constraints for molecular dating. We explore the relationships between the ages of members of a widespread plant genus (Planchonella, Sapotaceae) and their host islands across the Pacific to test various assumptions of dispersal and metapopulation vicariance. We sampled three nuclear DNA markers from 156 accessions representing some 100 Sapotaceae taxa, and analyzed these in BEAST with a relaxed clock to estimate divergence times and with a phylogeographic diffusion model to estimate range expansions over time. The phylogeny was calibrated with a secondary point (the root) and fossils from New Zealand. The dated phylogeny reveals that the ages of Planchonella species are, in most cases, consistent with the ages of the islands they inhabit. Planchonella is inferred to have originated in the Sahul Shelf region, to which it back-dispersed multiple times. Fiji has been an important source for range expansion in the Pacific for the past 23 myr. Our analyses reject metapopulation vicariance in all cases tested, including between oceanic islands, evolution of an endemic Fiji-Vanuatu flora, and westward rollback vicariance between Vanuatu and the Loyalty Islands. Repeated dispersal is the only mechanism able to explain the empirical data. The longest (8900 km) identified dispersal is between Palau in the Pacific and the Seychelles in the Indian Ocean, estimated at 2.2 Ma (0.4-4.8 Ma). The first split in a Hawaiian lineage (P. sandwicensis) matches the age of Necker Island (11.0 Ma), when its ancestor diverged into two species that are distinguished by purple and yellow fruits. Subsequent establishment across the Hawaiian archipelago supports, in part, progression rule colonization. In summary, we found no explanatory power in metapopulation vicariance and conclude that Planchonella has expanded its range across the Pacific by LDD. We contend that this will be seen in many other groups when analyzed in detail.

carruthersii

When dealing with the taxonomy of Pacific coastal species within the region of New Caledonia and Vanuatu, one should examine all names published in Australasia and other Pacific islands. When the putative new species is also closely related to a highly praised ornamental species with many cultigens and with many old horticultural names, the task becomes more arduous. This is the case for the new species we describe as Pseuderanthemum melanesicum Gâteblé, Ramon & Butaud, which is closely related to the now pantropical cultivated species P. carruthersii (Seem.) Guillaumin s.l. Compared to P. carruthersii, P. melanesicum has carnose and shiny leaves, pedicels and sepals covered with glandular hairs, a short and enlarged corolla tube and can produce fertile capsules. The new species is a coastal taxon occurring naturally in the Melanesian archipelagos of New Caledonia and Vanuatu. This species seems uncommon in the Loyalty Islands but more common in the archipelago of Vanuatu and we propose it as Critically Endangered in New Caledonia, Vulnerable in Vanuatu and Least Concern when the IUCN evaluation is done globally.