Strengthening rural community water safety planning in Pacific Island countries: evidence and lessons from Solomon Islands, Vanuatu, and Fiji.

Pacific Island Countries (PICs) collectively have the lowest rates of access to safely managed or basic drinking water and sanitation globally. They are also the least urbanised, have dynamic socioeconomic and increasing climate-linked challenges. Community-based water managers need to respond to variability in water availability and quality caused by a range of hazards. Water Safety Planning (WSP), a widely adopted approach to assessing water supply, offers a risk-based approach to mitigating both existing and future hazards. WSP is adaptable, and making modifications to prescribed WSP to adapt it to the local context is common practice. Within the Pacific Community Water Management Plus research project, we used formative research and co-development processes to understand existing local modifications, whether further modifications are required, and, to develop additional modifications to WSP in Fiji, Vanuatu and Solomon Islands. The types of additional local modifications we recommend reflect the unique context of PICs, including adjusting for community management of water supplies and required collective action, community governance systems, levels of social cohesion in communities, and preferred adult-learning pedagogies. Incorporating modifications that address these factors into future WSP will improve the likelihood of sustained and safe community water services in Pacific and similar contexts.

Ancient DNA from Guam and the peopling of the Pacific.

Humans reached the Mariana Islands in the western Pacific by ∼3,500 y ago, contemporaneous with or even earlier than the initial peopling of Polynesia. They crossed more than 2,000 km of open ocean to get there, whereas voyages of similar length did not occur anywhere else until more than 2,000 y later. Yet, the settlement of Polynesia has received far more attention than the settlement of the Marianas. There is uncertainty over both the origin of the first colonizers of the Marianas (with different lines of evidence suggesting variously the Philippines, Indonesia, New Guinea, or the Bismarck Archipelago) as well as what, if any, relationship they might have had with the first colonizers of Polynesia. To address these questions, we obtained ancient DNA data from two skeletons from the Ritidian Beach Cave Site in northern Guam, dating to ∼2,200 y ago. Analyses of complete mitochondrial DNA genome sequences and genome-wide SNP data strongly support ancestry from the Philippines, in agreement with some interpretations of the linguistic and archaeological evidence, but in contradiction to results based on computer simulations of sea voyaging. We also find a close link between the ancient Guam skeletons and early Lapita individuals from Vanuatu and Tonga, suggesting that the Marianas and Polynesia were colonized from the same source population, and raising the possibility that the Marianas played a role in the eventual settlement of Polynesia.

Management of saltwater intrusion using 3D numerical modelling: a first for Pacific Island country of Vanuatu.

Small island countries like Vanuatu are facing the brunt of climate change, sea level rise (SLR), tropical cyclones, and limited or declining access to freshwater. The Tagabe coastal aquifer in Port Vila (the capital of Vanuatu) shows the presence of salinity, indicating saltwater intrusion (SWI). This study aims to develop and evaluate effective SWI management strategies for Tagabe coastal aquifer. To manage SWI, the numerical simulation model for the study area was developed using the SEAWAT code. The flow model was developed using MODFLOW and the transport model was developed using MT3DMS. Whereby SEAWAT solved flow and transport equations simultaneously. The model was calibrated, and different scenarios were evaluated for the management of SWI. The SLR was also considered in the model simulations. The results indicated that increased population, pumping rates, and SLR affect the SWI rates. To manage the SWI, we introduced hydraulic barriers like barrier wells and injection wells which effectively managed SWI in Tagabe coastal aquifer. The results from this study are significantly important whereby, the water managers, site owners, and governing bodies can use the management strategies presented in this study to create policies and regulations for managing SWI rates in Port Vila. Additionally, the water industry, private businesses, and investors who wish to extract groundwater from the Tagabe can use this study as a reference for daily or yearly freshwater production rates without the risk of SWI.

Vocal input and output among infants in a multilingual context: Evidence from long-form recordings in Vanuatu.

What are the vocal experiences of children growing up on Malakula island, Vanuatu, where multilingualism is the norm? Long-form audio-recordings captured spontaneous speech behavior by, and around, 38 children (5-33 months, 23 girls) from 11 villages. Automated analyses revealed most children's vocal input came from female adults and other children's voices, with small contributions from male adult voices. The greatest changes with age involved an increase in the input vocalizations from other children. Total input (collapsing across child-directed and overheard speech, and across languages) was ∼11 min per hour, which was at least 5 min (31%) lower than that found in other populations studied using comparable methods in previous literature, as well as in archival American data analyzed with the same algorithm. In contrast, children's own vocalization counts were two to four times higher than previous reports for North-American English-learning monolingual infants at matched ages, and comparable to estimates from archival American data, consistent with a resilient language-learning cognitive system for this aspect of vocal development. The strongest association between input and output was with vocalizations by other children, rather than those by adults, which is consistent with research in anthropology but less so with current theoretical trends in developmental psychology. These results invite further research in populations that are under-represented in developmental science. RESEARCH HIGHLIGHTS: Combining long-form recordings with automated analyses, we estimated infants potentially exposed to ∼2.6 languages heard ∼11 min of speech per hour. Infants' input was dominated by vocalizations from female adults and from other children, particularly for the oldest infants in our sample. The strongest association between children's own vocalization counts and input counts was with those of other children, and not those with adults. Results invite further research on individual, group, and population variability in input quantity and composition, and its potential effects on vocal development.

Development of teaching in ni-Vanuatu children.

Teaching is an important mechanism of social learning. In industrialized societies, 3-year-olds tend to teach through demonstrations and short commands, while 5-year-olds use more verbal communication and abstract explanations. However, it remains unclear whether this generalizes to other cultures. This study presents results from a peer teaching game with 55 Melanesian children (4.7-11.4 years, 24 female) conducted in Vanuatu in 2019. Up to age 8, most participants taught through a participatory approach, emphasizing learning-by-doing, demonstrations, and short commands (57.1% of children aged 4-6 and 57.9% of children aged 7-8). Contrary to Western findings, abstract verbal communication only became common in children aged 9-11 (63.6%), suggesting that the ontogeny of teaching is shaped by the socio-cultural environment.

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.

Low birthweight newborns in Vanuatu: A longitudinal follow-up study.

AIM: Medical care and technology have increased the survival of low birthweight babies (LBW), but especially in low- and middle-income settings the longer term thriving of such babies is not assured because of their fragility, limited services and difficult access after discharge from hospital. In Vanuatu, a Pacific nation of dispersed islands, improving LBW outcomes and survival remains a significant challenge. In this study, we prospectively document the survival, developmental and nutritional outcomes of a cohort of LBW over the first year of life. We also explored the mother's experiences of caring for an LBW baby in hospital and at home. METHODS: A prospective descriptive cohort study of 49 newborns weighing less than 2.5 kg, born between April and August 2019. Data were recorded on their hospital stay, and they were followed up at 6 and 12 months post-discharge and outcomes recorded. Developmental milestones were assessed using the Denver Developmental Screening Test, using milestones appropriate for corrected age. Qualitative interviews were conducted to identify experiences and challenges the mothers faced in caring for their LBW baby. RESULTS: The mean birthweight was 1800 g at 35 weeks gestation (between 2nd and 9th centile). At 6 months of age the median weight was 6.5 kg (9th centile) and at 12 months it was 7.8 kg (9th centile). Three infants died in the first 6 months post-discharge. By 12 months of age, the proportion of infants who had achieved milestones of social and emotional (90%), language and communication (97%), cognition (85%) and motor (69%) development. One had evidence of retinopathy, and 19 had clinical anaemia. Mothers identified several stressors that they attributed as risk factors for premature delivery and outlined the difficulties and isolation of caring for an LBW baby. CONCLUSIONS: It is vital that all LBW babies are followed up in the years after discharge: nutritional, developmental and general health outcomes were generally good; however, post-discharge deaths are more common in this group than in the general population. Equally important is the support for mothers of LBW babies to achieve better outcomes.

First Nations music as a determinant of health in Australia and Vanuatu: political and economic determinants.

This article reports on findings that indicate how First Nations musical activities function as cultural determinants of health. Drawing on early findings from a 3-year Australian Research Council funded project titled The Remedy Project: First Nations Music as a Determinant of Health, we detail Australian and Ni Vanuatu First Nations musicians' reported outcomes of musical activity using a First Nations cultural determinants of health framework. The broader findings indicate that our respondents see musical activity as actively shaping all known domains of cultural health determinants, and some surrounding political and social determinants. However, this paper focusses specifically on the political and economic determinants that emerged in analysis as the most dominant subthemes. We argue that this study provides strong impetus for continued investigation and reconceptualization of the place of music in cultural health determinant models.

This article looks at how making and performing music, recording music and listening to music helps the health of First Nations peoples in Australia and Ni Vanuatu. Music is an important part of the lives of First Nations peoples from these places and so research was done to try to understand why it is meaningful. Music can be used as an outlet for personal feelings, and can also be a way that groups of people can express common concerns. First Nations musicians talked about how music makes them feel, and how music is used to strengthen relationships between people, and between people and their culture. Musicians also talked about how music helps them express their political and economic goals. The findings backed up existing First Nations' models of health that say that health for First Nations People's needs to be thought about in a holistic way. The findings also showed that the relationship between music and health needs to be studied more so that we can better understand how it helps maintain links with the past, gives a guide for the present and opens options for the future.

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.

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.

Rethinking the phonetics of baby-talk: Differences across Canada and Vanuatu in the articulation of mothers' speech to infants.

Infant-directed speech (IDS) is phonetically distinct from adult-directed speech (ADS): It is typically considered to have special prosody-like higher pitch and slower speaking rates-as well as unique speech sound properties, for example, more breathy, hyperarticulated, and/or variable consonant and vowel articulation. These phonetic features are widely observed in the IDS of caregivers from urbanized contexts who speak a handful of very well-researched languages. Yet studies with more diverse socio-cultural and linguistic samples show that this "typical" IDS prosody is not consistently observed across cultures. We extended cross-cultural work by examining IDS speech segment articulation, which-like prosody-is also thought to be a characteristic phonetic feature of IDS that might aid speech and language development. Here we asked whether IDS vowels have different articulatory features compared to ADS vowels in two distinct linguistic and socio-cultural contexts: urban English-speaking Canadian mothers, and rural Lenakel- and Southwest Tanna-speaking ni-Vanuatu mothers (n = 57, 20-46 years of age). Replicating prior work, Canadian mothers had more variable vowels in IDS compared to ADS, but also did not show clear register differences for breathiness or hyperarticulation. Vowels spoken by ni-Vanuatu mothers showed very distinct articulatory tendencies, using less variable (and less breathy) IDS vowels. Along with other work showing diversity in IDS phonetics across populations, this paper suggests that any understanding of how IDS might aid speech and language development are best examined through a culturally- and linguistically-specific lens.

Examining relations between performance on non-verbal executive function and verbal self-regulation tasks in demographically-diverse populations.

Self-regulation is a widely studied construct, generally assumed to be cognitively supported by executive functions (EFs). There is a lack of clarity and consensus over the roles of specific components of EFs in self-regulation. The current study examines the relations between performance on (a) a self-regulation task (Heads, Toes, Knees Shoulders Task) and (b) two EF tasks (Knox Cube and Beads Tasks) that measure different components of updating: working memory and short-term memory, respectively. We compared 107 8- to 13-year-old children (64 females) across demographically-diverse populations in four low and middle-income countries, including: Tanna, Vanuatu; Keningau, Malaysia; Saltpond, Ghana; and Natal, Brazil. The communities we studied vary in market integration/urbanicity as well as level of access, structure, and quality of schooling. We found that performance on the visuospatial working memory task (Knox Cube) and the visuospatial short-term memory task (Beads) are each independently associated with performance on the self-regulation task, even when controlling for schooling and location effects. These effects were robust across demographically-diverse populations of children in low-and middle-income countries. We conclude that this study found evidence supporting visuospatial working memory and visuospatial short-term memory as distinct cognitive processes which each support the development of self-regulation.

Genomic insights into the peopling of the Southwest Pacific.

The appearance of people associated with the Lapita culture in the South Pacific around 3,000 years ago marked the beginning of the last major human dispersal to unpopulated lands. However, the relationship of these pioneers to the long-established Papuan people of the New Guinea region is unclear. Here we present genome-wide ancient DNA data from three individuals from Vanuatu (about 3,100-2,700 years before present) and one from Tonga (about 2,700-2,300 years before present), and analyse them with data from 778 present-day East Asians and Oceanians. Today, indigenous people of the South Pacific harbour a mixture of ancestry from Papuans and a population of East Asian origin that no longer exists in unmixed form, but is a match to the ancient individuals. Most analyses have interpreted the minimum of twenty-five per cent Papuan ancestry in the region today as evidence that the first humans to reach Remote Oceania, including Polynesia, were derived from population mixtures near New Guinea, before their further expansion into Remote Oceania. However, our finding that the ancient individuals had little to no Papuan ancestry implies that later human population movements spread Papuan ancestry through the South Pacific after the first peopling of the islands.

Variation in caregivers' references to their toddlers: Child-directed speech in Vanuatu and Canada.

The authors examined similarities and differences in Canadian and ni-Vanuatu caregivers' child-directed speech to their toddlers (N = 35, Mage : 21 months, 20 girls). Speech samples were collected (2013-2016) during free play and analyzed with a focus on describing parents' references to their toddlers. Canadian caregivers referred significantly more to toddlers' tangible characteristics (relative risk, RR = 2.12) and internal states (RR = 2.31), whereas ni-Vanuatu caregivers referred more to actions (RR = 2.04). When referring to internal states, Canadian mothers referred significantly more to mind-minded states, whereas ni-Vanuatu caregivers referred more to body-minded states (RR = 7.98). These findings are interpreted as capturing meaningful differences in toddlers' opportunities to attend to themselves. Implications for self-concept development are discussed.

G Vernon Davies: unsung pioneer of old age psychiatry in Victoria.

OBJECTIVE: To provide a biography of G Vernon Davies who took up a career in old age psychiatry in 1955 at the age of 67 at Mont Park Hospital in an era when there few psychiatrists working in the field. CONCLUSION: In the 1950s and 1960s, Vernon Davies worked as an old age psychiatrist and published papers containing sensible practical advice informed by contemporary research and experience, broadly applicable to both primary and secondary care, presented in a compassionate and empathetic manner. His clinical research in old age psychiatry resulted in the first doctoral degree in psychiatry awarded at the University of Melbourne at the age of 79. Before commencing old age psychiatry, he served in the Australian Army Medical Corps as a Regimental Medical Officer and received the Distinguished Service Order. He spent 3 years as a medical missionary in the New Hebrides before settling at Wangaratta where he worked as a physician for over 30 years. He contributed to his local community in a broad range of activities. Vernon Davies is an Australian pioneer of old age psychiatry.

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.

'Most nurses in the rural or remote health clinics run away from their job due to no remote allowances and poor working equipment and environment'. Health professional leaders' perception of shortages in the nursing workforce in underserved areas in Vanuatu.

INTRODUCTION: Health professional leaders are key informants working at senior levels in various health facilities in the areas of policies and planning processes, and human resources. This study explores the factors affecting the nursing shortage in Vanuatu and recommends measures and interventions to resolve the shortage. METHODS: A qualitative study was used to collect data from 12 health professional leaders using focus group discussion in three randomly selected hospitals in Vanuatu. The qualitative data were collected using a semi-structured, open-ended questionnaire and were audio-recorded. The data were translated and transcribed, and then analysed using thematic analysis. RESULTS: Four themes were identified: inadequate planning, increased population growth, nurse turnover and proposed strategies to resolve nursing shortages. Subthemes for inadequate planning were inadequate policy and human resources planning, and inadequate enrolment. Subthemes for increased population growth were demographics and burden of disease. Subthemes for nurse turnover were job dissatisfaction, absenteeism and increased medical problems. Subthemes for proposed strategies to resolve the nursing shortage were increased enrolment, infrastructure and capacity building. CONCLUSION: The present study identified key factors affecting current nursing workforce shortages and the recommended measures and interventions to resolve nursing shortages. The findings will assist policymakers to refine and develop relevant policies to address and strengthen the Vanuatu Ministry of Health nursing workforce.

Development and implementation of the Bachelor of Nursing (Conversion) course in Vanuatu.

CONTEXT: Vanuatu, a Pacific Island nation in the Western Pacific region, has to date educated its nurses by diploma program. Research evidence in developed countries has consistently shown that nurses educated by bachelor degree improve patient health outcomes and reduce hospital length of stay. In seeking to improve health outcomes, the Vanuatu Ministry of Health decided to introduce a new Bachelor of Nursing degree to provide a skilled, safe nursing workforce for the provision of health care to its peoples{1-3}. The curriculum for this degree was to be developed by Ni-Vanuatu nurse educators with the collaboration of educators from the WHO Collaborating Centre, University of Technology Sydney. However, it was first necessary to upgrade (from diploma to bachelor level) the qualifications of teachers and senior nursing practitioners who would lead the new degree course by introducing a Bachelor of Nursing (Conversion) course. ISSUES: In order to design and implement a Bachelor of Nursing (Conversion) course that would be relevant for the educational and healthcare context in Vanuatu and that would meet qualification requirements of the local regulatory bodies, it was essential to build collaborative relationships with key stakeholders in Vanuatu. A second key concern was to design a program that would cater for participants who were working full time, who were not all living in the same physical location, and who had limited access to internet technology and resources. The course also needed to take into account that participants were multilingual, and that English was not their first language. LESSONS LEARNED: Lessons learned included the importance of coming to understand the sociocultural nexus within which this course was developed and implemented, as well as appreciating the constraints that affect nursing education within the Pacific.

Conjunctival Scarring, Corneal Pannus, and Herbert's Pits in Adolescent Children in Trachoma-endemic Populations of the Solomon Islands and Vanuatu.

BACKGROUND: In the Solomon Islands and Vanuatu, the sign trachomatous inflammation-follicular (TF) is common, but ocular infection with Chlamydia trachomatis is not. It is therefore debatable whether azithromycin mass drug administration (MDA), the recommended antibiotic treatment strategy for trachoma's elimination as a public health problem, is necessary in this setting. We set out to estimate what proportion of adolescents were at risk of progression of trachomatous scarring. METHODS: A cross-sectional survey was undertaken of all children aged 10-14 years resident in communities identified as high-TF clusters during previous population-based mapping. Graders examined children for clinical evidence of trachomatous scarring, pannus, and Herbert's pits (HPs) or limbal follicles in both eyes. A dried blood spot was collected from each child and tested for antibodies to C. trachomatis. RESULTS: A total of 492 children in 24 villages of the Solomon Islands and Vanuatu were examined. In total, 35/492 (7%) of children had limbal signs (pannus and/or HPs) plus any conjunctival scarring. And 9/492 (2%) had limbal signs and moderate or severe conjunctival scarring; 22% of children were anti-Pgp3 seropositive. CONCLUSIONS: Few adolescents here are at risk of future complications from trachoma, supporting the conclusion that further antibiotic MDA is not currently required for trachoma elimination purposes in these settings.

Cultural Components of Sex Differences in Color Preference.

Preferences for pink and blue were tested in children aged 4-11 years in three small-scale societies: Shipibo villages in the Peruvian Amazon, kastom villages in the highlands of Tanna Island, Vanuatu, and BaYaka foragers in the northern Republic of Congo; and compared to children from an Australian global city (total N = 232). No sex differences were found in preference for pink in any of the three societies not influenced by global culture (ds - 0.31-0.23), in contrast to a female preference for pink in the global city (d = 1.24). Results suggest that the pairing of female and pink is a cultural phenomenon and is not driven by an essential preference for pink in girls.