In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended six surgical metrics to enable countries to measure their surgical and anaesthesia care delivery. These indicators have subsequently been accepted by the World Bank for inclusion in the World Development Indicators. With support from the Royal Australasian College of Surgeons and the Pacific Islands Surgical Association, 14 South Pacific countries collaborated to collect the first four of six LCoGS indicators. Thirteen countries collected all four indicators over a 6-month period from October 2015 to April 2016. Australia and New Zealand exceeded the recommended LCoGS target for all four indicators. Only 5 of 13 countries (38%) achieved 2-hour access for at least 80% of their population, with a range of 20% (Papua New Guinea and Solomon Islands) to over 65% (Fiji and Samoa). Five of 13 (38%) countries met the target surgical volume of 5000 procedures per 100 000 population, with six performing less than 1600. Four of 14 (29%) countries had at least 20 surgical, anaesthesia and obstetric providers in their workforce per 100 000 population, with a range of 0.9 (Timor Leste) to 18.5 (Tuvalu). Perioperative mortality rate was reported by 13 of 14 countries, and ranged from 0.11% to 1.0%. We believe it is feasible to collect global surgery indicators across the South Pacific, a diverse geographical region encompassing high-income and low-income countries. Such metrics will allow direct comparison between similar nations, but more importantly provide baseline data that providers and politicians can use in advocacy national health planning.

Documenting locally identified challenges and opportunities for surgical care in Vanuatu is an important first step towards developing formal strategies for improving surgical services at the country level.

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.

Violence perpetrated by an intimate partner (IPV) is an important human rights and public health problem worldwide and when experienced during pregnancy is of special concern due to the harmful impact on maternal and child health. Women living in Vanuatu, and especially Sanma Province, experience high rates of IPV, however little is known about their experiences of violence when pregnant. The aim was to describe the prevalence, patterns and determinants of IPV among women who are pregnant in Sanma Province, Vanuatu. A cross-sectional survey was used. All healthy adult women attending Northern Provincial Hospital antenatal clinic from late May to late July 2019 were eligible and invited to participate. Psychological, physical and sexual IPV and controlling behaviours were assessed with a modified version of the World Health Organization Violence Against Women Instrument administered as an individual interview. Descriptive statistics were used to analyse prevalence and patterns of IPV and logistic regression models to identify determinants. Of 214 women who expressed interest in participating, 192 women contributed data. Overall 64.2% of women had experienced any IPV during their lifetime and 42.2% had experienced IPV during their current pregnancy. Experience of co-occurrence of violence types was common, and it was more common for IPV to continue than to cease during pregnancy. Factors which increased likelihood of experiencing IPV included being employed, occupying a lower socioeconomic position, having a partner who was unemployed or used alcohol or illicit substances at least once a week. IPV, in all its forms, is a common problem faced by women who are pregnant and living in Vanuatu.

No abstract