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Aim To enable improvements in global child health, the focus must move beyond child survival to child wellbeing. In the Pacific Islands, the wellbeing of children has received little attention. This study aimed to investigate the wellbeing of children from three primary schools in Tonga. Methods A cross‐sectional survey was completed in three primary schools in Nuku'alofa with children aged 5–15 years. The study participants (256 children, 143 caregivers) completed the Child Health and Illness Profile – Child Edition, CHIP‐CE (Version 1.0). Results On average, >70% of children and caregivers described home and school environments as positive. From the children's reports, boys had significantly lower scores for risk avoidance than girls (3.40 vs. 3.73, P < 0.001). Children aged 5–7 versus 8–15 years had significantly lower scores for satisfaction (3.63 vs. 3.92, P = 0.002), resilience (3.34 vs. 3.56, P = 0.016) and achievement (3.25 vs. 3.62, P = 0.002). From the caregivers' report, girls had significantly lower scores for academic performance than boys (3.60 vs. 3.81, P = 0.04). Boys had significantly lower scores for individual risk association compared to girls (3.93 vs. 4.29, P = 0.01). Overall CHIP‐CE scores were lower than those of comparable populations in the West, while at the same time protective factors were documented. Conclusions Understanding child wellbeing in the Pacific is critical for strengthening protective factors known to mitigate poor child health outcomes. Continuing to base global child health success on child survival alone misses opportunities for improving the wellbeing of nations.

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Introduction: There is minimal information available that describes the health of children of primary school age (5-12 years) living in the Pacific. Current tools that exist for measurement of health have not been developed with Pacific paradigms in mind. Our objective was to describe the development of a culturally and contextually appropriate health survey to enable measurement of the health status of 5-12 year olds living in a Pacific Island Nation. Methods: Integrating a Delphi method with Pacific methodologies, two rounds of online questionnaires involving 33 panel members reviewed what to include in a health survey for primary school-aged children living in Tonga. The panel consisted of paediatric clinicians and academics, teachers and parents from Tonga, New Zealand, USA, and the UK. Results: Panel consensus was met on a range of domains to be included in the survey including: general demographics (80%), environment (80%), resilience and risk (88%), household economics (80%), psychological functioning (92%), social functioning (92%), physical functioning (88%), cognitive functioning (92%) and individual health conditions (84%). Particular importance was placed on including questions that described exposure of children to violence and abuse (93%). Conclusions: Based upon the consensus of a diverse expert panel, the domains that are necessary for the measurement of health in primary school-aged children living in Tonga were identified. The Delphi method proved a valid and useful technique to assist with the development of such a health survey and enabled the incorporation of a Pacific lens – a Tongan understanding of measuring children’s health.

Background Comprehensive vision screening programmes for children are an important part of public health strategy, but do not exist in many countries, including Tonga. This project set out to assess: (1) the functional vision of children attending primary schools in Tonga and (2) how a new recognition acuity test (The Auckland Optotypes displayed on a tablet computer) compares to use of a standardised eye chart in this setting. Methods Children from three Tongan primary schools were invited to participate. Acuity testing was conducted using a standardised recognition acuity chart (Lea symbols) and the tablet test displaying two formats of The Auckland Optotypes. Measures of ocular alignment, stereo acuity and non‐cycloplegic photorefraction were also taken. Results Parents of 249 children consented to participate. One child was untestable. Only 2.8 per cent of testable children achieved visual acuity worse than 0.3 logMAR in the weaker eye. Results from the Spot Photoscreener suggested that no children had myopia or hyperopia, but that some children had astigmatism. The tablet test was practical in a community setting, and showed ±0.2 logMAR limits of agreement with the Lea symbols chart. Conclusion The sample of children in Tongan primary schools had good functional vision. A modified version of the tablet acuity test is a promising option for vision screening in this context.

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