Surviving versus thriving: The wellbeing of primary school aged children in Tonga

Abstract

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.

Investigating the health status of primary school children in Tonga: Lessons learnt and reflections on field work in the Pacific Islands

“…Children growing up in the region benefit from growing up in environments rich in culture, heritage and values; however, they also contend with challenges such as climate change, poverty and the double burden of communicable and non-communicable disease. 1 While there have been reductions in infant and under-five mortality rate in the Pacific, little else is known about child health in the region. 13 Registers and systems to collect and maintain high standard mortality and population data are lacking within Pacific countries.…”

“…With unanimous support ethical approval was gained from the University of Auckland Human Participants Ethics Committee (Reference 010569) and the Tonga National Health Ethics and Research Committee (Reference 040614.1). A wide range of stakeholders was canvassed, literature was reviewed, hospital data analysed, 15 and Pacific methodologies overlapped with a Delphi Process. 16 An exploratory study piloting the survey was completed in three primary schools in Nuku'alofa, Tonga (Fig.…”

“…§ Child self-rated, health-related quality of life using Child Health and Illness Profile -Child Edition, CHIP-CE (version 1.0)©. 1,24 generated. This long-term commitment to child health research is needed in the region in order to grow research capacity and respond to the growing burden of need in child health in the region.…”

“…While this pre-school-age prevention of mortality focus is necessary, a consequence is relative ignorance of the health of children older than 5 years, and of child wellbeing beyond child survival. 1 More under-5-year-olds are surviving globally; however, it is possible they are surviving with increasing odds of morbidity. 2 There has been some attention given to the adolescent age group 3 including the World Health Organization Global School-based Student Health Survey designed to help countries survey the behaviour, risk and protective factors in children aged 13-17 years.…”

“…Much of the global child health focus in recent decades has been on reducing under‐five mortality in response to the Millennium Development Goals and Sustainable Development Goals. While this pre‐school‐age prevention of mortality focus is necessary, a consequence is relative ignorance of the health of children older than 5 years, and of child wellbeing beyond child survival 1 . More under‐5‐year‐olds are surviving globally; however, it is possible they are surviving with increasing odds of morbidity 2 .…”