Estimates for cervical abnormalities in Vanuatu

Fotinatos, Nina; Warmington, Adrian; Walker, Todd; Pilbeam, Mark

doi:10.1111/j.1753-6405.2007.00146.x

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…The significant proportion of “other cancers” reported in Vanuatu adults is attributable, at least in part, to a prominence of thyroid cancer which is consistent with published incidence data for Vanuatu, and is not dissimilar to several other Pacific Island populations [ 22 , 23 ]. Previous studies report a higher incidence in Vanuatu of cervical cancer and high-grade epithelial abnormalities (2 %) on screening than Australia [ 24 ], which is consistent with findings that show cervical cancer as an important CoD in adult females. Screening is, however, very limited, and human papillomavirus (HPV) vaccine, which would benefit future generations of women, is not yet generally available.…”

Section: Discussionsupporting

confidence: 88%

Causes of death in Vanuatu

Carter

Tovu

Langati

et al. 2016

Popul Health Metrics

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BackgroundThe population of the Pacific Melanesian country of Vanuatu was 234,000 at the 2009 census. Apart from subsistence activities, economic activity includes tourism and agriculture. Current completeness of vital registration is considered too low to be usable for national statistics; mortality and life expectancy (LE) are derived from indirect demographic estimates from censuses/surveys. Some cause of death (CoD) data are available to provide information on major causes of premature death.MethodsDeaths 2001–2007 were coded for cause (ICDv10) for ages 0–59 years from: hospital separations (HS) (n = 636), hospital medical certificates (MC) of death (n = 1,169), and monthly reports from community health facilities (CHF) (n = 1,212). Ill-defined causes were 3 % for hospital deaths and 20 % from CHF. Proportional mortality was calculated by cause (excluding ill-defined) and age group (0–4, 5–14 years), and also by sex for 15–59 years. From total deaths by broad age group and sex from 1999 and 2009 census analyses, community deaths were estimated by deduction of hospital deaths MC. National proportional mortality by cause was estimated by a weighted average of MC and CHF deaths.ResultsNational estimates indicate main causes of deaths <5 years were: perinatal disorders (45 %) and malaria, diarrhea, and pneumonia (27 %). For 15–59 years, main causes of male deaths were: circulatory disease 27 %, neoplasms 13 %, injury 13 %, liver disease 10 %, infection 10 %, diabetes 7 %, and chronic respiratory disease 7 %; and for females: neoplasms 29 %, circulatory disease 15 %, diabetes 10 %, infection 9 %, and maternal deaths 8 %. Infection included tuberculosis, malaria, and viral hepatitis. Liver disease (including hepatitis and cancer) accounted for 18 % of deaths in adult males and 9 % in females. Non-communicable disease (NCD), including circulatory disease, diabetes, neoplasm, and chronic respiratory disease, accounted for 52 % of premature deaths in adult males and 60 % in females. Injuries accounted for 13 % in adult males and 6 % in females. Maternal deaths translate into an annual maternal mortality ratio of 130/100,000 for the period.ConclusionVanuatu manifests a double burden of disease with significant proportional mortality from perinatal disorders and infection/pneumonia <5 years and maternal mortality, coupled with significant proportional mortality in adults (15–59 years) from cardiovascular disease (CVD), neoplasms, and diabetes.

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Section: Discussionsupporting

confidence: 88%

Causes of death in Vanuatu

Carter

Tovu

Langati

et al. 2016

Popul Health Metrics

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“…Previous studies also report a higher incidence of cervical cancer and high-grade epithelial abnormalities (2.0%) on screening than Australia (349), which is consistent with findings here that show cervical cancer as an important CoD in adult females. Screening is however very limited.…”

Section: As Vanuatu Continues To Improve Data Collection and Further supporting

confidence: 92%

Mortality and cause of death in the Pacific

Carter¹

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Accurate data on mortality levels and causes of death is critical to assist governments to improve the health of their populations; by identifying priority areas for intervention, leveraging resources for such interventions, and to monitor the impact and effectiveness of health programs. To date, there has been little data available to agencies on mortality and causes of death in the Pacific Islands, and there is significant disparity in published estimates, with many considered implausible. Further, there are indications that improvements in life expectancy (LE) across the region have stagnated in contrast to previously published estimates, most likely as a consequence of premature adult mortality from non-communicable diseases (NCDs).In this research, routine vital registration collections from Pacific Island countries are examined to determine whether these data can improve our understanding of mortality and causes of death in the region. The work presents a review of available data, examines the potential flaws and biases in the data collections, and examines the methods best suited to working with the identified collections to generate valid, reliable estimates of mortality level and cause of death, disaggregated by age group and sex. Due to the scale and diversity of the Pacific Islands, six countries representing a broad range of population size, level of development, and all three sub-regions were selected for review. These were: Nauru, Fiji, Kiribati, Palau, Tonga and Vanuatu.Reporting systems were evaluated to identify potential impacts on the quality and completeness of available data using an assessment framework that considers the ii societal, administrative and system (administrative, technical and ownership) influences on the reporting system. Substantially more data was found to be available than has been previously analysed or published. Medical certificates of death are completed for some deaths in all of the study countries, and are required for all deaths in Nauru, Fiji, Tonga and Palau.Analytical strategies for deriving estimates of mortality level by age and sex were selected from available approaches based on the system assessments, data available and level of migration. Methods employed included direct calculation of mortality level and evaluation of trends over time (Nauru and Palau), evaluation of published data to establish plausible trends (Fiji and Tonga), direct demographic methods to assess completeness -the Brass Growth Balance analysis (Fiji), and capture-recapture analyses (Tonga and Kiribati). Only Vanuatu had insufficient data from routine collection systems to reliably generate mortality estimates. Findings from the use of model life tables in comparison to mortality estimates from empirical data in the other study countries were therefore reviewed to evaluate the plausibility of published estimates of mortality level from Vanuatu.Estimates of cause-specific mortality were calculated directly from the medical certificate data for Palau where the system review in...

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“…There has been a three-fold increase in the rate of highgrade cervical abnormalities over a 10-year period between two Vanuatu pap smear studies. 4,5 Similarly, Fotinatos et al reported a high-grade cervical abnormality rate of 2.0% that was more than three times the rate reported by the Victorian Cervical Cancer Registry (0.62%) during the same time period. 6 The main health centre in Vanuatu is located on Efate Island (Vila Central Hospital), with smaller medical facilities on the islands of Tanna, Ambae and Espiritu Santo (Luganville).…”

Section: Introductionmentioning

confidence: 89%