title: Low health-related quality of life in school-aged children in Tonga, a lower-middle income country in the South Pacific.
abstract: BACKGROUND
  Ensuring a good life for all parts of the population, including children, is high on the public health agenda in most countries around the world. Information about children's perception of their health-related quality of life (HRQoL) and its socio-demographic distribution is, however, limited and almost exclusively reliant on data from Western higher income countries.
  
  
  OBJECTIVE
  To investigate HRQoL in schoolchildren in Tonga, a lower income South Pacific Island country, and to compare this to HRQoL of children in other countries, including Tongan children living in New Zealand, a high-income country in the same region.
  
  
  METHODS
  A cross-sectional study from Tonga addressing all secondary schoolchildren (11-18 years old) on the outer island of Vava'u and in three districts of the main island of Tongatapu (2,164 participants). A comparison group drawn from the literature comprised children in 18 higher income and one lower income country (Fiji). A specific New Zealand comparison group involved all children of Tongan descendent at six South Auckland secondary schools (830 participants). HRQoL was assessed by the self-report Pediatric Quality of Life Inventory 4.0.
  
  
  RESULTS
  HRQoL in Tonga was overall similar in girls and boys, but somewhat lower in children below 15 years of age. The children in Tonga experienced lower HRQoL than the children in all of the 19 comparison countries, with a large difference between children in Tonga and the higher income countries (Cohen's d 1.0) and a small difference between Tonga and the lower income country Fiji (Cohen's d 0.3). The children in Tonga also experienced lower HRQoL than Tongan children living in New Zealand (Cohen's d 0.6).
  
  
  CONCLUSIONS
  The results reveal worrisome low HRQoL in children in Tonga and point towards a potential general pattern of low HRQoL in children living in lower income countries, or, alternatively, in the South Pacific Island countries.
authors.affiliation: Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Victoria, Australia; WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden; Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; solveig.petersen@pediatri.umu.se.
authors.forename: Solveig
authors.initials: S
authors.lastname: Petersen
authors.affiliation: WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia; School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Boyd
authors.initials: B
authors.lastname: Swinburn
authors.affiliation: WHO Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Mavoa
authors.affiliation: Fiji School of Medicine, College of Medicine, Nursing & Health Sciences, Fiji National University, Nuku'alofa, Tonga.
authors.forename: Kalesita
authors.initials: K
authors.lastname: Fotu
authors.affiliation: Research and Information, Division of Economic Development, Secretariat of the Pacific Community, Suva, Fiji.
authors.forename: Caroline
authors.initials: C
authors.lastname: Tupoulahi-Fusimalohi
authors.affiliation: School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Gavin
authors.initials: G
authors.lastname: Faeamani
authors.affiliation: Deakin Health Economics, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
authors.forename: Marjory
authors.initials: M
authors.lastname: Moodie
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D008603:Mental Health / Q000208:ethnology; D009520:New Zealand; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014058:Tonga / Q000208:ethnology
keywords: Epidemiology; adolescent health; child health; community health; low-income population; mental health; quality of life