PREVALENCE OF DIABETES, HYPERTENSION AND OBESITY AT DIFFERENT LEVELS OF URBANIZATION IN VANUATU

Objective: To determine the prevalence of non-communicable disease, specifically hypertension, diabetes and obesity, amongst populations at different levels of urbanisation in Vanuatu, and to relate the frequency of these conditions to the modernisation of way of life. Design: A cross-sectional population-based comparative study of indicative cluster samples. Setting: Republic of Vanuatu (south-west Pacific). A relatively undeveloped malarious island country. Participants: Adult (aged greater-than-or-equal-to 20 years) Melanesian ni-Vanuatu of both sexes. An occupation-based (civil servants) urban sample (n = 623) and area-based semi-rural (n = 349) and rural (n = 397) samples were employed. Response rates were 78%-92%. Interventions: Cases detected were referred for assessment and treatment by local medical staff. Main outcome measures: Body mass index, triceps skinfold thickness, blood pressure, plasma glucose (fasting and 2 hours after 75 g glucose), plasma cholesterol and triglyceride levels. Results: Modernity scores confirmed that the three locations represented different levels of acculturation. Prevalences of noncommunicable disease were relatively low compared to other Pacific island communities and industrialised countries. These conditions were nevertheless more common in the urban sample and least common in the rural sample. Non-communicable disease correlated positively with modernity scores and negatively with physical activity scores. Obesity correlated with blood pressure in the urban sample, and there was indirect evidence (urine sodium concentration) of higher salt intake with modernisation. Mean plasma cholesterol levels were lowest in the rural group. Conclusions: Prevalences of non-communicable disease are relatively low in Vanuatu, although rural-urban differentials are present, and likely to increase with continued development. The evidence presented is consistent with non-communicable disease being related to the modernisation of way of life; specifically: decreased exercise, obesity, and dietary change. Preventive activities should commence now.