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Background Over the last two decades, much of the global child health focus has been on the reduction of the under-five mortality rate. Concurrently, children in low-resource regions with the largest populations have received most of the global attention. While this is justified, the plight of children in the primary school age group in smaller, low-resource regions such as the Pacific have been largely ignored. The aim of this thesis is to investigate the health needs of primary school children in Tonga using a culturally appropriate survey methodology. Methods This thesis includes two reviews of the literature, one retrospective and two prospective studies, and reflections on community engagement, cultural competence, and fieldwork in Tonga. a) Literature reviews: Studies of (i) primary school children’s health in low and lower middle-income countries; and then (ii) of children’s health in Tonga were identified and reviewed. b) (Study 1) Child morbidity in Tonga as described by hospital admissions for primary school aged children 2009-2013: Admissions for children aged 5-11 years to the main hospital in Tonga from Jan-2009 to Dec-2013 were described. c) (Study 2) Developing a survey for primary school children in Tonga: Using a Delphi technique and Pacific methodologies, 33 panel members reviewed two rounds of online questionnaires to determine what to include in a survey to describe the health of primary school aged children living in Tonga. d) (Study 3) Exploratory study investigating the health needs of primary school children in Tonga: From the results of Study 1 and Study 2, a survey approach was developed that included …