Hospital on Funafuti is the only hospital in Tuvalu and the primary provider of medical services. Since the late 20th century, the biggest health problems in Tuvalu are obesity-related. The leading cause of death has been heart disease, which is closely followed by diabetes and high blood pressure. In 2016 the majority of deaths resulted from cardiac diseases, with diabetes mellitus, hypertension, obesity, and cerebral-vascular disease among the other causes of death. Education Education in Tuvalu is free and compulsory between the ages of 6 and 15 years. Each island has a primary school. Motufoua Secondary School is located on Vaitupu. Students board at the school during the school term, returning to their home islands each school vacation. Fetuvalu Secondary School, a day school operated by the Church of Tuvalu, is on Funafuti. Fetuvalu offers the Cambridge syllabus. Motufoua offers the Fiji Junior Certificate (FJC) at year 10, Tuvaluan Certificate at Year 11 and the Pacific Senior Secondary Certificate (PSSC) at Year 12, which is set by SPBEA, the Fiji-based exam board. Sixth form students who pass their PSSC go on to the Augmented Foundation Programme, funded by the Tuvalu government. This program is required for tertiary education programmes outside of Tuvalu and is available at the University of the South Pacific (USP) Extension Centre in Funafuti. Required attendance at school is 10 years for males and 11 years for females (2001). The adult literacy rate is 99.0% (2002). In 2010, there were 1,918 students who were taught by 109 teachers (98 certified and 11 uncertified). The teacher-pupil ratio for primary schools in Tuvalu is around 1:18 for all schools with the exception of Nauti School, which has a ratio of 1:27. Nauti School on Funafuti is the largest primary school in Tuvalu with more than 900 students (45 per cent of the total primary school enrolment). The pupil-teacher ratio for Tuvalu is low compared to the entire Pacific region (ratio of 1:29). Community Training Centres (CTCs) have been established within the primary schools on each atoll. They provide vocational training to students who do not progress beyond Class 8 because they failed the entry qualifications for secondary education. The CTCs offer training in basic carpentry, gardening and farming, sewing and cooking. At the end of their studies the graduates can apply to continue studies either at Motufoua Secondary School or the Tuvalu Maritime Training Institute (TMTI). Adults can also