Impact of Community Treatment With Ivermectin for the Control of Scabies on the Prevalence of Antibodies to Strongyloides stercoralis in Children.

The prevalence of antibodies to Strongyloides stercoralis was measured in 0-12-year-olds using a bead-based immunoassay before and after ivermectin mass drug administration (MDA) for scabies in the Solomon Islands. Seroprevalence was 9.3% before and 5.1% after MDA (P = .019), demonstrating collateral benefits of ivermectin MDA in this setting.

Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo.

BACKGROUND: Scabies is a public health problem in many countries, with impetigo and its complications important consequences. Ivermectin based mass drug administration (MDA) reduces the prevalence of scabies and, to a lesser extent, impetigo. We studied the impact of co-administering azithromycin on the prevalence of impetigo and antimicrobial resistance. METHODS: Six communities were randomized to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and 12 months. We collected impetigo lesions swabs at baseline, 3 and 12 months to detect antimicrobial resistance. RESULTS: At baseline, scabies and impetigo prevalences were 11.8% and 10.1% in the ivermectin-only arm and 9.2% and 12.1% in the combined treatment arm. At 12 months, the prevalences had fallen to 1.0% and 2.5% in the ivermectin-only arm and 0.7% and 3.3% in the combined treatment arm. The proportion of impetigo lesions containing Staphylococcus aureus detected did not change (80% at baseline vs 86% at 12 months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, P < .01). At 3 months, 53% (8/15) of S. aureus isolates were macrolide-resistant in the combined treatment arm, but no resistant strains (0/13) were detected at 12 months. CONCLUSIONS: Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone. The proportion of impetigo lesions containing pyogenic streptococci declined following MDA. There was a transient increase in the proportion of macrolide-resistant S. aureus strains following azithromycin MDA. CLINICAL TRIALS REGISTRATION: clinicaltrials.gov (NCT02775617).

Point-of-care tests for syphilis and yaws in a low-income setting - A qualitative study of healthcare worker and patient experiences.

INTRODUCTION: The human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta. Serological assays remain the most common diagnostic method for all treponemal infections. Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Alongside the test's performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Prior to the study serology was only routinely available at the local district hospital. METHODS: The POCT was deployed in the outpatient and ante-natal departments of a district hospital and four rural health clinics served by the hospital. Each site was provided with training and an SOP on the performance, interpretation and recording of results. Treatment for those testing positive was provided, in line with Solomon Islands Ministry of Health and Medical Services' guidelines for syphilis and yaws respectively. Alongside the implementation of the POCT we facilitated semi-structured interviews with both nurses and patients to explore individuals' experiences and beliefs in relation to use of the POCT. RESULTS AND DISCUSSION: Four main themes emerged in the interviews: 1) training and ease of performing the test; 2) time taken and ability to fit the test into a clinical workflow; 3) perceived reliability and trustworthiness of the test; and 4) level of the health care system the test was most usefully deployed. Many healthcare workers related their experience with the POCT to their experience using similar tests for malaria. Although the test was considered to take a relatively long time to perform the benefits of improved access to testing were considered positive by most healthcare workers. Qualitative data is needed to help inform better training packages to support the implementation of POCT in low-resource settings.

Measles outbreak investigation in a remote area of Solomon Islands, 2014.

OBJECTIVE: To describe a measles outbreak and health service response in a remote location in Malaita, Solomon Islands. METHODS: Epidemiological review of cases who presented to the Atoifi Adventist Hospital (AAH) during the outbreak period from July to December 2014. Rumour surveillance was used to gather information on unreported cases. RESULTS: A total of 117 cases were reported to AAH. The incidence rate was 123 per 10 000 individuals. Fifty-six per cent (66/117) of cases were hospitalized. Children under 5 years had the highest number of cases (n = 41) with 10 cases below 6 months old. The age-specific incidence rate of children under 5 years was 278.5 per 10 000 individuals. Eighty-two per cent of reported cases were 18 years old or younger. Rumour surveillance revealed about three quarters of children in one area of the East Kwaio Mountains had suspected measles not reported to AAH. There were three unreported deaths from measles outside AAH. During the outbreak, a total of 2453 measles-rubella vaccines were given in the AAH catchment area. CONCLUSION: A high incidence rate was observed in children and young people aged 18 years or younger, reflecting low childhood vaccination coverage. More than 50% of cases required hospitalization due to disease severity and challenges of accessing health services. The rumour surveillance discovered many unreported cases in the mountain areas and a few deaths possibly linked to the outbreak. Improvement of registration methods and follow-up systems and setting up satellite clinics are planned to improve measles surveillance and vaccination coverage.

Prevalence of soil-transmitted helminths in remote villages in East Kwaio, Solomon Islands.

OBJECTIVE: Although soil-transmitted helminths (STH) are endemic in Solomon Islands, there are few recent reports on their prevalence. This study aimed to determine the prevalence of STH in residents of remote communities in Solomon Islands. METHODS: A cross-sectional convenience-sampled survey of residents of four adjacent villages in Malaita, Solomon Islands was performed in Atoifi and Na'au in April 2011 and in Abitona and Sifilo in April 2012. All residents older than one year were invited to participate, which involved providing a single sample of faeces examined using a modified Kato-Katz technique and completing a questionnaire that asked demographic and STH-related behaviour questions. RESULTS: The overall participation rate was 52.8%, with 402 participants comprising 49.8% males. Hookworm was the predominant STH with only a single case of trichuriasis found in Atoifi. The total prevalence of hookworm was 22.6% (95% confidence interval: 18.6-27.1); the prevalence of hookworm in Abitona, Na'au and Sifilo was 20.0%, 29.9% and 27.4%, respectively, whereas in Atoifi it was 2.3% (P < 0.001). Intensity was low in all villages. Although health behaviours differed significantly between Atoifi and the other three villages, the type of toilet used was the only significant association with hookworm. DISCUSSION: Residents of Atoifi have a relative freedom from STH compared to the other three villages. Rather than a region-wide morbidity control approach, a "one village at a time" approach aiming to eliminate STH and dealing with each village as a separate autonomous unit empowered to manage its own challenges may be a preferred option.

Mental health issues from rising sea level in a remote coastal region of the Solomon Islands: current and future.

OBJECTIVE: There is little published research about mental health and climate change in the Pacific, including Solomon Islands. Solomon Islands has one of the highest rates of sea-level rise globally. The aim of this research was to document mental health issues related to sea-level rise for people in East Malaita, Solomon Islands. METHOD: A cross-sectional study was carried out in six low-lying villages in East Malaita, Solomon Islands. The researcher travelled to villages by dugout canoe. In addition to quantitative, closed-ended questions, open-ended questions with villagers explored individual and community responses to rising sea level. RESULTS: Of 60 people asked, 57 completed the questionnaire. Of these, 90% reported having seen a change in the weather patterns. Nearly all participants reported that sea-level rise is affecting them and their family and is causing fear and worry on a personal and community level. Four themes emerged from the qualitative analysis: experience of physical impacts of climate change; worry about the future; adaptation to climate change; government response needed. CONCLUSION: Given predictions of ongoing sea-level rise in the Pacific it is essential that more research is conducted to further understand the human impact of climate change for small island states which will inform local, provincial and national-level mental health responses.

Strengthening research capacity in the Pacific: an example from the Atoifi Health Research Group, Solomon Islands.

OBJECTIVE: To provide an example of one model of research capacity building for mental health from a remote setting in Solomon Islands. METHODS: The Atoifi Health Research Group is building health research capacity with a health service on the remote east coast of Malaita, Solomon Islands. The group uses a 'learn-by-doing' approach embedded in health service and community-level health projects. The group is eclectic in nature and deliberately engages a variety of partners to discover culturally informed methods of collecting, analysing and disseminating research findings. RESULTS: Key successes of the Atoifi Health Research Group are: that it was initiated by Solomon Islanders with self-expressed desire to learn about research; the learn-by-doing model; inclusion of community people to inform questions and socio-cultural appropriateness; and commitment to ongoing support by international researchers. CONCLUSIONS: Given different social, cultural, economic, geographic, spiritual and service contexts across the Pacific, locally appropriate approaches need to be considered. Such approaches challenge the orthodox approach of centralized investment to replicate specialist driven approaches of funder nations. Increasing expertise at all levels through participatory capacity building models that define and address local problems may be more sustainable and responsive to local mental health contexts.

A practical strategy for responding to a case of lymphatic filariasis post-elimination in Pacific Islands.

BACKGROUND: Lymphatic filariasis (LF) due to Wuchereria bancrofti is being eliminated from Oceania under the Pacific Elimination of Lymphatic Filariasis Programme. LF was endemic in Solomon Islands but in the 2010-2020 Strategic Plan of the Global Programme to Eliminate LF, Solomon Islands was listed as non-endemic for LF. In countries now declared free of LF an important question is what monitoring strategy should be used to detect any residual foci of LF? METHODS: The index case, a 44 year old male, presented to Atoifi Adventist Hospital, Malaita, Solomon Islands in April 2011 with elephantiasis of the lower leg. Persistent swelling had commenced 16 months previously. He was negative for antigen by TropBio Og4C3 ELISA and for microfilaria. A week later a survey of 197 people aged from 1 year to 68 years was conducted at Alasi, the index case's village, by a research team from Atoifi Adventist Hospital and Atoifi College of Nursing. This represented 66.3% of the village population. Blood was collected between 22:00 and 03:00 by finger-prick and made into thick smears to detect microfilaria and collected onto filter paper for W. bancrofti antigen tests. A second group of 110 specimens was similarly collected from residents of the Hospital campus and inpatients. W. bancrofti antigen was tested for using the Trop-Bio Og4C3 test. RESULTS: One sample (1/307) from an 18 year old male from Alsai was positive for W. bancrofti antigen. No samples were positive for microfilaria. Although antigen-positivity indicated a live worm, the case was regarded as having been acquired some years previously. CONCLUSIONS: We propose that when LF has been eliminated from a country, a case of elephantiasis should be a trigger to conduct a survey of the case's community using a decision pathway. W. bancrofti antigen should be tested for with screening for microfilariae in antigen positive cases. The field survey was designed and conducted by local researchers, highlighting the value of local research capacity in remote areas.

Incorporating sociocultural beliefs in mental health services in Kwaio, Solomon Islands.

OBJECTIVE: The aim of this paper is to describe the newly established mental health services at Atoifi Adventist Hospital, Solomon Islands, the sociocultural context in which it operates, and illustrate how the service is engaging with the Kwaio community to understand and incorporate local sociocultural beliefs into prevention, treatment and recovery journeys. METHOD: Five remote hamlets in East Kwaio, Malaita Province were visited in early 2008. Interviews were undertaken with 20 people with a history of buru spirit possession and 30 of their family members. RESULTS: Buru is a category of wild and malevolent spirits that possess people in East Kwaio and induce antisocial and unexpected behaviour. Signs of buru possession include mutism, suicidal ideas, delusion, aggression and social isolation. Traditional healers practice indigenous treatments with 50% of people receiving treatments described as cured, 30% temporary cured and 20% no effect from treatment. CONCLUSIONS: The new mental health service at Atoifi is taking steps to incorporate sociocultural beliefs, including of people possessed by buru, into routine practice. This provides a greater potential to support prevention, treatment and recovery journeys to advance the community's social, emotional and spiritual wellbeing.