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.

A marked decline in the incidence of malaria in a remote region of Malaita, Solomon Islands, 2008 to 2013.

SETTING: Atoifi Adventist Hospital (AAH), Solomon Islands, the only hospital in the East Kwaio region. OBJECTIVE: To use routine surveillance data to assess the trends in malaria from 2008 to 2013. DESIGN: Descriptive study of records from (1) AAH laboratory malaria records; (2) admissions to AAH for malaria; and (3) malaria treatments from outpatient records. RESULTS: AAH examined 35 608 blood films and diagnosed malaria in 4443 samples comprised of 2667 Plasmodium falciparum (Pf) and 1776 Plasmodium vivax (Pv). Between 2008 and 2013 the total number of malaria cases detected annually decreased by 86.5%, Pf by 96.7% and Pv by 65.3%. The ratio of Pf to Pv reversed in 2010 from 2.06 in 2008 to 0.19 in 2013. For 2013, Pf showed a seasonal pattern with no cases diagnosed in four months. From 2008 to 2013 admissions in AAH for malaria declined by 90.8%, and malaria mortality fell from 54 per 100 000 to zero. The annual parasite index (API) for 2008 and 2013 was 195 and 24, respectively. Village API has identified a group of villages with higher malaria incidence rates. CONCLUSION: The decline in malaria cases in the AAH catchment area has been spectacular, particularly for Pf. This was supported by three sources of hospital surveillance data (laboratory, admissions and treatment records). The decline was associated with the use of artemisinin-based combined therapy and improved vertical social capital between the AAH and the local communities. Calculating village-specific API has highlighted which villages need to be targeted by the AAH malaria control team.

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.