Epidemiology of and programmatic response to tuberculosis in Solomon Islands: analysis of surveillance data, 2016-2022.

Objective: To identify progress and challenges in the national response to tuberculosis (TB) in Solomon Islands through an epidemiological overview of TB in the country. Methods: A descriptive analysis was conducted using the national TB surveillance data for 2016-2022. Case notifications, testing data, treatment outcomes and screening activities were analysed. Results: The number of case notifications was 343 in 2022, with an average annual reduction of the case notification rate between 2016 and 2022 of 4.7%. The highest case notification rate was reported by Honiara City Council (126/100 000 population) in 2022. The number of people with presumptive TB tested by Xpert® rapidly increased from zero in 2016 to 870 in 2022. Treatment success rate remained consistently high between 2016 and 2022, ranging from 92% to 96%. Screening for HIV and diabetes mellitus (DM) among TB patients in 2022 was 14% and 38%, respectively. Most patients (97%) were hospitalized during the intensive phase of treatment in 2022; in contrast, during the continuation phase, the proportion of patients treated at the community level increased from 1% in 2016 to 63% in 2022. Despite an increase in household contact investigations, from 381 in 2016 to 707 in 2021, the uptake of TB preventive treatment (TPT) was minimal (7% among eligible child contacts). Discussion: This epidemiological analysis in Solomon Islands reveals both notable achievements and challenges in the country's TB programme. One major achievement is a potential actual reduction in TB incidence. Challenges identified were potential underdetection of cases in rural areas, suboptimal community-based care, and insufficient contact tracing and uptake of TPT. It is crucial to address these challenges (e.g. by optimizing resources) to advance the national TB response.

Strengthening rural community water safety planning in Pacific Island countries: evidence and lessons from Solomon Islands, Vanuatu, and Fiji.

Pacific Island Countries (PICs) collectively have the lowest rates of access to safely managed or basic drinking water and sanitation globally. They are also the least urbanised, have dynamic socioeconomic and increasing climate-linked challenges. Community-based water managers need to respond to variability in water availability and quality caused by a range of hazards. Water Safety Planning (WSP), a widely adopted approach to assessing water supply, offers a risk-based approach to mitigating both existing and future hazards. WSP is adaptable, and making modifications to prescribed WSP to adapt it to the local context is common practice. Within the Pacific Community Water Management Plus research project, we used formative research and co-development processes to understand existing local modifications, whether further modifications are required, and, to develop additional modifications to WSP in Fiji, Vanuatu and Solomon Islands. The types of additional local modifications we recommend reflect the unique context of PICs, including adjusting for community management of water supplies and required collective action, community governance systems, levels of social cohesion in communities, and preferred adult-learning pedagogies. Incorporating modifications that address these factors into future WSP will improve the likelihood of sustained and safe community water services in Pacific and similar contexts.

Solomon Islands Oncology Unit: Sustainability in Terms of Outcomes.

Bush et al emphasize that the key to establishing enduring and efficient global health systems lies in prioritizing local stakeholders and, above all, the welfare of patients.

"Feeling at home in Vanuatu": Integration of newcomers from the East during the last millennium.

Several localities across the Vanuatu archipelago (Melanesia), so-called 'Polynesian Outliers', are inhabited by communities that display Polynesian linguistic and cultural features although being located outside the Polynesian Triangle. Several introductions of Polynesian genetic components to Central and Southern Vanuatu during the last millenium have resulted in the cultural distinctiveness observed among the Polynesian Outliers in Vanuatu. However, social, political or economic process surrounding the exchange of genes between Polynesian and local individuals remain unidentified. Recent bioanthropological studies suggest the existence of female mobilities from neighboring regions to Vanuatu but also to the Polynesian Outliers of Taumako (Solomon Islands) within patrilocal societies. We aim to examine the hypothesis that Polynesian biological affinities observed in ancient individuals from Vanuatu are gendered or sex-specific, and that some of the Polynesian migrations during the last millennium may have involved practices of exogamy. By reconstructing phenotypes and biological identities from 13 archaeologically-recovered human skulls (400-300 years ago) from "Polynesian-related" regions of Vanuatu, we provide new insights to better contextualize the settlement patterns of Polynesian individuals. Eastern-Pacific associated phenotype are observable in 4 women from the Eretok burial complex (Efate region) and the Polynesian Outlier of Futuna, who were buried in close proximity to individuals with Western-Pacific associated phenotype. We suggest that close integration of individuals from the East into the local Vanuatu society, as well as the practice of exogamy, might have been key processes contributing to the preservation of Polynesian cultural features in Vanuatu over the past millennium. Our finding are cross-referenced with oral records from these two areas, as well as the known genetic makeup of the Vanuatu Polynesian Outliers.

Child health nurses in Solomon Islands, piloting the 'Bachelor of nursing: Child health'.

AIM: In 2016, the Solomon Islands National University developed and implemented the country's first nursing specialisation in child health, the Bachelor of Nursing: Child Health. This qualitative study aimed to explore the experiences of the first cohort of students (n = 14) during this course in order to evaluate the programme. BACKGROUND: The Bachelor of Nursing: Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and improve child health outcomes and so on. DESIGN: The qualitative evaluation study used an exploratory, descriptive design. METHODS: The 14 nurses who constituted the first cohort of students were selected as study participants. Individual semi-structured interviews were conducted between August and December 2018. Thematic analysis was undertaken following the Braun and Clarke six-phase process to generate themes and sub-themes from the data. The Consolidated Criteria for Reporting Qualitative Research checklist guided the reporting of the study. RESULTS: Interviews revealed important feedback about the course, including areas to strengthen and avenues to improve it in the future. Four themes emerged: learning during the Bachelor of Nursing: Child Health, support during the course, challenges experienced during the course and suggested course improvements in the future. The study found that theoretical sessions combined with practical and interactive activities were most effective in learning both theoretical concepts and their related clinical applications and skills. Although support was generally available during the course, participants emphasised their responsibility to take the lead in their learning and seek support when required. The lack of mentoring combined with logistical difficulties were perceived as barriers to learning. Participant recommendations support further development of the child health nursing specialisation, with specific strengthening in areas such as teaching and mentoring, logistics, course curriculum and human and material resources. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Given the potential benefits of increasing nurses' knowledge and skills in child health and paediatric care on reducing neonatal and child mortality and morbidity, ongoing support for the implementation of this course in Solomon Islands and more broadly across the Pacific region is recommended. The provision of such support is a local, regional and a global responsibility. Indeed, Sustainable Development Goal 3c calls for a substantial increase in health financing and in the recruitment, development, training and retention of the health workforce in low- and middle-income countries. CONCLUSIONS: Results of the evaluation demonstrate the positive aspects of the course in relation to content and curriculum delivery strategies as well as identifying areas where further refinement and strengthening is required.

Experience and impact of gender-based violence in Honiara, Solomon Islands: a cross-sectional study recording violence over a 12-month period.

OBJECTIVE: This study aims to collect data on the experience and impact of gender-based violence experienced by women attending health clinics in Honiara, Solomon Islands. METHOD: Any woman over the age of 18 who attended a local health clinic in Honiara, Solomon Islands during the time of recruitment (ten consecutive weekdays in May 2015) was eligible to participate in an interviewer administered, in-person survey, gathering data on gender-based violence over the past 12 months. RESULTS: A total of 100 women were recruited into this study. Of these women, 47% of women reported experiencing physical or sexual violence in the past 12 months. The most common perpetrators were the woman's husband or boyfriend. There are low rates of reporting, particularly through formal avenues such as to police or village leaders. Alcohol was involved in more than half the cases of reported violence. CONCLUSION: Women in this study report high rates of gender-based violence. To our knowledge, this is the only study examining women's personal experience of gender-based violence in the Solomon Islands, with self-reported data on the frequency and nature of the violence, and the impact on women, including physical and mental, utilisation of healthcare services, police and legal involvement. Efforts to reduce gender-based violence should aim to reduce intimate partner violence, increase reporting and address wider social attitudes towards gender equality.

First records of the Pacific sleeper shark Somniosus cf. pacificus in the western tropical Pacific.

Technological advances have enabled the expansion of ocean exploration to include the deep ocean, providing new species observations. Here, the authors present two new observations, captured by deep-sea cameras, of the sleeper shark Somniosus cf. pacificus from the Solomon Islands and Palau. This presents the first observation of S. cf. pacificus in the western Pacific tropics and extends its range about 2000 nautical miles south. The observations presented here provide much-needed information on the range of this species which can help guide future management and conservation actions.

Food price and availability in Solomon Islands during COVID-19: A food environment survey.

Background: In Solomon Islands, the retail food environment is an important food source, for instance, the dominant source of fresh fruit and vegetables for urban consumers is open markets. The effects of COVID-19 mitigation measures (such as restriction of human movement and border closures) in early 2020 placed food security at risk in many parts of the community. Of particular concern was the risk of price gouging in an already price-sensitive market. Aims: The study aimed to provide rapid and policy-relevant information on the pricing of foods in the urban food environment in Solomon Islands in the context of the unfolding COVID-19 pandemic. Methods: A vendor survey was conducted in July to August 2020 and repeated in July 2021 using a survey tool that collected information on type, quantity, and price of food on offer. Findings: We found price reductions among the majority of fresh fruit and non-starchy vegetables available. A trend of rising prices was reported for some other commodities, such as fresh locally caught fish. Conclusion: Our findings highlight the impact of 'schocks to the system' on food prices as a potential barrier or enabler to consumption of fresh foods purchased from urban areas - an important finding in a price sensitive market. The survey design was successful in collecting pricing data from the retail food environment during a time of external 'shock to the system'. Our approach is applicable to other settings needing a rapid survey of the external food environment.

A story of vicariance? how the geology of oceanic archipelagos influenced the evolutionary history of endemic damselflies.

South Pacific islands provide an ideal study system to explore patterns of speciation, specifically examining the role of dispersal versus vicariance. Dispersal is often the suggested mechanism of diversification in the South Pacific, specifically among remote island chains. Here, we provide a phylogeny of several related genera of Coenagrionidae (Odonata: Zygoptera) from the South Pacific, based on five molecular loci, in order to examine patterns of speciation in the region. We used the endemic damselfly genera Nesobasis, Nikoulabasis, and Vanuatubasis found across both Fiji and Vanuatu. Knowledge of the geologic history of the region was used to inform our understanding of the evolution of these genera. Both archipelagos used to be part of the Vitiaz arc which spanned from the Solomon Islands to Tonga and began to break apart 10-12 Ma. Results of our divergence-time estimations and biogeographic reconstructions support that the breakup of this arc acted as a significant vicariance event in the evolution of these taxa. Specifically, it led to the extant generic diversity seen in these damselflies. We find that within the archipelago of Vanuatu, that Espiritu Santo served as an important source for dispersal to other islands with Malekula acting as a stepping stone to Efate.

Effects of temperature, rainfall, and El Niño Southern Oscillations on dengue-like-illness incidence in Solomon Islands.

BACKGROUND: This study investigated associations between climate variables (average temperature and cumulative rainfall), and El Niño Southern Oscillation (ENSO) and dengue-like-illness (DLI) incidence in two provinces (Western and Guadalcanal Provinces) in Solomon Islands (SI). METHODS: Weekly DLI and meteorological data were obtained from the Ministry of Health and Medical Services SI and the Ministry of Environment, Climate Change, Disaster Management and Meteorology from 2015 to 2018, respectively. We used negative binomial generalized estimating equations to assess the effects of climate variables up to a lag of 2 months and ENSO on DLI incidence in SI. RESULTS: We captured an upsurge in DLI trend between August 2016 and April 2017. We found the effects of average temperature on DLI in Guadalcanal Province at lag of one month (IRR: 2.186, 95% CI: 1.094-4.368). Rainfall had minor but consistent effect in all provinces. La Niña associated with increased DLI risks in Guadalcanal Province (IRR: 4.537, 95% CI: 2.042-10.083), whereas El Niño associated with risk reduction ranging from 72.8% to 76.7% in both provinces. CONCLUSIONS: Owing to the effects of climate variability and ENSO on DLI, defining suitable and sustainable measures to control dengue transmission and enhancing community resilience against climate change in low- and middle-developed countries are important.

Prevalence and Factors Associated With Low Birth Weight in the Solomon Islands: Evidence From the 2015 Solomon Islands Demographic and Health Survey data.

Low birth weight (LBW) has contributed to more than 80% of under-5 deaths worldwide, most occurring in low- and middle-income countries. We used the 2015 Solomon Islands Demographic and Health Survey data to identify the prevalence and risks associated with LBW in the Solomon Islands. Low birth weight prevalence estimated was 10%. After adjustment for potential confounders, we found the risk of LBW for women with a history of marijuana and kava use was 2.6 times, adjusted relative risk (aRR) 2.64 and 2.5 times (aRR: 2.50) than among unexposed women, respectively. Polygamous relationship, no antenatal care, decision-making by another person were 84% (aRR: 1.84), 73% (aRR: 1.73), and 73% (aRR: 1.73) than among unexposed women, respectively. We also found that 10% and 4% of LBW cases in the Solomon Islands were attributable to a household of more than five members and tobacco and cigarette use history respectively. We concluded that LBW in the Solomon Islands relied more on behavioral risk factors, including substance use as well as health and social risk factors. We recommended further study on kava use and its impact on pregnancy and LBW.

Building Capability and Capacity: The Establishment of an Oncology Unit in the Solomon Islands.

PURPOSE: To describe the establishment of an oncology unit at the National Referral Hospital (NRH) in the Solomon Islands, a low-income nation in the South Pacific. METHODS: A scoping visit was carried out in 2016 to assist in the development of coordinated cancer services and to establish a medical oncology unit at the NRH at the request of the Medical Superintendent. This was followed by an observership visit to Canberra by an NRH doctor training in oncology in 2017. After a request from the Solomon Islands Ministry of Health, the Australian Government Department of Foreign Affairs and Trade (DFAT) arranged an in-country multidisciplinary mission under the Royal Australasian College of Surgeons/Royal Australasian College of Physicians Pacific Islands Program to help in the commissioning of the NRH Medical Oncology Unit in September 2018. Staff training and education sessions were held. The team, with the assistance of an Australian Volunteers International Pharmacist, has helped the NRH staff to develop localized Solomon Islands Oncology Guidelines. Donated equipment and supplies have helped with the initial establishment of the service. A second DFAT Oncology mission visit was made in 2019 followed by two NRH oncology nurses visiting Canberra on observership later that year and support of the Solomon's doctor to pursue postgraduate education in cancer sciences. Ongoing mentorship and support has been maintained. RESULTS: The island nation now has a sustainable oncology unit delivering chemotherapy treatments and management of patients with cancer. CONCLUSION: A collaborative multidisciplinary team approach by professionals from the high-income country working with colleagues from the low-income nation with coordination of different stakeholders was the key to this successful initiative in improving cancer care.

Validation of Pomacentrus novaeguineae, P. umbratilus and P. xanthocercus Allen, Erdmann & Pertiwi (Perciformes: Pomacentridae) from Melanesia and the eastern and central Indian Ocean.

N/A.

Redescription of Lepidodactylus flaviocularis (Squamata: Gekkonidae), with the description of a new species from Makira Island, Solomon Islands.

Several species of geckos of the genus Lepidodactylus are endemic to the Solomon Islands and very poorly known. I redescribe one of these, L. flaviocularis, from Guadalcanal, based on examination of a second, newly obtained specimen and quantification of diagnostically useful features of the digits. I also describe a closely related new species from nearby Makira Island in the southern Solomon Islands. Both species are distinguished by their large number of undivided subdigital lamellae, extensive toe webbing, and a continuous row of enlarged precloacal/femoral scales. The new species is distinguished from L. flaviocularis by a number of scalational features and the color of the circumorbial scales. Both species are inhabitants of interior forest, and it remains uncertain whether they are naturally rare, rare due to interactions with invasive species, or simply have cryptic ecological habits, though the last seems most likely. Current evidence for both species is consistent with the taxon-cycle hypothesis, which posits ecological displacement to inland habitats of ancient island inhabitants by newer colonizers, but this remains to be critically tested. The limited pool of specimens available for both species necessitates assessing the IUCN conservation status of each as Data Deficient.

Incidence and causes of stillbirth in the only tertiary referral hospital in the Solomon Islands: a hospital-based retrospective cohort study.

OBJECTIVES: Stillbirth is a major global health issue, which disproportionately affects families living in low-income and middle-income countries. The Solomon Islands is a Pacific nation with poor perinatal outcomes, however research investigating stillbirth is lacking. Thus, we aimed to investigate the incidence and cause of stillbirth occurring at the National Referral Hospital, Solomon Islands. DESIGN: We conducted a retrospective cohort study from January 2017 to December 2018. SETTING: At the only tertiary referral hospital in the Solomon Islands, on the main island of Guadalcanal. PARTICIPANTS: All births occurring in the hospital during the study period. OUTCOME MEASURES: Number of, causes and risk factors for stillbirths (fetal deaths before birth at ≥20 estimated gestational weeks, or ≥500 g in birth weight). RESULTS: Over 2 years 341 stillbirths and 11 056 total births were recorded, giving an institutional incidence of 31 stillbirths per 1000 births. Of the cases with a recorded cause of death, 72% were deemed preventable. Most stillbirths occurred antenatally and 62% at preterm gestations (<37 weeks). 59% had a birth weight below 2500 g and preventable maternal conditions were present in 42% of the cases. 46% of the cases were caused by an acute intrapartum event, and among these 92% did not receive intrapartum monitoring. CONCLUSIONS: Stillbirth affects 31 in every 1000 births at the National Referral Hospital in the Solomon Islands and many cases are preventable. Our findings highlight the urgent need for increased focus on perinatal deaths in the Solomon Islands with universal classification and targeted training, improved quality of obstetrical care and community awareness.

Melanesia holds the world's most diverse and intact insular amphibian fauna.

Identifying hotspots of biological diversity is a key step in conservation prioritisation. Melanesia-centred on the vast island of New Guinea-is increasingly recognised for its exceptionally species-rich and endemic biota. Here we show that Melanesia has the world's most diverse insular amphibian fauna, with over 7% of recognised global frog species in less than 0.7% of the world's land area, and over 97% of species endemic. We further estimate that nearly 200 additional candidate species have been discovered but remain unnamed, pointing to a total fauna in excess of 700 species. Nearly 60% of the Melanesian frog fauna is in a lineage of direct-developing microhylids characterised by smaller distributions than co-occurring frog families, suggesting lineage-specific high beta diversity is a key driver of Melanesian anuran megadiversity. A comprehensive conservation status assessment further highlights geographic concentrations of recently described range-restricted threatened taxa that warrant urgent conservation actions. Nonetheless, by world standards, the Melanesian frog fauna is relatively intact, with 6% of assessed species listed as threatened and no documented extinctions; and thus it provides an unparalleled opportunity to understand and conserve a megadiverse and relatively intact insular biota.

Female bone physiology resilience in a past Polynesian Outlier community.

Remodelling is a fundamental biological process involved in the maintenance of bone physiology and function. We know that a range of health and lifestyle factors can impact this process in living and past societies, but there is a notable gap in bone remodelling data for populations from the Pacific Islands. We conducted the first examination of femoral cortical histology in 69 individuals from ca. 440-150 BP Taumako in Solomon Islands, a remote 'Polynesian Outlier' island in Melanesia. We tested whether bone remodelling indicators differed between age groups, and biological sex validated using ancient DNA. Bone vascular canal and osteon size, vascular porosity, and localised osteon densities, corrected by femoral robusticity indices were examined. Females had statistically significantly higher vascular porosities when compared to males, but osteon densities and ratios of canal-osteon (~ 8%) did not differ between the sexes. Our results indicate that, compared to males, localised femoral bone tissue of the Taumako females did not drastically decline with age, contrary to what is often observed in modern populations. However, our results match findings in other archaeological samples-a testament to past female bone physiology resilience, also now observed in the Pacific region.

Wallacean and Melanesian Islands Promote Higher Rates of Diversification within the Global Passerine Radiation Corvides.

The complex island archipelagoes of Wallacea and Melanesia have provided empirical data behind integral theories in evolutionary biology, including allopatric speciation and island biogeography. Yet, questions regarding the relative impact of the layered biogeographic barriers, such as deep-water trenches and isolated island systems, on faunal diversification remain underexplored. One such barrier is Wallace's Line, a significant biogeographic boundary that largely separates Australian and Asian biodiversity. To assess the relative roles of biogeographic barriers-specifically isolated island systems and Wallace's Line-we investigated the tempo and mode of diversification in a diverse avian radiation, Corvides (Crows and Jays, Birds-of-paradise, Vangas, and allies). We combined a genus-level data set of thousands of ultraconserved elements (UCEs) and a species-level, 12-gene Sanger sequence matrix to produce a well-resolved supermatrix tree that we leveraged to explore the group's historical biogeography and the effects of the biogeographic barriers on their macroevolutionary dynamics. The tree is well resolved and differs substantially from what has been used extensively for past comparative analyses within this group. We confirmed that Corvides, and its major constituent clades, arose in Australia and that a burst of dispersals west across Wallace's Line occurred after the uplift of Wallacea during the mid-Miocene. We found that dispersal across this biogeographic barrier was generally rare, though westward dispersals were two times more frequent than eastward dispersals. Wallacea's central position between Sundaland and Sahul no doubt acted as a bridge for island-hopping dispersal out of Australia, across Wallace's Line, to colonize the rest of Earth. In addition, we found that the complex island archipelagoes east of Wallace's Line harbor the highest rates of net diversification and are a substantial source of colonists to continental systems on both sides of this biogeographic barrier. Our results support emerging evidence that island systems, particularly the geologically complex archipelagoes of the Indo-pacific, are drivers of species diversification. [Historical biogeography; island biogeography; Melanesia; molecular phylogenetics; state-dependent diversification and extinction.].

Understanding reasons for lack of acceptance of HIV programs among indigenous Papuans: a qualitative study in Indonesia.

BACKGROUND: Melanesians are indigenous Papuans racially and culturally different from most Indonesians. The Melanesia region is characterised by high poverty and inequalities, even though it has the highest revenue. Furthermore, Papua has the highest HIV prevalence rate, 24-fold higher than that of other regions. Therefore, this study aimed to examine the resistance of indigenous people residing in eastern Indonesia towards HIV programs. METHODS: This is a qualitative study analysed using grounded theory. Data were collected from July to September 2018 through semi-structured face-to-face interviews involving 23 Papuans. The interviews were conducted in Bahasa Indonesia, audio-recorded, summarised and transcribed for analysis. RESULTS: The results showed that being a good Papuan emerges from four interconnected categories, including culture and religion, dealing with modernisation, integrated HIV program and stigma reduction. As a substantive theory underpinning the indigenous people's experiences with HIV programs, 'Keep being a good Papuan' was a way of overcoming problems and dealing with modernism to eliminate HIV. This largely focuses on the local culture, implying any adjustment should keep their tradition and welcome modernism. CONCLUSIONS: The future of the HIV programs should be agreed upon, funded, implemented, measured and achieved by stakeholders. This could be achieved by elaborating a supportive culture and community-based interventions. Furthermore, the implementation should be prioritised to integrate and improve the programs' quality to take into account community needs and the available resources.

Do governance networks build collaborative capacity for sustainable development? Insights from Solomon Islands.

To build capacity for addressing complex sustainable development challenges, governments, development agencies, and non-governmental organizations are making substantial investments in governance networks. Yet, enthusiasm for establishing governance networks is not always matched by empirical evidence on their effectiveness. This gap challenges these groups to know whether investing in governance networks is worth their time and effort; a weighing-up that is particularly critical in contexts of limited resources. Through a qualitative case study in Solomon Islands, we evaluate the extent to which a governance network, called the Malaita Provincial Partners for Development, contributed to four dimensions of collaborative governance capacity: individual, relational, organizational, and institutional. We find that the network made moderate contributions to individual, relational and organizational capacity, while institutional capacity remained low despite the presence of the network. Based on these findings, we argue that governance networks are not a panacea. Continued efforts are needed to establish when, how, and in what contexts collaborative networks are effective for building collaborative capacity for sustainable development.