Impact of ivermectin administered for scabies treatment on the prevalence of head lice in Atoifi, Solomon Islands.

Scabies and head lice are ubiquitous ectoparasitic infestations that are common across the Pacific Islands. Ivermectin is an effective treatment for both conditions, although the doses used vary. At a community level, mass drug administration (MDA) with ivermectin is an effective strategy to decrease prevalence of scabies. To what extent MDA with ivermectin will also reduce prevalence of head lice is unknown. Head lice prevalence was assessed before and after MDA with oral ivermectin (at a dose of 200 micrograms per kilogram of body weight) administered on day 1 and day 8. The primary outcome was the change in prevalence of head louse infestation at two weeks compared to baseline. Longer term efficacy was assessed three months after MDA. 118 participants were enrolled. Baseline prevalence of active head louse infestation was 25.4% (95% CI 18.4-34.0). At three-month follow-up, prevalence was 7.5% (95% CI 2.7-12.3), a relative reduction of 70.6% (95% CI 72.7%-91.4%, p <0.001). Head louse infestation was associated with younger age (age ≤10 years: prevalence 46.7%; adjusted odds ratio compared to adults of 7.2, 95%CI 2.0-25.9) and with having at least one other member of the household with active head louse infestation (adjusted odds ratio 4.3, 95%CI 1.7-11.1). Head louse infestation is common in the Solomon Islands. This proof of principle study shows that oral ivermectin at a dose of 200 micrograms per kilogram can reduce the burden of active head louse infestation, offering an additional collateral benefit of MDA with ivermectin for scabies control. ClinicalTrials.gov NCT03236168

Research workshop to research work: initial steps in establishing health research systems on Malaita, Solomon Islands

<p>Abstract</p> <p>Introduction</p> <p>Atoifi Adventist Hospital is a 90 bed general hospital in East Kwaio, Malaita, Solomon Islands providing services to the population of subsistence villagers of the region. Health professionals at the hospital and attached College of Nursing have considerable human capacity and willingness to undertake health research. However they are constrained by limited research experience, training opportunities, research systems, physical infrastructure and access to resources. This brief commentary describes an 'Introduction to Health Research' workshop delivered at Atoifi Adventist Hospital in September 2009 and efforts to move from 'research workshop' to 'research work'.</p> <p>The Approach</p> <p>Using a participatory-action research approach underpinned by decolonising methodologies, staff from Atoifi Adventist Hospital and James Cook University (Queensland, Australia) collaboratively designed, implemented and evaluated a health research workshop. Basic health research principles and methods were presented using active learning methodologies. Following the workshop, Atoifi Adventist Hospital and Atoifi College of Nursing staff, other professionals and community members reported an increased awareness and understanding of health research. The formation of a local Research Committee, improved ethics review procedures and the identification of local research mentors followed the week long workshop. The workshop has acted as a catalyst for research activity, increasing structural and human resource capacity for local health professionals and community leaders to engage in research.</p> <p>Discussion and Conclusions</p> <p>Participants from a variety of educational backgrounds participated in, and received benefit from, a responsive, culturally and linguistically accessible health research workshop. Improving health research systems at a remote hospital and aligning these with local and national research agendas is establishing a base to strengthen public health research and practice on Malaita, Solomon Islands.</p

Comment: Inter-Island referrals in Solomon Islands: a remote hospital perspective

[Extract] We thank Negin, Martiniuk, Farrell and Dalipanda for their contribution in Rural and Remote Health to the field of inter-island referrals in the Solomon Islands¹. We agree that the provision of quality health services to people in remote areas is central to global efforts to achieve universal access to health care. We note with interest their findings that outline the increasing costs involved in referring patients to the National Referral Hospital (NRH) from the provinces, and the current Ministry of Health and Medical Services (MHMS) under-budgeting for these costs

A community builds a “bridge”: An example of community-led adaptation to sea-level rise in East Kwaio, Solomon Islands

Sea-level rise is negatively impacting many Pacific Islands Countries and Territories. In Solomon Islands, sea-level rise is particularly acute due to current movements, the geography of low-lying islands, and the physical structure and locations of villages on the islands. In East Kwaio, Solomon Islands a community-based response to rising sea-levels has meant that men and women from two villages have worked together to independently fund and build a raised walkway, and build seawalls in areas that are regularly inundated. This article describes community-based action, including the processes involved in building the walkway (“bridge”) and seawalls, and reports a community discussion with women about the impact of sea-level rise. Changes resulting from the bridge and seawalls, along with recommendations for future action, are reported. Local responses to local concerns underpin this community-based adaptation to sea-level rise in Solomon Islands. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.

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. © 2018 Marks et al

Mutual research capacity strengthening: A qualitative study of two-way partnerships in public health research

Introduction. Capacity building has been employed in international health and development sectors to describe the process of 'experts' from more resourced countries training people in less resourced countries. Hence the concept has an implicit power imbalance based on 'expert' knowledge. In 2011, a health research strengthening workshop was undertaken at Atoifi Adventist Hospital, Solomon Islands to further strengthen research skills of the Hospital and College of Nursing staff and East Kwaio community leaders through partnering in practical research projects. The workshop was based on participatory research frameworks underpinned by decolonising methodologies, which sought to challenge historical power imbalances and inequities. Our research question was, "Is research capacity strengthening a two-way process?". Methods. In this qualitative study, five Solomon Islanders and five Australians each responded to four open-ended questions about their experience of the research capacity strengthening workshop and activities: five chose face to face interview, five chose to provide written responses. Written responses and interview transcripts were inductively analysed in NVivo 9. Results: Six major themes emerged. These were: Respectful relationships; Increased knowledge and experience with research process; Participation at all stages in the research process; Contribution to public health action; Support and sustain research opportunities; and Managing challenges of capacity strengthening. All researchers identified benefits for themselves, their institution and/or community, regardless of their role or country of origin, indicating that the capacity strengthening had been a two-way process. Conclusions: The flexible and responsive process we used to strengthen research capacity was identified as mutually beneficial. Using community-based participatory frameworks underpinned by decolonising methodologies is assisting to redress historical power imbalances and inequities and is helping to sustain the initial steps taken to establish a local research agenda at Atoifi Hospital. It is our experience that embedding mutuality throughout the research capacity strengthening process has had great benefit and may also benefit researchers from more resourced and less resourced countries wanting to partner in research capacity strengthening activities. © 2012 Redman-MacLaren et al.; licensee BioMed Central Ltd

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). © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America

Strengthening capacity for local evidence to inform local responses to HIV in a remote Solomon Islands health service

BACKGROUND: Documenting specific knowledge and attitudes about HIV in the culturally diverse nation of Solomon Islands is essential to inform locally targeted public health responses. As part of a large capacity-strengthening project at Atoifi Adventist Hospital in East Kwaio, Solomon Islands, researchers, using a 'learn-by-doing' process, worked with participants in public health research methods. METHODS: Overall, 43 people attended research capacity building workshops in 2011; eight joined the HIV study group. A cross-sectional survey including semi-structured interviews on HIV was conducted by the group. In February 2014, a hospital administrator was interviewed about how the 2011 study informed local HIV responses. RESULTS: Of the 53 survey participants, 64% self-assessed as having little or no HIV knowledge, but 90% knew HIV could be transmitted between men and women during sex. Less than 50% knew HIV could be transmitted between two men having sex, 45% thought HIV could be transmitted by mosquitoes and 55% agreed condoms help protect from HIV. Most participants reported negative attitudes towards people with HIV. Three years later the health administrator reported ad hoc responses to HIV because of low HIV prevalence, increasing noncommunicable diseases, staff turnover and resource shortages. DISCUSSION: This HIV study was used to strengthen research skills in local health professionals and community members in Solomon Islands. It showed that community members require accurate information about HIV transmission and that entrenched stigma is an issue. Although results provided local evidence for local response, ongoing health system challenges and little local HIV transmission meant HIV services remain rudimentary

"We can move forward": challenging historical inequity in public health research in Solomon Islands

Background\ud \ud In resource-poor countries, such as Solomon Islands, the research agenda on health is often dominated by researchers from resource-rich countries. New strategies are needed to empower local researchers to set directions for health research. This paper presents a process which seeks to enable a local and potentially more equitable research agenda at a remote hospital in Solomon Islands.\ud \ud Methods\ud \ud In preparation for a health research capacity-building workshop at Atoifi Adventist Hospital, Malaita, Solomon Islands, a computer-based search was conducted of Solomon Islands public health literature. Using a levels-of-agreement approach publications were categorised as: a) original research, b) reviews, c) program descriptions and d) commentaries or discussion. Original research publications were further sub-categorised as: i) measurement, ii) descriptive research and iii) intervention studies. Results were reviewed with Solomon Islander health professionals in a focus group discussion during the health research workshop. Focus group participants were invited to discuss reactions to literature search results and how results might assist current or future local researchers to identify gaps in the published research literature and possible research opportunities at the hospital and surrounding communities. Focus group data were analysed using a grounded theory approach.\ud \ud Results\ud \ud Of the 218 publications meeting inclusion criteria, 144 (66%) were categorised as 'original research', 42 (19%) as 'commentaries/discussion', 28 (13%) as 'descriptions of programs' and 4 (2%) as 'reviews'. Agreement between three authors' (MRM, DM, AC) independent categorisation was 'excellent' (0.8 < κ). The 144 'original research' publications included 115 (80%) 'descriptive studies' (κ = 0.82); 19 (13%) 'intervention studies' (κ = 0.77); and 10 (7%) 'measurement studies'(κ = 0.80). Key themes identified in the focus group discussion challenged historical inequities evident from the literature review. These included: i) who has done/is doing research in Solomon Islands (largely non-Solomon Islanders); ii) when the research was done (research needs to keep up to date); iii) amount of published research (there should be more); iv) types of research (lack of intervention and operational research); v) value of published research (important); vi) gaps in published literature (need more research about nursing); vii) opportunities for research action (start small); viii) support required to undertake research at the hospital and in surrounding communities (mentoring and partnering with experienced researchers).\ud \ud Conclusions\ud \ud A search and collaborative review of public health literature for Solomon Islands at a health research capacity building workshop has uncovered and challenged historical inequity in the conduct and access to public health research. Emerging Solomon Islander researchers at a remote hospital are now working to set priorities and strengthen local research efforts. These efforts have highlighted the importance of collaboration and mentoring for Solomon Islanders to instigate and implement public health research to improve the health of individuals and communities served by this remote hospital

Impact of ivermectin administered for scabies treatment on the prevalence of head lice in Atoifi, Solomon Islands

Background: Scabies and head lice are ubiquitous ectoparasitic infestations that are common across the Pacific Islands. Ivermectin is an effective treatment for both conditions, although the doses used vary. At a community level, mass drug administration (MDA) with ivermectin is an effective strategy to decrease prevalence of scabies. To what extent MDA with ivermectin will also reduce prevalence of head lice is unknown. Methodology: Head lice prevalence was assessed before and after MDA with oral ivermectin (at a dose of 200 micrograms per kilogram of body weight) administered on day 1 and day 8. The primary outcome was the change in prevalence of head louse infestation at two weeks compared to baseline. Longer term efficacy was assessed three months after MDA. Results: 118 participants were enrolled. Baseline prevalence of active head louse infestation was 25.4% (95% CI 18.4–34.0). At two-week follow-up, prevalence was 2.5% (95% CI 0.9–7.2), a relative reduction of 89.1% (95% CI 72.7–91.4%, p<0.001). At three-month follow-up, prevalence was 7.5% (95% CI 2.7–12.3), a relative reduction of 70.6% (95% CI 72.7%-91.4%, p <0.001). Head louse infestation was associated with younger age (age ≤10 years: prevalence 46.7%; adjusted odds ratio compared to adults of 7.2, 95%CI 2.0–25.9) and with having at least one other member of the household with active head louse infestation (adjusted odds ratio 4.3, 95%CI 1.7–11.1). Conclusions: Head louse infestation is common in the Solomon Islands. This proof of principle study shows that oral ivermectin at a dose of 200 micrograms per kilogram can reduce the burden of active head louse infestation, offering an additional collateral benefit of MDA with ivermectin for scabies control. Trial registration: ClinicalTrials.gov NCT03236168. © 2018 Coscione et al. http://creativecommons.org/licenses/by/4.0/