Tuberculosis and gender in the Asia-Pacific region

We thank the NHMRC Tuberculosis Centre of Research Excellence, Australia, and Philippe Glaziou, Senior Epidemiologist, GTB/TME, WHO Headquarters, Geneva, Switzerlan

Incidental mosquitocidal effect of an ivermectin mass drug administration on Anopheles farauti conducted for scabies control in the Solomon Islands.

Background: The Solomon Islands is targeting elimination of malaria by 2030. The dominant vector is the predominantly exophagic, exophilic Anopheles farauti sensu strictu. This biting behaviour limits the efficacy of conventional vector control tools and highlights the need for new strategies. When administered to humans ivermectin has been shown to have a mosquitocidal effect. Mass drug administration (MDA) with ivermectin is an emerging strategy in the control of scabies. In this study we explored any incidental effect of ivermectin MDA conducted for scabies control on mosquitoes. Methods: MDA for scabies was conducted in three villages. We performed human landing catches and measured 5-day mortality amongst Anopheles mosquitoes caught before and after MDA. Cox regression was used to calculate hazard ratios (HR) for mortality between mosquitoes caught before and after MDA. Results: There was a significant increase in 5-day mortality in anopheline mosquitoes caught post-MDA which was highest on the day of MDA itself (HR 4.2 95% CI 1.8 to 10.1, p=0.001) and the following day (HR 4.4 95% CI 1.8 to 10.8, p=0.002) compared to mosquitoes caught before MDA. Conclusions: This study shows a possible mosquitocidal effect of ivermectin MDA conducted for scabies control. Studies with a larger sample size with clinical as well as entomological outcomes should be conducted in this population

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

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

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)

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

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

Objective:\ud 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.\ud \ud Method:\ud 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.\ud \ud Results:\ud 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\ud isolation. Traditional healers practice indigenous treatments with 50% of people receiving treatments described as cured, 30% temporary cured and 20%\ud no effect from treatment.\ud \ud Conclusions:\ud 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

HIV research on Malaita, Solomon Islands

[Extract] Although Solomon Islands has a relatively small number of people living with HIV (13 cumulative cases since 1994), the high rates of sexually transmitted\ud infections (STIs), gender inequality, many religious and cultural beliefs and limited health resources in the country all mean that HIV could rapidly spread through the\ud population

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

Redman-Maclaren, ML ORCiD: 0000-0002-2055-7733Sea-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.

Improving infection prevention and control practices in a culturally, linguistically and spiritually diverse environment

[Extract] Atoifi Adventist Hospital (AAH) in the Solomon Islands serves a population of 80,000 people, many living in small remote villages. Atoifi is situated on the east side of the island of Malaita in the East Kwaio region. Kwaio is one of 12 language groups on Malaita and most people engage in the subsistence economy