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

Genetic diversity in two sibling species of the Anopheles punctulatus group of mosquitoes on Guadalcanal in the Solomon Islands

<p>Abstract</p> <p>Background</p> <p>The mosquito <it>Anopheles irenicus</it>, a member of the <it>Anopheles punctulatus </it>group, is geographically restricted to Guadalcanal in the Solomon Islands. It shows remarkable morphological similarities to one of its sibling species, <it>An. farauti sensu stricto </it>(<it>An. farauti s.s</it>.), but is dissimilar in host and habitat preferences. To infer the genetic variations between these two species, we have analyzed mitochondrial <it>cytochrome oxidase subunit II </it>(<it>COII</it>) and nuclear ribosomal <it>internal transcribed spacer 2 </it>(<it>ITS2</it>) sequences from Guadalcanal and from one of its nearest neighbours, Malaita, in the Solomon Islands.</p> <p>Results</p> <p><it>An. farauti s.s</it>. was collected mostly from brackish water and by the human bait method on both islands, whereas <it>An. irenicus </it>was only collected from fresh water bodies on Guadalcanal Island. <it>An. irenicus </it>is distributed evenly with <it>An. farauti s.s</it>. (Φ_SC= 0.033, 0.38%) and its range overlaps in three of the seven sampling sites. However, there is a significant population genetic structure between the species (Φ_CT= 0.863, <it>P </it>< 0.01; Φ_ST= 0.865, <it>P </it>< 0.01 and <it>F</it>_ST= 0.878, <it>P </it>< 0.01). Phylogenetic analyses suggest that <it>An. irenicus </it>is a monophyletic species, not a hybrid, and is closely related to the <it>An. farauti s.s</it>. on Guadalcanal. The time estimator suggests that <it>An. irenicus </it>diverged from the ancestral <it>An. farauti s.s</it>. on Guadalcanal within 29,000 years before present (BP). <it>An. farauti s.s</it>. expanded much earlier on Malaita (<it>t</it>_exp= 24,600 BP) than the populations on Guadalcanal (<it>t</it>_exp= 16,800 BP for <it>An. farauti s.s</it>. and 14,000 BP for <it>An. irenicus</it>).</p> <p>Conclusion</p> <p>These findings suggest that <it>An. irenicus </it>and <it>An. farauti s.s</it>. are monophyletic sister species living in sympatry, and their populations on Guadalcanal have recently expanded. Consequently, the findings further suggest that <it>An. irenicus </it>diverged from the ancestral <it>An. farauti s.s</it>. on Guadalcanal.</p

Smallest Anopheles farauti occur during the peak transmission season in the Solomon Islands

Background: Malaria transmission varies in intensity amongst Solomon Island villages where Anopheles farauti is the only vector. This variation in transmission intensity might be explained by density-dependent processes during An. farauti larval development, as density dependence can impact adult size with associated fitness costs and daily survivorship. Methods: Adult anophelines were sampled from six villages in Western and Central Provinces, Solomon Islands between March 2014 and February 2017. The size of females was estimated by measuring wing lengths, and then analysed for associations with biting densities and rainfall. Results: In the Solomon Islands, three anopheline species, An. farauti, Anopheles hinesorum and Anopheles lungae, differed in size. The primary malaria vector, An. farauti, varied significantly in size among villages. Greater rainfall was directly associated with higher densities of An. farauti biting rates, but inversely associated with body size with the smallest mean sized mosquitoes present during the peak transmission period. A measurable association between body size and survivorship was not found. Conclusions: Density dependent effects are likely impacting the size of adult An. farauti emerging from a range of larval habitats. The data suggest that rainfall increases An. farauti numbers and that these more abundant mosquitoes are significantly smaller in size, but without any reduced survivorship being associated with smaller size. The higher malaria transmission rate in a high malaria focus village appears to be determined more by vector numbers than size or survivorship of the vectors

Influence of environmental factors on the abundance of Anopheles farauti larvae in large brackish water streams in Northern Guadalcanal, Solomon Islands

Background: The main vector of malaria in Solomon Islands is Anopheles farauti, which has a mainly coastal distribution. In Northern Guadalcanal, Solomon Islands, high densities of An. farauti are supported by large brackish streams, which in the dry season are dammed by localized sand migration. The factors controlling the high larval productivity of these breeding sites have not been identified. Accordingly the influence of environmental factors on the presence and density of An. farauti larvae was assessed in three large naturally dammed streams. Methods. Larval sites were mapped and anopheline larvae were collected monthly for 12 months (July 2007 to June 2008) from three streams using standard dippers. Larval collections were made from 10 locations spaced at 50 m intervals along the edge of each stream starting from the coast. At each collection point, floating filamentous algae, aquatic emergent plants, sun exposure, and salinity were measured. These environmental parameters along with rainfall were correlated with larval presence and density. Results: The presence and abundance of An. farauti larvae varied between streams and was influenced by the month of collection, and distance from the ocean (p < 0.001). Larvae were more frequently present and more abundant within 50 m of the ocean during the dry season when the streams were dammed. The presence and density of larvae were positively associated with aquatic emergent plants (presence: p = 0.049; density: p = 0.001). Although filamentous algae did not influence the presence of larvae, this factor did significantly influence the density of larvae (p < 0.001). Rainfall for the month prior to sampling was negatively associated with both larval presence and abundance (p < 0.001), as high rainfall flushed larvae from the streams. Salinity significantly influenced both the presence (p = 0.002) and density (p = 0.014) of larvae, with larvae being most present and abundant in brackish water at < 10 seawater. Conclusion: This study has demonstrated that the presence and abundance An. farauti larvae are influenced by environmental factors within the large streams. Understanding these parameters will allow for targeted cost effective implementation of source reduction and larviciding to support the frontline malaria control measures i.e. indoor residual spraying (IRS) and distribution of long-lasting insecticidal nets (LLINs)

A highly sensitive, nested polymerase chain reaction based method using simple DNA extraction to detect malaria sporozoites in mosquitos

Dried Anopheles farauti mosquitos caught in Solomon Islands in 1990 were examined for malaria sporozoites by ELISA and nested polymerase chain reaction (PCR). Only heads and thoraces were used. Plasmodium genus-specific nested PCR amplifications were carried out on all samples. Of the 402 pools of mosquitos that were processed, 30 were positive for malaria. Nest 1 products of positive samples were subjected to further PCR amplifications with species-specific primers for P. falciparum and P. vivax. Twenty pools were positive for P. vivax by PCR while only 7 were positive by ELISA. For P. falciparum 2 pools were positive by both ELISA and PCR, and one of these was a pool which was positive for P. vivax by PCR and ELISA. Thus the sensitivity of PCR for P. vivax was 100% while the specificity was 96.7%. For P. falciparum the sensitivity and specificity were 100%. The PCR technique is highly sensitive and can be used on dried mosquitos which makes it a valuable tool for determining sporozoite rates of mosquitos, even in remote areas

Changes in vector species composition and current vector biology and behaviour will favour malaria elimination in Santa Isabel Province, Solomon Islands

Background: In 2009, Santa Isabel Province in the Solomon Islands embarked on a malaria elimination programme. However, very little is known in the Province about the anopheline fauna, which species are vectors, their bionomics and how they may respond to intensified intervention measures. The purpose of this study was to provide baseline data on the malaria vectors and to ascertain the possibility of successfully eliminating malaria using the existing conventional vector control measures, such as indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN). Methods. Entomological surveys were undertaken during October 2009. To determine species composition and distribution larval surveys were conducted across on the whole island. For malaria transmission studies, adult anophelines were sampled using human landing catches from two villages - one coastal and one inland. Results: Five Anopheles species were found on Santa Isabel: Anopheles farauti, Anopheles hinesorum, Anopheles lungae, Anopheles solomonis, and Anopheles nataliae. Anopheles hinesorum was the most widespread species. Anopheles farauti was abundant, but found only on the coast. Anopheles punctulatus and Anopheles koliensis were not found. Anopheles farauti was the only species found biting in the coastal village, it was incriminated as a vector in this study; it fed early in the night but equally so indoors and outdoors, and had a low survival rate. Anopheles solomonis was the main species biting humans in the inland village, it was extremely exophagic, with low survival rates, and readily fed on pigs. Conclusion: The disappearance of the two major vectors, An. punctulatus and An. koliensis, from Santa Isabel and the predominance of An. hinesorum, a non-vector species may facilitate malaria elimination measures. Anopheles farauti was identified as the main coastal vector with An. solomonis as a possible inland vector. The behaviour of An. solomonis is novel as it has not been previously found biting humans in any numbers. Both species appear to be short-lived, a characteristic that will limit their transmission potential. The early night feeding behaviour and a degree of outdoor biting seen in An. farauti and particularly in An. solomonis will require that their response to IRS and LLIN be closely monitored. In coastal villages, where large, favourable breeding sites allow for high numbers of An. farauti may require the addition of larval control to achieve elimination

A high-resolution geospatial surveillance-response system for malaria elimination in Solomon Islands and Vanuatu

BACKGROUND A high-resolution surveillance-response system has been developed within a geographic information system (GIS) to support malaria elimination in the Pacific. This paper examines the application of a GIS-based spatial decision support system (SDSS) to automatically locate and map the distribution of confirmed malaria cases, rapidly classify active transmission foci, and guide targeted responses in elimination zones. METHODS Customized SDSS-based surveillance-response systems were developed in the three elimination provinces of Isabel and Temotu, Solomon Islands and Tafea, Vanuatu. Confirmed malaria cases were reported to provincial malaria offices upon diagnosis and updated into the respective SDSS as part of routine operations throughout 2011. Cases were automatically mapped by household within the SDSS using existing geographical reconnaissance (GR) data. GIS queries were integrated into the SDSS-framework to automatically classify and map transmission foci based on the spatiotemporal distribution of cases, highlight current areas of interest (AOI) regions to conduct foci-specific targeted response, and extract supporting household and population data. GIS simulations were run to detect AOIs triggered throughout 2011 in each elimination province and conduct a sensitivity analysis to calculate the proportion of positive cases, households and population highlighted in AOI regions of a varying geographic radius. RESULTS A total of 183 confirmed cases were reported and mapped using the SDSS throughout 2011 and used to describe transmission within a target population of 90,354. Automatic AOI regions were also generated within each provincial SDSS identifying geographic areas to conduct response. 82.5% of confirmed cases were automatically geo-referenced and mapped at the household level, with 100% of remaining cases geo-referenced at a village level. Data from the AOI analysis indicated different stages of progress in each province, highlighting operational implications with regards to strategies for implementing surveillance-response in consideration of the spatiotemporal nature of cases as well as logistical and financial constraints of the respective programmes. CONCLUSIONS Geospatial systems developed to guide Pacific Island malaria elimination demonstrate the application of a high resolution SDSS-based approach to support key elements of surveillance-response including understanding epidemiological variation within target areas, implementing appropriate foci-specific targeted response, and consideration of logistical constraints and costs.A.C.A.C. is supported by a Career Development Award from the Australian National Health and Medical Research Council (#631619)

Malaria early warning tool: linking inter-annual climate and malaria variability in northern Guadalcanal, Solomon Islands

BACKGROUND: Malaria control remains a significant challenge in the Solomon Islands. Despite progress made by local malaria control agencies over the past decade, case rates remain high in some areas of the country. Studies from around the world have confirmed important links between climate and malaria transmission. This study focuses on understanding the links between malaria and climate in Guadalcanal, Solomon Islands, with a view towards developing a climate-based monitoring and early warning for periods of enhanced malaria transmission. METHODS: Climate records were sourced from the Solomon Islands meteorological service (SIMS) and historical malaria case records were sourced from the National Vector-Borne Disease Control Programme (NVBDCP). A declining trend in malaria cases over the last decade associated with improved malaria control was adjusted for. A stepwise regression was performed between climate variables and climate-associated malaria transmission (CMT) at different lag intervals to determine where significant relationships existed. The suitability of these results for use in a three-tiered categorical warning system was then assessed using a Mann-Whitney U test. RESULTS: Of the climate variables considered, only rainfall had a consistently significant relationship with malaria in North Guadalcanal. Optimal lag intervals were determined for prediction using R2 skill scores. A highly significant negative correlation (R&nbsp;=&nbsp;-&nbsp;0.86, R2&nbsp;=&nbsp;0.74, p&nbsp;&lt;&nbsp;0.05, n&nbsp;=&nbsp;14) was found between October and December rainfall at Honiara and CMT in northern Guadalcanal for the subsequent January-June. This indicates that drier October-December periods are followed by higher malaria transmission periods in January-June. Cross-validation emphasized the suitability of this relationship for forecasting purposes [Formula: see text]&nbsp; as did Mann-Whitney U test results showing that rainfall below or above specific thresholds was significantly associated with above or below normal malaria transmission, respectively. CONCLUSION: This study demonstrated that rainfall provides the best predictor of malaria transmission in North Guadalcanal. This relationship is thought to be underpinned by the unique hydrological conditions in northern Guadalcanal which allow sandbars to form across the mouths of estuaries which act to develop or increase stagnant brackish marshes in low rainfall periods. These are ideal habitats for the main mosquito vector, Anopheles farauti. High rainfall accumulations result in the flushing of these habitats, reducing their viability. The results of this study are now being used as the basis of a malaria early warning system which has been jointly implemented by the SIMS, NVBDCP and the Australian Bureau of Meteorology

Mapping a Plasmodium transmission spatial suitability index in Solomon Islands: a malaria monitoring and control tool

Following publication of the original article [1], one of the authors flagged that the images for Figs.&nbsp;2 and 3 were swapped in the published article-Fig.&nbsp;2 had the image meant for Fig.&nbsp;3 and vice versa