Exploring provider and community responses to the new malaria diagnostic and treatment regime in Solomon Islands

<p>Abstract</p> <p>Background</p> <p>Improvements in availability and accessibility of artemisinin-based combination therapy (ACT) for malaria treatment and the emergence of multi-drug-resistant parasites have prompted many countries to adopt ACT as the first-line drug. In 2009, Solomon Islands (SI) likewise implemented new national treatment guidelines for malaria. The ACT, Coartem^®(artemether-lumefantrine) is now the primary pharmacotherapy in SI for <it>Plasmodium falciparum </it>malaria, <it>Plasmodium vivax </it>malaria or mixed infections. Targeted treatment is also recommended in the new treatment regime through maintenance of quality microscopy services and the introduction of Rapid Diagnostic Tests (RDTs). Ascertaining the factors that influence community and provider acceptance of and adherence to the new treatment regime will be vital to improving the effectiveness of this intervention and reducing the risk of development of drug resistance.</p> <p>Methods</p> <p>In order to understand community and prescriber perceptions and acceptability of the new diagnostic and treatment interventions, 12 focus group discussions (FGDs) and 12 key informant interviews (KII) were carried out in rural and urban villages of Malaita Province, Solomon Islands four months subsequent to roll out of these interventions.</p> <p>Results</p> <p>Lack of access to microscopy or distrust in the accuracy of diagnostic tools were reported by some participants as reasons for the ongoing practice of presumptive treatment of malaria. Lack of confidence in RDT accuracy has negatively impacted its acceptability. Coartem^®had good acceptability among most participants, however, some rural participants questioned its effectiveness due to lack of side effects and the larger quantity of tablets required to be taken. Storing of left over medication for subsequent fever episodes was reported as common.</p> <p>Conclusion</p> <p>To address these issues, further training and supportive supervision of healthcare workers will be essential, as will the engagement of influential community members in health promotion activities to improve acceptability of RDTs and adherence to the new treatment regime. Exploring the extent of these issues beyond the study population must be a priority for malaria programme managers. Practices such as presumptive treatment and the taking of sub-curative doses are of considerable concern for both the health of individuals and the increased risk it poses to the development of parasite resistance to this important first-line treatment against malaria.</p

Active case detection, treatment of falciparum malaria with combined chloroquine and sulphadoxine/pyrimethamine and vivax malaria with chloroquine and molecular markers of anti-malarial resistance in the Republic of Vanuatu

<p>Abstract</p> <p>Background</p> <p>Chloroquine-resistant <it>Plasmodium falciparum </it>was first described in the Republic of Vanuatu in the early 1980s. In 1991, the Vanuatu Ministry of Health instituted new treatment guidelines for uncomplicated <it>P. falciparum </it>infection consisting of chloroquine/sulphadoxine-pyrimethamine combination therapy. Chloroquine remains the recommended treatment for <it>Plasmodium vivax</it>.</p> <p>Methods</p> <p>In 2005, cross-sectional blood surveys at 45 sites on Malo Island were conducted and 4,060 adults and children screened for malaria. Of those screened, 203 volunteer study subjects without malaria at the time of screening were followed for 13 weeks to observe peak seasonal incidence of infection. Another 54 subjects with malaria were followed over a 28-day period to determine efficacy of anti-malarial therapy; chloroquine alone for <it>P. vivax </it>and chloroquine/sulphadoxine-pyrimethamine for <it>P. falciparum </it>infections.</p> <p>Results</p> <p>The overall prevalence of parasitaemia by mass blood screening was 6%, equally divided between <it>P. falciparum </it>and <it>P. vivax</it>. Twenty percent and 23% of participants with patent <it>P. vivax </it>and <it>P. falciparum </it>parasitaemia, respectively, were febrile at the time of screening. In the incidence study cohort, after 2,303 person-weeks of follow-up, the incidence density of malaria was 1.3 cases per person-year with <it>P. vivax </it>predominating. Among individuals participating in the clinical trial, the 28-day chloroquine <it>P. vivax </it>cure rate was 100%. The 28-day chloroquine/sulphadoxine-pyrimethamine <it>P. falciparum </it>cure rate was 97%. The single treatment failure, confirmed by <it>merozoite surface protein-2 </it>genotyping, was classified as a day 28 late parasitological treatment failure. All <it>P. falciparum </it>isolates carried the Thr-76 <it>pfcrt </it>mutant allele and the double Asn-108 + Arg-59 <it>dhfr </it>mutant alleles. <it>Dhps </it>mutant alleles were not detected in the study sample.</p> <p>Conclusion</p> <p>Peak seasonal malaria prevalence on Malo Island reached hypoendemic levels during the study observation period. The only <it>in vivo </it>malaria drug efficacy trial thus far published from the Republic of Vanuatu showed chloroquine/sulphadoxine-pyrimethamine combination therapy for <it>P. falciparum </it>and chloroquine alone for <it>P. vivax </it>to be highly efficacious. Although the chloroquine-resistant <it>pfcrt </it>allele was present in all <it>P. falciparum </it>isolates, mutant alleles in the <it>dhfr </it>and <it>dhps </it>genes do not yet occur to the extent required to confer sulphadoxine-pyrimethamine resistance in this population.</p

Vanuatu demographic and health survey : MICS 2013

xxvi, 395 pages : illustrations ; 31 cmThis report summarises the findings of the Vanuatu Demographic and Health Survey – Multiple Indicator Cluster Survey (DHS–MICS) 2013 implemented by the Vanuatu National Statistics Office in coordination with the Ministry of Health. The Secretariat of the Pacific Community (SPC) was the executing agency for the project. The Government of Vanuatu provided financial assistance in terms of in-kind contribution of government staff time, office space, and logistical support. The project was funded jointly by the Asian Development Bank, the United Nations Children’s Fund, the United Nations Population Fund and the Australian Agency for International Development. SPC was responsible for the overall coordination of the demographic and health survey operations, as well as the sample design, survey planning and budgeting, providing data processing support to the implementing agency, and coordinating the report. SPC had also provided technical assistance in the areas of survey design, questionnaires, manual adaptations, conduct of pretesting and main training, fieldwork monitoring, systems development, data processing and tabulation programmes as part of its contract with the Asian Development Bank. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the donor organisations

A profile of diabetes in Pacific Island countries and territories

Aim: To examine the available evidence about the epidemiology, health, social, and economic impact of diabetes in Pacific Island Countries and Territories (PICTs). Methods: We conducted a systematic review of the peer-reviewed literature published in English from January 1990 to January 2014, and relevant technical reports. Results: A total of 1548 articles were identified of which 35 studies of type 2 diabetes met the inclusion criteria. Eighteen technical reports were also included. We found no articles reporting on type 1 diabetes or gestational diabetes that met the inclusion criteria. The prevalence, risk factors and complications of diabetes were substantial. Diabetes prevalence rate of around 40% was common. Physical inactivity, overweight and obesity were leading risk factors. High rates of diabetes complications were reported e.g. up to 69% retinopathy. Poor clinical outcomes were also reported with over 70% not meeting glycaemic control targets and approximately 50% not meeting blood pressure and cholesterol targets. Conclusion: This review highlights the burden of diabetes in PICTs and the need for more intensive interventions to improve the quality and outcomes of diabetes care. Overall, further research is needed to monitor secular diabetes trends in PICTs using standardised criteria for diagnosing diabetes and its complications