Health systems research capacity building in Solomon Islands: a multiple case study approach

Humpress Harrington investigated four models used to build health systems research capacity in Solomon Islands. He found social, cultural and health system factors interacted with religious and spiritual beliefs to both support and impede research systems. For research to thrive all forms of knowledge need to be understood and incorporated

From the frontline: strengthening surveillance and response capacities of the rural workforce in the Asia-Pacific region. How can grass-roots implementation research help?

Health systems in the Asia-Pacific region are poorly prepared for pandemic threats, particularly in rural/provincial areas. Yet future emerging infectious diseases are highly likely to emerge in these rural/provincial areas, due to high levels of contact between animals and humans (domestically and through agricultural activities), over-stretched and under-resourced health systems, notably within the health workforce, and a diverse array of socio-cultural determinants of health. In order to optimally implement health security measures at the frontline of health services where the people are served, it is vital to build capacity at the local district and facility level to adapt national and global guidelines to local contexts, including health systems, and community and socio-cultural realities. During 2017/18 James Cook University (JCU) facilitated an implementation research training program (funded by Australian Department of Foreign Affairs and Trade) for rural/provincial and regional health and biosecurity workers and managers from Fiji, Indonesia, Papua New Guinea (PNG), Solomon Islands and Timor-Leste. This training was designed so frontline health workers could learn research in their workplace, with no funding other than workplace resources, on topics relevant to health security in their local setting. The program, based upon the WHO-TDR Structured Operational Research and Training IniTiative (SORT-IT) consists of three blocks of teaching and a small, workplace-based research project. Over 50 projects by health workers including surveillance staff, laboratory managers, disease control officers, and border security staff included: analysis and mapping of surveillance data, infection control, IHR readiness, prevention/response and outbreak investigation. Policy briefs written by participants have informed local, provincial and national health managers, policymakers and development partners and provided on-the-ground recommendations for improved practice and training. These policy briefs reflected the socio-cultural, health system and disease-specific realities of each context. The information in the policy briefs can be used collectively to assess and strengthen health workforce capacity in rural/provincial areas. The capacity to use robust but simple research tools for formative and evaluative purposes provides sustainable capacity in the health system, particularly the rural health workforce. This capacity improves responses to infectious diseases threats and builds resilience into fragile health systems

Seroprevalence of dengue, Zika, chikungunya and Ross River viruses across the Solomon Islands

Across the Pacific, and including in the Solomon Islands, outbreaks of arboviruses such as dengue, chikungunya, and Zika are increasing in frequency, scale and impact. Outbreaks of mosquito-borne disease have the potential to overwhelm the health systems of small island nations. This study mapped the seroprevalence of dengue, Zika, chikungunya and Ross River viruses in 5 study sites in the Solomon Islands. Serum samples from 1,021 participants were analysed by ELISA. Overall, 56% of participants were flavivirus-seropositive for dengue (28%), Zika (1%) or both flaviviruses (27%); and 53% of participants were alpha-virus-seropositive for chikungunya (3%), Ross River virus (31%) or both alphaviruses (18%). Seroprevalence for both flaviviruses and alphaviruses varied by village and age of the participant. The most prevalent arboviruses in the Solomon Islands were dengue and Ross River virus. The high seroprevalence of dengue suggests that herd immunity may be a driver of dengue outbreak dynamics in the Solomon Islands. Despite being undetected prior to this survey, serology results suggest that Ross River virus transmission is endemic. There is a real need to increase the diagnostic capacities for each of the arboviruses to support effective case management and to provide timely information to inform vector control efforts and other outbreak mitigation interventions

Ancylostoma ceylanicum

Although hookworm is highly prevalent in the Solomon Islands, the species involved are unknown. We initiated this study in response to finding Ancylostoma ceylanicum hookworm in a peacekeeper in Australia who had returned from the Solomon Islands. Kato-Katz fecal surveys performed in 2013 and 2014 in 2 village groups in East Malaita, Solomon Islands, identified hookworm-positive samples. These specimens were tested by cytochrome oxidase 1 (cox-1) gene multiplex PCR and sequenced. Of 66 positive specimens, 54 (81.8%) contained only Necator americanus, 11 (16.7%) contained only A. ceylanicum, and 1 (1.5%) contained both species. A. duodenale was not found. Haplotype analysis of cox-1 sequences placed all human isolates (99% bootstrap support) of A. ceylanicum within the zoonotic clade rather than the human-specific clade. This study confirms that A. ceylanicum is endemic in the East Malaita region of this Pacific Island nation. The strain of the A. ceylanicum in this region can be shared among humans, dogs, and cats

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

Community health service delivery and research at a remote Solomon Islands hospital

Atoifi Adventist Hospital and Atoifi College of Nursing are located on the remote Eastern coast of Malaita, Solomon Islands. The hospital primarily serves the mainly subsistence villagers in surrounding communities. The College of Nursing is one of two in the country and the only one in a remote provincial location. There are many community health issues including malaria, pneumonia, fungal infections, tuberculosis, child and maternal mortality, intestinal parasites and sexually transmitted infections. There is much capacity and willingness to improve service delivery and public health research at Atoifi. However, constraints such as limited financial resources, training opportunities, support to conduct research, transport (no roads) and physical infrastructure (including limited electricity and communication) are restricting health professionals from working to their potential on these important areas. Humpress Harrington, Principal of Atoifi College of Nursing and hospital administrator, will report upon health service conditions as they impact the service delivery and education of health professionals at Atoifi Hospital. Harrington will discuss health challenges and how they are being addressed in communities near the hospital. In particular, he will discuss recent public health research capacity building efforts which are enabling hospital and college staff to systematically gather evidence in partnership with surrounding communities to address health issues in the area. This will be exemplified by outlining how, for the first time, a soil transmitted helminth survey was conducted in a nearby village and how results are informing community health interventions including village-wide treatment, education and plans for improvement of sanitation infrastructure. Humpress Harrington will discuss Atoifi Hospital's plans to further develop health service delivery and research in this challenging tropical and resource-poor environment

Conducting community health research in tropical countries: reflections from Melanesia

Conducting community health research in the tropical counties of Melanesia can be filled with reward, frustration, satisfaction, exasperation and exhilaration - and that's just the first day! This presentation will reflect on lessons learned by a nurse educator from Solomon Islands and a public health researcher from Australia who have collaborated over the past two decades in community health service delivery and research. From their respective standpoints, these two men will discuss successes and challenges experienced when working with community leaders, faith-based organisations, government and non-government donors, health services and research institutions to implement community health research in remote locations across Solomon Islands and Papua New Guinea. Emphasis will be given to the importance of participatory methodologies with diverse and often disparate groups. Successes and challenges of working with and for people and communities not on or to people and communities will be discussed. Examples of how enduring relationships and mutually negotiated methodologies with community partners have enabled a range of projects to succeed will be discussed from the areas of culturally appropriate health care, tuberculosis treatment and management, soil transmitted helminth detection and control, and HIV prevention

Triathlon in the tropics: South Pacific style

Non-communicable diseases (NCD) are on the rise in Solomon Islands and have the potential to undermine labour supply, productivity, investment and education across the country. Interventions required to control NCDs exist outside the health sector and Solomon Island leaders have called for a whole of government and whole of society response to NCDs. In Solomon Islands, most of the population live in rural villages meaning public health initiatives need to be designed that are relevant and responsive to local contexts.\ud \ud Atoifi Hospital is located on the remote east coast of the island of Malaita. There are no bicycles and the only road is an eroded gravel track between the hospital and nearby grass airstrip. In this context, the NCD team at Atoifi ran a triathlon as one part of a broad initiative to get people more active and thus address the rising rates of life style diseases in the area. The triathlon was modified to be "South Pacific" style - paddling dugout canoes, swimming in the lagoon and running on rough bush tracks. This presentation outlines the challenges and successes of this triathlon and explains how triathlon can be conducted at the grassroots level in the tropics with limited facilities and resources

A systematic literature review of pediculosis due to head lice in the Pacific Island Countries and Territories: what country specific research on head lice is needed?

Background: Lack of guidelines on control of pediculosis in the Solomon Islands led to a search for relevant evidence on head lice in the Pacific Island Countries and Territories (PICTs). The aim of this search was to systematically evaluate evidence in the peer reviewed literature on pediculosis due to head lice ('Pediculus humanus var capitis') in the 22 PICTs from the perspective of its value in informing national guidelines and control strategies. Methods: PubMed, Web of Science, CINAHL and Scopus were searched using the terms (pediculosis OR head lice) AND each of the 22 PICTs individually. PRISMA methodology was used. Exclusion criteria were: i) not on topic; ii) publications on pediculosis not relevant to the country of the particular search; iii) in grey literature. Results: Of 24 publications identified, only 5 were included. Four related to treatment and one to epidemiology. None contained information relevant to informing national guidelines. Conclusions: Current local evidence on head lice in the PICTs is minimal and totally inadequate to guide any recommendations for treatment or control. We recommend that local research is required to generate evidence on: i) epidemiology; ii) knowledge, attitudes and practices of health care providers and community members; iii) efficacy of local commercially available pharmaceutical treatments and local customary treatments; iv) acceptability, accessibility and affordability of available treatment strategies; and iv) appropriate control strategies for families, groups and institutions. We also recommend that operational research be done by local researchers based in the PICTs, supported by experienced head lice researchers, using a two way research capacity building model