Gestational Diabetes in Melanesia and Appropriateness of Current Screening and Diagnostic Tests

Abstract@#In low-resource settings such as Melanesia, gestational diabetes often goes undiagnosed due to many factors, including the unsuitability of current tests. Ideally a gestational diabetes test for low-resource settings should meet criteria related to acceptability, test performance and operational characteristics, with minimal impositions on individual patients or the wider health system. None of the six tests recommended in country-specific gestational diabetes guidelines in Melanesia (2-hour oral glucose tolerance test, glucose challenge test, fasting plasma glucose, random plasma glucose, 2-hour postprandial glucose and glycated haemoglobin) meet criteria related to these attributes. Additionally, each Melanesian country has different, complex algorithms that use multiple tests in different combinations. With a high and increasing burden of diabetes mellitus (and therefore assumed gestational diabetes), Melanesian health practitioners and policymakers should be aware of the limitations of recommended tests for gestational diabetes and be open to alternative technologies that may be more appropriate.

A Case of Ancylostoma ceylanicum Infection Occurring in an Australian Soldier Returned from Solomon Islands

A 26-year-old male member of the Australian Defense Force presented with a history of central abdominal pain of 4 weeks duration and peripheral eosinophilia consistent with eosinophilic enteritis. Acute hookworm disease was diagnosed as the cause. Adult worms recovered from feces after therapy with albendazole were morphologically consistent with Ancylostoma ceylanicum. As the patient had been deployed with the Regional Assistance Mission to Solomon Islands for 6 months prior to this presentation, it is very likely that the A. ceylanicum was acquired in Solomon Islands. Until now, it has been assumed that any Ancylostoma spp. recovered from humans in Solomon Islands is A. duodenale. However, this case demonstrates that human hookworm infection acquired in the Solomon Islands could be caused by A. ceylanicum.

Assessment of thyroid status of patients in Solomon Islands: a retrospective study

Thyroid Function Tests are used for assessing the thyroid status of an individual. In the Solomon Islands blood samples for thyroid function tests are collected and sent to the Royal Brisbane Hospital Laboratory in Australia on a weekly basis. The major objective of this study was to use the thyroid function tests results obtained over the period 2008 to 2012 to retrospectively assess the prevalence of thyroid dysfunction in the Solomon Islands. This study used convenience sampling that included all the 2070 requests for thyroid function tests from 2008 to 2012 recorded in the registry books in the Clinical Biochemistry Department in the National Medical Laboratory Pathology Division in the National Referral Hospital in Honiara Solomon Islands. The data collected were analyzed using Microsoft excel for Windows 8 and the Statistical Packages for Social Sciences version 20 for Windows. Ethical clearance and permission were obtained from the appropriate authorities. A total of 1485 (71.7%) recorded results were used for data analysis. Thyroid disorders were prevalent in 51.5% of the patients in 2008, 43.9% of the patients in 2009, 54.8% of the patients in 2010, 52.6% of the patients in 2011 and 51.8% of the patients in 2012. The prevailing thyroid disorder in each of the five years was primary hyperthyroidism, 36.4% in 2008, 25.8% in 2009, 31.5% in 2010, 28.7% in 2011 and 28.2% in 2012. The number of thyroid function tests requests for females was about twice that of males in all the various years. Prevalence of primary and subclinical hyperthyroidism was significantly higher among the female patients compared to the male patients in all the various years.

Lessons and recommendations gained through "Project for Strengthening of Malaria Control in Solomon Islands" / 国際保健医療

Summarized in the following are lessons and recommendations gained through the three-year project on -Strengthening of Malaria Control in Solomon Islands”. The poor quality of malaria services and people's lack of access to proper services remain as a tremendous obstacle in developing countries. In areas remote from the central town, both morbidity and mortality from malaria tend to be higher than those in the central area. The concern shared by many living in such remote areas is how to prevent severe cases of malaria. Recommendations for malaria-related strategies in the isolated area include (1) fostering the capacity of the community to respond to severe cases of malaria through strengthening the key health facility in the malaria management (2) having the community residents themselves to have the ownership of the activities, and constructing malaria control for the community by the community. Nevertheless, it has been recognized that creating a malaria control guideline as well as its complete implementation is not enough to achieve the objectives. The guideline simply provides a standard or a benchmark, and it is, above all, not only flexible but also sensible and timely decisions suited to each circumstance, as well as actions backed by a strong sense of mission that, in the end, save the lives of malaria patients. In addition, if self-help efforts in the country are to be expected, it is of foremost importance to train healthcare workers and reserve officers.

Status of iodine nutrition among school-age children (6 – 12years) in Honiara Solomon Islands

The effectiveness of the universal salt iodization strategy in the control and elimination of iodine deficiency in a community requires systematic monitoring of urinary iodine concentration, which is the key biochemical indicator recommended for assessing the impact of iodine deficiency control programs. Published data on the salt iodization programme for control of iodine deficiency in the Solomon Islands is scanty. The aims of this study were to determine the iodine content of salt in the households and the urinary iodine concentrations (UIC) in schoolchildren, age 6 – 12 years, in Honiara, Solomon Islands. This was a prospective school-based study. Multistage cluster sampling method was used for selecting the study population. Simple random sampling technique was used to select 19 of the 28 primary schools in Honiara Solomon Islands. The iodine content in salt samples was measured using the single wavelength semi-automated WYD Iodine Checker Photometer. UIC was estimated using the Sandell-Kolthoff reaction. Salt was available and used in 99.5% of the households. The mean iodine content in household salt samples was 55.2  17.7ppm. The iodine content was  15.0ppm in salt samples from 99.1% of households. Data indicates successful implementation of universal salt iodisation strategy. Median UIC for all the children was 328.0ug/L, Inter-quartile range was 210.38 – 437.0ug/L. UIC in 97.2% of all the children was  100ug/L and 0.7% had UIC below 50ug/L. Median UIC values for the male and female children were 337.0ug/L and 325.0ug/L respectively. UIC in 97.1% of male and 97.4% of female children was  100ug/L. Data indicate that iodine deficiency is not a public health problem among schoolchildren, age 6 – 12yrs, in Honiara. Our findings indicate the need for an efficient, sustainable, and functional monitoring system to strengthen and improve on the achievements of the USI strategy in Honiara, Solomon Islands.

A Field Trial of an Educational Program for Malaria Study in Primary Schools of Solomon Islands Using an Innovated LED Light Box and Microscopy / 国際保健医療

 Malaria is a parasitic disease of major health significance that arrests the development of the tropical countries, and the developmental education on malaria for the local residents has crucial effects for the successful control of malaria. In the present study, we tried to innovate an effective education program for a community primary school in a malaria endemic area of Solomon islands. The integrated program was consisted mainly with practical exercises of the surveillance of mosquito larvae that transmit malaria parasites, identification of the species of mosquito larvae and the mapping of the breeding sites and the localization of the residence of village people under the cooperation of the local residents and teachers. We successfully established a risk map showing the approximate localization of <i>Anopheles</i> larvae that transmits malaria. An impressive observation of mosquito larvae was performed with microscope equipped with LED light box in the dark classroom without electric power equipments. Though no students have ever observed the mosquito larvae and few students have some knowledge for malaria, all students replied that they learned about malaria with a deep interest by the educational program. Thus, this educational program is shown to be promising for the health education in the schools of malaria endemic area.

LED Malaria Program / 国際保健医療

Malaria is a parasitic disease of major global health significance that causes an estimated 1.5-2.7 million deaths each year. Though immunochromatographic test (ICT) have been used for the convenient method of diagnosis of malaria, microscopy of Giemsa-stained thick and thin films by a skilled microscopist has still remaind the standard laboratory method for the diagnosis of malaria in the endemic area of developing countries. In the present study, we innovated a small light box equipped with light emitting diode (LED) for the source of light of microscopy to improve the blood check in the field of malaria endemic area. We performed field trials for the check of the utility of the light box in Malaita Province, Solomon Islands. All the microscopists of some clinics answered that the LED light box is a promising tool for improvement of diagnosis of malaria with microscopy.

The Long-Term Psychological Impact of Ethnic Tension in Adolescents of the Solomon Islands / 国際保健医療

<b>Objective</b><br>The purpose of this study was to assess the psychological impact and associated factors in adolescents 5 years after the ethnic tension in the Solomon Islands. <br><b>Methods</b><br>In total, 199 high school students and villagers from Guadalcanal province and Malaita province participated in this study. To examine the psychological impact of the ethnic tension, a semi-structured interview was performed using a questionnaire and the Impact of Event Scale Revised (IES-R) for posttraumatic stress disorders (PTSD) symptoms. The participants were divided into three groups according to the places (A, B, C) where the participants lived at the beginning of the ethnic tension. <br><b>Results</b><br>Recalled emotions of traumatic experiences were significantly more severe in the most affected areas (group A, B). Although previous studies showed females are more emotionally impacted than males in disaster, the emotional impact was significantly more frequent in males than females in this study. Especially, the IES-R score was significantly higher in males of group A. No differences were found in the IES-R scores among the three groups; A: 33.4, B: 30.0, C: 34.5. The adolescents in this study had higher IES-R scores.<br><b>Conclusions</b><br>This study indicates that the PTSD symptoms of the adolescents have persisted for 5 years after the ethnic tension in the Solomon Islands.

THE ROLES OF WESTERN BIOMEDICINE AND FOLK MEDICINE IN RURAL SOLOMON ISLANDS: A QUANTITATIVE ANALYSIS OF VILLAGERS' RESPONSE TO ILLNESS

This study aimed to explore factors determining treatment-seeking behaviors of villagers in a rural Roviana society of the Solomon Islands. Participants (n ≈ 116) were interviewed every evening for 42 days about the occurrence of illnesses and how they had been treated. The study period was divided into two: 22 days during which a nurse was stationed in the village and 20 days when the nurse was absent. As the results show, nurse‘s presence had a negative effect on traditional folk medicine use (OR ≈ 0.39, [95% CI: 0.21-0.72]). Fever or headache was treated more preferably with biomedicine (3.82 [1.81-8.07] or 6.75 [2.75-16.55], respectively), whereas <I>putuputu</I>, an illness with an indigenous etiology, was treated with the latter (34.7 [3.13-384.41]). In addition, biomedicine was preferably used (7.72 [2.65-22.44]) for the treatment of severe illnesses. While folk medicine was used in 40% of all ill person-days, it has likely been partly displaced by effective Western biomedicine. Still, some folk medicine functioned as a culturally indispensable element in treating indigenous illnesses.