ABSTRACT
Endemic malaria still exists in the Republic of Vanuatu, an 80-island archipelago that sits astride the southeast margin of the Southeast Asian-Melanesian malaria band (Buxton Line 170 degrees E, 20 degrees S). The annual parasite incidence has decreased dramatically over the past decade, which has been attributed to an intensive insecticide-treated bednet distribution program and implementation of a revised Plasmodium falciparum treatment policy that employs combination chloroquine + sulfadoxinelpyrimethamine as a first-line therapy. Standard malariometric surveys were conducted at 10 locations in 2 provinces, screening 2351 adults and children towards the end of the peak transmission season. Spleen rates were consistent with mesoendemic malaria. Examination of blood slides revealed a mean slide-positive rate of 22% (range 4% to 33%). P. falciparum predominated, accounting for 73% of infections, followed by P. vivax (25%). Among 396 individuals with P. falciparum, the gametocyte rate was 54%, with 37% presenting gametocytes alone without asexual stages. Only 8% and 4% of persons with asexual stage P. falciparum and P. vivax parasitaemia, respectively, were symptomatic. These data suggest that malaria transmission has increased in some locations in Vanuatu over the past decade and this report underscores the importance of appropriate bednet use and vector control in this setting as well as the impact of adding sulfadoxine/pyrimethamine and removing primaquine from the national malaria treatment formulary.
Subject(s)
Malaria , VanuatuABSTRACT
@#A review of cases of ectopic pregnancy operated upon at Vila Central Hospital during 1992 with an analysis of clinical presenting features and diagnostic factors is presented. Comparison is made between hospital, regional and national figures and possible explanations for the differences are given. Recommendations are made to ensure that ectopic pregnancy is always at the forefront of differential diagnosis in women presenting with abdominal pain.
Subject(s)
Female , Pregnancy , Diagnosis, Differential , Medical Audit , VanuatuABSTRACT
Yaws has been resurgent in the island of Tanna in southern Vanatu in the 1980's. Screening, conducted in 1988 and in 1989 during a mass treatment program identified a total of 464 clinical cases from the population of 20,200, a rate of 23 per thousand. Most of these (82%) were under 15 years of age. Serology was performed on 286 of which 23% were VDRL positive. Primary care services had been hampered in controlling yaws by difficulties with transport, isolation, community resistance and the lack of skilled personel to diagnose yaws and arrange prophylactic treatment. A mass screening and treatment program was implemented in 1989 with 91.8% coverage. This program was designed to work in the context of primary health care and thus has enhanced the relationship between the health services and local villagers. The program was successfully integrated with other health activities including health education, treatment of other diseases and vector control.