Impact of ivermectin administered for scabies treatment on the prevalence of head lice in Atoifi, Solomon Islands.

BACKGROUND: Scabies and head lice are ubiquitous ectoparasitic infestations that are common across the Pacific Islands. Ivermectin is an effective treatment for both conditions, although the doses used vary. At a community level, mass drug administration (MDA) with ivermectin is an effective strategy to decrease prevalence of scabies. To what extent MDA with ivermectin will also reduce prevalence of head lice is unknown. METHODOLOGY: Head lice prevalence was assessed before and after MDA with oral ivermectin (at a dose of 200 micrograms per kilogram of body weight) administered on day 1 and day 8. The primary outcome was the change in prevalence of head louse infestation at two weeks compared to baseline. Longer term efficacy was assessed three months after MDA. RESULTS: 118 participants were enrolled. Baseline prevalence of active head louse infestation was 25.4% (95% CI 18.4-34.0). At two-week follow-up, prevalence was 2.5% (95% CI 0.9-7.2), a relative reduction of 89.1% (95% CI 72.7-91.4%, p<0.001). At three-month follow-up, prevalence was 7.5% (95% CI 2.7-12.3), a relative reduction of 70.6% (95% CI 72.7%-91.4%, p <0.001). Head louse infestation was associated with younger age (age ≤10 years: prevalence 46.7%; adjusted odds ratio compared to adults of 7.2, 95%CI 2.0-25.9) and with having at least one other member of the household with active head louse infestation (adjusted odds ratio 4.3, 95%CI 1.7-11.1). CONCLUSIONS: Head louse infestation is common in the Solomon Islands. This proof of principle study shows that oral ivermectin at a dose of 200 micrograms per kilogram can reduce the burden of active head louse infestation, offering an additional collateral benefit of MDA with ivermectin for scabies control. TRIAL REGISTRATION: ClinicalTrials.gov NCT03236168.

High prevalence of ascariasis on two coral atolls in the Solomon Islands.

Background: There is a deficiency in up-to-date soil-transmitted helminth (STH) prevalence data for many regions, including Oceania. This study investigated the prevalence of STH in two closely associated coral atoll communities in East Kwaio, Solomon Islands, reflective of many similar island communities throughout the Oceania region. Methods: An STH survey, using the Kato-Katz technique, was conducted on human subjects living on two coral atolls in the Eastern Solomon Islands. The capacity of Ascaris lumbricoides eggs to float in seawater was also evaluated by passive flotation. Results: Of 583 people tested on both islands, 311 (53.3%) harboured A. lumbricoides, with 51.7% (n=161) of those having moderate to high-intensity infections. Hookworm was detected in 139 (23.7%) participants and Trichuris trichiura infection in 18 (3.1%). A. lumbricoides eggs were not found to float in seawater. Discussion: The high prevalence and intensity of ascariasis on these two atolls was contrasted with previously described STH studies in mainland East Kwaio villages, where hookworm predominates and ascariasis is almost absent. This led to a preliminary consideration that transmission of A. lumbricoides on densely populated coral atolls might be associated with defecation into the sea and transmission in seawater, although further work is required to investigate this hypothesis.

Steps on a journey to TB control in Solomon Islands: a cross-sectional, mixed methods pre-post evaluation of a local language DVD.

BACKGROUND: In Solomon Islands many people with Tuberculosis (TB) have challenges in accessing services because of socio-cultural, geographic and health service reasons, resulting in delays in TB treatment and low detection rates. The purpose of this project was to (i) develop a local language audio-visual resource (DVD) about TB (ii) share this resource with people in remote villages and (iii) evaluate the process and outcomes. METHODS: The project involved the development and evaluation of a DVD in local Kwaio language. The DVD included five short videos based on the Australian Respiratory Council TB Education Flipchart. The DVD also included short videos of: traditional music/chanting (ai'imae); drama that presented an allegory of TB; and a short documentary on the redevelopment of the local TB Ward. A mixed-methods approach evaluated changes in TB knowledge and investigated the impact of the DVD. RESULTS: The DVD was recorded and produced in March-June 2013 and screened in 41 villages and hamlets. The pre-post DVD survey was completed by 64% (255/400) of people who viewed the DVD in the villages. Pre-DVD survey responses showed a moderate to high knowledge about TB signs, symptoms and treatment but 76/255 (30%) stated TB was caused by sorcery and 85/255 (33%) incorrectly stated that TB medication should be stopped when a patient feels better. The post-DVD survey showed a significant increase in people in coastal villages reporting (i) a 3-week cough would trigger a medical assessment and (ii) TB is mainly spread through the air. Statements that TB is not caused by sorcery increased post-DVD in both coastal and mountain villages, however belief in sorcery in mountain villages remained high at 20/70 (29%). CONCLUSIONS: The local DVD resource was developed within local cultural understandings and oral traditions of Kwaio people. Using modern but accessible DVD technology generated a lot of interest about the disease and the stories. The project evaluation indicates that current delays in seeking treatment may be more due to socio-cultural and health service factors than awareness of the disease. Therefore the development of TB services, including TB education, which are culturally sensitive, remains important.

Mutual research capacity strengthening: a qualitative study of two-way partnerships in public health research.

INTRODUCTION: Capacity building has been employed in international health and development sectors to describe the process of 'experts' from more resourced countries training people in less resourced countries. Hence the concept has an implicit power imbalance based on 'expert' knowledge. In 2011, a health research strengthening workshop was undertaken at Atoifi Adventist Hospital, Solomon Islands to further strengthen research skills of the Hospital and College of Nursing staff and East Kwaio community leaders through partnering in practical research projects. The workshop was based on participatory research frameworks underpinned by decolonising methodologies, which sought to challenge historical power imbalances and inequities. Our research question was, "Is research capacity strengthening a two-way process?" METHODS: In this qualitative study, five Solomon Islanders and five Australians each responded to four open-ended questions about their experience of the research capacity strengthening workshop and activities: five chose face to face interview, five chose to provide written responses. Written responses and interview transcripts were inductively analysed in NVivo 9. RESULTS: Six major themes emerged. These were: Respectful relationships; Increased knowledge and experience with research process; Participation at all stages in the research process; Contribution to public health action; Support and sustain research opportunities; and Managing challenges of capacity strengthening. All researchers identified benefits for themselves, their institution and/or community, regardless of their role or country of origin, indicating that the capacity strengthening had been a two-way process. CONCLUSIONS: The flexible and responsive process we used to strengthen research capacity was identified as mutually beneficial. Using community-based participatory frameworks underpinned by decolonising methodologies is assisting to redress historical power imbalances and inequities and is helping to sustain the initial steps taken to establish a local research agenda at Atoifi Hospital. It is our experience that embedding mutuality throughout the research capacity strengthening process has had great benefit and may also benefit researchers from more resourced and less resourced countries wanting to partner in research capacity strengthening activities.

Incorporating sociocultural beliefs in mental health services in Kwaio, Solomon Islands.

OBJECTIVE: The aim of this paper is to describe the newly established mental health services at Atoifi Adventist Hospital, Solomon Islands, the sociocultural context in which it operates, and illustrate how the service is engaging with the Kwaio community to understand and incorporate local sociocultural beliefs into prevention, treatment and recovery journeys. METHOD: Five remote hamlets in East Kwaio, Malaita Province were visited in early 2008. Interviews were undertaken with 20 people with a history of buru spirit possession and 30 of their family members. RESULTS: Buru is a category of wild and malevolent spirits that possess people in East Kwaio and induce antisocial and unexpected behaviour. Signs of buru possession include mutism, suicidal ideas, delusion, aggression and social isolation. Traditional healers practice indigenous treatments with 50% of people receiving treatments described as cured, 30% temporary cured and 20% no effect from treatment. CONCLUSIONS: The new mental health service at Atoifi is taking steps to incorporate sociocultural beliefs, including of people possessed by buru, into routine practice. This provides a greater potential to support prevention, treatment and recovery journeys to advance the community's social, emotional and spiritual wellbeing.

Reorienting health services through community health promotion in Kwaio, Solomon Islands.

When ethnic minorities adhere to cultural practices which mark them as unique, structural impediments within health services can deny access and significantly add to the burden of disease. This is particularly pertinent if the development of health services is not done in partnership with all population groups in the area. This is the case at Atoifi Hospital, which structure prevents certain Kwaio people (Solomon Islands) from receiving benefits of hospital services and maintaining cultural beliefs at the same time. A Participatory Action Research process was used to collaboratively work with health service providers and community groups to review the situation, design and build a health facility with both medically and culturally appropriate policies and procedures. The Participatory Action Research process of collectively looking, thinking, planning and acting towards reorienting health services to become more culturally appropriate at Atoifi was the first time leaders, from both the community and hospital, had collectively sat together in a mutually respectful way to discuss community health promotion initiatives. The project was complete in 2006 with collaboration and dialogue between both groups proving vital to its success. Numerous indicators are present that the culturally appropriate health facility is making a difference, not only in terms of the hospital usage by all, but also for the feeling of "community ownership."