Health Care Providers' Perceptions of Maternal Health Concerns in the Solomon Islands.

PURPOSE: The objective of this study was to explore the maternal health risk factors and sentinel events among women in the Solomon Islands, from the viewpoints of health care providers in the Solomon Islands. DESIGN AND METHOD: Three focus group interviews were conducted in July and August 2011 at a secondary referral hospital in an urban area. The study consisted of 10 registered nurses and 11 skilled birth assistants. Thematic analysis was used for this qualitative data analysis. FINDINGS: Six major themes were emerged from the data: (a) environmental hazard: malaria, (b) malnutrition: iron deficiency anemia, (c) adolescent pregnancy, (d) betel nut chewing, (e) cultural beliefs influencing women's health, and (f) difficulty accessing health care services. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results of this study provide a useful first step toward identifying specific maternal health risks among women in the Solomon Islands. The findings may assist the health sector and midwives/antenatal educators to better understand the health risks and reduce the disease burden among pregnant women in South Pacific countries. The results may also contribute to the development of policies to improve maternal health and to accelerate progress toward the fifth target goal of UNICEF's Millennium Development Goals.

Intermittent preventive treatment with sulfadoxine-pyrimethamine versus weekly chloroquine prophylaxis for malaria in pregnancy in Honiara, Solomon Islands: a randomised trial.

Background: Solomon Islands is a malarious nation in the Pacific with all four human Plasmodium species present. Although chloroquine prophylaxis is recommended for pregnant women, its effectiveness is uncertain because of chloroquine resistance. Methods: We conducted a parallel-group, open label, individually randomised superiority trial comparing weekly chloroquine prophylaxis (CQ) with intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) between August 2009- June 2010 among pregnant women aged 15 to 49 years. Participants were randomised at the first antenatal visit using a computer-generated sequence and followed until delivery. Data on mosquito avoidance measures, and pregnancy outcomes were collected. Results: Because of the low prevalence of malaria, enrolment was prematurely terminated. Among 660 participants (336 in CQ arm, and 324 in IPTp), 68% used a bednet, 53% used window-screens, and 26% lived in a house sprayed in the last 6 months; 91% used at least one of these methods. Peripheral parasitemia at enrolment was 1.5%. At delivery there were no differences between weekly CQ and IPTp in placental parasitemia (0/259 vs. 1/254) or peripheral parasitemia (2/281 vs. 1/267). There were no differences in maternal anaemia, birth outcomes or serious adverse events. A self-reported sulfa-allergy required non-inclusion for 199 of 771 ineligible women (26%). Conclusions: The use of SP for IPTp is not suitable for prevention of malaria in pregnancy in Solomon Islands, given the low malaria prevalence and the possible high prevalence of sulfa-allergy. Scaling up of transmission-reducing interventions has probably contributed to the malaria reduction in Honiara. Trial registration: NCT00964691 ClinicalTrials.gov.

Surgical care in the Solomon Islands: a road map for universal surgical care delivery.

BACKGROUND: Access to surgical care and emergency obstetrical care is limited in low-income countries. The Solomon Islands is one of the poorest countries in the Pacific region. Access to surgical care in Solomon Islands is limited and severely affected by a country made up of islands. Surgical care is centralized to the National Referral Hospital (NRH) on Guadalcanal, leaving a void of care in the provinces where more than 80% of the people live. METHODS: To assess the ability to provide surgical care to the people living on outer islands in the Solomon Islands, the provincial hospitals were evaluated using the World Health Organization's Global Initiative for Emergency and Essential Surgical Care Needs Assessment Tool questionnaire. Data on infrastructure, workforce, and equipment available for treating surgical disease was collected at each provincial hospital visited. RESULTS: Surgical services are centralized to the NRH on Guadalcanal in Solomon Islands. Two provincial hospitals provide surgical care when a surgeon is available. Six of the hospitals evaluated provide only very basic surgical procedures. Infrastructure problems exist at every hospital including lack of running water, electricity, adequate diagnostic equipment, and surgical supplies. The number of surgeons and obstetricians employed by the Ministry of Health is currently inadequate for delivering care at the outer island hospitals. CONCLUSIONS: Shortages in the surgical workforce can be resolved in Solomon Islands with focused training of new graduates. Training surgeons locally, in the Pacific region, can minimize the "brain drain." Redistribution of surgeons and obstetricians to the provincial hospitals can be accomplished by creating supportive connections between these hospitals, the NRH, and international medical institutions.