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Le B, Clarke NE, Hii SF, Byrne A, Khattak A, Lake S, Lazu E, Wickham S, Wand H, Olsen N, Zendejas-Heredia PA, Sokana O, Romani L, Engelman D, Nasi T, Boara D, Kaldor J, Steer A, Traub R, Nery SV. Effectiveness of one and two doses of ivermectin mass drug administration in reducing the prevalence and intensity of soil-transmitted helminth (STH) infections in Western Province, Solomon Islands: a cluster-randomised, before-after analysis. Lancet Reg Health West Pac 2024; 42:100942. [PMID: 38357395 PMCID: PMC10865046 DOI: 10.1016/j.lanwpc.2023.100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/23/2023] [Accepted: 10/09/2023] [Indexed: 02/16/2024]
Abstract
Background Ivermectin mass drug administration (MDA) is effective for controlling onchocerciasis and scabies, with evidence supporting its role in some species of soil-transmitted helminth (STH) infections. In the context of RISE, a cluster-randomised trial for scabies, this study evaluated the effectiveness of ivermectin MDA in reducing STH burden in the Western Province of Solomon Islands. Methods Twenty villages were randomised 1:1 to receive ivermectin MDA as one dose (IVM-1) or two doses (IVM-2) for scabies. The effectiveness of one and two doses in reducing STH prevalence and intensity was evaluated before (May 2019) and 21 months after (February 2021) MDA in May 2019. All residents aged 12 months or older in the study villages were eligible to participate and provide stool specimens. Species-specific STH infection and intensity were assessed using quantitative PCR. We compared prevalence and intensity of infection between baseline and 21 months in each intervention arm individually using cluster-level analysis (adjusted for clustering) and individual-level analysis (adjusted for sex, age, and clustering). The primary outcomes were the prevalence risk difference (RD) from the cluster-level analysis, and the change in adjusted odds of infection from the individual-level analysis. Secondary outcomes included change in incident rates of mean eggs per gram (epg) of stool from baseline to 21 months, relative risk difference in prevalence and relative change in odds of infection between arms at 21 months. Sex data (male/female) were self-reported. Findings Overall, STH infection was assessed in 830 participants from 18 villages at baseline and 1172 from 20 villages at follow-up. Females represented 58% (n = 478) of the sample at baseline and 59% (n = 690) at follow-up. We observed a reduction in Strongyloides spp. prevalence following two doses of ivermectin MDA in the cluster-level analysis from 7.0% (32/458 participants) to 1.2% (8/674 participants), corresponding to a RD of -0.07 (95% CI -0.14 to -0.01, p = 0.036), and in the individual-level analysis (OR 0.11, 95% CI 0.04-0.33, p < 0.001). T. trichiura prevalence decreased following one dose from 19.4% (74/372 participants) to 11.7% (56/505 participants) (OR 0.44, 95% CI 0.26-0.73, p = 0.0040), while egg count reduced in both arms (IVM-1: IRR 0.28, 95% CI 0.11-0.70, p = 0.0070; IVM-2: IRR 0.18, 95% CI 0.08-0.40, p < 0.001), in the individual-level analysis. We did not detect a significant difference in effect measures between the one- and two-dose arms for any species after 21 months. Interpretation Our study highlights the long-term benefits of ivermectin MDA in reducing the burden of Strongyloides spp. and T. trichiura. STH control programs should leverage the geographical overlap of NTDs, existing drug distribution channels, and broad-spectrum agents. Funding The National Health and Medical Research Council of Australia.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Naomi E. Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Sze Fui Hii
- The University of Melbourne, Melbourne, Australia
| | - Aisling Byrne
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Alam Khattak
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Susanna Lake
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Nick Olsen
- Stats Central, University of New South Wales, Sydney, Australia
| | | | - Oliver Sokana
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Titus Nasi
- Ministry of Health & Medical Services, Honiara, Solomon Islands
| | | | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Parker A, Tek Chheng E, Nasi T, Orelly T, Aho G, Whitaker S, Weaver J, Phin S, Baker R, Woolfenden S, Currow K. Taking Paediatrics Abroad: Working with low- and middle-income countries in a global pandemic. J Paediatr Child Health 2021; 57:981-985. [PMID: 34085347 PMCID: PMC8242619 DOI: 10.1111/jpc.15598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022]
Abstract
Children and young people around the world face challenges to their health and wellbeing. In particular, in low- and middle-income countries they experience a higher burden of disease, exacerbated by global inequity limiting access to quality health care. According to the inverse care law, the availability of quality health care varies inversely to the need of the population, and hardworking health-care professionals in under-resourced countries may face impediments to continued education or subspecialty training. In line with the Sustainable Development Goals, collaborations have been developed between high-income and low- and-middle-income countries to address global disparities in health. These collaborations face challenges of high financial costs, difficulties creating long-term sustainable change, and with the emergence of the COVID-19 pandemic, border closures preventing fly-in volunteers. In this paper, we describe the development of an innovative, paediatric-specific model of care for training and support between high- and low-income countries - Taking Paediatrics Abroad Ltd. Taking Paediatrics Abroad supports the development of mutually beneficial relationships between Australian paediatric health-care professionals and paediatric health-care professionals in developing countries and remote, underserved Australian Aboriginal communities. Since May 2020, there have been over 100 sessions covering a vast array of paediatric specialties. This article explores Taking Paediatrics Abroad's model of care, its implementation and challenges, and opportunities for the future.
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Affiliation(s)
- Anneka Parker
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia
| | - Eap Tek Chheng
- National Paediatric HospitalPhnom PenhCambodia,Discipline of PaediatricsUniversity of Health Sciences of CambodiaPhnom PenhCambodia
| | - Titus Nasi
- Department of PaediatricsNational Referral HospitalHoniaraSolomon Islands
| | - Thyna Orelly
- Department of PaediatricsPort Vila Central HospitalPort VilaVanuatu
| | - George Aho
- Department of PaediatricsVaiola HospitalNuku'alofaTonga
| | - Sally Whitaker
- Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia
| | - James Weaver
- Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia,Department of CardiologyRoyal Prince Alfred HospitalSydneyAustralia
| | - Sue Phin
- Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia,Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Ruth Baker
- Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia,Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- Discipline of Paediatrics, School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia,Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Kathryn Currow
- Taking Paediatrics Abroad Advisory GroupTaking Paediatrics Abroad LtdSydneyNew South WalesAustralia,Faculty of MedicineUniversity of Notre DameSydneyNew South WalesAustralia
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Lake SJ, Engelman D, Sokana O, Nasi T, Boara D, Marks M, Whitfeld MJ, Romani L, Kaldor JM, Steer AC, Carvalho N. Health-related quality of life impact of scabies in the Solomon Islands. Trans R Soc Trop Med Hyg 2021; 116:148-156. [PMID: 34182575 PMCID: PMC8804887 DOI: 10.1093/trstmh/trab096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/03/2021] [Accepted: 06/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background Scabies causes intense itching and skin lesions. A small number of studies have shown that scabies impacts health-related quality of life (HRQoL), but no studies have been conducted in the Pacific region. We assessed the impact of scabies on HRQoL in a high-prevalence setting using the Children's Dermatology Life Quality Index (CDLQI) and Dermatology Life Quality Index (DLQI). We also assessed the validity of these tools in a Pacific Island population. Methods The study was conducted in the Solomon Islands. Participants with and without skin disease were randomly selected. HRQoL indices were scored on a scale of 0–30. Results We surveyed 1051 adults (91 with scabies) and 604 children (103 with scabies). Scabies had a small impact on HRQoL, with a median DLQI score of 2 (interquartile range [IQR] 0–6) and a CDLQI score of 2 (IQR 0–4). Scores increased linearly with severity. The greatest impact on QoL was due to itch, sleep disturbance and impacts on education and employment. Conclusions Scabies has a small but measurable impact on HRQoL. The DLQI and CDLQI scores were discriminated between the skin-related QoL of patients with scabies and the control group, indicating that these tools are appropriate to measure skin-related QoL in the Solomon Islands.
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Affiliation(s)
- Susanna J Lake
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Solomon Islands
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, UK.,Hospital for Tropical Diseases, London, UK
| | - Margot J Whitfeld
- St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Lake SJ, Engelman D, Sokana O, Nasi T, Boara D, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor JM, Steer AC. Defining the need for public health control of scabies in Solomon Islands. PLoS Negl Trop Dis 2021; 15:e0009142. [PMID: 33617544 PMCID: PMC7932527 DOI: 10.1371/journal.pntd.0009142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/04/2021] [Accepted: 01/14/2021] [Indexed: 01/22/2023] Open
Abstract
Pacific Island countries have a high burden of scabies and impetigo. Understanding of the epidemiology of these diseases is needed to target public health interventions such as mass drug administration (MDA). The aim of this study is to determine the prevalence of scabies and impetigo in Solomon Islands as well as the relationship between them and their distribution. We conducted a prevalence study in 20 villages in Western Province in Solomon Islands. All residents of the village were eligible to participate. Nurses conducted clinical assessments including history features and skin examination. Diagnosis of scabies was made using the 2020 International Alliance for the Control of Scabies diagnostic criteria. Assessments were completed on 5239 participants across 20 villages. Overall scabies prevalence was 15.0% (95%CI 11.8-19.1). There was considerable variation by village with a range of 3.3% to 42.6%. There was a higher prevalence of scabies in males (16.7%) than females (13.5%, adjusted relative risk 1.2, 95%CI 1.1-1.4). Children aged under two years had the highest prevalence (27%). Overall impetigo prevalence was 5.6% (95%CI 4.2-7.3), ranging from 1.4% to 19% by village. The population attributable risk of impetigo associated with scabies was 16.1% (95% CI 9.8-22.4). The prevalence of scabies in our study is comparable to previous studies in Solomon Islands, highlighting a persistent high burden of disease in the country, and the need for public health strategies for disease control.
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Affiliation(s)
- Susanna J. Lake
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara Solomon Islands
| | - Anneke C. Grobler
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Millicent H. Osti
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australia
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | | | - Lucia Romani
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - John M. Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew C. Steer
- Tropical Diseases Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Melbourne Children’s Global Health, Melbourne, Australia
- * E-mail:
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5
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Marks M, Romani L, Sokana O, Neko L, Harrington R, Nasi T, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Kaldor JM, Steer AC. Prevalence of Scabies and Impetigo 3 Years After Mass Drug Administration With Ivermectin and Azithromycin. Clin Infect Dis 2021; 70:1591-1595. [PMID: 31131410 PMCID: PMC7145994 DOI: 10.1093/cid/ciz444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/24/2019] [Indexed: 12/01/2022] Open
Abstract
Background Ivermectin-based mass drug administration has emerged as a promising strategy for the control of scabies and impetigo in settings where the diseases are endemic. Current follow-up data are limited to 12 months for the majority of studies. Longer-term data are vital to inform the sustainability of interventions. Methods We conducted a prevalence survey for scabies and impetigo in 10 villages in Choiseul Province of the Solomon Islands 36 months after a single round of ivermectin and azithromycin mass drug coadministration. In the primary analysis, we compared the prevalence of scabies and impetigo at 36 months to the prevalence at baseline. Results At 36 months, the prevalence of scabies was 4.7% (95% confidence interval [CI], 3.6–6.1), which was significantly lower than at baseline (18.7%; relative reduction, 74.9%; 95% CI, 61.5%–87.7%; P < .001). The prevalence of impetigo was 9.6% (95% CI, 8.1%–11.4%), significantly lower than at baseline (24.7%; relative reduction, 61.3%; 95% CI, 38.7%–100%; P < .001). The highest prevalence of scabies was among children aged <5 years (12.5%; adjusted odds ratio, 33.2; 95% CI, 6.6–603.2), and the highest prevalence of impetigo was among children aged 5–9 years (16.4%; adjusted odds ratio, 8.1; 95% CI, 3.6–21.8). Conclusions There was a sustained impact of a single round of ivermectin and azithromycin mass drug coadministration on the prevalence of scabies and impetigo 3 years after the intervention. Our data provide further support to adopt this intervention as a central component of global scabies control efforts. Clinical Trials Registration Australian and New Zealand Trials Registry (ACTRN12615001199505).
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Hospital for Tropical Diseases, London, United Kingdom
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Lazarus Neko
- Ministry of Health and Medical Services, Choiseul
| | | | - Titus Nasi
- Ministry of Health and Medical Services, Honiara
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Hospital for Tropical Diseases, London, United Kingdom
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney
| | - Andrew C Steer
- Kirby Institute, University of New South Wales, Sydney.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
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Abstract
INTRODUCTION Congenital syphilis remains a significant cause of newborn mortality and long-term neurodevelopmental problems in some low- and middle-income countries. This study was done in Honiara, Solomon Islands to determine the incidence of babies born to mothers with a positive venereal disease research laboratory (VDRL) test and a positive Treponema pallidum haemagglutination assay (TPHA); to determine the VDRL status of newborns and features of congenital syphilis; and to estimate the proportion of stillbirths associated with syphilis. METHODOLOGY All neonates born to VDRL-positive mothers, including stillbirths were included between April and July 2019. Neonates were examined, investigated and treated. RESULTS Among 1534 consecutive births, 1469 were live births and 65 (4.2%) were stillbirths. One hundred and forty-three neonates were born to VDRL-positive mothers: 130 (90.1%) were live infants and 13 (8.9%) stillbirths. Of the 130 VDRL-exposed live-born infants, 72 (55%) had reactive VDRL and a positive TPHA and 7 (9.7%) had clinical signs of congenital syphilis. Five of the infants with clinical signs of syphilis infection had a 4-fold higher VDRL titre than their mother. Four infants of VDRL-positive mothers died during admission, all of whom had clinical signs of syphilis. Ninety percent of affected infants were born to mothers who were not treated or only partially treated during pregnancy. CONCLUSIONS In this study, 1:210 live-born babies had clinical and serological evidence of congenital syphilis, and evidence of Treponema infection was found disproportionately in stillbirths. In a setting where Treponema infections are common, an empirical approach to prevention may be needed.
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Affiliation(s)
- Maxson Lifigao
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Titus Nasi
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Carol Titiulu
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Steven Lumasa
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Parkville, 3052, Australia.,School of Medicine and Health Sciences, University of Papua New Guinea, Taurama, National Capital District, Papua New Guinea
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Lake SJ, Phelan SL, Engelman D, Sokana O, Nasi T, Boara D, Gorae C, Schuster T, Grobler AC, Osti MH, Andrews R, Marks M, Whitfeld MJ, Romani L, Kaldor J, Steer A. Protocol for a cluster-randomised non-inferiority trial of one versus two doses of ivermectin for the control of scabies using a mass drug administration strategy (the RISE study). BMJ Open 2020; 10:e037305. [PMID: 32868360 PMCID: PMC7462236 DOI: 10.1136/bmjopen-2020-037305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Scabies is a significant contributor to global morbidity, affecting approximately 200 million people at any time. Scabies is endemic in many resource-limited tropical settings. Bacterial skin infection (impetigo) frequently complicates scabies infestation in these settings. Community-wide ivermectin-based mass drug administration (MDA) is an effective control strategy for scabies in island settings, with a single round of MDA reducing population prevalence by around 90%. However, current two-dose regimens present a number of barriers to programmatic MDA implementation. We designed the Regimens of Ivermectin for Scabies Elimination (RISE) trial to investigate whether one-dose MDA may be as effective as two-dose MDA in controlling scabies in high-prevalence settings. METHODS AND ANALYSIS RISE is a cluster-randomised non-inferiority trial. The study will be conducted in 20 isolated villages in Western Province of Solomon Islands where population prevalence of scabies is approximately 20%. Villages will be randomly allocated to receive either one dose or two doses of ivermectin-based MDA in a 1:1 ratio. The primary objective of the study is to determine if ivermectin-based MDA with one dose is as effective as MDA with two doses in reducing the prevalence of scabies after 12 months. Secondary objectives include the effect of ivermectin-based MDA on impetigo prevalence after 12 and 24 months, the prevalence of scabies at 24 months after the intervention, the impact on presentation to health facilities with scabies and impetigo, and the safety of one-dose and two-dose MDA. ETHICS AND DISSEMINATION This trial has been approved by the ethics review committees of the Solomon Islands and the Royal Children's Hospital, Australia. Results will be disseminated in peer-reviewed publications and in meetings with the Solomon Islands Ministry of Health and Medical Services and participating communities. TRIAL REGISTRATION DETAILS Australian New Zealand Clinical Trials Registry: ACTRN12618001086257. Date registered: 28 June 2018.
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Affiliation(s)
- Susanna J Lake
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sophie L Phelan
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Engelman
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Dickson Boara
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Christina Gorae
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Tibor Schuster
- Clinical Epidemiology and Biostatistics Unit, McGill University, Montreal, Quebec, Canada
| | - Anneke C Grobler
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Millicent H Osti
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ross Andrews
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Marks
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, London, UK
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Disease Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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8
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Romani L, Marks M, Sokana O, Nasi T, Kamoriki B, Cordell B, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Kaldor JM, Steer AC. Efficacy of mass drug administration with ivermectin for control of scabies and impetigo, with coadministration of azithromycin: a single-arm community intervention trial. Lancet Infect Dis 2019; 19:510-518. [PMID: 30956111 PMCID: PMC6483975 DOI: 10.1016/s1473-3099(18)30790-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND In small community-based trials, mass drug administration of ivermectin has been shown to substantially decrease the prevalence of both scabies and secondary impetigo; however, their effect at large scale is untested. Additionally, combined mass administration of drugs for two or more neglected diseases has potential practical advantages, but efficacy of potential combinations should be confirmed. METHODS The azithromycin ivermectin mass drug administration (AIM) trial was a prospective, single-arm, before-and-after, community intervention study to assess the efficacy of mass drug administration of ivermectin for scabies and impetigo, with coadministration of azithromycin for trachoma. Mass drug administration was offered to the entire population of Choiseul Province, Solomon Islands, and of this population we randomly selected two sets of ten sentinel villages for monitoring, one at baseline and the other at 12 months. Participants were offered a single dose of 20 mg/kg azithromycin, using weight-based bands. Children weighing less than 12·5 kg received azithromycin oral suspension (20 mg/kg), and infants younger than 6 months received topical 1% tetracycline ointment. For ivermectin, participants were offered two doses of oral ivermectin 200 μg/kg 7-14 days apart using weight-based bands, or 5% permethrin cream 7-14 days apart if ivermectin was contraindicated. Our study had the primary outcomes of safety and feasibility of large-scale mass coadministration of oral ivermectin and azithromycin, which have been previously reported. We report here the prevalence of scabies and impetigo in residents of the ten baseline villages compared with those in the ten 12-month villages, as measured by examination of the skin, which was a secondary outcome of the trial. Further outcomes were comparison of the number of all-cause outpatient attendances at government clinics in Choiseul Province at various timepoints before and after mass drug administration. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12615001199505). FINDINGS During September, 2015, over 4 weeks, 26 188 people (99·3% of the estimated population of Choiseul [n=26 372] as determined at the 2009 census) were treated. At baseline, 1399 (84·2%) of 1662 people living in the first ten villages had their skin examined, of whom 261 (18·7%) had scabies and 347 (24·8%) had impetigo. At 12 months after mass drug administration, 1261 (77·6%) of 1625 people in the second set of ten villages had their skin examined, of whom 29 (2·3%) had scabies (relative reduction 88%, 95% CI 76·5-99·3) and 81 (6·4%) had impetigo (relative reduction 74%, 63·4-84·7). In the 3 months after mass drug administration, 10 614 attended outpatient clinics for any reason compared with 16 602 in the 3 months before administration (decrease of 36·1%, 95% CI 34·7-37·6), and during this period attendance for skin sores, boils, and abscesses decreased by 50·9% (95% CI 48·6-53·1). INTERPRETATION Ivermectin-based mass drug administration can be scaled to a population of over 25 000 with high efficacy and this level of efficacy can be achieved when mass drug administration for scabies is integrated with mass drug administration of azithromycin for trachoma. These findings will contribute to development of population-level control strategies. Further research is needed to assess durability and scalability of mass drug administration in larger, non-island populations, and to assess its effect on the severe bacterial complications of scabies. FUNDING International Trachoma Initiative, Murdoch Children's Research Institute, Scobie and Claire Mackinnon Trust, and the Wellcome Trust.
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Affiliation(s)
- Lucia Romani
- The Kirby Institute, UNSW, Sydney, NSW, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Bakaai Kamoriki
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Billie Cordell
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Handan Wand
- The Kirby Institute, UNSW, Sydney, NSW, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | | | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia.
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Romani L, Marks M, Sokana O, Nasi T, Kamoriki B, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Steer AC, Kaldor JM. Feasibility and safety of mass drug coadministration with azithromycin and ivermectin for the control of neglected tropical diseases: a single-arm intervention trial. Lancet Glob Health 2018; 6:e1132-e1138. [PMID: 30223985 PMCID: PMC6139784 DOI: 10.1016/s2214-109x(18)30397-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/18/2018] [Accepted: 08/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mass drug administration has made a major contribution to the public health control of several important neglected tropical diseases. For settings with more than one endemic disease, combined mass drug administration has potential practical advantages compared with separate programmes but needs confirmation of feasibility and safety. We undertook a study of mass drug administration in the Solomon Islands for trachoma and scabies control using ivermectin and azithromycin, key drugs in the control of neglected tropical diseases worldwide. METHODS The entire population of Choiseul province, Solomon Islands, was eligible to participate. An azithromycin-based mass drug administration regimen was offered in line with standard recommendations for trachoma elimination (oral azithromycin or topical tetracycline). An ivermectin-based mass drug administration regimen was offered at the same time (oral ivermectin or topical permethrin), with a further dose 7-14 days later, using a modified version of a regimen demonstrated to be effective for scabies control. All participants underwent safety assessments 7-14 days later. Participants in ten randomly selected sentinel villages underwent a more detailed safety assessment. Routine health system reports of hospital or clinic admissions and deaths were also obtained to compare health outcomes in the 12 month period before and after the mass drug administration. FINDINGS The study enrolled 26 188 participants, 99·3% of the estimated resident population as determined at the 2009 census. Of those enrolled, 25 717 (98·2%) received the trachoma regimen and 25 819 (98·6%) received the first dose of the scabies regimen between Sept 1, and Oct 2, 2015. A second dose of the scabies regimen was received by 21 931 (83·7%) of participants. Adverse events, all mild and transient, were recorded in 571 (2·6%) of the entire study population and 58 (4·1%) of participants in the ten sentinel villages. In the 12 months before and after the mass drug administration the numbers of hospital admissions (1530 vs 1602) and deaths (73 vs 83) were similar. In the month after the mass drug administration, 84 individuals were admitted to hospital and two died, compared with a monthly median of 116 admissions (IQR 106-159) and six deaths (IQR 4-7) in the 12 months before and after the mass drug administration. INTERPRETATION In the largest trial so far involving coadministration of regimens based on ivermectin and azithromycin, the combination was safe and feasible in a population of more than 26 000 people. Coadministration of mass drug administration based on these two drugs opens up new potential for the control of neglected tropical diseases. FUNDING International Trachoma Initiative, Murdoch Children's Research Institute, Scobie and Claire Mackinnon Trust, Wellcome Trust.
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Affiliation(s)
- Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, London, UK
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Titus Nasi
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Bakaai Kamoriki
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for International Child Health, University of Melbourne, Melbourne, VIC, Australia
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Sandakabatu M, Nasi T, Titiulu C, Duke T. Evaluating the process and outcomes of child death review in the Solomon Islands. Arch Dis Child 2018; 103:685-690. [PMID: 29618484 PMCID: PMC6047158 DOI: 10.1136/archdischild-2017-314662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/08/2018] [Accepted: 03/10/2018] [Indexed: 11/14/2022]
Abstract
While maternal and perinatal mortality auditing has been strongly promoted by the World Health Organization (WHO), there has been very limited promotion or evaluation of child death auditing in low/middle-income settings. In 2017, a standardised child death review process was introduced in the paediatric department of the National Hospital in Honiara, Solomon Islands. We evaluated the process and outcomes of child death reviews. The child death auditing process was assessed through systematic observations made at each of the weekly meetings using the following standards for evaluation: (1) adapted WHO tools for paediatric auditing; (2) the five stages of the audit cycle; (3) published principles of paediatric audit; and (4) WHO and Solomon Islands national clinical standards of Hospital Care for Children. Thirty-three child death review meetings were conducted over 6 months, reviewing 66 neonatal and child deaths. Some areas of the process were satisfactory and other areas were identified for improvement. The latter included use of a more systematic classification of causes of death, inclusion of social risk factors and community problems in the modifiable factors and more follow-up with implementation of action plans. Areas for improvement were in communication, clinical assessment and treatment, availability of laboratory tests, antenatal clinic attendance and equipment for high dependency neonatal and paediatric care. Many of the changes recommended by audit require a quality improvement team to implement. Child death auditing can be done in resource-limited settings and yield useful information of gaps which are linked to preventable deaths; however, using the data to produce meaningful changes in practice is the greatest challenge. Audit is an iterative and evolving process that needs a structure, tools, evaluation, and needs to be embedded in the culture of a hospital as part of overall quality improvement, and requires a quality improvement team to follow-up and implement action plans.
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Affiliation(s)
- Mathew Sandakabatu
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Titus Nasi
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Carol Titiulu
- Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia
- Child health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Tosif S, Nasi T, Gray A, Sadr-Azodi N, Ogaoga D, Duke T. Assessment of the quality of neonatal care in the Solomon Islands. J Paediatr Child Health 2018; 54:165-171. [PMID: 28905447 DOI: 10.1111/jpc.13686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/15/2017] [Accepted: 07/21/2017] [Indexed: 01/01/2023]
Abstract
AIM To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower-middle-income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under-5 deaths (30.1/1000). METHODS A cross-sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited. RESULTS Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) 'fresh' stillbirths and 96 (1.8%) 'macerated' stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life. CONCLUSIONS Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health-care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Titus Nasi
- Department of Paediatrics, National Referral Hospital, Honiara, Solomon Islands
| | - Amy Gray
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nahad Sadr-Azodi
- Child Survival and Development, United Nations Children's Fund, Suva, Fiji
| | - Divi Ogaoga
- Reproductive and Child Health Division, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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Kennedy E, La Vincente S, Timeon P, Tiro T, Conway N, Nasi T, Kenilorea G, Engelman D, Carapetis J, Colquhoun S. PS289 Challenges Facing Sustainability and Integration of RHD Control and Prevention Programmes in Pacific Small Island Nations. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Marks M, Taotao-Wini B, Satorara L, Engelman D, Nasi T, Mabey DC, Steer AC. Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme. PLoS Negl Trop Dis 2015; 9:e0004246. [PMID: 26624616 PMCID: PMC4666486 DOI: 10.1371/journal.pntd.0004246] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Scabies is a major public health problem in the Pacific and is associated with an increased risk of bacterial skin infections, glomerulonephritis and rheumatic fever. Mass drug administration with ivermectin is a promising strategy for the control of scabies. Mass treatment with ivermectin followed by active case finding was conducted in five communities in the Solomon Islands between 1997 and 2000 and resulted in a significant reduction in the prevalence of both scabies and bacterial skin infections. METHODS We conducted a prospective follow-up study of the communities where the original scabies control programme had been undertaken. All residents underwent a standardised examination for the detection of scabies and impetigo. RESULTS Three hundred and thirty eight residents were examined, representing 69% of the total population of the five communities. Only 1 case of scabies was found, in an adult who had recently returned from the mainland. The prevalence of active impetigo was 8.8% overall and 12.4% in children aged 12 years or less. DISCUSSION We found an extremely low prevalence of scabies 15 years after the cessation of a scabies control programme. The prevalence of impetigo had also declined further since the end of the control programme. Our results suggest that a combination of mass treatment with ivermectin and intensive active case finding may result in long term control of scabies. Larger scale studies and integration with other neglected tropical disease control programmes should be priorities for scabies control efforts.
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Betty Taotao-Wini
- Department of Paediatrics, National Referral Hospital, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Lorraine Satorara
- National Health Training Research Institute, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Daniel Engelman
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Group A Streptococcal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Titus Nasi
- Department of Paediatrics, National Referral Hospital, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - David C. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London, United Kingdom
| | - Andrew C. Steer
- Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Group A Streptococcal Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Kennedy L, Nasi T, Ludawane B, Ogaoga D, Colquhoun S, Carapetis J, Kenilorea G, Wheaton G. PT443 Burden of Rheumatic Heart Disease in the Solomon Islands. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Colquhoun S, Ogaoga D, Tamou M, Nasi T, Subhi R, Duke T. Child health nurses in the Solomon Islands: lessons for the Pacific and other developing countries. Hum Resour Health 2012; 10:45. [PMID: 23171144 PMCID: PMC3545833 DOI: 10.1186/1478-4491-10-45] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 11/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To understand the roles of nurses with advanced training in paediatrics in the Solomon Islands, and the importance of these roles to child health. To understand how adequately equipped child health nurses feel for these roles, to identify the training needs, difficulties and future opportunities. DESIGN Semi-structured interviews. SETTINGS Tertiary hospital, district hospitals and health clinics in the Solomon Islands. PARTICIPANTS Twenty-one paediatric nurses were interviewed out of a total of 27 in the country. RESULTS All nurses were currently employed in teaching, clinical or management areas. At least one or two nurses were working in each of 7 of the 9 provinces; in the two smaller provinces there were none. Many nurses were sole practitioners in remote locations without back-up from doctors or other experienced nurses; all had additional administrative or public health duties. Different types of courses were identified: a residential diploma through the University of Papua New Guinea or New Zealand and a diploma by correspondence through the University of Sydney. CONCLUSIONS Child health nurses in the Solomon Islands fulfill vital clinical, public health, teaching and administrative roles. Currently they are too few in number, and this is a limiting factor for improving the quality of child health services in that country. Current methods of training require overseas travel, or are expensive, or lack relevance, or remove nurses from their work-places and families for prolonged periods of time. A local post-basic child health nursing course is urgently needed, and models exist to achieve this.
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Affiliation(s)
- Samantha Colquhoun
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, MCRI,, 50 Flemington Road, Parkville,, 3052, Melbourne, Australia
| | | | | | | | - Rami Subhi
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, MCRI,, 50 Flemington Road, Parkville,, 3052, Melbourne, Australia
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, MCRI,, 50 Flemington Road, Parkville,, 3052, Melbourne, Australia
- School of Medicine and Health Sciences, University of Papua New Guinea, Papua New Guinea
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Abstract
AIMS The Solomon Islands health service, infrastructure and economy were severely affected by the civil conflict that occurred between 1998 and 2003. In 2002 plans to rebuild health services for children, especially those provided in provincial hospitals, were developed by paediatricians, in collaboration with the World Health Organization. We aimed to inform this process by an assessment of the strengths and weaknesses of the child health service, particularly in provincial hospitals. METHODS A systematic assessment of the quality of hospital care for children in Solomon Islands was conducted in November 2003. The study used a WHO assessment tool, modified for use in the Asia-Pacific region. RESULTS The assessment highlighted several problems in clinical care, human resources, health financing, referral systems, and training, and has been used as a basis for several interventions for improving the quality of paediatric care. CONCLUSION This study and the initiatives that have followed it demonstrate the link between such assessments, child health policy and quality improvement activities. Such programs can be implemented even where resources are very limited. Sustaining initiatives based on this assessment will be important for the Solomon Islands if it is to achieve the Millennium Development Goals for child survival by 2015.
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Affiliation(s)
- James Auto
- Honiara National Referral Hospital, Ministry of Health, Solomon Islands, and Centre for International Child Health, University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
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Nasi T, Vince JD, Mokela D. Mortality in children admitted to Port Moresby General Hospital: how can we improve our hospital outcomes? P N G Med J 2003; 46:113-24. [PMID: 16454393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A detailed audit, part retrospective and part prospective, of deaths occurring in children admitted to the children's wards of the Port Moresby General Hospital over a 12-month period was made. 238 children died out of the 4898 admitted, an overall case fatality rate of 4.9%, with a monthly range of 3.7%-9.6%. The proportion of deaths approximated the proportion of admissions in each age group. 92% of the children had a weight of less than 80% of the standard weight for age and 30% weighed less than 60% of the standard weight for age. 24 (11%) of the deaths occurred within the first 6 hours of admission, 39 (17%) within the first 12 hours and 58 (26%) within the first 24 hours. 89 children (40%) died more than one week after admission. Pneumonia, meningitis, measles and septicaemia were the four leading certified causes of death and paediatric AIDS was the fifth. Less than half of the deceased children were appropriately immunized for their age. 27 deaths (12%) were assessed as preventable. 150 (67%) were classified as from treatable causes but unavoidable, 18 (8%) from untreatable causes, 22 (10%) of undetermined cause and 34 (15%) avoidable. The factors associated with avoidable deaths were delayed treatment (20 children), inadequate treatment (8 children), incorrect treatment (1 child) and others (5 children). Infant and child mortality could be reduced by general measures such as improving community nutrition and immunization status and improving care-seeking behaviour. Hospital-related measures to reduce mortality include improving the accuracy and effectiveness of triage and provision of adequate staffing levels and bed space. Periodic in-depth audit is necessary to assess quality of patient care, to identify problems and to point towards their solution. Accurate recordkeeping is essential for appropriate audit and planning.
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Affiliation(s)
- Titus Nasi
- Department of Paediatrics, Port Moresby General Hospital, Papua New Guinea
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