Abstract
BackgroundThe Solomon Islands has made significant progress in the control of malaria through vector control, access and use of improved diagnostics and therapeutic drugs. As transmission is reduced there is a need to understand variations in transmission risk at the provincial and village levels to stratify control methods.MethodsA cross-sectional survey of malaria in humans was conducted in the Solomon Islands during April 2018. Nineteen villages across 4 provinces were included. The presence of Plasmodium species parasites in blood samples was detected using PCR.ResultsBlood samples were analysed from 1,914 participants. The prevalence of DNA of Plasmodium falciparum was 1.2 % (n = 23) and for Plasmodium vivax was 1.5 % (n = 28). 22 % (n = 5/23) of P. falciparum DNA positive participants were febrile and 17 % of P. vivax DNA positive participants (n = 5/28). The prevalence of both P. falciparum and P. vivax was extremely spatially heterogeneous. For P. falciparum, in particular, only 2 small foci of transmission were identified among 19 villages. Plasmodium falciparum infections were uniformly distributed across age groups. Insecticide-treated bed net use the night prior to the survey was reported by 63 % of participants and significantly differed by province.ConclusionsMalaria transmission across the Solomon Islands has become increasingly fragmented, affecting fewer villages and provinces. The majority of infections were afebrile suggesting the need for strong active case detection with radical cure with primaquine for P. vivax. Village-level stratification of targeted interventions based on passive and active case detection data could support the progress towards a more cost-effective and successful elimination programme.
Highlights
The Solomon Islands has made significant progress in the control of malaria through vector control, access and use of improved diagnostics and therapeutic drugs
Vector control Insecticide-treated bed net use (predominately longlasting insecticide treated nets (LLINs)) the night prior to the survey was reported by 63 % of participants and Survey dates Number of participants Number of samples analysed Age–Range Age–Median Percentage female P. falciparum prevalence P. vivax prevalence Mixed infection prevalence Percentage P. vivax
Historically in the Solomon Islands, P. falciparum was the dominant species with a higher prevalence in younger age groups [18, 19], but as transmission declined, the proportion of P. vivax cases increased and the prevalence of submicroscopic malaria infections was high [20, 21], with malaria transmission becoming increasingly fragmented, affecting fewer villages and provinces [7, 20]
Summary
The Solomon Islands has made significant progress in the control of malaria through vector control, access and use of improved diagnostics and therapeutic drugs. Vector control has been the principal preventative intervention to reduce malaria transmission over the past two decades with long-lasting insecticidal nets (LLINs) and IRS, both globally and in the Solomon Islands. These strategies have seen Plasmodium falciparum replaced by Plasmodium vivax as the dominant malaria parasite in the Solomon Islands [7]. The malaria caseloads, in the other six provinces (Choiseul 0.7 %, Isabel 0.5 %, Makira 4.2 %, Rennell-Bellona 0 %, Temotu 2.5 %, and Western 6.0 %) were responsible for only 14 % of the national malaria burden [8] This heterogeneity argues for a stratified approach to malaria control. A cross-sectional survey of malaria in humans was undertaken to understand the heterogeneity in malaria transmission risk at the provincial and village levels
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