title: Malaria elimination in Isabel Province, Solomon Islands: establishing a surveillance-response system to prevent introduction and reintroduction of malaria.
abstract: BACKGROUND
  The Solomon Islands National Malaria Programme is currently focused on intensified control and progressive elimination. Recent control efforts in Isabel Province have reduced their malaria incidence to 2.6/1,000 population in 2009 1 whereas most neighbouring provinces have much higher incidences. A malaria surveillance-response system that involves testing all travellers entering Isabel Province using rapid diagnostic tests (RDT) to prevent cases being imported had been proposed by local health authorities. This study provides information on the feasibility and acceptability of implementing a new approach of surveillance and response in the context of low levels of indigenous malaria transmission in Isabel Province.
  
  
  METHODS
  A total of 13 focus group discussions (FGD) and 22 key informant interviews (KII) were conducted in Isabel Province, Solomon Islands. Key topics included: the travel patterns of people to, from and within Isabel Province; the acceptability, community perceptions, attitudes and suggestions towards the proposed surveillance programme; and management of suspected malaria cases. This information was triangulated with data obtained from port authorities, airlines and passenger ships travelling to and from Isabel Province in the preceding two years.
  
  
  RESULTS
  Travel within Isabel Province and to and from other provinces is common with marked seasonality. The majority of inter-provincial travel is done on scheduled public transport; namely passenger ships and aircrafts. In Isabel Province there is a healthy community spirit as well as high concern regarding malaria and its importation and there is currently effective malaria passive case detection and management. Conducting malaria screening at ports and airports would be acceptable to the community.
  
  
  CONCLUSIONS
  A robust surveillance-response system is essential when moving towards malaria elimination. Many factors contribute positively towards the feasibility of an RDT based malaria surveillance system in Isabel Province. Due to financial and logistical restraints local health authorities have concluded that a system of community-based vigilance to identify new arrivals in villages and direct them to have malaria testing is more feasible than formal screening at ports and airports. A surveillance response system to prevent introduction of malaria into Isabel Province can be integrated into the National Malaria Control Programme provided the operational steps are carefully planned with regards to human and financial resources.
authors.affiliation: Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia. mjosullivan22@gmail.com
authors.forename: Matthew
authors.initials: M
authors.lastname: O'Sullivan
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Kenilorea
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Albino
authors.initials: A
authors.lastname: Bobogare
authors.forename: Landry
authors.initials: L
authors.lastname: Losi
authors.forename: Jo-An
authors.initials: JA
authors.lastname: Atkinson
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.forename: Maxine
authors.initials: M
authors.lastname: Whittaker
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Rushika
authors.initials: R
authors.lastname: Wijesinghe
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008542:Melanesia / Q000453:epidemiology; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D055815:Young Adult