title: Operational research to inform a sub-national surveillance intervention for malaria elimination in Solomon Islands.
abstract: BACKGROUND
  Successful reduction of malaria transmission to very low levels has made Isabel Province, Solomon Islands, a target for early elimination by 2014. High malaria transmission in neighbouring provinces and the potential for local asymptomatic infections to cause malaria resurgence highlights the need for sub-national tailoring of surveillance interventions. This study contributes to a situational analysis of malaria in Isabel Province to inform an appropriate surveillance intervention.
  
  
  METHODS
  A mixed method study was carried out in Isabel Province in late 2009 and early 2010. The quantitative component was a population-based prevalence survey of 8,554 people from 129 villages, which were selected using a spatially stratified sampling approach to achieve uniform geographical coverage of populated areas. Diagnosis was initially based on Giemsa-stained blood slides followed by molecular analysis using polymerase chain reaction (PCR). Local perceptions and practices related to management of fever and treatment-seeking that would impact a surveillance intervention were also explored using qualitative research methods.
  
  
  RESULTS
  Approximately 33% (8,554/26,221) of the population of Isabel Province participated in the survey. Only one subject was found to be infected with Plasmodium falciparum (Pf) (96 parasites/μL) using Giemsa-stained blood films, giving a prevalence of 0.01%. PCR analysis detected a further 13 cases, giving an estimated malaria prevalence of 0.51%. There was a wide geographical distribution of infected subjects. None reported having travelled outside Isabel Province in the previous three months suggesting low-level indigenous malaria transmission. The qualitative findings provide warning signs that the current community vigilance approach to surveillance will not be sufficient to achieve elimination. In addition, fever severity is being used by individuals as an indicator for malaria and a trigger for timely treatment-seeking and case reporting. In light of the finding of a low prevalence of parasitaemia, the current surveillance system may not be able to detect and prevent malaria resurgence.
  
  
  CONCLUSIONS
  An adaption to the malERA surveillance framework is proposed and recommendations made for a tailored provincial-level surveillance intervention, which will be essential to achieve elimination, and to maintain this status while the rest of the country catches up.
authors.affiliation: School of Population Health, University of Queensland, Brisbane, Australia. joan.atkinson@uq.edu.au
authors.forename: Jo-An
authors.initials: JA
authors.lastname: Atkinson
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Johnson
authors.forename: Rushika
authors.initials: R
authors.lastname: Wijesinghe
authors.forename: Albino
authors.initials: A
authors.lastname: Bobogare
authors.forename: L
authors.initials: L
authors.lastname: Losi
authors.forename: Matthew
authors.initials: M
authors.lastname: O'Sullivan
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Kenilorea
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.forename: Qin
authors.initials: Q
authors.lastname: Cheng
authors.forename: Andrew
authors.initials: A
authors.lastname: Ebringer
authors.forename: Lisa
authors.initials: L
authors.lastname: Bain
authors.forename: Karen
authors.initials: K
authors.lastname: Gray
authors.forename: Ivor
authors.initials: I
authors.lastname: Harris
authors.forename: Maxine
authors.initials: M
authors.lastname: Whittaker
authors.forename: Heidi
authors.initials: H
authors.lastname: Reid
authors.forename: Archie
authors.initials: A
authors.lastname: Clements
authors.forename: Dennis
authors.initials: D
authors.lastname: Shanks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000469:parasitology; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000235:genetics; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008542:Melanesia / Q000453:epidemiology; D008853:Microscopy; D008875:Middle Aged; D018512:Parasitemia / Q000175:diagnosis; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011635:Public Health Administration / Q000379:methods*; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan