Malaria disproportionately affects the poorest countries of the world, with 85% of the total disease burden borne by Africa and India. The disease has 4 known strains, but 2 strains- Plasmodium falciparum and P vivax-are responsible for the majority of clinical disease globally. Malaria is caused by the transmission of a parasite from the female Anopheles mosquito into humans. Malaria is a mosquito-borne infectious disease that, according to the World Health Organization (WHO), is responsible for more than 200 million episodes of illness per year across the globe, resulting in up to 400,000 deaths annually. In addition, we reviewed the laboratory results for all malaria parasite smears performed during 2016 in Makira-Ulawa Province. Each of these patients also underwent an RDT cartridge test.
In response to these practical observations, we performed a small prospective study of patients presenting to Kirakira Hospital with fever and a positive malaria parasite smear during a 4-week period in 2017. However, the nurses at Kirakira Hospital had stopped using the RDT cartridges because they were “never positive” and “did not work.” No specific data were available on when the nurses stopped using the RDTs, but they had not been observed using them since Bond University medical students started completing placements in Kirakira Hospital in 2013. The hospital also has a store of rapid diagnostic test (RDT) cartridges that have been shown to be accurate in diagnosing acute malaria cases in other settings. Trained microscopists perform as many as 50 malaria parasite smears each day at Kirakira Hospital. 4 Makira-Ulawa has one small hospital located in the provincial capital Kirakira. Makira-Ulawa is the fifth largest province by population, estimated at 52,000 inhabitants in 2017, and is located approximately 180 km southeast of Honiara, the capital city of Solomon Islands. Limited data are available about malaria in Makira-Ulawa Province of Solomon Islands. Glucose-6-phosphate dehydrogenase (G6PD) screening has been a requirement prior to commencing primaquine treatment. Artemisinin-based combination therapy (ACT) has been the first-line treatment for all febrile cases of acute malaria, with 14 days of primaquine used for radical treatment of Plasmodium vivax.
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Since 2009, the diagnosis and treatment of malaria in Solomon Islands has been available free of charge through public health facilities. In 2011, rates ranged from 1.6 cases per 1,000 population in Isabel Province to 96.8 cases per 1,000 population in Guadalcanal Province. Despite a reported reduction of 89% in confirmed malaria cases from 1993 to 2011, 1 wide discrepancies exist in the reported incidences across the 9 provinces of Solomon Islands. Malaria remains endemic in Solomon Islands, but progress toward eradication has been slow and challenging. A focus on attempting to eradicate P vivax in the community through improved compliance with treatment protocols is suggested as a possible way forward to best manage malaria in Makira-Ulawa Province. The parasite load detected in the 45 patients diagnosed with malaria in this study was low.
RDTs were not helpful in the diagnosis of malaria at Kirakira Hospital. P vivax was detected in 5,212 (94.7%) and Plasmodium falciparum in 285 (5.2%) of patients with malaria.Ĭonclusion: P vivax is the predominant strain of malaria present in Makira-Ulawa Province. In 2016, 5,505 of 17,195 patients (32.0%) screened had malaria parasites detected on a malaria parasite smear. None of the 45 CareStart RDTs performed was positive. The median parasite load was 280 parasites per μL (range, 160 to 640 parasites per μL). Results: All 45 patients diagnosed with malaria in a 4-week period in 2017 were positive for Plasmodium vivax. The data for all malaria parasite smears performed in Makira-Ulawa Province in 2016 were collated for comparison.
Simultaneous testing using the CareStart Malaria HRP2/pLDH (Pf/pan) Combo RDT was conducted. The parasite count for each smear was calculated. Methods: Forty-five patients who presented to Kirakira Hospital with symptoms of fever had a positive malaria parasite smear during a 4-week period in 2017. This study from Makira-Ulawa Province aimed to identify the most prevalent strain of malaria and assess if the available rapid diagnostic test (RDT) was effective in Kirakira Hospital. Background: Malaria remains endemic in Solomon Islands, but data on malaria in the provinces of Solomon Islands are limited.
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