Success in the Solomon Islands

28 World Health • SlstYeor, No. 3, Moy-June 1998 Success in the Solomon Islands Kevin Palmer Government commitment and international support to an intensified control programme aimed at making the island republic's capital, Honiara, a healthier place to live in cut the incidence of malaria by more than 7 6 % between 1992 and 199 7. tion of larvicides to all mosquito breeding sites; • mass drug administration; • mass blood surveys followed by treatment and follow-up of posi- tive cases; A comprehensive set of measures to protect the population of Solomon Islands from malaria resulted in a 6 I% reduction in incidence. • installation of an innovative pipeline to control mosquito breeding in the main river flow- ing through the centre of town; Photo WHO/S. Yobao Since 1992, Solomon Islands has made significant progress in reducing its malaria problem, bringing the number of reported cases down by 61 %. In 1992 there were 153 359 confirmed cases in a population of about 350 OOO. This translated into an annual incidence rate of 440 per 1000 population, making Solomon Islands one of the most malarious countries in the world outside of Africa. By using a carefully selected combination of control strategies, the number of cases was brought down to 72 OOO in 1997 ( 170 per 1 OOO population). In Honiara, the capital city, the decline has been even more dramatic. In 1992 there were 48 421 microscopically diag- nosed cases reported in a population of 45 131 (an annual incidence of 1072 per 1000). By 1997 the num- ber of cases had dropped to 17 569 in a population of 66 507 (an annual incidence of 264 per 1000). That was a decline of 75%. The success of the Solomon Islands Malaria Control Programme is the result of several factors. First, the total reorganization and reorien- tation of the Programme that took place in 1993 resulted in the Government giving its full commit- ment to malaria control. Realistic targets were set, control strategies were selected, a programme for retraining the staff was set up, and commitment from international donor partners was obtained. In 1995, realizing that more than one- third of the total malaria cases were in Honiara, the Government - with special support from WHO - initi- ated an intensified control programme with the goal of making Honiara a healthier place in which to live and work. The intensified activities in Honiara included: • improvements in the availability and quality of diagnosis and treatment of malaria; • use of insecticide-treated mos- quito nets; • residual spraying of houses; • ultra low volume spraying in the most problematic areas; • cleaning of streams and rivers together with the regular applica- • introduction of a computerized malaria information system; • active surveillance to detect infection in people who were not seeking treatment and to check on the malaria status of visitors and residents returning from other parts of the country. In the provinces, activities have focused on improving programme management, improving the diagno- sis and treatment of malaria, attain- ing high coverage with insecticide- treated mosquito nets , and spraying houses in the most problematic localities. Not only has this resulted in an overall reduction in incidence of 61 %, but in addition, by the end of 1997, four of the eight provinces had annual incidence rates of less than 100 per 1 OOO population. Crucial to the success of malaria control in the Solomon Islands has been the full support rrceived from both the Government and its many international donor partners. • Dr Kevin Palmer is a WHO Moloriologisf working in the Solomon Islands; his address is P.O. Box 22, Honiara, Solomon Islands.