Introduction:

Malaria is a health problem worldwide, regional and locally including Solomon Islands.
According to the country profile 2010, malaria was on the rise which associated with climate
change. The data shows that from the month of November to May 2011 to 2014 malaria trends
are similar. Malaria is cause by plasmodium protozoa carried and transmitted by the female
anopheles mosquito. It has two hosts, human being and the mosquito. If one of the two is not
present, the disease will not be transmitted. The plasmodium parasite usually injected into a
healthy person directly into the blood vessel by the female anopheles mosquito. The mosquito
also picks the malaria parasite directly from the sick person’s blood stream

Malaria is one of the disease threats in the Solomon Islands for years. Attempts to eradicate
the disease in the 1970s did not work and so a new strategy, “Malaria Control” was developed
only to control the disease from spreading and to prevent the disease from affecting the life of
the people. Currently, there are provinces that are under experimental eradication program to
see if the disease could be eradicated. These Provinces are Temotu and Ysabel. So far nothing
has yet documented as to prove that the experiment attempts are effective as referred in the
Malaria strategic plan 2010-2015, (2009)

Malaria is one of the leading causes of deaths in Solomon Islands. With the current trend,
malaria appears to be one of the skyrocketing diseases that would kill many people in the
country in the next 20 years if measures are taken lightly from the protocols developed to
control and treat the disease. The increase of malaria cases often correlate with the country
whether season usually from November to April when heavy rain and cyclone threats display
their natural falls upon the country. The current situation is about 60% to 70% of all the taken
slides that are laboratory proven positive cases of the plasmodium falciparum. (Solomon
Islands country profile, 2010) The other remaining rate is of the plasmodium vivax species.

The Honiara suburbs are the common areas in which malaria density is high and therefore the
selected site for this study was at Ports Area to the Mbokonavera clinic in which it is under the
Mbokonavera Clinic catchment area. The area of study is specifically only covers the houses of
the right side of the stream that runs down to the Ports area. The population of the area is

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about 350 people which hold mainly the workers of the Ports Authority. Though the size of the
area is the smallest one of the clinic catchment areas, it recorded the second highest incidence
rate of plasmodium falciparum in 2014, (Clinic monthly report 2014).

Purpose of the investigation:

The purpose of the investigation is to find or identify the reasons why the rise of plasmodium
falciparum malaria was raised to a highest peak at the Port Authority in 2014 than any other
year among all other areas under the Mbokonavera Clinic Catchment area.

Question:

What are the factors that contribute to the rise of plasmodium falciparum malaria at the
residential Ports Authority area in 2014?

Statement:
Malaria is an endemic disease in the Solomon Islands which has been the most disease that expenses
the health budget on its prevention, control and cure and yet it is still on the rise in the heart of the
capital Honiara especially in one of the minor area under the Mbokonavera catchment area.

Methods used for obtaining data:

The collection of data was done in three methods. One was through interview on both qualitative and
quantitative in nature according to a designed questionnaire on how malaria transmits and on how best
and conducive the breeding areas of its responsible vector, the anopheles female mosquito is like, two
was through observation of the environment and three through clinical data for the year 2014.

The sample group selected was all adults of 10males and 10 females who are permanently residing in
the area. The interview was done in a random manner in which after every two people seen was asked
to provide information. Out of the number suggested, only 80% interviewed otherwise the rest were
declined to give information.

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Literature:

Croft A. (2000) stated that “The main causes of outbreaks as described in these papers were
categorized according to whether they were related to population migration, environmental
factors, vector and host related factors, and operational problems of the health services.

Yunnan, Hainan, Y. (1998) Stated that malaria control appears to be of particular importance to
the national malaria programme. Strengthening of surveillance for malaria and early radical
treatment of cases should be considered among the most important tools for preventing
malaria outbreaks and for the final goal of malaria elimination

Kain KC, Harrington MA, Tennyson S. (1998) stated that Imported malaria on prospective
analysis of the contributing problems is important in diagnosis and the management of
malaria. This is the reason for doing the investigation identify if the rise in Pf malaria is the
result of imported resistance species from somewhere.

Marsh K, Forster D, Waruiru C, et al. (1995) on the environmental as a home for disease
development. A poor hygienic environment is a very conducive home for malaria existence and
spread.

Kain KC, Keystone JS. (1998).wrote about the prevention measures should be taken beyond
administrating treatment including the turnover of every being human’s behaviour is the utter
most problem of the spread of Malaria. If every living soul shows to the world that they are
ready to take the responsibility of his or her life, then the disease would wipe out completely
from the face of the earth

Ethical Consideration
The understanding of individuality and respect to the rights were considered and respected.
Permissions were obtained prior to the interviews and respect the right of those who refused to provide
information. A permission letter was also given to the nurse in charge of the Mbokonavera clinic before
searching through their records.

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Results:
Fig:1 . P.F Malaria per month in 2014 at Mbokonavera- Port Authority Area.

PF Malaria
35
30
25
No. of patient

20
15
10
5
0
Jan Feb Mar April May June July August Sept Oct Nov Dec
Months

Positive PF malaria – Source- Record Mbokonavera Clinic

Fig: 2. Number of houses

No. Sleeping houses

20
10
No. of Houses

0
w en ut ut
ndo cre afh etH
wi s le ar
k
r& No en M
do
o Op
ed
een
r
Sc
Types of houses

Houses which people found interviewed.

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Fig: 3. Number of people interviewed:

People interviewed
no. people interviewed

10
9
8
7
6
5
4
3
2
1
0
Female Male
Gender

People interviewed by gender.

Fig: 4: Shows the types of treatment preferred

Treatment taken

80
70
60
Perecentage

50
40
30
20
10
0
Clinic Home medicine Others
Types of treatment taken

Treatment preference

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Fig:5: Show how often malaria health education at the area

Malaria health Education

100
Percentages

80
60
40
20
0
once a month three monthy twice a year Never at all
Frequency or how often

Malaria health education time frequency.

Interpretation/Discussion

Fig 1: Shows P.F malaria incidence rate per month in 2014. Malaria high incidence corresponds
to the weather pattern in Solomon Islands. The incidence cases of malaria between December
and May are within the range of 30-35 positive Pf cases about 7.5-10% of the total population.
In Dec 2014 the trend raised again to about 28 PF cases the beginning of another rainy season.
From June to November 2014 the trend went down the range between 10 -15 Pf cases about
2.9% t0 4.3% of the population respectively. The record taken from Mbokonavera clinic
revealed that it was the highest area in tis catchment with the highest prevalence rate in 2014.(
Mbokonavera Clinic Record 2014)

Fig: 2: Shows the condition of the sleeping houses there was so poor. There are 29 permanent
houses of which about 54% of the entire sleeping house and out of the permanent houses 40%
are well screened and another 60% are not screened or with broken screened doors and
windows. Of all the sleeping houses 46% are either small little leaf houses which most are
without doors and the market huts. The market huts are also used as their sleeping huts.

Fig: 3: Shows that the number interviewed are most females as they were found at home
during the day. Most men were out for work or on the street walkabout. Out of the total
interviewees, 20% refused to provide information. With the respect to their rights, they were
not forced to be interviewed.

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Fig: 4: Indicates the type types of treatment people prefer to take when they have fever. Out
the total interviewees, 70% go the clinic, 23% preferred custom medicine and 7% refers to
those that either takes panadol, septrine or amoxicillin for fever.

According to the investigation the Mbokonavera Clinic record revealed that Pf Malaria was the
Species that was common in its catchment area. Amazingly the trend shows that the Ports
Authority area is the highest of them all. For this reason when a permission letter was given to
them, they chose the area to be investigated.

Fig: 5: Shows that there has been no malaria health education done in the area though they are
so close to the Town council Health Division Head quarter at the Town Council Area.

According to the interview, it is evident that most people seem not to fear malaria as they
believe that they have their own treatment for cure than to go to the clinic to be treated.
Though most people go to the clinic, a good portion of the population is still yet to have good
knowledge of the disease and how it is transmitted and where to go for treatment. When asked
why people do not have net screens on their windows and the doors, most responses were
given across to the Authority that it is their responsibility to see to the problem. Others who
live in small leaf huts and in the market huts are not have no nets at all but using smokes from
the fire to chase mosquitoes away as they were only there the whole year selling the betel nut
products for money as school fees are too high for them to meet. Therefore they do not care
whether they catch malaria or not as money became the most important thing to worry about.

Observation shows that there have been small pools around the area that remain stagnant
with draining into the main stream. Waste disposals everywhere that it made the place to
appear filthy for people to clean up the place. The area was also too dense with small bushes
and covered with rain trees. This gives the mosquitoes a good harbouring environment for
them to breed and to visit people very close for blood meals. At the same they give the parasite
for them. (Marsh K, Forster D, Waruiru C, et al. 1995)

The knowledge some people have is too low especially as a disease that can kill, left people
with disability, and that it can be transmitted faster if the place is conducive for mosquitoes
breeding. Besides, that if they choose wrong treatment or do not comply with treatment drug
resistance may come about, (Plowe CV 2005). These are the reasons why PF malaria prevalence

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cases were so high in that area. Generally, people should be well aware of the fact that Pf
malaria is very dangerous for pregnant mothers and children less than five years old as they can
lead to death and pregnant problems such as giving birth earlier than nine month or the baby
may die in the belly, or even both the baby and the mother may die. (Marsh K, Forster D,
Waruiru C, et al .1995)

Interview also proved that there have not been at anytime that the health officers or malaria
officers gave health talk awareness about malaria except on dengue. This is the reason why
people tend to choice herbal medicine (custom) for fever. That is the only disease they know
that it is transmitted by mosquitoes. (MHMS. 2009)

To conclude malaria is known as an endemic disease in Solomon Islands and it is more

associated with condition such as poor environmental hygiene and human behaviour. People
who do not care and fail to look after their environment are seen as they are planning their
environment to give them diseases such as malaria. The Port Authority area which is so close to
the Mbokonavera Clinic is so small compare to other clinic areas and yet provided a high
prevalence Pf malaria cases in 2014. There are many factors which are associated with this high
trend which include people ignorance, lack of health education, money minded, housing style
and hygiene, environmental hygiene and human behaviour.

Should all these be looked into and plan strategic moves to correct the situation, the area
would be an example to other bigger areas of the city to learn from.

Recommendation:

According to the survey result, it would be helpful if the malaria Division is to regularly visit and
plan an education awareness week for the people of the area and teach them during the nights
and do a mass cleaning up during the day. This should also be collaborated with the Ports
Authority to provide appropriate tools for effective cleaning up and to meet the Primary Health
Care approach “Multisectoral approach” (WHO – PHC 1978)

The malaria division of the Town council is to provide treated bed nets for them and advise
them to use them properly. The division to do an environment insecticide spray weekly until
the entire infected mosquito are all dead with a mass blood survey and drug administration to
the entire population in order to treat all the hidden cases and malaria carriers. (MHMS, 2009)

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The Ports Authority is to provide net screen to all its houses and order illegal leaf huts and
market hut owners to be removed from its residential area.

REFERENCES:

 Croft A. (2000) Extracts from "Clinical Evidence." Malaria prevention in travellers. BMJ.

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 Kain KC, Keystone JS. (1998). Malaria in travellers, Epidemiology, disease, and
prevention. Infection Diseases, Clin North Am

 Kain KC, Harrington MA, Tennyson S. (1998) Imported malaria a prospective analysis of
problems in diagnosis and management. Clinical Infectious Diseases. Kenia, Africa.

 Marsh K, Forster D, Waruiru C, et al (1995) Indicators of life-threatening malaria in

African children. N England, J Med.

 MHMS (2009) Malaria Prevention and Control Strategic plan 2010 – 2015, Malaria
Division, MHMS, Honiara, S.I.

 Plowe CV. (2005) Antimalarial drug resistance in Africa: Strategies for monitoring and
deterrence. Curr Top Microbiol Immunol. 2005; 295:55-79. [Medline].

SOLOMON ISLANDS NATIONAL UNIVERSITY

SCHOOL OF NURSING & ALLIED HEALTH SCIENCES

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 PHS 11- BASIC APPLIED EPIDEMIOLOGY

MALARIA SURVEY QUESTIONAIRE: PORTS AUTHORITHY AREA:

------------------------------------------------------------------------------------------------------------------
General questions:

1. No. of houses________________________________________

2. Population: ________________Male_____________Female____________

3. Reason for residing at the area:- Employed__________ Education__________

Others_______ Relatives ______________

4. How long have you been staying here?_________________

Malaria:

5. Have you been ever sick? _________________

6. What treatment did they give you?

___________________________________________________________________________
___________________________________________________________________________

7. What was the treatment for?

________________________________________________________________________
________________________________________________________________________

8. How long did you advised to take the treatment?

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

9. Do you have any reason why you were sick with malaria?
_______________________________________________________________________

10. What passes on malaria to others?

________________________________________________________________________

11. Where do malaria mosquitoes live?

________________________________________________________________________
________________________________________________________________________

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 12. Do you have nets on your windows and doors?

________________________________________________________________________

13. How often do your clean up around your area?

_______________________________________________________________________

14. Did you report the condition of the houses to the employers?
______________________________________________________________________

15. Are your leaf house belongs to the Port Authority?

________________________________________________________________________

16. Who did you seek permission to sell you market (betel nut) here?
________________________________________________________________________

17. Do you think malaria is dangerous?

________________________________________________________________________

18. Where do you go for treatment if you get sick?

________________________________________________________________________

Education:

19. How often did you receive health talk here?

________________________________________________________________________

20. What was the topic you were educated on?

________________________________________________________________________

Spraying:

21. What about house spraying or environmental spray?

________________________________________________________________________

22. Any mass malaria blood survey contacted here?

________________________________________________________________________

Thank you very much for the information. The information will be kept privately except for the
purpose of the study.

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