Progress towards TB control in East Kwaio, Solomon Islands

[Extract] The recently published project report TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands1, reported that tuberculosis (TB) remains an important issue to communities and health providers. The island of Malaita has the highest rate of TB in Solomon Islands. Many complex issues are contributors to this concerning level of disease. Factors such as remoteness, socioeconomic and sociocultural issues have been described. Massey et al particularly highlighted how cultural differences based on different worldviews had resulted in some TB patients being unable to access routine hospital based services. Since the development of a research-capacity strengthening approach with the Atoifi Adventist Hospital (AAH) in 20094, and the TB project of 20111, important initiatives and outcomes have been seen, including: * Building a new TB Ward that is culturally safer: a site for the new ward, that meets both socio-cultural and health requirements, has been agreed with mountain area Chiefs and AAH. The area has been cleared, plans drawn up and builders engaged. * Food for TB inpatients: AAH now purchases food each week for TB inpatients to enhance treatment. Currently other hospital inpatients provide their own food. * Active case finding and treatment: the AAH TB Team have conducted active case finding in distant TB ‘hotspots’ including the Kwaibaita Valley and remote mountain hamlets. Ten new cases were found during community visits and treated, including one person treated only in the community setting. * Funded Project to develop TB resources: AAH was successful in applying for a grant from the Australian Respiratory Council to develop local TB resources. This project will work with the traditional oral story-telling model of education and communication, but with modern technology. Locally made videos in local language and Pijin are being developed for community based TB education, including taking DVD players and video clips into remote hamlets and villages to stimulate discussion. * Stronger links with the National TB Program: the Provincial TB Coordinator is involved in the TB DVD project and has invited AAH to run research-training workshops in the provincial capital. * Reported TB case numbers increased: Since the commencement of the research capacity-strengthening approach and concentration on TB, annual reported cases of TB at AAH have increased from four cases in 2009 to 34 cases in 2012, increasing the case detection rate