1. Humpress Harrington 1, Eileen Otuana 1, David MacLaren 2, Rick Speare 2,3 1. Atoifi Adventist Hospital 2. James Cook University 3. Tropical Health Solutions CULTURAL LEADERSHIP ENABLES RESEARCH In 2011, researchers from the Atoifi Health Research Group conducted a study of LF transmission in a village near Atoifi in Malaita Province in response to a 40 year old male presenting to Atoifi Hospital with elephantiasis of the lower limb. Researchers involved in the Alasi study created a decision tree to investigate suspected cases of LF in a previous endemic area. (Harrington 2013) Atoifi Nurse Eileen Otuana had participated in research workshops at Atoifi and was a research assistant in the LF study in nearby Alasi. Eileen’s involvement in this research made her think about her home of Fauro Island in the Outer Shortland Islands. She knew that some of her relatives were living with elephantiasis and she was concerned that LF was still present and transmitting on the Island. Eileen then requested that the Atoifi Health Research Group conduct an LF survey in villages on Fauro Island. Eileen asked her father Benard Otuana, as the paramount chief, if he would support the investigation of active LF in Shortland Islands. Chief Bernard Otuana met with the research team and suggested the research team conduct investigations in Samanagho, Toumua and Kariki villages. Eileen participated in the research group as a research team member and importantly as a cultural broker throughout the study. Image 4: Photo of person with Elephantiasis BACKGROUND Solomon Islands was declared free of the disabling disease lymphatic filariasis (LF) by WHO in 2011. Stories from the Outer Shortland Islands suggest that cases of elephantiasis, the end stage of LF, are still present there. The Outer Shortland Islands are just a few kilometres from Bougainville (Papua New Guinea) where LF is endemic. Stories (or rumours) can provide strong leads about disease transmission, but they must be fully investigated. This study tested rumour verification as a tool in the LF elimination programme. METHODS To investigate the suspected cases of LF, researchers used an algorithm developed by members of the Atoifi Health Research Group for responding to suspect cases in the post- elimination phase (Harrington 2013, Figure 2). 1. Identify key informants 2. Discuss the program with the village chief 3. Conduct awareness with the community 4. Collect blood and do antigen test on high risk individuals 5. Feedback of result to individuals, the village community and health workers Put a figure here that explores one articular outcome in a complicated table of results. Literature cited Harrington H, Asugeni A, Jimuru C, Gwalaa J, Ribeyro E, Bradbury R, Joseph H, Melrose W, MacLaren D, Speare R. A practical strategy for responding to a case of lymphatic filariasis post-elimination in Pacific Islands. Parasites and Vectors 2013;6:218 Graves PM1, Makita L, Susapu M, Brady MA, Melrose W, Capuano C, Zhang Z, Dapeng L, Ozaki M, Reeve D, Ichimori K, Kazadi WM, Michna F, Bockarie MJ, Kelly-Hope LA. Lymphatic filariasis in Papua New Guinea: distribution at district level and impact of mass drug administration, 1980 to 2011. Parasit Vectors 2013;6:7. Redman-MacLaren M, MacLaren D, Harrington H, Asugeni R, Timothy-Harrington R, Kekeubata E, et al. Mutual research capacity strengthening: a qualitative study of two-way partnerships in public health research. International Journal for Equity in Health. 2012;11(1):79. Acknowledgments We thank paramount Chief Benard Otuana for his support and partnership in this research. This research was funded by the James Cook University College of Medicine Incentive Grant. In-kind support was provided by Atoifi Adventist Hospital, Atoifi College of Nursing and Tropical Health Solutions. Presented at Atoifi Health Research Symposium, East Kwaio, Solomon Islands AIMS OF THE STUDY 1. To trial rumour verification as a tool for the Global Elimination Programme for Lymphatic Filariasis (LF). 2. To determine whether the rumours that lymphatic filariasis is still present in the Outer Shortland Islands, Solomon Islands is supported by evidence that would justify a population survey to confirm that the causative parasite (Wuchereria bancrofti) is present. 3. To raise awareness of LF, including its life cycle, clinical effects, management and control in the community and health care providers in the Outer Shortland Islands. 4. To build capacity of research colleagues based at Atoifi Adventist Hospital, Solomon Islands, to respond to rumours of the occurrence of LF and other infectious diseases. RESULTS 1. Research conducted in three villages: Samanagho, Toumua, Kariki 2. One man with elephantiasis was found. His blood tested negative for antigen using the BinoxNow Filariasis chromatographic card test. An additional 48 people also tested negative. These people were family members of previous elephantiasis cases, or had intermittent swelling of limbs or recurrent episodes of acute fever. Although only 49 people were tested, they all belonged to a high risk group for LF 3. Four awareness sessions for approximately 300 people explaining parasite transmission cycle and testing processes. 4. Two Solomon Islander health researchers from Atoifi Hospital, supported by two Australian health researchers successfully implemented the study. There is now increased capacity to respond to infectious diseases at Atoifi. CONCLUSIONS These results mean that it is unlikely that LF is still transmitting in the Outer Shortland Islands. The rumour verification method is useful tool for investigation suspected LF in Solomon Islands Active surveillance is an important next step for investigating ongoing transmission of LF By providing community awareness about the causative agent (Wuchereria bancrofti), myths about elephantiasis such as violating traditional taboo, were discussed and transmission cycles explained This research project strengthens the research capacity for both Solomon Islanders and international researchers. This research helps to reinforce the research skills through learn-by-doing model (Redman MacLaren 2012) RECOMMENDATIONS If future community surveys are required to investigate LF transmission in Solomon Islands, local health research teams should lead such investigations. Figure 1. Shortland Islands are adjacent to PNG, a hotspot for LF. Figure 2. Decision Tree (Harrington et al 2013) Solomon Islands Bougainville (PNG) Fauro Island Image 1. Professor Rick Speare, Humpress Harrington. Eileen Otuana, Dr David MacLaren leaving Toumua Health Centre Image 2. Humpress Harrington, Professor Rick Speare and Eileen Otuana in Samanagho Primary School during community awareness Image 3. P. Eileen Otuana, Humpress Harrington and Professor Rick Speare conducting blood tests in Kairiki Village