Serological measures to assess the efficacy of malaria control programme on Ambae Island, Vanuatu.

BACKGROUND: Seroepidemiology can provide evidence for temporal changes in malaria transmission and is an important tool to evaluate the effectiveness of control interventions. During the early 2000s, Vanuatu experienced an acute increase in malaria incidence due to a lapse in funding for vector control. After the distribution of subsidised insecticide-treated nets (ITNs) resumed in 2003, malaria incidence decreased in the subsequent years. This study was conducted to find the serological evidence supporting the impact of ITN on exposure to Anopheles vector bites and parasite prevalence. METHODS: On Ambae Island, blood samples were collected from 231 and 282 individuals in 2003 and 2007, respectively. Parasite prevalence was determined by microscopy. Antibodies to three Plasmodium falciparum (PfSE, PfMSP-119, and PfAMA-1) and three Plasmodium vivax (PvSE, PvMSP-119, and PvAMA-1) antigens, as well as the Anopheles-specific salivary antigen gSG6, were detected by ELISA. Age-specific seroprevalence was analysed using a reverse catalytic modelling approach to estimate seroconversion rates (SCRs). RESULTS: Parasite rate decreased significantly (P < 0.001) from 19.0% in 2003 to 3.2% in 2007, with a shift from P. falciparum predominance to P. falciparum-P. vivax co-dominance. Significant (P < 0.001) decreases were observed in seroprevalence to all three P. falciparum antigens but only two of three P. vivax antigens (except PvAMA-1; P = 0.153), consistent with the more pronounced decrease in P. falciparum prevalence. Seroprevalence to gSG6 also decreased significantly (P < 0.001), suggesting that reduced exposure to vector bites was important to the decrease in parasite prevalence between 2003 and 2007. Analyses of age-specific seroprevalence showed a three-fold decrease in P. falciparum transmission, but the evidence for the decrease in P. vivax transmission was less clear. CONCLUSIONS: Serological markers pointed to the effectiveness of ITNs in reducing malaria prevalence on Ambae Island between 2003 and 2007. The recombinant gSG6 antigen originally developed to indicate exposure to the Afrotropical vector An. gambiae may be used in the Pacific to complement the traditional measure of entomological inoculation rate (EIR)

Syndromic surveillance in Vanuatu since Cyclone Pam: a descriptive study.

In 2012, Vanuatu designed and implemented a syndromic surveillance system based on the guidelines developed by the Pacific Community and the World Health Organization to provide early warning of outbreaks and other important public health events. Four core syndromes were endorsed for surveillance: acute fever and rash, prolonged fever, influenza-like illness and acute watery diarrhoea. In March 2015, Vanuatu was struck by Cyclone Pam, after which several important changes and improvements to the country's syndromic surveillance were made. To date, there has been no formal evaluation of whether regular reports are occurring or that core syndromes are being documented. We therefore carried out a descriptive study in the 11 sentinel sites in Vanuatu conducting syndromic surveillance between July and December 2015. There was a total of 53 822 consultations which were higher in the first 13 weeks (n = 29 622) compared with the last 13 weeks (n = 24 200). During the six months, there were no cases of acute fever and rash or prolonged fever. There were cases with influenza-like illness from week 27 to 35, but no case was reported after week 35. Acute watery diarrhoea occurred in one or two cases per week during the whole study period. For these two core syndromes, there were generally more females than males, and about one third were children aged under 5 years. In conclusion, Vanuatu implemented changes to its new syndromic surveillance system from July to December 2015, although laboratory components had not yet been incorporated. The laboratory components are working in 2016 and will be the subject of a further report

Integrated Mapping of Yaws and Trachoma in the Five Northern-Most Provinces of Vanuatu.

Yaws and trachoma are targeted for eradication and elimination as public health problems. In trachoma-endemic populations mass administration of azithromycin can simultaneously treat yaws. We conducted a population-based prevalence survey in the five northernmost provinces of Vanuatu, where trachoma and yaws are suspected to be co-endemic. Clinical signs of trachoma were evaluated using the WHO simplified grading system, and skin examination with a serological rapid diagnostic test used to identify yaws. We enrolled 1004 households in 59 villages over 16 islands, and examined 3650 individuals of all ages for trachoma. The overall adjusted prevalence of trachomatous inflammation-follicular (TF) in 1-9 year-olds was 12.0% (95% Confidence Interval: 8.1-16.7%), and the overall adjusted prevalence of TT in those aged 15 years and greater was 0.04% (95% CI 0-0.14%). In multivariate analysis, the odds of children having TF was 2.6 (95% CI = 1.5-4.4) times higher in households with unimproved latrines, and independently associated with the number of children in the household (OR 1.3, 95% CI = 1.0-1.6 for each additional child). We examined the skin of 821 children aged 5-14 years. Two children had yaws, giving an estimated prevalence of active yaws in those aged 5-14 years of 0.2% (95% CI = 0.03-0.9%). Mass treatment with azithromycin is recommended in these provinces. Given the apparent low burden of yaws, integration of yaws and trachoma control programmes is likely to be useful and cost-effective to national programmes

"Die meisten wollen einfach hören, dass das Kind gesund ist." - Das Bild von Behinderung in der ärztlichen Beratung zu Pränataldiagnostik

Dieser Beitrag untersucht, welches Bild von Behinderung schwangerschaftsbegleitende Ärzt*innen haben und wie sich dieses in ihrer Beratung werdender Eltern zu Pränataldiagnostik (PND) ausdrückt. Die Datengrundlage bilden 20 Expert*innen-Interviews mit niedergelassenen Gynäkolog*innen. Die Auswertung erfolgt mithilfe der qualitativen Inhaltsanalyse nach Gläser und Laudel (2010). Mehrheitlich bildet sich in den Interviews eine kritische Haltung gegenüber der gezielten vorgeburtlichen Suche nach fetalen Beeinträchtigungen ab. Die Befragten verstehen es als entscheidenden Teil der ärztlichen Aufgabe, im Rahmen der Schwangerschaftsbegleitung durch Information, Aufklärung und Beratung informierte Entscheidungen zu ermöglichen. Obwohl Ableismus und vorgeburtliche Selektion kritisiert werden, sind die Interviews durchzogen von diskriminierender Sprache und ableistischen Annahmen. Um eine ergebnisoffenere ärztliche Beratung zu PND zu gewährleisten, gilt es also, das weiterhin wirkmächtige Medizinische Modell von Behinderung abzubauen.This article explores how the perceptions of disability of doctors providing pregnancy care are reflected in their counselling of expectant parents on prenatal diagnostics. The research is based on 20 expert interviews with practising gynaecologists. The data was analysed using Gläser and Laudel's qualitative content analysis (2010). The majority of the interviews reveal that doctors are critical of targeted prenatal screening for foetal impairment. The interviewees believe that it is an essential part of their professional role to provide counselling during pregnancy to enable truly informed choices by providing information, education and counselling. Although ableism and prenatal selection are criticized, the interviews are riddled with discriminatory language and ableist assumptions. It is, therefore, important to dismantle the influential medical model of disability to ensure open and unbiased medical counselling on prenatal diagnosis

Impact of the Lymphatic Filariasis Control Program towards elimination of filariasis in Vanuatu, 1997-2006

Background: Lymphatic filariasis (LF) occurs when filarial parasites are transmitted to humans through mosquitoes. The filarial worms affect the lymphatic system which leads to abnormal enlargement of body parts, chronic pain, disability, and social discrimination. In 1999, a commitment was made to eliminate LF from the Pacific Region by 2010. The Pacific Program to Eliminate LF began, with Vanuatu being one of the 16 endemic countries included in this program. Methods: In 1997/1998 a LF prevalence baseline survey was conducted to determine the need for mass drug administration (MDA) in Vanuatu. In 1999, the Vanuatu Lymphatic Filariasis Control Program was established, and nationwide MDA was implemented from 2000 to 2004. LF prevalence was collected during the MDA through sentinel site and spot check surveys, and after 5 years of MDA. MDA implementation methods included health worker training, social mobilization, and culturally appropriate health promotion strategies. Results: LF prevalence at baseline was 4.79%; after MDA this declined to 0.16% in 2005/2006. Average MDA coverage ranged from 75.5–81.5% across 5 years. All three evaluation units surveyed in 2005/2006 were below the 1% threshold required to stop MDA. Conclusions: The LF Control Program between 1997 and 2006 was successful in reducing LF prevalence to <1%. High MDA coverage was a critical component of this success. This period of the Vanuatu LF Control Program played an important role in helping to eliminate LF in Vanuatu

Challenges and key research questions for yaws eradication.

Yaws is endemic in west Africa, southeast Asia, and the Pacific region. To eradicate yaws by 2020, WHO has launched a campaign of mass treatment with azithromycin. Progress has been made towards achievement of this ambitious goal, including the validation of point-of-care and molecular diagnostic tests and piloting of the strategy in several countries, including Ghana, Vanuatu, and Papua New Guinea. Gaps in knowledge need to be addressed to allow refinement of the eradication strategy. Studies exploring determinants of the spatial distribution of yaws are needed to help with the completion of baseline mapping. The finding that Haemophilus ducreyi causes lesions similar to yaws is particularly important and further work is needed to assess the effect of azithromycin on these lesions. The integration of diagnostic tests into different stages of the eradication campaign needs investigation. Finally, studies must be done to inform the optimum mass-treatment strategy for sustainable interruption of transmission

Lines of Thought: the Serendipitous Emergence of Collaborative Learning

What happens when you give an open invitation to edutwitter to collaboratively write a poem, and encourage remixes? Over the last few months we have watched a collaborative project unfold in ways that continue to amaze, inspire and nourish us. This has opened up a conversation about the power of online collaborations and the adaptability of these for more formal models of learning. In January 2021 one of the authors tweeted a joke about writing a 106-line poem. The other author took this line of thought and designed a collaborative challenge - to contribute lines of thought and collectively write the poem. Over 48 hours, 44 people worked on a shared Google Doc making over 4,000 edits. The outcome was a poem titled: 106 Lines of Thought. As we watched it unfold we began to think of ways to remix it. We created a second opportunity - to ask people to record poem stanzas that we would stitch together. 21 people offered, and an orated version of the poem was produced. Hearing the voices bought an intimacy into the project and allowed different parts of the poem to stand alone. We then saw the poem remixed into forms we had never imagined. This relates to the conference theme of digital well-being.The past year has been a challenge for all of us, educators and learners alike, and opportunities to connect authentically with others have become even more important. Our online communities have sustained us throughout this pandemic, highlighting for us the importance of collaborations that permit making learning personally relevant. This is vital for the well-being of educators as well as students - one author had recently lost her job in the HE sector and this project sustained a connection with other educators. We will explain the genesis of the project and show some results. We will discuss the educational theories that underpin the practices of remix, showing how these seemingly trivial practices of creative playfulness allow deep and meaningful learning to serendipitously emerge. We reflect critically on the project, appreciating our luck in having participants who understood the underlying philosophy of the DS106 community and acknowledging the privileged status of participants with regard to digital literacy and digital access. We also acknowledge a possible lack of diversity: while we know our participants were global, with an open project there is no attempt to be equitable or ensure a diverse mix of people respond. While our example is of online educators spontaneously participating, we show how this can be adapted for use with a multiplicity of situations, and help build learning communities based on trust and authentic participation. We suggest a post-pandemic pedagogy will harness the power of online collaboration and show learners the freedom of serious fun

Calendar Connections

Can collaborative creativity help to connect digital practitioners with each other and enhance their well-being? In order to answer this we undertook a piece of qualitative research. Using bricolage as our methodology, we surveyed participants of a collaborative creative project and used grounded theory in order to categorise the responses. In order to illustrate our findings and better explain the nature of the creative project, we share some of the artwork and music that was created by participants as part of this project. We conclude that as well as enhancing well-being, this creative endeavour also added to the personal learning of these participants