Decreased endemic malaria in Suriname: moving towards elimination.

BACKGROUND: Suriname has moved from being the country with the highest annual parasite index in the Americas to one on the threshold of elimination. The progress toward elimination in the stable populations of Suriname between 2000 and 2015 is reviewed. METHODS: Data was obtained from the Medical Mission and the Ministry of Health Malaria Programme case-reporting systems, and analysed with a focus on disease burden and differentiation of the disease geographically, by malaria species, age, gender, ethnicity, incidence and gametocytaemia. RESULTS: Between 2000 and 2015 there were 57,811 locally acquired cases of malaria in the stable populations of Suriname. A significant reduction in indigenous malaria cases was observed from 2006 to 2015. The number of imported malaria cases saw a relative increase compared to the number of autochthonous cases. In 2015 over 95% of the cases reported in stable communities are imported, mainly from neighbouring French Guiana, a department of France. The overall decline in malaria case incidence followed the mass-distribution of free long-lasting insecticide-impregnated mosquito nets and increased awareness building efforts, improved access to malaria services as a result of the introduction of Rapid Diagnostic Tests and the implementation of active case detection in high risk areas. In addition, improved management of Plasmodium falciparum infections was achieved with the introduction of artemisinin combination therapy. CONCLUSIONS: The existence of a network of policlinics in the interior ran by Medical Mission, for the indigenous population, allowed the rapid implementation of the strategy in stable communities. The success of malaria control in Suriname indicates that the availability at local level, of prompt and adequate prevention, diagnosis and treatment is a key requirement for the elimination of malaria.

Association of Mercury Exposure and Maternal Sociodemographics on Birth Outcomes of Indigenous and Tribal Women in Suriname.

Information regarding adverse birth outcomes (ABO) of Indigenous and Tribal women living in the remote tropical rainforest of Suriname, where mercury (Hg) use is abundant in artisanal gold mining, is not available. In the context of a health system analysis, we examined the association between Hg exposure, maternal sociodemographics on the ABO of Indigenous and Tribal women living in Suriname's interior and its capital, Paramaribo. ABO were determined in pregnant women enrolled from December 2016 to July 2019 in the Caribbean Consortium for Environmental and Occupational Health prospective environmental epidemiologic cohort study. Associations were explored using Pearson's χ2-test and the Mann-Whitney U-test. Among 351 singleton participants, 32% were Indigenous, residing mainly in the interior (86.8%), and 23.1% had ABO. Indigenous participants had higher rates of ABO (29.8% vs. 19.8%) and preterm birth (PTB) (21.2% vs. 12.4%), higher Hg levels, delivered at a younger age, were less educated, and had lower household income compared to Tribal participants. Multivariate logistic regression models revealed that Indigenous participants had higher odds of ABO (OR = 3.60; 95% CI 1.70-7.63) and PTB (OR = 3.43; 95% CI 1.48-7.96) compared with Tribal participants, independent of Hg exposure and age at delivery. These results highlight the importance of effective risk reduction measures in support of Indigenous mothers, families, and communities.

Prenatal Mercury Exposure in Pregnant Women from Suriname's Interior and Its Effects on Birth Outcomes.

Prenatal mercury (Hg) exposure was determined in a sub-cohort of the Caribbean Consortium for Environmental and Occupational Health's environmental epidemiologic prospective cohort study of pregnant women living in Suriname's interior. The associations between Hg exposure, low birth weight (LBW, <2500 g) and preterm birth (PTB, <37 weeks) were explored. Correlation analysis, Fisher's exact test and logistic regression analyses were conducted to evaluate the associations between maternal hair Hg levels and birth weight, LBW and PTB, and between potential confounders, LBW and PTB, respectively. Among 204 singleton births were 198 live births, five stillbirths and one miscarriage. The mean participant age was 26 years; 15.7% of participants had PTBs and 8.1% delivered a child with a LBW. The median hair Hg level was 3.48 µg/g hair. Low hair Hg exposure, based on lowest tertile < 2.34 µg/g, was associated with LBW (OR = 7.2; 95% CI 1.5-35.6; p = 0.015); this association was independent of maternal age, ethnic background, household income and village location, and no correlation was found between hair Hg and PTB. Young maternal age was associated with PTB (RR = 5.09, 95% CI: 1.92-13.85; p = 0.0004) while maternal age was not associated with hair Hg or LBW. The impact of prenatal Hg exposure on pediatric neurodevelopment is currently being evaluated in the infant sub-cohort.

Fifty years of primary health care in the rainforest: temporal trends in morbidity and mortality in indigenous Amerindian populations of Suriname.

BACKGROUND: The Amazonian Amerindian populations living in the southern and southwestern hinterlands of Suriname (South America) have come into contact with western health care since approximately fifty years ago. In this study, secondary data were used to assess the impact of Medical Mission's fifty-year old primary health care program on the health status of these populations. METHODS: Using data from the primary health care facilities of Medical Mission for 1965-1970, 1973-1977, 1982-1985, and 1997-2014, temporal trends in incidence and mortality of respiratory tract infections, gastroenteritis, and malaria; population composition; birth and death rates; and polyclinic consultations in these communities have been assessed over the period between 1965 and 2014. RESULTS: In the period covered by this study, the incidence of respiratory tract infections and gastroenteritis declined by about 75% and 53%, respectively, while malaria incidence rose sharply from the 1980s through 2005 but subsequently declined to levels approximating elimination. Crude death rates dropped by about 70% while birth rates declined by about 50% in the 1980s and since then remained at this level. The population doubled in size and increased in all age groups, particularly in the age group of ≥59 years. The infant mortality rate declined by 50%. In addition, the average yearly number of polyclinic visits per person decreased 6- to 7-fold during this period. CONCLUSIONS: The significant reduction of the infectious disease burden; the doubling of the population size and the growth of the proportion of elderly individuals due to the declining death rates; the declining infant mortality rates to levels comparable to the national average as well as the decline in average numbers of polyclinic consultations per person, indicate that Medical Missions health service provision achieved its goal of improving the health and survival of the indigenous people by providing free, accessible and permanent medical services. Building upon this successful experience Medical Mission could be instrumental in addressing potential contemporary life-style related health threats.