Core principles of Malakit intervention for transferability in other contexts.

To eliminate malaria, all populations must be included. For those who are not reached by the health care system, specific interventions must be tailor-made. An innovative Malakit strategy, based on the distribution of self-diagnosis and self-treatment kits, has been evaluated in the Suriname-French Guiana- Amapá (Brazil) region. The results showed effectiveness and good acceptability. The Malakit intervention is complex and has many components. Its transferability requires adaptation to other populations and regions, while retaining the main features of the intervention. This article provides the keys to adapting, implementing and evaluating it in other contexts facing residual malaria in hard-to-reach and/or mobile populations. The process of transferring this intervention includes: diagnosis of the situation (malaria epidemiology, characteristics of the population affected) to define the relevance of the strategy; determination of the stakeholders and the framework of the intervention (research project or public health intervention); adaptation modalities (adaptation of the kit, training, distribution strategy); the role of community health workers and their need for training and supervision. Finally, evaluation needs are specified in relation to prospects for geographical or temporal extension. Malaria elimination is likely to increasingly involve marginalized people due to climate change and displacement of populations. Evaluation of the transferability and effectiveness of the Malakit strategy in new contexts will be essential to increase and refine the evidence of its value, and to decide whether it could be an additional tool in the arsenal recommended in future WHO guidelines.

Implementing group care in Dutch and Surinamese maternity and child care services: the vital importance of addressing outer context barriers.

BACKGROUND: By addressing physical and psychosocial needs, group care (GC) improves health-related behaviours, peer support, parent-provider interactions and may improve birth outcomes. Hence, global implementation of GC is encouraged. Context analyses prior to implementation are vital to elucidate which local factors may support or hinder implementation. METHODS: Contextual analyses conducted in the Netherlands and Suriname were compared to identify the factors relevant to the implementability of GC as perceived by healthcare professionals (HCPs). 32 semi-structured interviews were conducted with Dutch and Surinamese healthcare professionals. Audio recordings were transcribed verbatim and coded using the Framework approach. The Consolidated Framework for Implementation Research guided the development of the interview guide and of the coding tree. RESULTS: Outer setting: Concerns regarding funding surfaced in both countries. Due to limited health insurance coverage, additional fees would limit accessibility in Suriname. In the Netherlands, midwives dreaded lower revenue due to reimbursement policies that favour one-on-one care. Inner setting: Appropriate space for GC was absent in one Dutch and three Surinamese facilities. Role division regarding GC implementation was clearer in the Netherlands than in Suriname. INNOVATION: HCPs from both countries expected increased social support, health knowledge among women, and continuity of care(r). Individuals/innovation deliverers: Self-efficacy and motivation emerged as intertwined determinants to GC implementation in both countries. Individuals/innovation recipients: Competing demands can potentially lower acceptability of GC in both countries. While Dutch HCPs prioritised an open dialogue with mothers, Surinamese HCPs encouraged the inclusion of partners. PROCESS: Campaigns to raise awareness of GC were proposed. Language barriers were a concern for Dutch but not for Surinamese HCPs. CONCLUSIONS: While the most striking differences between both countries were found in the outer setting, they trickle down and affect all layers of context. Ultimately, at a later stage, the process evaluation will show if those outer setting barriers we identified prior to implementation actually hindered GC implementation. Changes to the health care systems would ensure sustained implementation in both countries, and this conclusion feeds into a more general discussion: how to proceed when contextual analyses reveal barriers that cannot be addressed with the time and resources available.

Pre-contact and post-colonial ecological legacies shape Surinamese rainforests.

Disturbances in tropical forests can have long-lasting ecological impacts, but their manifestations (ecological legacies) in modern forests are uncertain. Many Amazonian forests bear the mark of past soil modifications, species enrichments, and fire events, but the trajectories of ecological legacies from the pre-contact or post-colonial period remain relatively unexplored. We assessed the fire and vegetation history from 15 soil cores ranging from 0 to 10 km from a post-colonial Surinamese archaeological site. We show that (1) fires occurred from 96 bc to recent times and induced significant vegetation change, (2) persistent ecological legacies from pre-contact and post-colonial fire and deforestation practices were mainly within 1 km of the archaeological site, and (3) palm enrichment of Attalea, Oenocarpus and Astrocaryum occurred within 0, 1, and 8 km of the archaeological site, respectively. Our results challenge the notion of spatially extensive and persistent ecological legacies. Instead, our data indicate that the persistence and extent of ecological legacies are dependent on their timing, frequency, type, and intensity. Examining the mechanisms and manifestations of ecological legacies is crucial in assessing forest resilience and Indigenous and local land rights in the highly threatened Amazonian forests.

Possible Risk Factors and Their Potential Associations with Combined Heavy Metal Exposures in Pregnant Women in the Republic of Suriname.

Background: The exposure of pregnant women to multiple environmental pollutants may be more disadvantageous to birth outcomes when compared to single-compound contaminations. Objective: This study investigated the mixed exposures to mercury, manganese, or lead in 380 pregnant Surinamese women. The factors that might be associated with the heavy metal exposures and the relative risk of the potential factors to cause the mixed exposures were explored. The influencing factors of exposures to mixed contaminants assessed were living in Suriname's rural regions, several parts of which are contaminated with heavy metals emitted from artisanal and small-scale gold mining and agricultural activities; the consumption of potentially contaminated foods; advanced maternal age; as well as a relatively low formal educational level and monthly household income. Methods: Descriptive statistics were used to calculate frequency distributions and χ2-contingency analyses to calculate associations and relative risks (RR) with 95% confidence intervals (CI). Findings: Blood levels of two or three of the heavy metals above public health limits were observed in 36% of the women. These women were more often residing in the rural regions, primarily consumed potentially contaminated food items, were 35 years or older, were lower educated, and more often had a lower household income. However, only living in the rural regions (RR = 1.48; 95% CI 1.23-1.77) and a low household income (RR = 1.38; 95% CI 1.15-1.66) significantly increased the risk of exposure exceeding levels of concern to two or three of the heavy metals (by 48% and 38%, respectively). Conclusion: More comprehensive pharmacological, ecological, and epidemiological studies about exposures to mixed heavy metal contaminations in pregnant women are warranted.

The United States reference values of the Bayley III motor scale are suitable in Suriname.

To determine if the United States reference values of the Bayley Scales of Infant and Toddler Development, version III motor scale are suitable for Surinamese infants, we assessed 151 healthy infants at 3, 12, 24 and 36 months of age. The mean fine motor, gross motor, and composite scores of the total group did not significantly differ from the US norms, although some significant but not clinically relevant differences were found (lower fine motor scores at 12 months, lower gross motor and total composite scores at 24 months, and higher scores for gross motor and composite scores at 3 months).

Improving disseminated histoplasmosis diagnosis in HIV/AIDS patients in Suriname: The role of a urine lateral flow assay.

Histoplasmosis is a frequent cause of infections in people living with HIV/AIDS (PLWHA). This study introduces the application of a Histoplasma capsulatum urine antigen lateral flow assay (LFA) for diagnosing disseminated histoplasmosis in PLWHA in Suriname. The LFA's diagnostic accuracy was compared with the current diagnostic approach, aiming to assess whether this test resulted in improved early detection and management. Additionally, the prevalence of histoplasmosis among advanced stage HIV patients without clinical suspicion of infection was evaluated using the same LFA. In total, 98 patients were included in the study, of which 58 were classified as "possible disseminated histoplasmosis (DH)" based on clinical criteria and 40 as "controls". Of these possible DH cases, only 19 (32.7%) had a positive LFA. During the study, decisions for treatment were made without the treating physician being aware of the LFA result. Only 55% of the patients who started treatment for histoplasmosis based on clinical criteria had a positive LFA, and 21% of untreated patients had a positive LFA. This study shows that combining clinical signs with LFA results enhances diagnostic accuracy and is cost effective, resulting in better treatment decisions.

Development of a Pilot Literacy Scale to Assess Knowledge, Attitudes, and Behaviors towards Climate Change and Infectious Disease Dynamics in Suriname.

Prior research has shown that climate literacy is sparse among low- and middle-income countries. Additionally, no standardized questionnaire exists for researchers to measure climate literacy among general populations, particularly with regards to climate change effects on vector-borne diseases (VBDs). We developed a comprehensive literacy scale to assess current knowledge, attitudes, and behaviors towards climate change and VBD dynamics among women enrolled in the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort in Suriname. Items were generated by our research team and reviewed by a group of six external climate and health experts. After the expert review, a total of 31 climate change and 21 infectious disease items were retained. We estimated our sample size at a 10:1 ratio of participants to items for each scale. In total, 301 women were surveyed. We validated our scales through exploratory (n = 180) and confirmatory factor analyses (n = 121). An exploratory factor analysis for our general Climate Change Scale provided a four-construct solution of 11 items. Our chi-squared value (X2 = 74.32; p = 0.136) indicated that four factors were sufficient. A confirmatory factor analysis reinforced our findings, providing a good model fit (X2 = 39.03; p = 0.23; RMSEA = 0.015). Our Infectious Disease Scale gave a four-construct solution of nine items (X2 = 153.86; p = 0.094). A confirmatory factor analysis confirmed these results, with a chi-squared value of 19.16 (p = 0.575) and an RMSEA of 0.00. This research is vitally important for furthering climate and health education, especially with increases in VBDs spread by Aedes mosquitoes in the Caribbean, South America, and parts of the southern United States.

La influencia del poder colonial sobre la población y la naturaleza determinaron los asentamientos de la enfermedad de Hansen en Surinam / No disponible

Los colonizadores holandeses en Surinam afirmaban que la lepra (o enfermedad de Hansen) era muy contagiosa y se transmitía entre humanos. Se construyó un "cordón sanitario" alrededor de los pacientes, sobre todo esclavos africanos y asiáticos contratados como trabajadores y sus descendientes. Se les perseguía y eran recluidos en aldeas para afectados de lepra muy remotas localizadas en la selva tropical. Algunos pacientes obedecieron a las autoridades, mientras que otros resistieron y se rebelaron. Sus historias revelan conceptos confusos sobre la enfermedad con su cultura y el medioambiente surinamés, y contienen importantes informaciones para comprender su mundo y la vida dentro y fuera de las colonias para lepra. Combinaban prácticas sanitarias tradicionales y plantas medicinales de su hábitat natural con tratamientos biomédicos (practicando un pluralismo médico). Creían en una gran variedad de explicaciones sobre la enfermedad, predominantemente los conceptos tabúes treef, tyina y animales tótem asociados con su hábitat natural (el bioma surinamés). Algunas de las explicaciones de su imaginario (por ejemplo, la lepra es transmitida por la tierra y ciertos animales) revelan una analogía sorprendente con descubrimientos científicos recientes. Nuestra investigación revela que la naturaleza contribuye a moldear el mundo de los pacientes de Hansen. Un planteamiento ecológico puede contribuir significativamente a la hora de comprender su mundo. Hay que efectuar una investigación histórica y antropológica comparativa para trazar la influencia de distintos biomas sobre los modelos locales. Las colonias de Hansen actualmente abandonadas y sus entornos naturales son lugares importantes para el patrimonio cultural

According to the Dutch colonizers in Suriname, leprosy (or Hansen's disease) was highly contagious and transmitted from human-to-human. A "cordon sanitaire" was constructed around the patients, mainly African slaves and Asian indentured laborers and their descendants. They were tracked down and incarcerated in remote leprosy settlements located in the rainforest. Some patients obeyed the authorities while others resisted and rebelled. Their narratives, revealing conceptual entanglement of the disease with their culture and the Surinamese natural environment, contain important information for understanding their world and their life inside and outside of leprosy settlements. They combined traditional health practices and medicinal plants from their natural habitat with biomedical treatments (practicing medical pluralism). They believed in a diversity of disease explanations, predominantly the taboo concepts treef, tyina, and totem animals associated with their natural habitat (the Surinamese biome). Some of their imaginary explanations (e.g., "leprosy is carried and/or transmitted through soil and certain animals") show a surprising analogy with recent findings from leprosy scientists. Our research shows that nature contributes to shaping the world of Hansen's disease patients. An ecological approach can make a valuable contribution to understanding their world. Comparative historical and anthropological research needs to be conducted to map the influence of different biomes on local explanatory models. The now deserted Hansen's disease settlements and their natural environments are interesting research sites and important places of cultural heritage

Quality of death counts and adult mortality registration in Suriname and its main regions / Qualidade dos registros de óbitos e estimativas de mortalidade adulta no Suriname e regiões / Calidad de los recuentos de registros de muerte y mortadlidad adulta en Surinam y sus principales regiones

Suriname statistical office assumes that mortality data in the country is of good quality and does not perform any test before producing life table estimates. However, lack of data quality is a concern in the less developed areas of the world. The primary objective of this article is to evaluate the quality of death counts registration in the country and its main regions from 2004 to 2012 and to produce estimates of adult mortality by sex. We use data from population, by age and sex, from the last censuses and death counts from the Statistical office. We use traditional demographic methods to perform the analysis. We find that the quality of the death count registration in Suriname and its central regions is reasonably good. We also find that population data can be considered good. The results reveal a small difference in the completeness for males and females and that for the sub-national population the choice of method has implication on the results. To sum up, data quality in Suriname is better than in most countries in the region, but there are considerable regional differences as observed in other locations.

O Instituto de Estatística do Suriname assume que os dados de mortalidade no país são de boa qualidade e não realiza nenhum teste antes de produzir estimativas da tabela de vida. No entanto, a falta de qualidade dos dados é uma preocupação nas áreas menos desenvolvidas do mundo. O objetivo principal deste artigo é avaliar a qualidade do registro de óbitos no país e suas principais regiões, entre 2004 e 2012, e produzir estimativas de mortalidade adulta por sexo. Utilizamos dados populacionais, por idade e sexo, dos últimos censos e contagem de mortes do Centro Nacional de Estatística. Para realizar a análise, foram empregados métodos demográficos tradicionais. Concluímos que a qualidade do registro de óbitos no Suriname e em suas regiões centrais é razoável. Também mostramos que os dados de registro da população podem ser considerados bons. Os resultados revelam uma pequena diferença no grau de cobertura do registro de óbitos para homens e mulheres e que, para as regiões, a escolha do método tem implicações nos resultados. Em suma, a qualidade dos dados no Suriname é melhor do que na maioria dos países da região, mas há diferenças regionais consideráveis, como observado em outros lugares.

La oficina de estadísticas de Surinam supone que los datos de mortalidad en el país son de buena calidad y no hace ninguna prueba antes de producir estimaciones de la tabla de vida. Sin embargo, la falta de calidad de datos es una preocupación en las zonas menos desarrolladas del mundo. El objetivo principal de este artículo es evaluar la calidad del registro de recuentos de defunciones en el país y sus principales regiones entre 2004 y 2012 y producir estimaciones de mortalidad de adultos por sexo. Utilizamos datos de la población, por edad y sexo, de los últimos censos y recuentos de muertes de la oficina de Estadística. Utilizamos métodos demográficos tradicionales para realizar el análisis. Encontramos que la calidad del registro del recuento de defunciones en Surinam y sus regiones centrales es de razonable a buena. Asimismo, hallamos que los datos de población pueden considerarse también buenos. Los resultados revelan una pequeña diferencia en la integridad para hombres y mujeres y que para la población subnacional la elección del método tiene implicaciones en los resultados. En resumen, la calidad de los datos en Surinam es mejor que la de la mayoría de los países de la región, pero existen diferencias regionales considerables, como también se observa en otros lugares.

Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk / Evaluación de la factibilidad del estudio Vida Sana en Suriname: uso de hemodinámica avanzada para evaluar el riesgo de enfermedades cardiovasculares / Avaliação da viabilidade do Estudo de Vida Saudável no Suriname: uso de hemodinâmica avançada para avaliar o risco cardiovascular

ABSTRACT Objectives To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. Methods This was a preliminary study conducted in May – June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method to assess the feasibility of the HELISUR—a large-scale, cross-sectional population study of cardiovascular risk factors and disease in Suriname. Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of 135 volunteers 18 – 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center. The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. Results The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended. Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. Conclusions Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

RESUMEN Objetivos Determinar la factibilidad de evaluar el riesgo de enfermedades cardiovasculares en la población utilizando hemodinámica avanzada en el estudio Vida Sana en Suriname (HELISUR por su sigla en inglés). Métodos Este fue un estudio preliminar realizado de mayo a junio del 2012 empleando el método de factibilidad técnica, económica, legal, operativa y de programación (TELOS) para evaluar la factibilidad del HELISUR, un estudio poblacional transversal a gran escala de factores de riesgo y enfermedades cardiovasculares en Suriname. Suriname, un país de ingresos medianos de América del Sur, con una población de etnicidad principalmente africana y asiática, presenta un riesgo alto de enfermedades cardiovasculares. En el estudio participó un total de 135 voluntarios de 18 a 70 años de edad. Se puso a prueba un cuestionario de salud en un centro de atención primaria de salud, y se realizaron evaluaciones cardiovasculares no invasoras en un centro de salud académico. La evaluación cardiovascular incluyó mediciones de presión arterial en posición sentada, supina y de pie, y los criterios de valoración intermedios, como el gasto cardíaco, la resistencia vascular periférica, la velocidad de la onda de pulso y el índice de aumento. Resultados En las pruebas del método TELOS se encontró que la comunicación por teléfono celular era la más eficaz para asegurar la asistencia a las citas y que a menudo se requería la presencia de un entrevistador capacitado para ayudar a los voluntarios a llenar el cuestionario; se recomienda modificar las preguntas para que sean más claras. Con respecto a las evaluaciones cardiovasculares prolongadas de hemodinámica periférica y central, los resultados demostraron que eran técnica y operativamente factibles, y bien toleradas por los participantes en cuanto a la carga y duración. Conclusiones Los resultados de esta evaluación de factibilidad indican que las evaluaciones detalladas y a gran escala del riesgo de enfermedades cardiovasculares, que incluyen un cuestionario y hemodinámica central y periférica avanzada, son factibles para una población de alto riesgo en un país de ingresos medianos.

RESUMO Objetivos Determinar a viabilidade de avaliar o risco cardiovascular da população por meio de avaliação hemodinâmica avançada no Estudo de Vida Saudável no Suriname (HELISUR). Métodos Estudo preliminar realizado em maio-junho de 2012 com o uso da metodologia TELOS (análise técnica, financeira, jurídica, operacional e do cronograma) para avaliar a viabilidade do HELISUR – estudo transversal de base populacional em grande escala dos fatores de risco e doenças cardiovasculares no Suriname. O Suriname é um país sul-americano de renda média de população majoritariamente de origem afro-asiática com alto risco da doença cardiovascular. Participaram do estudo 135 voluntários com 18 a 70 anos de idade. O questionário sobre saúde foi testado em uma unidade básica de saúde e avaliações cardiovasculares não invasivas foram realizadas em um centro de saúde acadêmico. A avaliação cardiovascular consistiu da medida da pressão arterial em posição sentada, supino e em pé, e da medida de parâmetros (endpoints) intermediários como débito cardíaco, resistência vascular periférica, velocidade da onda de pulso e índice de amplificação. Resultados A análise TELOS indicou maior eficiência na adesão às consultas com a comunicação por celular e a necessidade frequente de auxílio de um entrevistador treinado para o preenchimento do questionário. Modificações para melhorar a compreensão das perguntas são recomendadas. Também se demonstrou que o amplo estudo da hemodinâmica central e periférica é viável do ponto de vista técnico e operacional e que os participantes toleram bem o incômodo e o tempo de avaliação. Conclusões Os resultados da avaliação de viabilidade indicam que a avaliação aprofundada do risco cardiovascular em grande escala, incluindo a administração de questionário e estudos de hemodinâmica avançada central e periférica, é viável em uma população de renda média com alto risco.

Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in Suriname / Vinculación de la Encuesta Mundial de Tabaquismo en Jóvenes (EMTJ) a la política de control del tabaco en Surinam

Abstract: Objective: To use evidence from the Global Youth Tobacco Survey (GYTS) to inform tobacco-control policy in Suriname. Materials and methods: The GYTS was conducted in 2000, 2004 and 2009 among secondary school students (13 to 15 years) in a two-stage cluster sample design. Results: 2744 students, age 13 to 15, participated. From 2000 to 2009, results showed an increased prevalence of “current use of cigarettes” and “other tobacco products” in females (31 and 98%). Additionally, students reported high exposure to second-hand smoking at home (56.6 to 46.6%) and in public places (67.8 to 53.3%). Less than half of all respondents were taught about the dangers of smoking in school. Conclusion: National smoking prevalence coincides with regional trends. The results of the GYTS provided the evidence-base towards developing comprehensive tobacco control legislation. Tobacco legislation was passed in 2013. Future GYTS will monitor legislation implementation and progress made in achieving WHO Framework Convention on Tobacco Control (FCTC) goals.

Resumen: Objetivo: Utilizar evidencia de la Encuesta Mundial de Tabaquismo en Jóvenes (EMTJ) para comunicar las políticas de control del tabaco en Surinam. Material y métodos: Las EMTJ se desarrollaron en los años 2000, 2004 y 2009 entre estudiantes de secundaria (de entre 13 y 15 años de edad) mediante diseño muestral en dos etapas. Resultados: Participaron en total 2744 estudiantes. De 2000 a 2009, los resultados mostraron una mayor prevalencia de “uso actual de cigarrillos” y “otros productos de tabaco” en mujeres (31 y 98%). Asimismo, se evidenció un alto grado de exposición pasiva al humo de tabaco en hogares (56.6 a 46.6%) y en lugares públicos (67.8 a 53.3%), además de la exposición a publicidad protabaco (periódicos/revistas: 76.3 a 54.0%; vallas publicitarias: 77.4 a 52.6%). Menos de la mitad de los estudiantes que participaron fueron instruidos sobre los peligros de fumar en las escuelas. Conclusión: La prevalencia nacional de tabaquismo coincide con la tendencia regional. Los resultados de la EMTJ proporcionan evidencia exhaustivas sobre la legislación del control de tabaquismo aprobada en 2013. Futuras EMTJ pueden promover y monitorear la implementación de la norma y su progreso en la consecución de los objetivos de OMS y el Convenio Marco para el Control de Tabaco.

Severity of acute Zika virus infection: A prospective emergency room surveillance study during the 2015­2016 outbreak in Suriname

Acute Zika virus (ZIKV) infection is usually mild and self-limiting. Earlier, we reported three cases of fatal acute ZIKV infection in patients without typical signs of ZIKV, but rather with criteria of systemic inflammation response syndrome (SIRS). To follow up these observations, we prospectively included patients at the emergency room with temperature instability and suspected to have acute ZIKV infection, SIRS, or both. A total of 102 patients were included of whom N =21 (21%) were suspected of acute ZIKV infection, N =56 (55%) of acute ZIKV infection with SIRS criteria, and N =25 (24%) of SIRS alone. ZIKV-PCR was positive in N =21 (20%) patients. Eight (38%) ZIKV-positive patients needed admission to the hospital of whom four (50%) presented with SIRS alone. One ZIKV-positive patient had vascular co-morbidity and died following shock and severe coagulopathy. We confirm the hypothesis that acute ZIKV infection can present atypical and severely with systemic inflammation and have lethal course particularly amongst patients with significant prior disease...(AU)

Three atypical lethal cases associated with acute Zika virus infection in Suriname

Acute Zika virus infection usually presents with a self-limiting triad of fever, rash and arthritis. There is limited information on severe or lethal cases. We report three cases of lethal acute Zika infection, confirmed with polymerase chain reaction, in adult patients with some co-morbidities. The patients showed rapid clinical deterioration with hemorrhagic and septic shock, and exaggerated acute and innate inflammatory responses with pronounced coagulopathy, and died soon after admission to the hospital. It remains unclear whether the fatal outcomes were due to acute Zika virus infection alone or to the combination with exacerbated underlying prior disease or co-infection. Nonetheless, the severity of these cases implies that increased awareness for atypical presentations of Zika virus infection, and careful clinical assessment of patients with symptoms of Zika, is warranted during current and future outbreaks...(AU)

Moving toward universal access to health and universal health coverage: a review of comprehensive primary health care in Suriname / Avanzando hacia el acceso universal a la salud y la cobertura universal de salud: un análisis de la atención primaria de salud integral en Suriname

OBJECTIVE: To provide an overview of comprehensive primary health care (CPHC) development and implementation in Suriname in peer-reviewed literature. METHODS: Building on work funded by the Teasdale-Corti Global Health Research Partnership Program/People's Health Movement, the authors searched MEDLINE, the Cochrane Library, and POPLINE for articles focused on CPHC within the Surinamese context. Two authors independently reviewed abstracts and then jointly reviewed the selected abstracts. The final selection was completed using a data extraction form. RESULTS: The initial search resulted in 1 556 abstracts. The initial review identified 58 articles. Only three of the 58 articles met the inclusion criteria for the final review. The three selected articles provided partial overviews of CPHC in Suriname and examples of its implementation, with a focus on the service delivery network in the interior of the country, which was designed to improve rural access to basic health care services by training community members as service providers. They also included examples of how preparations for health reform in Suriname in the late 1990s and early 2000s, influenced by global neoliberal reforms, led to expectations that disparities in health status, design of health system components, and service provision related to differences in power and historical context (e.g., the influence of medical professionals, political parties/ethnic groups, and wealthier populations concentrated in urban areas) would be addressed. CONCLUSIONS: Given the focus on primary health care in the Americas and the notable developments that have occurred in Surinamese health policy and health care, particularly in health care reform, the paucity of published research on CPHC in Suriname was an unexpected finding that may be partly due to prioritizing research on disease control rather than health policy and systems research. The limited amount of scientific literature on this topic 1) prevents clear understanding of CPHC development and implementation in Suriname and 2) underscores the need to strengthen the national health research system to better inform policies for moving the country toward universal health access and coverage to improve the health of all of its citizens.

OBJETIVO: Proporcionar una visión de conjunto de la implantación de la atención primaria de salud integral en Suriname en la bibliografía arbitrada. MÉTODOS: Aprovechando el trabajo financiado por el Programa de Alianza de Investigación en Salud Mundial Teasdale-Corti/Movimiento de Salud de los Pueblos, los autores efectuaron búsquedas en MEDLINE, la Biblioteca Cochrane y POPLINE de artículos que se centraran en la atención primaria de salud integral en el contexto surinamés. Dos autores analizaron los resúmenes independientemente y a continuación examinaron conjuntamente los resúmenes seleccionados. La selección final se completó mediante el empleo de un formulario de extracción de datos. RESULTADOS: La búsqueda inicial obtuvo como resultado 1 556 resúmenes. El análisis inicial seleccionó 58 artículos. Solo tres de estos 58 artículos satisficieron los criterios de inclusión en el análisis final. Los tres artículos seleccionados proporcionaban un panorama parcial de la atención primaria de salud integral en Suriname y ejemplos de su implantación, se centraban especialmente en la red de prestación de servicios del interior del país, diseñada para mejorar el acceso a los servicios de atención básica de salud en el entorno rural mediante la capacitación de los miembros de la comunidad como proveedores de servicios. También incluían ejemplos de cómo los preparativos para la reforma sanitaria de Suriname a fines de los años noventa y principios de siglo XXI, influidos por las reformas neoliberales a escala mundial, generaron expectativas de que se abordarían las disparidades en el estado sanitario, el diseño de los componentes del sistema sanitario, y la prestación de servicios de atención de salud relacionadas con diferencias de poder y contexto histórico (por ejemplo, la influencia de los profesionales de la medicina, partidos políticos y grupos étnicos, y las poblaciones más ricas concentradas en las zonas urbanas). CONCLUSIONES: Dada la importancia concedida a la atención primaria de salud en la Región de las Américas y el notable desarrollo experimentado por la política de salud y la atención de salud de Suriname, particularmente en la reforma del sector sanitario, la escasa investigación publicada sobre la atención primaria de salud integral en Suriname fue un hallazgo inesperado, que en parte puede ser debido a que se ha priorizado más la investigación sobre el control de enfermedades que la investigación sobre políticas y sistemas de salud. La limitada cantidad de bibliografía científica sobre este tema 1) impide una comprensión clara del desarrollo y la implantación de la atención primaria de salud integral en Suriname y 2) destaca la necesidad de fortalecer el sistema nacional de investigación en salud con objeto de fundamentar mejor las políticas que hagan avanzar al país hacia el acceso y la cobertura universales de salud para una mejora de la salud de todos sus ciudadanos.

Control de la lepra y contagionismo en suriman / No disponible

La lepra, aunque actualmente está desapareciendo, no ha sido derrotada todavía en Surinam. En la época colonial fue un gran problema para el gobierno colonial y la población, siendo la mayoría de pacientes (en la época pre-abolicionista) esclavos. En el siglo XVIII se estableció un sistema de control que ya incluía la en la legislación la detección y el confinamiento como métodos importantes. Los médicos holandeses que ejercían en Surinam durante el siglo XVIII y primera mitad del siglo XIX propusieron modelos contagionistas de contención que sugieren que la lepra era causada por una mezcla de factores, siendo la infección uno de ellos. Pero durante la primera mitad del siglo XIX, los investigadores europeos rechazaron mayoritariamente la infección y prevaleció el anti-contagionismo, considerando la herencia y los factores medioambientales como su causa. Al mismo tiempo, en Surinam - puesto que la lepra estaba incontrolada - la lucha contra la lepra se reforzó promulgando leyes implacables para perseguir e identificar a los leprosos. A su vez, Charles Louis Drognat-Landré defendió el punto de vista (tesis Utrecht) de que solamente la infección es la causa de la lepra. Su argumento sobre el contagionismo fue rechazado en Holanda, pero posteriormente publicó sus ideas en francés y así llegaron a ser más conocidas internacionalmente e influyeron en el noruego Hansen. Este descubrió algunos años después el microorganismo causal. Se afirma que hay una relación entre el desarrollo de una forma de contagionismo típico surimanés, un sistema de control de la lepra brutal y la estructura política autocrática, no liberal (hacia los esclavos) de la colonia holandesa de Surinam

Leprosy is nowadays a disappearing but not yet defeated disease in Suriname. In colonial times it was a burden for colonial government and people, the majority of patients (in preabolition times) being slaves. In the 18th century a control system was established, with detection and isolation, anchored in legislation, as major methods. Dutch physicians working in Suriname in the 18th and first half of the 19th century proposed contingent contagionistic models, according to which leprosy was caused by a mixture of factors, infection being one of them. But in the first half of the 19th century European researchers generally denied infection as the cause of leprosy and the paradigm of anti-contagionism prevailed, considering heredity and environmental factors as its cause. At the same time in Suriname - because leprosy appeared uncontrollable - the fight against the disease was reinforced by promulgating more relentless laws to hunt and identify lepers. In line with this, the Suriname born Charles Louis Drognat-Landré defended the view (thesis Utrecht) that infection is the one and only cause of leprosy. His extreme contagionism was sharply rejected in The Netherlands, but then he published his ideas in French and so could reach the international scene and influence the Norwegian Hansen. The latter discovered the culpable micro-organism a few years later. We claim a correlation between the development of a typical Surinamese form of contagionism, the brutal leprosy control system and the autocratic, non-liberal (towards the slaves) political structure of the Dutch colony Suriname

Triatominae species of Suriname (Heteroptera: Reduviidae) and their role as vectors of Chagas disease

Nine species of Triatominae, representing three tribes and five genera, are currently known in Suriname. An annotated list of the species based on the collections of the Bureau of Public Health (Suriname), the National Zoological Collection Suriname and the National History Museum Leiden (the Netherlands) is provided. Additionally, the results of several years of opportunistic collection in two domestic environments are presented. The most common species are Rhodnius pictipes Stål, 1972, Rhodnius robustus Larrouse, 1972 and Panstrongylus geniculatus (Latreille, 1811). The significance of the species as vectors of Chagas disease in Suriname is discussed.

Evidence of an increased incidence of day 3 parasitaemia in Suriname: an indicator of the emerging resistance of Plasmodium falciparum to artemether

The emerging resistance to artemisinin derivatives that has been reported in South-East Asia led us to assess the efficacy of artemether-lumefantrine as the first line therapy for uncomplicated Plasmodium falciparum infections in Suriname. This drug assessment was performed according to the recommendations of the World Health Organization in 2011. The decreasing number of malaria cases in Suriname, which are currently limited to migrating populations and gold miners, precludes any conclusions on artemether efficacy because adequate numbers of patients with 28-day follow-up data are difficult to obtain. Therefore, a comparison of day 3 parasitaemia in a 2011 study and in a 2005/2006 study was used to detect the emergence of resistance to artemether. The prevalence of day 3 parasitaemia was assessed in a study in 2011 and was compared to that in a study in 2005/2006. The same protocol was used in both studies and artemether-lumefantrine was the study drug. Of 48 evaluable patients in 2011, 15 (31%) still had parasitaemia on day 3 compared to one (2%) out of 45 evaluable patients in 2005/2006. Overall, 11 evaluable patients in the 2011 study who were followed up until day 28 had negative slides and similar findings were obtained in all 38 evaluable patients in the 2005/2006 study. The significantly increased incidence of parasite persistence on day 3 may be an indication of emerging resistance to artemether.

Carbon dioxide baited trap catches do not correlate with human landing collections of Anopheles aquasalis in Suriname

Three types of carbon dioxide-baited traps, i.e., the Centers for Disease Control Miniature Light Trap without light, the BioGents (BG) Sentinel Mosquito Trap (BG-Sentinel) and the Mosquito Magnet® Liberty Plus were compared with human landing collections in their efficiency in collecting Anopheles (Nyssorhynchus) aquasalis mosquitoes. Of 13,549 total mosquitoes collected, 1,019 (7.52 percent) were An. aquasalis. Large numbers of Culex spp were also collected, in particular with the (BG-Sentinel). The majority of An. aquasalis (83.8 percent) were collected by the human landing collection (HLC). None of the trap catches correlated with HLC in the number of An. aquasalis captured over time. The high efficiency of the HLC method indicates that this malaria vector was anthropophilic at this site, especially as carbon dioxide was insufficiently attractive as stand-alone bait. Traps using carbon dioxide in combination with human odorants may provide better results.

Anaemia in young children living in the Surinamese interior: the influence of age, nutritional status and ethnicity

OBJECTIVE: Anaemia may lead to poor motor development and impaired neurocognitive function and affects 43% of children 1–5 years worldwide. Currently, there is little information on the prevalence of anaemia in young children living in the interior of Suriname. This study investigates the prevalence of anaemia in these children and the influence of the associated factors of age, nutritional status and ethnicity. SUBJECTS AND METHODS: Haemoglobin levels and anthropometric measurements of children aged 1–5 years were collected, after informed consent was provided, in three different interior regions of Suriname in the period September–October 2015. World Health Organization(WHO) standards for anaemia and underweight assessment were applied. Logistic regression models were computed to examine independent associations between the anaemic and non-anaemic groups and were expressed as odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: Six hundred and six children were included: 330(55%) very young (1–3 years) and 276 older (4–5 years). Younger age was associated with anaemia (OR = 2.45;95% CI 1.75, 3.45). Anaemia was less prevalent in Amerindian than in Maroon children (OR = 0.51; 95% CI0.34, 0.76). Haemoglobin level was not influenced by nutritional status. CONCLUSIONS: The prevalence of anaemia in children 1–5years old living in Suriname’s interior is high (55%) compared to similar aged children in Latin America and the Caribbean (4–45%). Children 1–3 years of age were more affected than 4–5-year old children, as were Maroon children compared to Amerindian children. Nutritional status was not of influence. These findings call for further studies and may support adaptation of anaemia prevention and control programmes in young children in Suriname.

Prevalence of major cardiovascular risk factors in urban Suriname: The HELISUR study

OBJECTIVE: To assess the prevalence of major cardiovascular risk factors among the multi-ethnic population of Suriname, a middle-income country in South America. SUBJECTS AND METHODS: The Healthy Life in Suriname (HELISUR) study is a cross-sectional study conducted in a random clustered household sample of 1800 participants living in urban Paramaribo. Ancestry was self-defined. Data were collected with the use of questionnaires and physical and laboratory examinations. Height, weight and sitting blood pressure were measured in duplicate. Differences between ethnic groups were tested using ÷2 tests.RESULTS: Questionnaires were administered to 1800 subjects(mean age: 43 [range 18-71] years). Of this sample, 1159 (65%) participated in the physical examination, including South Asians (34%), Indonesians (9%), Creole(21%), Maroons (19%) and other ancestries (17%). Prevalence of cardiovascular risk factors was 37% for obesity, 40% for hypertension, 15% for diabetes and 11% for hypercholesterolaemia. Except for obesity and hypertension, we found substantial differences in prevalence of risk factors between ancestry groups (all p < 0.01). Prevalence of diabetes and hypercholesterolaemia was higher among South Asians and Indonesians compared to Creole and Maroons. CONCLUSION: We found a high prevalence of cardiovascular risk factors in urban Surinamese participants. Compared to African-Surinamese, Asian-Surinamese showed a more adverse cardiovascular risk profile. Ethnic specific strategies prioritizing screening and control of cardiovascular risk factors should be developed to safeguard the cardiovascular health of the Surinamese population.