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.

Is religious affiliation associated with parent disciplinary behavior in Suriname and Guyana.

BACKGROUND: Although limited, there is some evidence that certain physical punishments may vary by household religion. OBJECTIVE: This study aimed to determine whether parent disciplinary behavior varies by religious affiliation in two countries which have large, diverse religious groups. PARTICIPANTS AND SETTING: Data from Multiple Indicator Cluster Surveys for Suriname (2018) and Guyana (2019-20), which contain nationally representative household samples, were used. The study was restricted to the three most prevalent religious groups: Christians, Hindus, and Muslims. METHODS: Adult responses to a standardized survey that included questions about use of disciplinary behaviors in the household towards children (aged 1-14 years) were examined in relation to religious affiliation of the head-of-household and multiple covariates. RESULTS: Of the 3518 Suriname households, 62.4 %, 23.3 % and 14.3 % were Christians, Hindus, and Muslims, respectively. Compared to Christians, children in both Hindu and Muslim households had significantly lower odds of being hit with an object in adjusted logistic regression models. However, only Hindus had lower odds of being spanked and Muslims lower odds of exposure to a combined physical and non-physical practice, compared to Christians. Of the 2535 Guyana households, 69.5 %, 23.5 % and 7.0 % were Christians, Hindus, and Muslims, respectively. Children in Hindu, but not Muslim households, had significantly lower odds of being spanked, hit with an object, and exposed to a combine practice in adjusted models compared to Christians. CONCLUSIONS: Partial support was found for a potential influence of religion on some disciplinary behaviors. Further investigation is warranted to identify possible conditions and mechanisms.

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.

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.

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).

Evaluating elimination of mother-to-child transmission of HIV in Suriname: a mixed method study / Estudio con métodos mixtos para evaluar la eliminación de la transmisión maternoinfantil del VIH en Suriname / Avaliação da eliminação da transmissão materno-infantil do HIV no Suriname: estudo de métodos mistos

[ABSTRACT]. Objectives. To evaluate the cascade of care for the elimination of mother-to-child-transmission of human immunodeficiency virus (HIV) in Suriname and identify sociodemographic and clinical factors preventing transmission to exposed infants. Methods. A mixed-methods study design was used. Antenatal care data from the 2018 cross-sectional multi- indicator cluster survey on 1 026 women aged 15–49 years who had had a live birth in the previous 2 years were used. Furthermore, national data on a cohort of 279 mothers with HIV and their 317 infants born from 2016 to 2018 were evaluated. Additionally, 13 cases of mother-to-child-transmission of HIV were reviewed. Results. In 89.3% of cases, no mother-to-child HIV transmission occurred. Early cascade steps show that 28.4% of women had unmet family planning needs, 15% had no antenatal visits, 8% delivered outside a health facility, and 71.5% received an HIV test during antenatal care. Of the pregnant women with HIV, 84.2% received antiretroviral therapy, while 95.5% of their infants received HIV prophylactic treatment. Receiving antiretroviral therapy for the mother (odds ratio (OR) 45.4, 95% confidence interval (CI) 9.6–215.3) and the child (OR 145.7, 95% CI 14.4–1477.4) significantly increased the odds of a negative HIV test result in infants. Conversely, living in the interior decreased the odds (OR 0.2, 95% CI 0.4–0.7) compared with urban living. Conclusions. HIV medication for mothers with HIV and their infants remains key in the prevention of mother- to-child-transmission of HIV. Early prenatal care with follow-up should be strengthened in Suriname.

[RESUMEN]. Objetivos. Evaluar la secuencia de la atención para la eliminación de la transmisión maternoinfantil del virus de la inmunodeficiencia humana (VIH) en Suriname y determinar los factores sociodemográficos y clínicos que previenen la transmisión a lactantes expuestos al virus. Métodos. En este estudio se empleó un diseño de métodos mixtos. Se utilizaron los datos de atención prena- tal procedentes de la encuesta transversal de indicadores múltiples por conglomerados del 2018, realizada en 1 026 mujeres de entre 15 y 49 años que habían dado a luz a un nacido vivo en los dos años anteriores. También se evaluaron los datos nacionales correspondientes a una cohorte de 279 madres con infección por el VIH y sus 317 bebés nacidos entre el 2016 y el 2018. Además, se analizaron en detalle 13 casos de trans- misión maternoinfantil del VIH. Resultados. En el 89,3% de los casos no hubo transmisión maternoinfantil del VIH. En las etapas iniciales de la secuencia de la atención se observó que el 28,4% de las mujeres no tenían cubiertas sus necesidades de planificación familiar; además, el 15% no dispusieron de consultas de atención prenatal, el 8% dieron a luz fuera de un centro de salud y en el 71,5% se llevó a cabo una prueba de detección del VIH en el marco de la atención prenatal. De las mujeres embarazadas con infección por el VIH, el 84,2% recibió un tratamiento antirretroviral, mientras que el 95,5% de los bebés recibieron un tratamiento profiláctico contra el VIH. La administración de tratamiento antirretroviral a la madre (cociente de posibilidades [OR] = 45,4; intervalo de confianza [IC] del 95%: 9,6-215,3) y al bebé (OR = 145,7; IC del 95%: 14,4-1477,4) hizo que aumentaran significativamente las posibilidades de obtener un resultado negativo en la prueba de detección del VIH en los lactantes. Por el contrario, residir en el interior del país hizo que disminuyeran dichas posibilidades (OR = 0,2; IC del 95%: 0,4-0,7), en comparación con residir en un entorno urbano. Conclusiones. Para las madres con infección por el VIH y para sus bebés, los medicamentos contra el VIH siguen siendo esenciales para prevenir la transmisión maternoinfantil del VIH. En Suriname debe reforzarse la atención prenatal temprana, incluido el seguimiento.

[RESUMO]. Objetivos. Avaliar a cascata de atendimento para a eliminação da transmissão materno-infantil do vírus da imunodeficiência humana (HIV) no Suriname e identificar fatores sociodemográficos e clínicos que impedem a transmissão a bebês expostos. Métodos. Foi utilizado um delineamento de estudo com métodos mistos. Foram usados dados de atendi- mento pré-natal de uma pesquisa de indicadores múltiplos por conglomerados de corte transversal realizada em 2018, que incluiu 1 026 mulheres com idades entre 15 e 49 anos que haviam tido um nascido vivo nos dois anos anteriores. Além disso, foram avaliados os dados nacionais de uma coorte de 279 mães com HIV e seus 317 bebês nascidos vivos de 2016 a 2018, além de 13 casos de transmissão materno-infantil de HIV. Resultados. Em 89,3% dos casos, não houve transmissão materno-infantil do HIV. As etapas iniciais da cas- cata demonstram que 28,4% das mulheres tiveram necessidades não atendidas de planejamento familiar, 15% não fizeram consultas pré-natais, 8% tiveram o parto fora de uma unidade de saúde e 71,5% receberam um teste de HIV durante o atendimento pré-natal. Das gestantes com HIV, 84,2% receberam terapia antirre- troviral, e 95,5% de seus bebês receberam tratamento profilático para o HIV. O tratamento antirretroviral da mãe (razão de chances [RC]: 45,4; intervalo de confiança [IC] de 95%: 9,6–215,3) e da criança (RC: 145,7; IC 95%: 14,4–1477,4) aumentou significativamente a probabilidade de um resultado negativo no teste de HIV dos bebês. Por outro lado, morar no interior diminuiu a probabilidade (RC: 0,2; IC 95%: 0,4–0,7) em compa- ração com o ambiente urbano. Conclusões. A medicação de mães e bebês contra o HIV continua sendo fundamental para a prevenção da transmissão materno-infantil do HIV. Deve-se reforçar o atendimento pré-natal precoce com acompanha- mento no Suriname.

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.

Fruit and seed traits and vertebrate-fruit interactions of tree species occurring in Guyana, Suriname, and French Guiana.

Seed dispersal is widely considered an important mechanism for the conservation of plant diversity. In tropical regions, over 80% of woody plant species are dispersed by vertebrates, often through the consumption of fruits. Our understanding of what drives interactions between vertebrates and fruits is limited. Through a systematic literature search, we compiled a database of fruit and seed traits and vertebrate-fruit interactions for tree and vertebrate species occurring in the Guianas, with the aim of facilitating research into seed dispersal and seed predation of tree species in the Guianas. The database was compiled by extracting data from 264 published sources. It consists of 21,082 records, of which 19,039 records contain information about 19 different fruit and seed traits belonging to 1622 different tree species. The other 2043 records contain information on vertebrate-fruit interactions between 161 vertebrate species and 464 tree species. Our analyses showed a taxonomic bias, particularly in the interaction data, toward large-bodied vertebrates, with most interactions recorded for the bearded saki (Chiropotes chiropotes), followed by the lowland tapir (Tapirus terrestris). For plants we found an overrepresentation of the Sapotaceae and Moraceae families and an underrepresentation of the Rubiaceae, Myrtaceae, and Lauraceae families in the interactions. There are no copyright restrictions on the data set; please cite this publication when using these data.

The Case for Investment in Prevention and Control of Noncommunicable Diseases and Mental Disorders in Suriname: A return-on-investment analysis

This report presents the results of the investment case for prevention and control of noncommunicable diseases (NCDs) and mental health in Suriname, and develops evidence and guidance to support the financing and implementation of national multisectoral NCDs prevention, control strategies, and treatment of mental health conditions. The study estimates the return on investment from implementing or scaling up priority interventions to reduce specific NCDs and mental health conditions, and also evaluates the political feasibility of putting these interventions into practice.

Contrasting mercury contamination scenarios and site susceptibilities confound fish mercury burdens in Suriname, South America.

In Suriname, mercury (Hg) use has recently increased because of gold mining, which has put fish-reliant communities (e.g., Indigenous and Tribal) at risk of enhanced Hg exposure through the riverine fish these communities consume. To quantify how the magnitude of these risks change according to location and time, we measured total mercury (HgT) in fish at sites downstream and upstream of an artisanal and small-scale gold mining (ASGM) operation in 2004-2005 and in 2017-2018. We tested whether fish HgT burdens over dynamic ranges were increased. Surprisingly, our findings did not support broadly increased fish Hg burden over time or that proximity to ASGM was diagnostic to fish HgT-burden. Subsequently, we elected to test the HgT stable isotope ratios on a set of freshly collected 2020 fish to determine whether differences in Hg source and delivery pathways might cofound results. We found that remote unmined sites were more susceptible to gaseous elemental Hg deposition pathways, leading to enhanced risk of contamination, whereas ASGM proximate sites were not. These results highlight that elemental mercury releases from ASGM practices may have significant impact on fish-reliant communities that are far removed from ASGM point source contamination.

From an interventional study to a national scale-up: lessons learned from the Malakit strategy at the French Guiana-Suriname border.

Scaling-up an experimental intervention is always a challenge. On the border between French Guiana, Brazil and Suriname, an interventional study demonstrated the effectiveness of distributing self-diagnosis and self-treatment kits (Malakits) to control malaria in mobile and hard-to-reach populations. Its integration into the Suriname's National Malaria Elimination Plan after a 2-year experiment faced numerous challenges, including human resources to cope with the additional workload of coordinators and to maintain the motivation of community health workers. The economic recession in Suriname, the Covid pandemic, and logistical issues also hampered the scale-up. Finally, thanks to the commitment of stakeholders in Suriname and French Guiana, the integration of Malakit distribution into the Surinamese national programme was proved possible.

Anticipated benefits and challenges of implementing group care in Suriname's maternity and child care sector: a contextual analysis.

BACKGROUND: Suriname is a uppermiddle-income country with a relatively high prevalence of preventable pregnancy complications. Access to and usage of high-quality maternity care services are lacking. The implementation of group care (GC) may yield maternal and child health improvements. However, before introducing a complex intervention it is pivotal to develop an understanding of the local context to inform the implementation process. METHODS: A context analysis was conducted to identify local needs toward maternity and postnatal care services, and to assess contextual factor relevant to implementability of GC. During a Rapid Qualitative Inquiry, 63 online and face-to-face semi-structured interviews were held with parents, community members, on-and off-site healthcare professionals, policy makers, and one focus group with parents was conducted. Audio recordings were transcribed in verbatim and analysed using thematic analysis and Framework Method. The Consolidated Framework for Implementation Research served as a base for the coding tree, which was complemented with inductively derived codes. RESULTS: Ten themes related to implementability, one theme related to sustainability, and seven themes related to reaching and participation of the target population in GC were identified. Factors related to health care professionals (e.g., workload, compatibility, ownership, role clarity), to GC, to recipients and to planning impact the implementability of GC, while sustainability is in particular hampered by sparse financial and human resources. Reach affects both implementability and sustainability. Yet, outer setting and attitudinal barriers of health professionals will likely affect reach. CONCLUSIONS: Multi-layered contextual factors impact not only implementability and sustainability of GC, but also reach of parents. We advise future researchers and implementors of GC to investigate not only determinants for implementability and sustainability, but also those factors that may hamper, or facilitate up-take. Practical, attitudinal and cultural barriers to GC participation need to be examined. Themes identified in this study will inspire the development of adaptations and implementation strategies at a later stage.

Corrigendum to factors associated with COVID-19 length of hospitalization and mortality during four epidemic waves, March 2020–November 2021, Suriname

[ENGLISH]. Corrigendum to Gokoel AR; Jairam M; Mendeszoon A; Liauw Kie Fa L; Poese F; Jarbandhan A, et al. Factors associated with COVID-19 length of hospitalization and mortality during four epidemic waves, March 2020–November 2021, Suriname. Rev Panam Salud Publica. 2023;47:e100. https://doi.org/10.26633/RPSP.2023.100

[ESPAÑOL]. Corrigendum a Gokoel AR; Jairam M; Mendeszoon A; Liauw Kie Fa L; Poese F; Jarbandhan A, et al. Factores asociados a la duración de la hospitalización y la mortalidad por COVID-19 en cuatro oleadas epidémicas, de marzo del 2020 a noviembre del 2021 en Suriname. Rev Panam Salud Publica. 2023;47:e100. https://doi.org/10.26633/RPSP.2023.100

[PORTUGUÊS]. Corrigendum à Fatores associados à duração da internação e à mortalidade por COVID-19 durante quatro ondas epidêmicas, de março de 2020 a novembro de 2021, no Suriname. Rev Panam Salud Publica. 2023;47:e100. https://doi.org/10.26633/RPSP.2023.100

Perfil de carga de enfermedad por diabetes 2023: Suriname

El propósito fundamental de esta serie de perfiles nacionales de la carga de enfermedad por diabetes y de enfermedad renal crónica debida a diabetes es apoyar a los países de la Región de las Américas en el seguimiento de las estrategias puestas en marcha para enfrentar la diabetes. Esta primera versión de los perfiles, que abarca el período comprendido entre el 2000 y el 2019, muestra la tendencia de la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida ajustados por discapacidad de ambas enfermedad. Se han elaborado con los últimos datos disponibles de las estimaciones mundiales de salud de la Organización Mundial de la Salud y tiene como objetivo convertirse en una herramienta útil para llevar a cabo el monitoreo de las estrategias conexas.

Involving hard-to-reach populations is pivotal for the tailoring and implementation of an epidemiological study in cross-border communities of French Guiana and Suriname.

Background: Hard-to-reach, vulnerable and cross-border populations are often disproportionately affected by communicable diseases. Epidemiological data on viral hepatitis in French Guiana and Suriname are available for urban areas, but not for remote communities. The Maroni River, which separates FG and Suriname, is home to Tribal and Indigenous communities. Reaching these populations is challenging due to logistical constraints, cultural and language barriers, and mistrust of outsiders. Objectives: We aimed to conduct an epidemiological study of viral hepatitis [Maroni Hepatites Virales (MaHeVi)] in this remote and complex area. Here, we describe the operational hurdles and solutions required to achieve this. Methods: We undertook a preliminary assessment of the area with local community leaders and health workers to gain approval of MaHeVi, acceptance of blood sampling, and suggestions for adapting the study to cultural and logistical constraints. Anthropological assessments were conducted through focus groups and interviews with key individuals to assess knowledge, beliefs and risk factors for VH. Results: MaHeVi was well received by the local communities. The approval of the community leaders was crucial for the implementation and acceptance of the study. The main adaptations were hiring community health mediators to overcome cultural and language differences, using blotting paper instead of venipuncture for logistical and acceptability reasons, and adapting communication materials. Conclusion: Careful preparation and tailoring of the communication materials and research protocol have enabled the successful implementation of the study. This process could be replicated in this area and transferred to other complex contexts combining borders, logistical hurdles and populations requiring cultural adaptations.