Adequate antenatal care and ethnicity affect preterm birth in pregnant women living in the tropical rainforest of Suriname.

BACKGROUND: Adequate antenatal care (ANC) services are key for early identification of pregnancy related risk factors and maintaining women's health during pregnancy. This study aimed to assess the influence of ANC provided by the Medical Mission Primary Health Care Suriname (MMPHCS) and of ethnicity on adverse birth outcomes in Tribal and Indigenous women living in Suriname's remote tropical rainforest interior. METHOD: From April 2017 to December 2018 eligible Tribal and Indigenous women with a singleton pregnancy that received ANC from MMPHCS were included in the study. Data on low birth weight (LBW < 2500 g), preterm birth (PTB < 37 weeks), low Apgar score (< 7 at 5 min), parity (≤1 vs. > 1) and antenatal visits utilization (≥8 vs. < 8) in 15 interior communities were retrospectively analyzed using descriptive statistics, crosstabs and Fisher's exact tests. RESULTS: A total of 204 women were included, 100 (49%) were Tribal, mean age was 26 ± 7.2 years and 126 women (62%) had 8 or more ANC visits. One participant had a miscarriage; 22% had adverse birth outcomes: 16 (7.9%) LBW and 30 (14.8%) PTB; 7 women had a child with both PTB and LBW; 5 women had stillbirths. None of the newborns had low Apgar scores. Maternal age, ethnicity, ANC and parity were associated with PTB (χ2 = 8,75, p = 0.003, χ2 = 4,97, p = 0.025, χ2 = 17,45, p < 0.001, χ2 = 11,93, p < 0.001 respectively). CONCLUSION: Despite an almost 100% study adherence over one fifth of women that received ANC in the interior of Suriname had adverse birth outcomes, in particular PTB and LBW. Younger nulliparous Indigenous women with less than the recommended 8 ANC visits had a higher risk for PTB. The rate of adverse birth outcomes highlights the need for further research to better assess factors influencing perinatal outcomes and to put strategies in place to improve perinatal outcomes. Exposure assessment of this sub-cohort and neurodevelopment testing of their children is ongoing and will further inform on potential adverse health effects associated with environmental exposures including heavy metals such as mercury and lead.

Knowledge and awareness of health effects related to the use of mercury in artisanal and small-scale gold mining in Suriname.

BACKGROUND: The use of mercury in artisanal and small-scale gold mining has negative effects on human health and the environment. In Suriname, the current gold rush resulted in estimated mercury emissions up to 63t per year. To reduce the use of mercury and the subsequent health impact to gold miners and local inhabitants, knowledge and awareness in the community should be increased. METHODS: This study evaluated the effects of a health education programme (HEP) on the levels of knowledge and awareness among local inhabitants and small-scale gold miners in active gold mining areas in the interior of Suriname, South-America. Baseline knowledge levels were assessed with a survey prior to the implementation of the HEP. Thereafter, the exact same questions were asked to evaluate the effects. A total of 959 local inhabitants and 140 gold miners completed the survey including five topics: general knowledge on mercury, potential routes of exposure, health risks for children versus adults, mercury related health effects, and reproductive risks. Additionally, participants were asked in a separate survey (n = 107) about potential exposure reduction techniques and their willingness to be involved in a future human biomonitoring programme. RESULTS: The HEP influenced knowledge on exposure routes of mercury (increase from 64% to 78% of respondents who could name the relevant exposure routes) and on health effects attributed to mercury (increase from 48% to 70% of respondents who were able to list the correct health effects). After the HEP, 70% of the respondents affirmed the higher sensitivity of children, while knowledge on reproductive health effects increased from 39% to 63%. Self-estimated levels of knowledge also increased, indicating lower anxiety regarding potential risks of mercury. Gold miners reported to be willing to improve their work procedures (e.g. burning amalgam with a retort), although suitable tools were not always available. Consistent results were found for individuals included in both surveys, before and after the health education programme. Almost all respondents in the separate survey reported to be willing to give consent for participation in a future human biomonitoring programme, for themselves and their children. CONCLUSION: The implementation of a health education programme within an existing local healthcare structure proved effective and levels of knowledge and awareness improved. Most improved was the knowledge on health effects attributable to mercury, more specifically reproductive health effects.

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

PURPOSE: This study investigates the prevalence of anemia in young children living in the interior of Suriname and the influence of the associated factors age, nutritional status and ethnicity. RESULTS: In this cross-sectional observational study, 606 children aged 1-5 years from three different regions of Suriname's interior were included, and hemoglobin levels and anthropometric measurements were collected. Logistic regression models were computed to examine independent associations between anemic and nonanemic groups and to measure the influence of age, nutritional status and ethnicity. RESULTS: A total of 606 children were included, of whom 330 (55%) were aged 1-3 years and 276 were aged 4-5 years. The overall prevalence of anemia was 63%. Younger age was associated with anemia (odds ratio [OR]=1.78; 95% confidence interval [CI]: 1.27-2.51). Anemia was less prevalent in Amerindian than in Maroon children (OR=0.51; 95% CI: 0.34-0.76). Hemoglobin level was not influenced by nutritional status nor by sex. CONCLUSION: The prevalence of anemia in children aged 1-5 years living in Suriname's interior is high (63%) compared to that in similar aged children in Latin America and the Caribbean (4-45%). Children aged 1-3 years were more affected than those aged 4-5 years as were Maroon children compared to Amerindian children. Nutritional status and sex were not of influence.

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.