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.

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.

The impact of COVID-19 on heart failure admissions in Suriname-A call for action.

INTRODUCTION: During the height of the COVID-19 pandemic, there was a worldwide reorganization of healthcare systems focusing on limiting the spread of the virus. The impact of these measures on heart failure (HF) admissions is scarcely reported in Low and Middle Income Countries (LMICs) including Suriname. We therefore assessed HF hospitalizations before and during the pandemic and call for action to improve healthcare access in Suriname through the development and implementation of telehealth strategies. METHODS: Retrospectively collected clinical (# hospitalizations per patient, in hospital mortality, comorbidities) and demographic (sex, age, ethnicity) data of people hospitalized with a primary or secondary HF discharge ICD10 code in the Academic Hospital Paramaribo (AZP) from February to December 2019 (pre-pandemic) and February to December 2020 (during the pandemic) were used for analysis. Data are presented as frequencies with corresponding percentages. T-tests were used to analyze continuous variables and the two-sample test for proportions for categorical variables. RESULTS: There was an overall slight decrease of 9.1% HF admissions (N pre-pandemic:417 vs N during the pandemic: 383). Significantly less patients (18.3%, p-value<0.00) were hospitalized during the pandemic (N: 249 (65.0%)) compared to pre-pandemic (N: 348 (83.3%)), while readmissions increased statistically significantly for both readmissions within 90 days (75 (19.6%) vs 55 (13.2%), p-value = 0.01) and readmissions within 365 days (122 (31.9%) vs 70 (16.7%), p-value = 0.00) in 2020 compared to 2019. Patients admitted during the pandemic also had significantly more of the following comorbidities: hypertension (46.2% vs 30.6%, p-value = 0.00), diabetes (31.9% vs 24.9%, p-value = 0.03) anemia (12.8% vs 3.1%, p-value = 0.00), and atrial fibrillation (22.7% vs 15.1%, p-value = 0.00). CONCLUSION: HF admissions were reduced during the pandemic while HF readmissions increased compared to the pre-pandemic period. Due to in-person consultation restrictions, the HF clinic was inactive during the pandemic period. Distance monitoring of HF patients via telehealth tools could help in reducing these adverse effects. This call for action identifies key elements (digital and health literacy, telehealth legislation, integration of telehealth tools within the current healthcare sector) needed for the successful development and implementation of these tools in LMICs.

National Action Plan for the Prevention and Control of Noncommunicable Diseases 2015-2020

NCDs are the main cause of mortality and morbidity in Suriname, as is the case in most of the countries in the world. At the UN High Level Meeting in September 2011, Suriname endorsed the UN resolution on NCDs, immediately after which the government assigned a special budget to the MOH to support prevention and control activities in the area of NCDs. This illustrates that the government takes up its own responsibility in the fight against the epidemic of NCDs. One of the first priorities has been the development of this National Action Plan for the Prevention and Control of NCDs which provides a framework for a coordinated and integrated approach during the coming years in the fight against NCDs in our country. The elements of the NCD plan focus on public awareness of the NCD burden, healthy lifestyle promotion, health systems strengthening, strengthening of the legal framework, strengthening of surveillance and operational research and the strengthening of monitoring and evaluation systems. For the coming years the priority NCDs namely cancer, diabetes, and cardiovascular disease which account for 60% of mortality nationwide will be targeted. Another priority health area which also will be included is mental health and substance abuse. The fight against NCDs cannot be successful without a strong intersectoral collaboration which is crucial for healthy lifestyle promotion and risk factor reduction. This plan calls for a collective effort through the establishment of structured intersectoral cooperation with other ministries, private sector and civil society. Periodic evaluations are an essential part of the fight of all diseases and specifically of NCDs which require more complex interventions than the communicable diseases. This NCD plan is a dynamic document which will be periodically revised in order to enable us to keep on track towards the goals set. As health sector and as a nation we have to join hands, be accountable and share responsibility to be able to really tackle the burden of NCDs. We owe it to the next generation.

[The many challenges of population health and healthcare in Suriname since 1975]. / De vele uitdagingen van de gezondheidszorg in Suriname sinds 1975.

Suriname inherited a weak colonial health system after political independence in 1975. In the decades that followed, political and economic developments have had an undeniable influence on the health situation and healthcare in Suriname, as well as on the (feasibility of the implementation of) plans to reform the healthcare system. The Surinamese health outcomes are not only particularly unfavorable compared to the Netherlands, but also compared to other states in the Caribbean region. Some national determinants strongly related to the implementation of effective health measures contribute to this: a low GDP, low control on corruption, sparsely populated areas and high ethnic diversity. The enormous impact of the COVID-19 pandemic in Suriname appears to have been the tipping point for a renewed relationship with the Netherlands. Almost 50 years after political independence, the Surinamese Ministry of Health, with the support of funding and expertise from the Netherlands, is embarking on an ambitious program to restore the health system.

Reduced Mortality among COVID-19 ICU Patients after Treatment with HemoClear Convalescent Plasma in Suriname.

Convalescent plasma is a promising therapy for coronavirus disease 2019 (COVID-19), but its efficacy in intensive care unit (ICU) patients in low- and middle-income country settings such as Suriname is unknown. Bedside plasma separation using the HemoClear device made convalescent plasma therapy accessible as a treatment option in Suriname. Two hundred patients with severe SARS-CoV-2 infection requiring intensive care were recruited. Fifty eight patients (29%) received COVID-19 convalescent plasma (CCP) treatment in addition to standard of care (SOC). The CCP treatment and SOC groups were matched by age, sex, and disease severity scores. Mortality in the CCP treatment group was significantly lower than that in the SOC group (21% versus 39%; Fisher's exact test P = 0.0133). Multivariate analysis using ICU days showed that CCP treatment reduced mortality (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.18 to 0.66; P = 0.001), while complication of acute renal failure (creatinine levels, >110 mol/L; HR, 4.45; 95% CI, 2.54 to 7.80; P < 0.0001) was independently associated with death. Decrease in chest X-ray score in the CCP treatment group (median -3 points, interquartile range [IQR] -4 to -1) was significantly greater than that in the SOC group (median -1 point, IQR -3 to 1, Mann-Whitney test P = 0.0004). Improvement in the PaO2/FiO2 ratio was also significantly greater in the CCP treatment group (median 83, IQR 8 to 140) than in the SOC group (median 35, IQR -3 to 92, Mann-Whitney P = 0.0234). Further research is needed for HemoClear-produced CCP as a therapy for SARS-CoV-2 infection together with adequately powered, randomized controlled trials. IMPORTANCE This study compares mortality and other endpoints between intensive care unit COVID-19 patients treated with convalescent plasma plus standard of care (CCP), and a control group of patients hospitalized in the same medical ICU facility treated with standard of care alone (SOC) in a low- and middle-income country (LMIC) setting using bedside donor whole blood separation by gravity (HemoClear) to produce the CCP. It demonstrates a significant 65% survival improvement in HemoClear-produced CCP recipients (HR, 0.35; 95% CI, 0.19 to 0.66; P = 0.001). Although this is an exploratory study, it clearly shows the benefit of using the HemoClear-produced CCP in ICU patients in the Suriname LMIC setting. Additional studies could further substantiate our findings and their applicability for both LMICs and high-income countries and the use of CCP as a prepared readiness method to combat new viral pandemics.

Prevalence of musculoskeletal complaints and health-related quality of life in a Maroon and Kalinya Indigenous rural village in Suriname.

PURPOSE: Musculoskeletal complaints (MSCs), a leading contributor to disability worldwide, have a major impact on health-related quality of life (HRQoL). Poor general health related to lifestyle factors such as smoking, alcohol consumption and physical inactivity can lead to a higher risk to suffer MSCs. For minority groups in Suriname such as the Maroons and the Indigenous peoples no research has been conducted regarding prevalence of MSCs, HRQoL and various lifestyle factors. The aims were to determine the prevalence of MSCs and HRQoL in two rural tribal villages in the forested interior of Suriname and to identify various lifestyle factors associated with HRQoL in these communities. METHOD: This was a cross-sectional community-based study using the Community Oriented Program for the Control of Rheumatic Diseases stage 1, phase 1 & 2 methodology in Goejaba, a Maroon village and Galibi, an Indigenous rural village. Sociodemographic data, self-reported comorbidities, past MSCs (for longer than seven days), lifestyle factors including smoking, alcohol use, body mass index (BMI) and physical activity (PA), and HRQoL (using the 36-item Short Form Survey (SF-36)) data were gathered among 153 Indigenous individuals in Galibi, and 516 Maroons in Goejaba. Regression models were constructed to explore associations between presence of MSCs, lifestyle factors and HRQoL. RESULTS: High prevalence rates for past MSCs were reported in Galibi (72.4%) and Goejaba (58.3%). In both communities, respondents with MSCs reported significantly worse HRQoL than persons without MSCs. MSCs and the presence of comorbidities had a strong negative association with HRQoL, whereas PA positively influenced the physical and mental health domains of the SF-36. Smoking, alcohol use and BMI showed no association with HRQoL. CONCLUSIONS: In this first study, a high prevalence for MSCs was reported in an Indigenous and Maroon rural community in Suriname. MSCs and comorbidities had a significant negative impact on HRQoL. PA was associated with higher self-reported HRQoL.

Dengue, chikungunya and Zika virus infections among Dutch travellers to Suriname: a prospective study during the introduction of chikungunya and Zika virus, 2014 to 2017.

BackgroundSuriname, a country endemic for dengue virus (DENV), is a popular destination for Dutch travellers visiting friends and relatives and tourist travellers. Chikungunya and Zika virus (CHIKV, ZIKV) were introduced in 2014 and 2015, respectively. Data on infection risks among travellers are limited.AimWe aimed to prospectively study incidence rate (IR) and determinants for DENV, ZIKV and CHIKV infection in adult travellers to Suriname from 2014 through 2017.MethodsParticipants kept a travel diary and were tested for anti-DENV, anti-ZIKV and anti-CHIKV IgG antibodies (Euroimmun). Selected samples were subjected to an in-house DENV and ZIKV PRNT50. The IR (infections/1,000 person-months of travel) and IR ratio and determinants for infection were calculated.ResultsTravel-acquired infections were found in 21 of 481 participants: 18 DENV, four ZIKV and two CHIKV, yielding an IRDENV of 47.0 (95% CI: 29.6-74.6), IRZIKV of 11.6 (95% CI: 4.4-31.0) and IRCHIKV of 5.6 (95% CI: 1.4-22.2)/1,000 person-months. In nine DENV and three ZIKV infected participants, infections were PRNT50-confirmed, yielding a lower IRDENV of 23.3 (95% CI: 12.1-44.8) and an IRZIKV of 8.4 (95% CI: 2.7-26.1) per 1,000 person-months. Tourist travel was associated with DENV infection. ZIKV and CHIKV infections occurred soon after their reported introductions.ConclusionsDespite an overestimation of serologically confirmed infections, Dutch travellers to Suriname, especially tourists, are at substantial risk of DENV infection. As expected, the risk of contracting ZIKV and CHIKV was highest during outbreaks. Cross-reaction and potential cross-protection of anti-DENV and -ZIKV antibodies should be further explored.

Physical activity, fear avoidance beliefs and level of disability in a multi-ethnic female population with chronic low back pain in Suriname: A population-based study.

BACKGROUND: Chronic low back pain (CLBP) is an important cause for reduced daily physical activity (PA) and loss of quality of life, especially in women. In Suriname, a middle-income country in South America, the relationship between PA and CLBP is still unknown. AIMS: To assess the level of PA in women with CLBP of different ethnicity, and to identify whether fear avoidance beliefs (FAB), disability, co-occurring musculoskeletal pain sites and various sociodemographic and lifestyle factors were associated with self-reported PA. METHODS: A cross-sectional community-based house-to-house survey was conducted between April 2016 and July 2017. The survey followed the Community Oriented Program for Control of Rheumatic Diseases methodology. Selection criteria were being female of Asian-Surinamese, African-Surinamese or of Mixed ethnicity and aged 18 or older, living in an urban area, and reporting CLBP. Data was collected on PA, FAB, disability, co-occurring musculoskeletal pain sites, CLBP intensity and sociodemographic and lifestyle factors. RESULTS: Urban adult women with current CLBP (N = 210) were selected. Nearly 57% of the population met the WHO recommendation on PA, with work-related PA as the largest contributor to total self-reported PA. Most women showed low FAB scores (FABQ-Work ≤34 (96.2%) and FABQ-PA ≤14 (57.6%)) and low disability levels (Oswestry Disability Index ≤20 (62.4%)). An inverse association between total PA and FABQ-Work (OR = 0.132, CI: 0.023; 0.750) was found. In contrast, total PA had a significant, positive association with disability (OR = 2.154, CI: 1.044; 4.447) and workload (OR = 2.224, CI: 1.561; 3.167). All other variables showed no association with total PA. CONCLUSION: This was the first study in Suriname reporting that 43.3% of urban adult women with CLBP were physically inactive. Total self-reported PA is influenced by FABQ-Work, average to heavy workload and moderate to severe disability. In this study, PA-Work was the major contributor to total PA. Therefore, future longitudinal studies should evaluate different types and aspects of PA in relation to CLBP management.

Incidence of Early and Late Onset Neonatal Sepsis in Suriname: A National Tertiary Hospital Birth-cohort Study.

BACKGROUND: Early onset neonatal sepsis (EONS) and late onset neonatal sepsis (LONS) are important causes of neonatal mortality and morbidity. A pressing need for reliable and detailed data of low- and middle-income countries exists. This study aimed to describe the incidence and outcome of neonatal sepsis in the only tertiary hospital of Suriname, a middle-income country in South America. METHODS: Infants born at the Academic Hospital of Paramaribo from May 2017 through December 2018 were prospectively included at birth. Perinatal data, duration of antibiotic treatment, blood culture results and mortality data were gathered. Neonatal sepsis was defined as positive blood culture with a pathogenic microorganism within the first 28 days of life. RESULTS: Of the 2190 infants included, 483 (22%) were admitted to neonatal (intensive) care. The incidence of EONS was 2.1 (95% CI: 0.9-5) per 1000 live births, with no deaths. Antibiotics for suspected EONS were administrated to 189 (8.6%) infants, of whom 155 (82%) were born prematurely. The incidence of LONS cases was 145 (95% CI: 114-176) per 1000 admissions. Gramnegative bacteria accounted for 70% (48 out of 70) of causative organisms. Seventeen deaths were directly caused by sepsis (35 per 1000 admissions). CONCLUSIONS: Findings from this tertiary center birth cohort study in a middle-income setting indicate EONS incidence and outcomes comparable to high-income settings, whereas LONS is a more prevalent and significant challenge with a predominance of gram-negative bacteria, and high mortality.

In a life full of risks, COVID-19 makes little difference. Responses to COVID-19 among mobile migrants in gold mining areas in Suriname and French Guiana.

Worldwide, the socioeconomic impacts of COVID-19 disproportionally affect vulnerable groups in society. This paper assesses responses to, and impacts of, the pandemic among mobile migrant populations who work in Artisanal and Small-scale Gold Mining (ASGM) in Suriname and French Guiana. These populations are characterized by poverty, informal or illegal status, and limited access to health care and information. Field research in Suriname (November 2020-January 2021) and French Guiana (January, May, June 2021) included qualitative interviews, informal conversations and observations, and a quantitative survey with 361 men and women in ASGM communities. Contrary to reports from the ASGM sector elsewhere, interviewed inhabitants of ASGM areas in Suriname and French Guiana showed little concern about COVID-19. Respondents reported feeling safer in the forest where they work than in the urban areas or in their home country. Trust in home remedies and over-the-counter pharmaceuticals further reduced anxiety about the pandemic. Three-quarters of survey respondents reported that the COVID-19 pandemic had not affected their work or income at all. The researchers conclude that in these remote Amazon communities, responses to COVID-19 mirror attitudes and behavior vis-à-vis malaria and other health risks: self-medicate, ignore, and pray. Living on the margins of society mitigates the socioeconomic impacts of COVID-19, as containment measures are not applied to these socially invisible populations. Whereas the urban poor are severely hit by the pandemic, this hidden population benefits from high gold prices, an outdoors lifestyle, and traditional resourcefulness in dealing with a life full of risks.

A survey of depression and anxiety disorders in urban and rural Suriname.

BACKGROUND: Suriname is a Low-middle income country consisting of diverse population groups. Epidemiological studies concerning mental disorders like depression and anxiety had not been conducted until 2015. The treatment gap for mental disorders in Low and middle-income countries (LMICs) may reach 76-80% as treatment is not always readily available. In this study, we estimate and compare the prevalence of potential cases of depression and anxiety, as well as the size of the treatment gap in a rural (Nickerie) and urban (Paramaribo) region of Suriname, a lower middle-income country. METHODS: Subjects were selected by a specific sampling method of the national census bureau. The Center for Epidemiological Studies-Depression (CES-D) was used to assess depression. Generalized anxiety disorder was assessed with the Generalized Anxiety Disorder 7 (GAD-7) and The Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ) were used to assess Panic disorder. The treatment gap was calculated by estimating the percentage of subjects with depression or anxiety that did not seek out professional help. RESULTS: About 18% of the respondents from Nickerie and 16% from Paramaribo were at risk of depression and the established cut-off values of the instruments used indicate that about 3-4% in both regions may suffer from Generalized Anxiety Disorder. Women in both samples were most at risk of high anxiety about body sensations and maladaptive thoughts about panic. The treatment gap varies between 78 and 100% for the two disorders. CONCLUSIONS: A high depression rate has been found in both areas, especially among young females. In addition, a high treatment gap is noted which insinuates that more therapeutic strategies are required to tackle depression and anxiety in Suriname.

Factors Associated With Being Overweight or Obese in Suriname.

Objective: To identify the socio-demographic risk factors that are associated with adult Body Mass Index. Methods: We apply probit and ordinal probit models to a sample of 3,803 adults aged 20 and above from the 2016/17 round of the Suriname Survey of Living Conditions. Results: Women, the elderly, and couples who are either married and/or living together are more likely to be obese or overweight. This is also true for individuals who have chronic illnesses. We also find that individuals who engage in a sport or in other forms of exercise, even if modest, have lower odds of being overweight or obese. Interestingly, our findings indicate that individuals who benefit from government social safety net programs are less likely to be associated with being overweight or obese. Conclusion: Obesity could become a serious public health issue if not addressed appropriately. Policymakers should promptly develop a national strategy to help health care systems cope with the outcomes of obesity and to tackle the risk factors that have the greatest impacts on individual Body Mass Index.

Differences in prevalence of hepatitis B virus infection and genotypes between ethnic populations in Suriname, South America.

Epidemiological data on hepatitis B virus (HBV) are needed to benchmark HBV elimination goals. We recently assessed prevalence of HBV infection and determinants in participants attending the Emergency Department in Paramaribo, Suriname, South America. Overall, 24.5% (95%CI = 22.7-26.4%) of participants had anti-Hepatitis B core antibodies, which was associated with older age (per year, adjusted Odds Ratio [aOR] = 1.03, 95%CI = 1.02-1.04), Afro-Surinamese (aOR = 1.84, 95%CI = 1.52-2.19) and Javanese ethnicity (aOR = 1.63, 95%CI = 1.28-2.07, compared to the grand mean). 3.2% of participants were Hepatitis B surface Ag-positive, which was also associated with older age (per year, aOR = 1.02, 95%CI = 1.00-1.04), Javanese (aOR = 4.3, 95%CI = 2.66-6.95) and Afro-Surinamese ethnicity (aOR = 2.36, 95%CI = 1.51-3.71). Sex, nosocomial or culturally-related HBV transmission risk-factors were not associated with infection. Phylogenetic analysis revealed strong ethnic clustering: Indonesian subgenotype HBV/B3 among Javanese and African subgenotypes HBV/A1, HBV/QS-A3 and HBV/E among Afro-Surinamese. Testing for HBV during adulthood should be considered for individuals living in Suriname, specifically with Javanese and Afro-Surinamese ancestry.

Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study.

BACKGROUND: Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women. METHODS: Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics. RESULTS: The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester. CONCLUSIONS: Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Depression during pregnancy may lead to adverse health effects in mothers and children. While one in five pregnancies resulted in an adverse birth outcome in Suriname, and perceived stress and depression are important risk factors for birth outcomes, data on depression and its risk factors are lacking. This study aimed to determine the association between perceived stress and prenatal depression in Surinamese pregnant women participating in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara study.A total of 1143 pregnant women were included in the study. Using questionnaires, data was collected on demographic factors, perceived stress, social support (including resilience), and probable depression.Perceived stress was somewhat higher during the first two trimesters (27.2%), than the third trimester (24.7%). This was also the case for probable depression; higher during the first two trimesters (22.4%) than during the third trimester (17.6%). The study found a statistically significant association of high perceived stress, low perceived individual resilience, lower education and older maternal age with probable depression during pregnancy.Early detection and effective management of perceived stress and depression during pregnancy are very important. There is a need for prenatal clinics in Suriname to routinely screen for symptoms of perceived stress and depression to minimize the potential impact on mother and child. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Ideal Cardiovascular Health Behaviours in Nationally Representative School-Based Samples of Adolescents in the Caribbean.

BACKGROUND: Ideal cardiovascular health behaviour (CVHB) measures four ideal health behaviours (non-smoking, body mass index <85th Percentile, healthy diet, and physical activity). This study aimed to determine the prevalence, distribution, and correlates of ideal CVHB among adolescents in the Caribbean. METHODS: Nationally representative cross-sectional data of 2016 or 2017 with complete CVHB measurements were analysed from 7556 school adolescents from four Caribbean countries. RESULTS: The prevalence of 0-1 ideal metrics CVHB was 20.4%, 2 ideal metrics 48.7%, and 3-4 ideal metrics 30.8%. Only 5.0% had all 4 ideal CVHB metrics, 41.0% intermediate CVH (≥1 metric in the intermediate category and none in the poor category), and 54.0% had poor CVH (≥1 metric in poor category). In adjusted logistic regression analysis, compared to students from Dominican Republic, students from Jamaica (Adjusted Odds Ratio-AOR: 1.36, 95% confidence interval-CI: 1.01-1.85), students from Trinidad and Tobago (AOR: 1.46, 95% CI: 1.17-1.82) and male sex (AOR: 1.35, 95% CI: 1.11-1.64) were positively associated with meeting 3-4 ideal CVHB metrics. In addition, in unadjusted analysis, rarely or sometimes experiencing hunger was negatively and high peer and parent support were positively associated with meeting 3-4 ideal CVHB metrics. CONCLUSION: The proportion of meeting 3-4 ideal CVHB metrics was low among adolescents in four Caribbean countries. Both high-risk and school-wide intervention programmes should be implemented in aiding to improve CVHB in Caribbean countries. Several factors associated with ideal CVHB were identified, which can be targeted in school health interventions.

Classifying maternal deaths in Suriname using WHO ICD-MM: different interpretation by Physicians, National and International Maternal Death Review Committees.

The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. BACKGROUND: Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. METHODS: The classification of pregnancy-related deaths in Suriname during 2010-2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. RESULTS: Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). CONCLUSIONS: Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

Viral causes of severe acute respiratory infection in hospitalized children and association with outcomes: A two-year prospective surveillance study in Suriname.

BACKGROUND: Viruses are the most frequent cause of severe acute respiratory infection (SARI) in children. It is currently unknown whether presence of a virus, the number of viruses, or type of virus, are associated with clinical outcomes of pediatric SARI in developing countries. METHODS: Between 2012 and 2014 nasopharyngeal swabs and demographic and clinical variables were prospectively collected for surveillance of viral causes of SARI in Surinamese children within 48 hours after hospitalization. These swabs were tested for 18 respiratory viruses using a multiplex polymerase chain reaction (PCR) panel to identify the specific viral causes of SARI, unknown to the treating physicians. In post hoc analyses we evaluated if the PCR results, and demographic and clinical characteristics, were associated with course of disease, duration of respiratory support, and length of stay (LOS). RESULTS: Of a total of 316 analyzed children, 290 (92%) had one or more viruses. Rhinovirus/enterovirus (43%) and respiratory syncytial virus (34%) were most prevalent. Course of disease was mild in 234 (74%), moderate in 68 (22%), and severe in 14 (4%) children. Neither presence of a single virus, multiple viruses, or the type of virus, were different between groups. Prematurity and lower weight-for-age-z-score were independent predictors of a severe course of disease, longer duration of respiratory support, and longer LOS. CONCLUSIONS: Viruses are common causes of pediatric SARI in Suriname, yet not necessarily associated with clinical outcomes. In developing countries, demographic and clinical variables can help to identify children at-risk for worse outcome, while PCR testing may be reserved to identify specific viruses, such as influenza, in specific patient groups or during outbreaks.

Modelling the effect of the COVID-19 pandemic on violent discipline against children.

BACKGROUND: The COVID-19 pandemic could increase violence against children at home. However, collecting empirical data on violence is challenging due to ethical, safety, and data quality concerns. OBJECTIVE: This study estimated the anticipated effect of COVID-19 on violent discipline at home using multivariable predictive regression models. PARTICIPANTS: Children aged 1-14 years and household members from the Multiple Indicator Cluster Surveys (MICS) conducted in Nigeria, Mongolia, and Suriname before the COVID-19 pandemic were included. METHODS: A conceptual model of how the COVID-19 pandemic could affect risk factors for violent discipline was developed. Country specific multivariable linear models were used to estimate the association between selected variables from MICS and a violent discipline score which captured the average combination of violent disciplinary methods used in the home. A review of the literature informed the development of quantitative assumptions about how COVID-19 would impact the selected variables under a "high restrictions" pandemic scenario, approximating conditions expected during a period of intense response measures, and a "lower restrictions" scenario with easing of COVID-19 restrictions but with sustained economic impacts. These assumptions were used to estimate changes in violent discipline scores. RESULTS: Under a "high restrictions" scenario there would be a 35%-46% increase in violent discipline scores in Nigeria, Mongolia and Suriname, and under a "lower restrictions" scenario there would be between a 4%-6% increase in violent discipline scores in these countries. CONCLUSION: Policy makers need to plan for increases in violent discipline during successive waves of lockdowns.