Acceptability and Feasibility of Provision of COVID-19 Services by Community Health Workers to Remote Gold Mining Communities in Suriname.

Gold mining communities in the Amazon region typically have limited access to public health services. In Suriname, the Ministry of Health Malaria Program (MoH-MP) works with community health workers (CHWs), people from mining communities without a formal medical degree, to provide malaria diagnostic and treatment services. During the COVID-19 pandemic, the MoH-MP trained 21 of these CHWs in COVID-19 outreach and testing, using rapid antigen tests for symptomatic persons in their communities; afterward, a mixed methods research approach was used to investigate whether including COVID-19 services in the tasks of the CHWs was feasible and accepted among gold mining populations. Also, CHWs took part in active case detection missions to proactively offer COVID-19 testing to all inhabitants of specific mining areas, regardless of symptoms. In the 6 months of field implementation (May-October 2022), 1,300 persons were tested for COVID-19, among whom 28.7% were women. Eight percent tested positive. Of the 312 asymptomatic persons tested, 2.2% tested positive. Qualitative semi-structured interviews with the CHWs and quantitative pre- and postintervention surveys revealed that the communities appreciated the nearby and free COVID-19 testing opportunity. The intervention motivated individuals who otherwise would not have been tested to test for COVID-19. Twenty-nine percent of those who had tested at least once for COVID-19 reported that their most recent test was conducted through the services of the CHWs. The results suggest that integrating COVID-19 testing into other CHW services can lower health access barriers in difficult-to-reach populations in remote communities.

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

[This corrects the article DOI: 10.26633/RPSP.2023.100.].

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.

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.

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

Factors associated with COVID-19 length of hospitalization and mortality during four epidemic waves, March 2020-November 2021, Suriname.

Objectives: To determine the sociodemographic risk factors associated with coronavirus disease 2019 (COVID-19) mortality in Suriname. Methods: This was a retrospective cohort study. All registered deaths from COVID-19 in Suriname (n=1112) between March 13, 2020 and November 11, 2021 were included. Data were collected from medical records and included demographic variables and hospitalization duration of patients who died. Descriptive statistics, chi-squared tests, ANOVA models, and logistic regression analyses were used to determine associations between sociodemographic variables, length of hospitalization, and mortality during four epidemic waves. Results: The case fatality rate over the study period was 22 per 1 000 population. The first epidemic wave was from July to August 2020, the second from December 2020 to January 2021, the third from May to June 2021, and the fourth from August to September 2021. Significant differences were found in the number of deaths and hospitalization duration by wave (p<0.001). Patients were more likely to have a longer hospitalization during the first (OR 1.66; 95% CI: 0.98, 2.82) and third waves (OR 2.37; 95% CI: 1.71, 3.28) compared with the fourth wave. Significant differences in mortality were also seen between ethnicities by wave (p=0.010). Compared with the mixed and other group, people of Creole ethnicity (OR 2.7; 95% CI: 1.33, 5.29) and Tribal people (OR 2.8; 95% CI: 1.12, 7.02) were more likely to die during the fourth wave than the third wave. Conclusions: Tailored interventions are needed for males, people of Creole descent, Tribal and Indigenous peoples, and people older than 65 years.

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

[ABSTRACT]. Objective. To determine the sociodemographic risk factors associated with coronavirus disease 2019 (COVID- 19) mortality in Suriname. Methods. This was a retrospective cohort study. All registered deaths from COVID-19 in Suriname (n=1112) between March 13, 2020 and November 11, 2021 were included. Data were collected from medical records and included demographic variables and hospitalization duration of patients who died. Descriptive statistics, chi-squared tests, ANOVA models, and logistic regression analyses were used to determine associations between sociodemographic variables, length of hospitalization, and mortality during four epidemic waves. Results. The case fatality rate over the study period was 22 per 1 000 population. The first epidemic wave was from July to August 2020, the second from December 2020 to January 2021, the third from May to June 2021, and the fourth from August to September 2021. Significant differences were found in the number of deaths and hospitalization duration by wave (p<0.001). Patients were more likely to have a longer hospitalization during the first (OR 1.66; 95% CI: 0.98, 2.82) and third waves (OR 2.37; 95% CI: 1.71, 3.28) compared with the fourth wave. Significant differences in mortality were also seen between ethnicities by wave (p=0.010). Compared with the mixed and other group, people of Creole ethnicity (OR 2.7; 95% CI: 1.33, 5.29) and Tribal people (OR 2.8; 95% CI: 1.12, 7.02) were more likely to die during the fourth wave than the third wave. Conclusions. Tailored interventions are needed for males, people of Creole descent, Tribal and Indigenous peoples, and people older than 65 years.

[RESUMEN]. Objetivo. Determinar los factores de riesgo sociodemográficos asociados a la mortalidad por la enfermedad por el coronavirus del 2019 (COVID-19) en Suriname. Métodos. Este fue un estudio de cohortes retrospectivo. Se analizaron todas las muertes por COVID-19 reg- istradas en Suriname (n=1112) entre el 13 de marzo del 2020 y el 11 de noviembre del 2021. Los datos se recopilaron a partir de los expedientes médicos, e incluyeron las variables demográficas y la duración de la hospitalización de los pacientes fallecidos. Se utilizaron métodos estadísticos descriptivos, la prueba de la ji al cuadrado, modelos de análisis de la varianza y análisis de regresión logística para determinar las asocia- ciones entre las variables sociodemográficas, la duración de la hospitalización y la mortalidad durante cuatro oleadas epidémicas. Resultados. La tasa de letalidad en el período del estudio fue de 22 por cada 1 000 habitantes. La primera oleada epidémica fue de julio a agosto del 2020; la segunda, de diciembre del 2020 a enero del 2021; la tercera, de mayo a junio del 2021; y la cuarta, de agosto a septiembre del 2021. Se observaron diferencias significativas en el número de muertes y la duración de la hospitalización entre las oleadas (p<0,001). Fue más probable que los pacientes tuvieran una hospitalización más prolongada durante la primera oleada (razón de posibilidades [odds ratio, OR] 1,66; IC del 95%: 0,98, 2,82) y la tercera (OR 2,37; IC del 95%: 1,71, 3,28) en comparación con la cuarta. También se observaron diferencias significativas en la mortalidad entre etnias según la oleada (p=0,010). En comparación con el grupo poblacional de origen mixto y de otro origen, las personas de la etnia criolla (OR 2,7; IC del 95%: 1,33, 5,29) y de origen tribal (OR 2,8; IC del 95%: 1,12, 7,02) tuvieron una mayor probabilidad de fallecer durante la cuarta oleada que durante la tercera. Conclusiones. Es preciso llevar a cabo intervenciones diseñadas específicamente para los hombres, las personas de ascendencia criolla, los pueblos tribales e indígenas y las personas mayores de 65 años.

[RESUMO]. Objetivo. Determinar os fatores de risco sociodemográficos associados à mortalidade por doença pelo coro- navírus 2019 (COVID-19) no Suriname. Métodos. Este foi um estudo de coorte retrospectivo. Foram incluídos todos os óbitos por COVID-19 registra- dos no Suriname (n=1112) entre 13 de março de 2020 e 11 de novembro de 2021. Os dados foram coletados de registros médicos e incluíram variáveis demográficas e a duração da internação dos pacientes que mor- reram. Estatísticas descritivas, testes de qui-quadrado, modelos de ANOVA e análises de regressão logística foram usados para determinar associações entre variáveis sociodemográficas, a duração da internação e a mortalidade durante quatro ondas epidêmicas. Resultados. A taxa de letalidade durante o período do estudo foi de 22 por 1 000 habitantes. A primeira onda epidêmica ocorreu de julho a agosto de 2020, a segunda, de dezembro de 2020 a janeiro de 2021, a terceira, de maio a junho de 2021 e a quarta, de agosto a setembro de 2021. Foram encontradas diferenças signifi- cativas no número de mortes e na duração da internação entre as ondas (p<0,001). Os pacientes tinham maior probabilidade de ter uma internação mais longa na primeira (razão de chances [RC]: 1,66; intervalo de confiança (IC 95%): 0,98–2,82) e na terceira onda (RC: 2,37; IC 95%: 1,71–3,28) em comparação com a quarta. Também foram observadas diferenças significativas entre etnias na mortalidade por onda (p=0,010). Em comparação com o grupo misto e outros, as pessoas de etnia crioula (RC: 2,7; IC 95%: 1,33–5,29) e tribal (RC: 2,8; IC 95%: 1,12–7,02) tinham maior probabilidade de morrer na quarta onda do que na terceira onda. Conclusões. São necessárias intervenções adaptadas para homens, pessoas de descendência crioula, povos tribais e indígenas e pessoas com mais de 65 anos.

Prevalence of persistent symptoms after having COVID-19 in a cohort in Suriname.

Objectives: To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods: A sample of adults 18 years and older who were registered 3-4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results: A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were interviewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabetes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions: About 40% of the cohort had at least one persistent symptom 3-4 months after having had COVID-19, with differences observed by sex and ethnic group.

Prevalence of persistent symptoms after having COVID-19 in a cohort in Suriname

[ABSTRACT]. Objectives. To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods. A sample of adults 18 years and older who were registered 3–4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results. A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were inter- viewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabe- tes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions. About 40% of the cohort had at least one persistent symptom 3–4 months after having had COVID-19, with differences observed by sex and ethnic group.

[RESUMEN]. Objetivos. Determinar la prevalencia de síntomas persistentes tras la enfermedad por coronavirus 2019 (COVID-19) en una cohorte en Suriname, y evaluar los factores asociados a la COVID-19 de larga duración. Métodos. Se seleccionó una muestra de personas mayores de 18 años que habían sido registradas tres a cuatro meses antes en una base de datos nacional debido a un resultado positivo en una prueba de COVID-19. Se les realizaron preguntas sobre sus características socioeconómicas, estado de salud y modo de vida previos a la COVID-19 y sobre sus síntomas durante y después de esta enfermedad. A un subconjunto de participantes se les realizó un examen físico para determinar su índice de masa corporal, perímetro abdominal, parámetros cardiovasculares, función pulmonar y estado funcional. Resultados. Se entrevistó a 106 participantes (media de edad: 49 años [desviación estándar: 15 años]; 62,3% mujeres); de los cuales a 32 se les realizó una exploración física. La mayor parte de los participantes tenían ascendencia indostana (22,6%). En términos generales, el 37,7% de los participantes eran sedentarios, el 26,4% tenían hipertensión o diabetes mellitus y al 13,2% les habían diagnosticado previamente una cardiopatía. La mayor parte (56,6%) habían presentado síntomas leves de COVID-19 y el 14,2% síntomas graves. Una proporción elevada (39,6%) había manifestado al menos un síntoma persistente tras recuperarse de un cuadro crítico de COVID-19; esto se daba con mayor frecuencia en las mujeres (47,0% de las mujeres frente a 27,5% de los hombres). Los síntomas más frecuentes fueron fatiga y alopecia, seguidos por disnea y alteraciones del sueño. Se observaron diferencias entre los grupos étnicos. De acuerdo con los resultados del examen físico, el 45,0% del subgrupo era obeso y el 67,7% tenía un perímetro abdominal muy elevado. Conclusiones. Aproximadamente el 40% de la cohorte presentaba al menos un síntoma persistente tres o cuatro meses tras haber tenido COVID-19, con diferencias en función del sexo y el grupo étnico.

[RESUMO]. Objetivos. Determinar a prevalência de sintomas persistentes pós-doença do coronavírus de 2019 (COVID- 19) em uma coorte no Suriname e avaliar os fatores associados à COVID longa. Métodos. Foi selecionada uma amostra de adultos (a partir dos 18 anos) que haviam sido cadastrados 3 a 4 meses antes do estudo em um banco de dados nacional devido a um teste positivo para COVID-19. Os indivíduos selecionados foram entrevistados acerca de seu perfil socioeconômico, estado de saúde, estilo de vida pré-COVID-19 e sintomas durante e após a COVID-19. Um subconjunto de participantes foi submetido a exame físico para determinar índice de massa corporal, circunferência abdominal, parâmetros cardiovasculares, função pulmonar e funcionalidade. Resultados. Foram entrevistados 106 participantes (média de idade, 49 anos; desvio padrão, 15 anos; 62,3% do sexo feminino), dos quais 32 foram submetidos ao exame físico. A maior proporção de participantes era de ascendência hindu (22,6%). No total, 37,7% dos participantes eram fisicamente inativos, 26,4% tinham hiper- tensão ou diabetes e 13,2% tinham diagnóstico prévio de cardiopatia. A maioria dos participantes (56,6%) teve COVID-19 leve, e 14,2%, COVID-19 grave. Uma grande proporção (39,6%) apresentou pelo menos um sintoma persistente após a recuperação da COVID-19 aguda. Mais mulheres foram afetadas (47,0% das mul- heres versus 27,5% dos homens). Fadiga e alopecia foram os sintomas mais comuns, seguidos de dispneia e distúrbios do sono. Foram observadas diferenças entre grupos étnicos. Dos participantes submetidos ao exame físico, 45,0% eram obesos e 67,7% tinham circunferência abdominal muito larga. Conclusões. Cerca de 40% da coorte apresentou pelo menos um sintoma persistente 3 a 4 meses após a COVID-19. Foram observadas diferenças por sexo e grupo étnico.

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.

[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 persistent symptoms after having COVID-19 in a cohort in Suriname / Prevalencia de síntomas persistentes tras la COVID-19 en una cohorte en Suriname / Prevalência de sintomas persistentes após COVID-19 em uma coorte no Suriname

ABSTRACT Objectives. To determine the prevalence of persistent symptoms after having coronavirus disease 2019 (COVID-19) in a cohort in Suriname, and assess the factors associated with long COVID. Methods. A sample of adults 18 years and older who were registered 3-4 months previously in a national database because of a positive COVID-19 test were selected. They were interviewed about socioeconomic characteristics, pre-COVID-19 health status and lifestyle, and symptoms during and after COVID-19. A subset of participants underwent a physical examination to determine body mass index, waist circumference, cardiovascular parameters, lung function, and functionality. Results. A total of 106 participants (mean age 49 (standard deviation 15) years; 62.3% female) were interviewed, of whom 32 were physically examined. The greatest proportion of participants was of Hindustani descent (22.6%). Overall, 37.7% of participants were physically inactive, 26.4% had hypertension or diabetes mellitus, and 13.2% had been previously diagnosed with heart disease. Most participants (56.6%) had experienced mild COVID-19 and 14.2% had experienced severe COVID-19. A large proportion (39.6%) had experienced at least one persistent symptom after recovery from acute COVID-19 and more women were affected (47.0% of women versus 27.5% of men). Fatigue and alopecia were the most common symptoms, followed by dyspnea and sleep disturbance. Differences were observed between ethnic groups. Based on physical examination, 45.0% of the subset was obese and 67.7% had very high waist-circumference. Conclusions. About 40% of the cohort had at least one persistent symptom 3-4 months after having had COVID-19, with differences observed by sex and ethnic group.

RESUMEN Objetivos. Determinar la prevalencia de síntomas persistentes tras la enfermedad por coronavirus 2019 (COVID-19) en una cohorte en Suriname, y evaluar los factores asociados a la COVID-19 de larga duración. Métodos. Se seleccionó una muestra de personas mayores de 18 años que habían sido registradas tres a cuatro meses antes en una base de datos nacional debido a un resultado positivo en una prueba de COVID-19. Se les realizaron preguntas sobre sus características socioeconómicas, estado de salud y modo de vida previos a la COVID-19 y sobre sus síntomas durante y después de esta enfermedad. A un subconjunto de participantes se les realizó un examen físico para determinar su índice de masa corporal, perímetro abdominal, parámetros cardiovasculares, función pulmonar y estado funcional. Resultados. Se entrevistó a 106 participantes (media de edad: 49 años [desviación estándar: 15 años]; 62,3% mujeres); de los cuales a 32 se les realizó una exploración física. La mayor parte de los participantes tenían ascendencia indostana (22,6%). En términos generales, el 37,7% de los participantes eran sedentarios, el 26,4% tenían hipertensión o diabetes mellitus y al 13,2% les habían diagnosticado previamente una cardiopatía. La mayor parte (56,6%) habían presentado síntomas leves de COVID-19 y el 14,2% síntomas graves. Una proporción elevada (39,6%) había manifestado al menos un síntoma persistente tras recuperarse de un cuadro crítico de COVID-19; esto se daba con mayor frecuencia en las mujeres (47,0% de las mujeres frente a 27,5% de los hombres). Los síntomas más frecuentes fueron fatiga y alopecia, seguidos por disnea y alteraciones del sueño. Se observaron diferencias entre los grupos étnicos. De acuerdo con los resultados del examen físico, el 45,0% del subgrupo era obeso y el 67,7% tenía un perímetro abdominal muy elevado. Conclusiones. Aproximadamente el 40% de la cohorte presentaba al menos un síntoma persistente tres o cuatro meses tras haber tenido COVID-19, con diferencias en función del sexo y el grupo étnico.

RESUMO Objetivos. Determinar a prevalência de sintomas persistentes pós-doença do coronavírus de 2019 (COVID-19) em uma coorte no Suriname e avaliar os fatores associados à COVID longa. Métodos. Foi selecionada uma amostra de adultos (a partir dos 18 anos) que haviam sido cadastrados 3 a 4 meses antes do estudo em um banco de dados nacional devido a um teste positivo para COVID-19. Os indivíduos selecionados foram entrevistados acerca de seu perfil socioeconômico, estado de saúde, estilo de vida pré-COVID-19 e sintomas durante e após a COVID-19. Um subconjunto de participantes foi submetido a exame físico para determinar índice de massa corporal, circunferência abdominal, parâmetros cardiovasculares, função pulmonar e funcionalidade. Resultados. Foram entrevistados 106 participantes (média de idade, 49 anos; desvio padrão, 15 anos; 62,3% do sexo feminino), dos quais 32 foram submetidos ao exame físico. A maior proporção de participantes era de ascendência hindu (22,6%). No total, 37,7% dos participantes eram fisicamente inativos, 26,4% tinham hipertensão ou diabetes e 13,2% tinham diagnóstico prévio de cardiopatia. A maioria dos participantes (56,6%) teve COVID-19 leve, e 14,2%, COVID-19 grave. Uma grande proporção (39,6%) apresentou pelo menos um sintoma persistente após a recuperação da COVID-19 aguda. Mais mulheres foram afetadas (47,0% das mulheres versus 27,5% dos homens). Fadiga e alopecia foram os sintomas mais comuns, seguidos de dispneia e distúrbios do sono. Foram observadas diferenças entre grupos étnicos. Dos participantes submetidos ao exame físico, 45,0% eram obesos e 67,7% tinham circunferência abdominal muito larga. Conclusões. Cerca de 40% da coorte apresentou pelo menos um sintoma persistente 3 a 4 meses após a COVID-19. Foram observadas diferenças por sexo e grupo étnico.

Factors associated with COVID-19 length of hospitalization and mortality during four epidemic waves, March 2020-November 2021, Suriname / 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 / 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

ABSTRACT Objectives. To determine the sociodemographic risk factors associated with coronavirus disease 2019 (COVID-19) mortality in Suriname. Methods. This was a retrospective cohort study. All registered deaths from COVID-19 in Suriname (n=1112) between March 13, 2020 and November 11, 2021 were included. Data were collected from medical records and included demographic variables and hospitalization duration of patients who died. Descriptive statistics, chi-squared tests, ANOVA models, and logistic regression analyses were used to determine associations between sociodemographic variables, length of hospitalization, and mortality during four epidemic waves. Results. The case fatality rate over the study period was 22 per 1 000 population. The first epidemic wave was from July to August 2020, the second from December 2020 to January 2021, the third from May to June 2021, and the fourth from August to September 2021. Significant differences were found in the number of deaths and hospitalization duration by wave (p<0.001). Patients were more likely to have a longer hospitalization during the first (OR 1.66; 95% CI: 0.98, 2.82) and third waves (OR 2.37; 95% CI: 1.71, 3.28) compared with the fourth wave. Significant differences in mortality were also seen between ethnicities by wave (p=0.010). Compared with the mixed and other group, people of Creole ethnicity (OR 2.7; 95% CI: 1.33, 5.29) and Tribal people (OR 2.8; 95% CI: 1.12, 7.02) were more likely to die during the fourth wave than the third wave. Conclusions. Tailored interventions are needed for males, people of Creole descent, Tribal and Indigenous peoples, and people older than 65 years.

RESUMEN Objetivo. Determinar los factores de riesgo sociodemográficos asociados a la mortalidad por la enfermedad por el coronavirus del 2019 (COVID-19) en Suriname. Métodos. Este fue un estudio de cohortes retrospectivo. Se analizaron todas las muertes por COVID-19 registradas en Suriname (n=1112) entre el 13 de marzo del 2020 y el 11 de noviembre del 2021. Los datos se recopilaron a partir de los expedientes médicos, e incluyeron las variables demográficas y la duración de la hospitalización de los pacientes fallecidos. Se utilizaron métodos estadísticos descriptivos, la prueba de la ji al cuadrado, modelos de análisis de la varianza y análisis de regresión logística para determinar las asociaciones entre las variables sociodemográficas, la duración de la hospitalización y la mortalidad durante cuatro oleadas epidémicas. Resultados. La tasa de letalidad en el período del estudio fue de 22 por cada 1 000 habitantes. La primera oleada epidémica fue de julio a agosto del 2020; la segunda, de diciembre del 2020 a enero del 2021; la tercera, de mayo a junio del 2021; y la cuarta, de agosto a septiembre del 2021. Se observaron diferencias significativas en el número de muertes y la duración de la hospitalización entre las oleadas (p<0,001). Fue más probable que los pacientes tuvieran una hospitalización más prolongada durante la primera oleada (razón de posibilidades [odds ratio, OR] 1,66; IC del 95%: 0,98, 2,82) y la tercera (OR 2,37; IC del 95%: 1,71, 3,28) en comparación con la cuarta. También se observaron diferencias significativas en la mortalidad entre etnias según la oleada (p=0,010). En comparación con el grupo poblacional de origen mixto y de otro origen, las personas de la etnia criolla (OR 2,7; IC del 95%: 1,33, 5,29) y de origen tribal (OR 2,8; IC del 95%: 1,12, 7,02) tuvieron una mayor probabilidad de fallecer durante la cuarta oleada que durante la tercera. Conclusiones. Es preciso llevar a cabo intervenciones diseñadas específicamente para los hombres, las personas de ascendencia criolla, los pueblos tribales e indígenas y las personas mayores de 65 años.

RESUMO Objetivo. Determinar os fatores de risco sociodemográficos associados à mortalidade por doença pelo coronavírus 2019 (COVID-19) no Suriname. Métodos. Este foi um estudo de coorte retrospectivo. Foram incluídos todos os óbitos por COVID-19 registrados no Suriname (n=1112) entre 13 de março de 2020 e 11 de novembro de 2021. Os dados foram coletados de registros médicos e incluíram variáveis demográficas e a duração da internação dos pacientes que morreram. Estatísticas descritivas, testes de qui-quadrado, modelos de ANOVA e análises de regressão logística foram usados para determinar associações entre variáveis sociodemográficas, a duração da internação e a mortalidade durante quatro ondas epidêmicas. Resultados. A taxa de letalidade durante o período do estudo foi de 22 por 1 000 habitantes. A primeira onda epidêmica ocorreu de julho a agosto de 2020, a segunda, de dezembro de 2020 a janeiro de 2021, a terceira, de maio a junho de 2021 e a quarta, de agosto a setembro de 2021. Foram encontradas diferenças signifi­cativas no número de mortes e na duração da internação entre as ondas (p<0,001). Os pacientes tinham maior probabilidade de ter uma internação mais longa na primeira (razão de chances [RC]: 1,66; intervalo de confiança (IC 95%): 0,98-2,82) e na terceira onda (RC: 2,37; IC 95%: 1,71-3,28) em comparação com a quarta. Também foram observadas diferenças significativas entre etnias na mortalidade por onda (p=0,010). Em comparação com o grupo misto e outros, as pessoas de etnia crioula (RC: 2,7; IC 95%: 1,33-5,29) e tribal (RC: 2,8; IC 95%: 1,12-7,02) tinham maior probabilidade de morrer na quarta onda do que na terceira onda. Conclusões. São necessárias intervenções adaptadas para homens, pessoas de descendência crioula, povos tribais e indígenas e pessoas com mais de 65 anos.

Sexually transmitted infections on the border between Suriname and French Guiana: A scoping review.

Purpose: The Maroni basin -delineating the border between Suriname and French Guiana- presents sociocultural, geographical and economic circumstances that have been conducive to the circulation of sexually transmitted infections and to delays in diagnosis and care. Given the scarcity of published data, we aimed to describe different sexually transmitted infections along the Maroni and to gain a broader understanding of the epidemiologic situation. Methods: We conducted a scoping review of the efforts to approach the problem of sexually transmitted infections in this complex border area. Temporal trends were plotted and crude numbers were divided by local population numbers. Results: For HIV, despite increasing testing efforts, most patients still present at the advanced HIV stage (median CD4 count at diagnosis is < 20 per mm3), and 25% of patients in Saint Laurent du Maroni were lost to follow-up within 6 years. However, progress on both sides has led to a decline in AIDS cases and mortality. Despite a rapid increase in the 1990's along the Maroni, the current HIV prevalence seemed lower (0.52%) in the rural villages than in coastal urban centers (> 1%). High risk HPV infection prevalence among women reaches 23.3%. The incidence of gonorrhea was 4.2 per 1,000 population aged 15-59. For chlamydiasis it was 3.4 per 1,000 population aged 15-59. For syphilis, the incidence was 2.5 per 1,000 population aged 15-59. Gonorrhea, chlamydiasis, hepatitis B detection increased over time with greater testing efforts and new diagnostic tests. Since the COVID-19 epidemic, congenital syphilis has dramatically increased in Saint Laurent du Maroni reaching 808 per 100,000 live births. Conclusion: Sexually transmitted infections seemed more prevalent in Saint Laurent du Maroni -the sole urban center-than in the remote villages along the Maroni. The syndromic approach and the heterogeneity of diagnostic platforms presumably overlook most infections in the region. Therefore, a concerted approach and a shared diagnostic upgrade with molecular diagnosis and rapid diagnostic tests seem necessary to reduce the burden of sexually transmitted infections on both sides of the Maroni. Congenital syphilis resulting from COVID-19 disruption of health services requires urgent attention.

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.

Annual Report 2020. Universal Health and the Pandemic. Resilient Health Systems. Suriname

Founded in 1902 as the independent specialized health agency of the inter-American system, the Pan American Health Organization (PAHO) has developed recognized competence and expertise, providing technical cooperation to its Member States to fight communicable and noncommunicable diseases and their causes, to strengthen health systems, and to respond to emergencies and disasters throughout the Region of the Americas. In addition, acting in its capacity as the World Health Organization’s Regional Office, PAHO participates actively in the United Nations Country Team, collaborating with other agencies, the funds and programs of the United Nations system to contribute to the achievement of the Sustainable Development Goals (SDGs) at country level. This 2020 annual report reflects PAHO’s technical cooperation in the country for the period, implementing the Country Cooperation Strategy, responding to the needs and priorities of the country, and operating within the framework of the Organization’s regional and global mandates and the SDGs. Under the overarching theme of Universal Health and the Pandemic – Resilient Health Systems, it highlights PAHO’s response to the COVID-19 pandemic as well as its continuing efforts in priority areas such as communicable diseases, noncommunicable diseases, mental health, health throughout the life course, and health emergencies. It also provides a financial summary for the year under review.

[Awake prone positioning in covid-19 patients]. / Buikligging bij niet-beademde patiënten met covid-19.

Awake prone positioning in COVID-19 patients with respiratory failure has been applied worldwide. We hypothesize that early intervention of awake prone positioning in this patient category might avoid invasive mechanical ventilation and referral to ICU. We observed approximately 30 patients in Suriname in whom awake prone positioning was applied. Also, we reviewed the existing literature on awake prone positioning and discussion of the advantages and disadvantages of this relatively simple intervention. Prospective studies show an improvement in oxygenation, albeit sometimes temporary, but not a reduction in mortality rate or intubation. Mean duration of symptoms in these studies is 10-11 days. Awake prone positioning in COVID-19 patients with a longer duration of symptoms does not improve survival or need for intubation. No prospective studies on early prone position in COVID-19 patients have been conducted yet.

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.