Malaria Champions of the Americas 2016 – Suriname
Since 2009, following near elimination of malaria in village communities, the MoH Malaria Program in Suriname has a focus on malaria transmission in remaining risk populations and areas, which are mostly mobile, illegal miners from Brazilian origin in gold mines. The Program aims to fill the gap of lacking malaria
services in these risk areas and among these populations. It is also working towards prevention of re-establishment of malaria in areas where malaria has been eliminated. The prevention effort is partly directed towards interception of import malaria, which made up about 75% of the number of cases diagnosed last year.
The four main strategies of the Malaria Program are:
Improved access to diagnosis and treatment, and case investigation. (T3 recommendations applied in the specific conditions of the gold mines)
Prevention in the highest risk areas with Long Lasting Impregnated mosquito Nets (LLINs).
Awareness building to change behavior.
National en regional Partnerships.
Improved access to diagnosis and treatment is achieved by establishment of Malaria Service Deliverers, so-called MSDs, in high risk areas. MSDs are people originating from risk populations and based in risk areas who are trained to provide diagnosis and treatment to their peers under supervision of the Malaria Program. The geographical distribution of MSDs in the MSD network is guided by the national surveillance system and has a focus on remote areas of high risk or areas where import of malaria is common. In addition, in areas where no MSDs are stationed yet, but which are prone to incidental outbreaks, regular Active Case Detections (ACD) campaigns are executed, guided by epidemiological data. Some of these areas, depending on priority, are serviced by mobile MSDs, traveling with all-terrain-vehicles (ATV) or boat. Trained MSD-supervisors of the Malaria Program support the local MSDs with case investigations in the areas of transmission.
LLINs provided to high risk mobile populations are of a specific design. The design was established prior to the onset of the current Program via community involvement and can be used for both beds and hammocks. They are distributed via the MSD network and during ACD surveys. Villages close to mining areas where transmission still occurs are considered susceptible to malaria re-establishment and are included in the LLINs distribution. Distribution here is done in cooperation with Medical Mission (MM), responsible for primary health care in stabile populations in the Interior.
Awareness building strategies are based on recommendation from previous studies on Knowledge, Attitude and Practices. The campaign takes into account amongst other factors, the ethnicity (language), education level (significant part illiterate) and mobility (messages also via SMS) of the target population.
National partnerships include cooperation with the MM and with multi-nationals active in logging and mining in Suriname. MoUs have been established with these partners with an aim to cooperate in the prevention and control of malaria. This secures ownership and sustainability of malaria prevention and control efforts. There is a continuous communication with neighboring countries for the exchange of epidemiological data and to support international cooperation.
Miners active in French Guiana cross into Suriname to sell gold and buy equipment Due to a hard-line policy of France towards illegal mining, the miners are not able to do this in French Guiana. The significant malaria problem in French mining areas and continuous cross-border movement of miners result in high importation of malaria into Suriname. The Malaria Program addressed this by establishing border posts for screening at the main garimpeiro crossing points. The Malaria Program has also started executing surveillance by boat along the South-Eastern part of the border, which facilitates provision of services to remote camps, boat landing sites and resting places. The border surveillance along the remainder of the border is supported by the Medical Mission clinics in villages.
The MSDs, many of which are from Brazilian origin, were trained/re-trained with help of Brazilian counterparts. Re-training is a continuous effort due to the high mobility and turn-over of the MSDs. This is the result of changes in profitability of mining areas. The garimpeiros are following the gold. The MSDs and most field personnel of the Malaria Program are Portuguese speaking enabling them to interact with the priority target population.
Annually the Malaria Program organizes a re-training of national malaria microscopists in order for them to maintain capacity for diagnosis in a near elimination setting. The national trainers have been trained and certified abroad. Also the Program is currently in the process of developing and implementing a guideline for all screening posts/personnel (including hospitals, private labs, private clinics, MM clinics etc) on the diagnosis, treatment and data management of malaria cases, again to help maintain capacity in situations where malaria is nowadays seldom encountered.
Personnel of the malaria program have participated in training on recognizing human trafficking and on the prevention of stigma and discrimination (related to illegality/ethnicity of the target population, sex workers in the mining areas, and HIV status (as part of integration of services and testing of HIV by Malaria Program personnel))
Active outreach towards the target populations includes activities both in the transmission settings as well as in selected neighborhoods in the capital, where the target population resides. The Program has a trained Outreach Officer. The Outreach Officer is also responsible for communication with hospitals and is available for support of hospitals when experiencing difficulties in interacting with patients of the target population (esp. due to language barriers).
Malaria Champions of the Americas 2016 – Suriname
Since 2009, following near elimination of malaria in village communities, the MoH Malaria Program in Suriname has a focus on malaria transmission in remaining risk populations and areas, which are mostly mobile, illegal miners from Brazilian origin in gold mines. The Program aims to fill the gap of lacking malaria
services in these risk areas and among these populations. It is also working towards prevention of re-establishment of malaria in areas where malaria has been eliminated. The prevention effort is partly directed towards interception of import malaria, which made up about 75% of the number of cases diagnosed last year.
The four main strategies of the Malaria Program are:
Improved access to diagnosis and treatment, and case investigation. (T3 recommendations applied in the specific conditions of the gold mines)
Prevention in the highest risk areas with Long Lasting Impregnated mosquito Nets (LLINs).
Awareness building to change behavior.
National en regional Partnerships.
Improved access to diagnosis and treatment is achieved by establishment of Malaria Service Deliverers, so-called MSDs, in high risk areas. MSDs are people originating from risk populations and based in risk areas who are trained to provide diagnosis and treatment to their peers under supervision of the Malaria Program. The geographical distribution of MSDs in the MSD network is guided by the national surveillance system and has a focus on remote areas of high risk or areas where import of malaria is common. In addition, in areas where no MSDs are stationed yet, but which are prone to incidental outbreaks, regular Active Case Detections (ACD) campaigns are executed, guided by epidemiological data. Some of these areas, depending on priority, are serviced by mobile MSDs, traveling with all-terrain-vehicles (ATV) or boat. Trained MSD-supervisors of the Malaria Program support the local MSDs with case investigations in the areas of transmission.
LLINs provided to high risk mobile populations are of a specific design. The design was established prior to the onset of the current Program via community involvement and can be used for both beds and hammocks. They are distributed via the MSD network and during ACD surveys. Villages close to mining areas where transmission still occurs are considered susceptible to malaria re-establishment and are included in the LLINs distribution. Distribution here is done in cooperation with Medical Mission (MM), responsible for primary health care in stabile populations in the Interior.
Awareness building strategies are based on recommendation from previous studies on Knowledge, Attitude and Practices. The campaign takes into account amongst other factors, the ethnicity (language), education level (significant part illiterate) and mobility (messages also via SMS) of the target population.
National partnerships include cooperation with the MM and with multi-nationals active in logging and mining in Suriname. MoUs have been established with these partners with an aim to cooperate in the prevention and control of malaria. This secures ownership and sustainability of malaria prevention and control efforts. There is a continuous communication with neighboring countries for the exchange of epidemiological data and to support international cooperation.
Miners active in French Guiana cross into Suriname to sell gold and buy equipment Due to a hard-line policy of France towards illegal mining, the miners are not able to do this in French Guiana. The significant malaria problem in French mining areas and continuous cross-border movement of miners result in high importation of malaria into Suriname. The Malaria Program addressed this by establishing border posts for screening at the main garimpeiro crossing points. The Malaria Program has also started executing surveillance by boat along the South-Eastern part of the border, which facilitates provision of services to remote camps, boat landing sites and resting places. The border surveillance along the remainder of the border is supported by the Medical Mission clinics in villages.
The MSDs, many of which are from Brazilian origin, were trained/re-trained with help of Brazilian counterparts. Re-training is a continuous effort due to the high mobility and turn-over of the MSDs. This is the result of changes in profitability of mining areas. The garimpeiros are following the gold. The MSDs and most field personnel of the Malaria Program are Portuguese speaking enabling them to interact with the priority target population.
Annually the Malaria Program organizes a re-training of national malaria microscopists in order for them to maintain capacity for diagnosis in a near elimination setting. The national trainers have been trained and certified abroad. Also the Program is currently in the process of developing and implementing a guideline for all screening posts/personnel (including hospitals, private labs, private clinics, MM clinics etc) on the diagnosis, treatment and data management of malaria cases, again to help maintain capacity in situations where malaria is nowadays seldom encountered.
Personnel of the malaria program have participated in training on recognizing human trafficking and on the prevention of stigma and discrimination (related to illegality/ethnicity of the target population, sex workers in the mining areas, and HIV status (as part of integration of services and testing of HIV by Malaria Program personnel))
Active outreach towards the target populations includes activities both in the transmission settings as well as in selected neighborhoods in the capital, where the target population resides. The Program has a trained Outreach Officer. The Outreach Officer is also responsible for communication with hospitals and is available for support of hospitals when experiencing difficulties in interacting with patients of the target population (esp. due to language barriers).