BackgroundSuriname has experienced a significant change in malaria transmission risk and incidence over the past years. The country is now moving toward malaria elimination. The first objective of this study is to describe malaria epidemiological trends in Suriname between 2000 and 2016. The second objective is to identify spatiotemporal malaria trends in notification points between 2007 and 2016.MethodsNational malaria surveillance data resulting from active and passive screening between 2000 and 2016 were used for the temporal trend analysis. A space–time cluster analysis using SaTScan™ was conducted on Malaria Programme-data from 2007 to 2016 comparing cases (people tested positive) with controls (people tested negative).ResultsSuriname experienced a period of high malaria incidence during 2000–2005, followed by a steep decline in number of malaria cases from 2005 onwards. Imported malaria cases, mostly of Brazilian nationality and travelling from French Guiana, were major contributors to the reported number of cases, exceeding the national malaria burden (94.2% of the total). Most clusters in notification points are found in the border area between Suriname and French Guiana. Clustering was also found in the migrant clinic in Paramaribo.ConclusionsSuriname has successfully reduced malaria to near-elimination level in the last 17 years. However, the high malaria import rate resulting from cross-border moving migrants is a major challenge for reaching elimination. This requires continued investment in the national health system, with a focus on border screening and migrant health. A regional approach to malaria elimination within the Guianas and Brazil is urgently needed.
Background In French Guiana, gold miners working illegally represents a major reservoir of malaria. This mobile population, mainly of Brazilian descent, enters the French Guianese forest from neighbouring countries, Suriname and Brazil. A complex and innovative intervention was piloted as a cooperation with the three involved countries involved to control malaria in this specific population. The principle was that health workers called “facilitators” provide the participants with a self-diagnosis and self-treatment kit along with adequate training and material to rapidly manage an episode of malaria symptoms on their own, when they find themselves isolated from health care services. Methods This paper describes the design, development, content of the intervention and players’ organization of this multi-country project, the opportunities and constraints encountered, and the lessons learnt at this stage. Results The choice not to implement the usual “Test and Treat” approach within the community is mainly driven by regulatory reasons. The content of medical messages tends to balance the tension between thoroughness, accuracy and efficacy. The wide range of tools developed through a participatory approach was intended to cope with the challenges of the literacy level of the target population. Despite the difficulties encountered due to language, regulation differences and distance between partners, cooperation was fruitful, due to the complementary of stakeholders, their involvement at all important stages and regular face-to-face meetings. Discussion and conclusion This experience shows the feasibility of an ambitious project of action-research in a border malaria context, involving several countries and with a mobile and undocumented population. It reveals some factors of success which may be transferable in analogous settings.
Background A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution, after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity. Main text This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions. As expected, being part of or close to the study community was an essential condition to enable deliverers, referred to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one third of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of delivery, the main issue was the excess of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing malaria management services is recommended to ensure sustainability. Conclusions These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts. Trial registration ClinicalTrials.gov. NCT03695770. 10/02/2018 “Retrospectively registered”.
Background: An innovative strategy to combat malaria was tested with a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile population. The intervention strategy tested was the distribution, after training, of self-diagnosis and self-treatment kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas territory. The main evaluation criterion was the reported behavioral change in case of malaria symptoms, measured by pre- and post-intervention surveys. Method: This article informs on the quality of delivery, content adherence and facilitation strategies, exposure to the intervention, participants responsiveness and unintended consequences. The information sources are the post-intervention survey, a short data collection carried out in a very isolated gold mining site, continuous data collection during the intervention, observations made during supervision visits, and in-depth feedback from the project players. Results and Discussion: As expected, being part of or close to the study community was an essential condition for facilitators to overcome the usual wariness of this population. Regarding the content of the delivered messages, the main issue with facilitators was the excess of information rather than the omission of information but was corrected over time. The content of the intervention was overall in line with what was planned. With an estimation of one third of the population reached, the exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc offsite distribution according to the needs. Participants’ responsiveness was the main strength of the intervention but could be enhanced by reducing the duration of the process to get a kit, which can be disincentive in some places. The expected decrease in malaria became a source of reduced interest in the kit. Expanding the remit of facilitators may be a suitable response. Better integration of the articulation with the existing malaria management services is recommended for sustainability.Conclusion: These findings provide valuable implementation outcomes to complement the evaluation outcomes for assessing the relevance of the strategy and information useful to sustain and transfer it in analogous contexts.Trial registration: ClinicalTrials.gov Registration number: NCT03695770Date of registration: 10/02/2018 “Retrospectively registered”
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