Fifty years of primary health care in the rainforest: temporal trends in morbidity and mortality in indigenous Amerindian populations of Suriname

Abstract

BackgroundThe Amazonian Amerindian populations living in the southern and southwestern hinterlands of Suriname (South America) have come into contact with western health care since approximately fifty years ago. In this study, secondary data were used to assess the impact of Medical Mission’s fifty-year old primary health care program on the health status of these populations.MethodsUsing data from the primary health care facilities of Medical Mission for 1965-1970, 1973-1977, 1982-1985, and 1997-2014, temporal trends in incidence and mortality of respiratory tract infections, gastroenteritis, and malaria; population composition; birth and death rates; and polyclinic consultations in these communities have been assessed over the period between 1965 and 2014.ResultsIn the period covered by this study, the incidence of respiratory tract infections and gastroenteritis declined by about 75% and 53%, respectively, while malaria incidence rose sharply from the 1980s through 2005 but subsequently declined to levels approximating elimination. Crude death rates dropped by about 70% while birth rates declined by about 50% in the 1980s and since then remained at this level. The population doubled in size and increased in all age groups, particularly in the age group of ≥59 years. The infant mortality rate declined by 50%. In addition, the average yearly number of polyclinic visits per person decreased 6- to 7-fold during this period.ConclusionsThe significant reduction of the infectious disease burden; the doubling of the population size and the growth of the proportion of elderly individuals due to the declining death rates; the declining infant mortality rates to levels comparable to the national average as well as the decline in average numbers of polyclinic consultations per person, indicate that Medical Missions health service provision achieved its goal of improving the health and survival of the indigenous people by providing free, accessible and permanent medical services. Building upon this successful experience Medical Mission could be instrumental in addressing potential contemporary life-style related health threats.

<p>Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries</p>

“…90 Multiple studies report that PHC initiatives are linked with higher quality healthcare. [91][92][93] For example, PHC can reduce the total mortality rate, including premature death, often caused by chronic respiratory, CVDs, cancer, infant mortality, low birth weight, and self-rated health and the improved access to healthcare provided by PHC is related to a higher level of patient satisfaction and reduced total health spending. [91][92][93] Multiple Australian research studies also report that a comprehensive PHC strategy comprises a range of healthcare activities, including promotional, preventive, rehabilitative, and curative, which have a positive impact on population health.…”

Ethnic disparities in tuberculosis incidence and related factors among indigenous and other communities in ethnically diverse Suriname

“…Only 20.1% of Indigenous people live in Paramaribo, while the remainder inhabit rural districts and Suriname’s interior [20] . Medical Mission, a non-governmental organization, provides much of the primary healthcare in the interior but secondary care is mostly concentrated in Paramaribo [10] , [21] .…”

“…An investigation by van Crevel et al assessing TB cases between 1995 and 2000 among Trio Indians living in Kwamalasamutu—a village remotely situated in Suriname’s tropical rainforest interior near the southern border with Brazil—revealed a higher incidence and familial clustering of TB. These observations were attributed to lifestyle, a possible genetic predisposition for TB, and limited access to healthcare among the Trio Indians [9] , who live in relative isolation [10] . Tollefson et al estimated that the prevalence of TB among this community was seven times higher than Suriname’s national comparison rate [2] .…”

Equity in health care: An urban and rural, and gender perspective; the Suriname Health Study

“…The lower perceived need and actual use of health care services in the rural interior, despite the higher health care coverage could partly be explained by a lower chronic disease burden illustrated by the relatively statistically significantly lower prevalence of self-reported diabetes and hypertension. Studies have shown declining rates of infectious diseases, especially malaria, over the past decades in the rural interior, and consequently a dwindling annual average number of polyclinic visits, which can be attributed to successful antimalaria and other infectious disease programs [21] , [22] . On the other hand, there still is a relatively low, though slowly increasing, burden of chronic diseases (diabetes, hypertension) which could be attributed to the more traditional lifestyle of rural interior populations consisting of hunting, fishing and gardening [23] – [25] .…”