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.

Decent Work Country Programme 2019 to 2021

Suriname is located in the South American continent with a population of approximately 573,0003 and geographic size of slightly under 164,000km. It is a democratic country which became independent from the Netherlands in 1975. Its Gross National Income (GNI) per capita is USD 5,1504 . In terms of human development, in 2017 it was classified as an upper middle income country and ranks 100 out of 189 countries on the Human Development Index (HDI). The population density is approximately 3.6 persons per square kilometre, making it the lowest in the Latin America and Caribbean region. Most of the population lives in the capital city of Paramaribo and surrounding areas, located on the country's northern coast. However, there are populations which live in the interior rural regions of Suriname. The relatively high cost of transportation and communication challenges pose barriers to the provision of services.

Quality of death counts and adult mortality registration in Suriname and its main regions / Qualidade dos registros de óbitos e estimativas de mortalidade adulta no Suriname e regiões / Calidad de los recuentos de registros de muerte y mortadlidad adulta en Surinam y sus principales regiones

Suriname statistical office assumes that mortality data in the country is of good quality and does not perform any test before producing life table estimates. However, lack of data quality is a concern in the less developed areas of the world. The primary objective of this article is to evaluate the quality of death counts registration in the country and its main regions from 2004 to 2012 and to produce estimates of adult mortality by sex. We use data from population, by age and sex, from the last censuses and death counts from the Statistical office. We use traditional demographic methods to perform the analysis. We find that the quality of the death count registration in Suriname and its central regions is reasonably good. We also find that population data can be considered good. The results reveal a small difference in the completeness for males and females and that for the sub-national population the choice of method has implication on the results. To sum up, data quality in Suriname is better than in most countries in the region, but there are considerable regional differences as observed in other locations.

O Instituto de Estatística do Suriname assume que os dados de mortalidade no país são de boa qualidade e não realiza nenhum teste antes de produzir estimativas da tabela de vida. No entanto, a falta de qualidade dos dados é uma preocupação nas áreas menos desenvolvidas do mundo. O objetivo principal deste artigo é avaliar a qualidade do registro de óbitos no país e suas principais regiões, entre 2004 e 2012, e produzir estimativas de mortalidade adulta por sexo. Utilizamos dados populacionais, por idade e sexo, dos últimos censos e contagem de mortes do Centro Nacional de Estatística. Para realizar a análise, foram empregados métodos demográficos tradicionais. Concluímos que a qualidade do registro de óbitos no Suriname e em suas regiões centrais é razoável. Também mostramos que os dados de registro da população podem ser considerados bons. Os resultados revelam uma pequena diferença no grau de cobertura do registro de óbitos para homens e mulheres e que, para as regiões, a escolha do método tem implicações nos resultados. Em suma, a qualidade dos dados no Suriname é melhor do que na maioria dos países da região, mas há diferenças regionais consideráveis, como observado em outros lugares.

La oficina de estadísticas de Surinam supone que los datos de mortalidad en el país son de buena calidad y no hace ninguna prueba antes de producir estimaciones de la tabla de vida. Sin embargo, la falta de calidad de datos es una preocupación en las zonas menos desarrolladas del mundo. El objetivo principal de este artículo es evaluar la calidad del registro de recuentos de defunciones en el país y sus principales regiones entre 2004 y 2012 y producir estimaciones de mortalidad de adultos por sexo. Utilizamos datos de la población, por edad y sexo, de los últimos censos y recuentos de muertes de la oficina de Estadística. Utilizamos métodos demográficos tradicionales para realizar el análisis. Encontramos que la calidad del registro del recuento de defunciones en Surinam y sus regiones centrales es de razonable a buena. Asimismo, hallamos que los datos de población pueden considerarse también buenos. Los resultados revelan una pequeña diferencia en la integridad para hombres y mujeres y que para la población subnacional la elección del método tiene implicaciones en los resultados. En resumen, la calidad de los datos en Surinam es mejor que la de la mayoría de los países de la región, pero existen diferencias regionales considerables, como también se observa en otros lugares.

Zika cases: Epi Week 22, 2017

This table contains numerical data sourced from surveillance of cases related to Zika Virus disease and Guillain-Barré Syndrome (GBS). Entries began in the year 2015, Month 8, Epidemiological Week 32 and ended in 2017, Month 5, Epidemiological Week 22. They were made under the following headings: Zika Disease Confirmed case; Zika disease Suspected case; Cases of GBS; Cases of GBS lab­ confirmed for ZIKV; Other Neurological Syndromes; Other Neurological Syndromes lab­ confirmed for ZIKV; Suspected Cases of Congenital Syndrome Associated with ZIKV; Probable Cases of Congenital Syndrome Associated with ZIKV; and Confirmed Cases of Congenital Syndrome Associated with ZIKV. A total for each of the categories listed was displayed.

Linking Global Youth Tobacco Survey (GYTS) data to tobacco control policy in Suriname / Vinculación de la Encuesta Mundial de Tabaquismo en Jóvenes (EMTJ) a la política de control del tabaco en Surinam

Abstract: Objective: To use evidence from the Global Youth Tobacco Survey (GYTS) to inform tobacco-control policy in Suriname. Materials and methods: The GYTS was conducted in 2000, 2004 and 2009 among secondary school students (13 to 15 years) in a two-stage cluster sample design. Results: 2744 students, age 13 to 15, participated. From 2000 to 2009, results showed an increased prevalence of “current use of cigarettes” and “other tobacco products” in females (31 and 98%). Additionally, students reported high exposure to second-hand smoking at home (56.6 to 46.6%) and in public places (67.8 to 53.3%). Less than half of all respondents were taught about the dangers of smoking in school. Conclusion: National smoking prevalence coincides with regional trends. The results of the GYTS provided the evidence-base towards developing comprehensive tobacco control legislation. Tobacco legislation was passed in 2013. Future GYTS will monitor legislation implementation and progress made in achieving WHO Framework Convention on Tobacco Control (FCTC) goals.

Resumen: Objetivo: Utilizar evidencia de la Encuesta Mundial de Tabaquismo en Jóvenes (EMTJ) para comunicar las políticas de control del tabaco en Surinam. Material y métodos: Las EMTJ se desarrollaron en los años 2000, 2004 y 2009 entre estudiantes de secundaria (de entre 13 y 15 años de edad) mediante diseño muestral en dos etapas. Resultados: Participaron en total 2744 estudiantes. De 2000 a 2009, los resultados mostraron una mayor prevalencia de “uso actual de cigarrillos” y “otros productos de tabaco” en mujeres (31 y 98%). Asimismo, se evidenció un alto grado de exposición pasiva al humo de tabaco en hogares (56.6 a 46.6%) y en lugares públicos (67.8 a 53.3%), además de la exposición a publicidad protabaco (periódicos/revistas: 76.3 a 54.0%; vallas publicitarias: 77.4 a 52.6%). Menos de la mitad de los estudiantes que participaron fueron instruidos sobre los peligros de fumar en las escuelas. Conclusión: La prevalencia nacional de tabaquismo coincide con la tendencia regional. Los resultados de la EMTJ proporcionan evidencia exhaustivas sobre la legislación del control de tabaquismo aprobada en 2013. Futuras EMTJ pueden promover y monitorear la implementación de la norma y su progreso en la consecución de los objetivos de OMS y el Convenio Marco para el Control de Tabaco.

Assessing the feasibility of the Healthy Life in Suriname Study: using advanced hemodynamics to evaluate cardiovascular risk / Evaluación de la factibilidad del estudio Vida Sana en Suriname: uso de hemodinámica avanzada para evaluar el riesgo de enfermedades cardiovasculares / Avaliação da viabilidade do Estudo de Vida Saudável no Suriname: uso de hemodinâmica avançada para avaliar o risco cardiovascular

ABSTRACT Objectives To determine the feasibility of assessing population cardiovascular risk with advanced hemodynamics in the Healthy Life in Suriname (HELISUR) study. Methods This was a preliminary study conducted in May – June 2012 using the Technical-Economic-Legal-Operational-Scheduling (TELOS) method to assess the feasibility of the HELISUR—a large-scale, cross-sectional population study of cardiovascular risk factors and disease in Suriname. Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of 135 volunteers 18 – 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center. The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. Results The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended. Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. Conclusions Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

RESUMEN Objetivos Determinar la factibilidad de evaluar el riesgo de enfermedades cardiovasculares en la población utilizando hemodinámica avanzada en el estudio Vida Sana en Suriname (HELISUR por su sigla en inglés). Métodos Este fue un estudio preliminar realizado de mayo a junio del 2012 empleando el método de factibilidad técnica, económica, legal, operativa y de programación (TELOS) para evaluar la factibilidad del HELISUR, un estudio poblacional transversal a gran escala de factores de riesgo y enfermedades cardiovasculares en Suriname. Suriname, un país de ingresos medianos de América del Sur, con una población de etnicidad principalmente africana y asiática, presenta un riesgo alto de enfermedades cardiovasculares. En el estudio participó un total de 135 voluntarios de 18 a 70 años de edad. Se puso a prueba un cuestionario de salud en un centro de atención primaria de salud, y se realizaron evaluaciones cardiovasculares no invasoras en un centro de salud académico. La evaluación cardiovascular incluyó mediciones de presión arterial en posición sentada, supina y de pie, y los criterios de valoración intermedios, como el gasto cardíaco, la resistencia vascular periférica, la velocidad de la onda de pulso y el índice de aumento. Resultados En las pruebas del método TELOS se encontró que la comunicación por teléfono celular era la más eficaz para asegurar la asistencia a las citas y que a menudo se requería la presencia de un entrevistador capacitado para ayudar a los voluntarios a llenar el cuestionario; se recomienda modificar las preguntas para que sean más claras. Con respecto a las evaluaciones cardiovasculares prolongadas de hemodinámica periférica y central, los resultados demostraron que eran técnica y operativamente factibles, y bien toleradas por los participantes en cuanto a la carga y duración. Conclusiones Los resultados de esta evaluación de factibilidad indican que las evaluaciones detalladas y a gran escala del riesgo de enfermedades cardiovasculares, que incluyen un cuestionario y hemodinámica central y periférica avanzada, son factibles para una población de alto riesgo en un país de ingresos medianos.

RESUMO Objetivos Determinar a viabilidade de avaliar o risco cardiovascular da população por meio de avaliação hemodinâmica avançada no Estudo de Vida Saudável no Suriname (HELISUR). Métodos Estudo preliminar realizado em maio-junho de 2012 com o uso da metodologia TELOS (análise técnica, financeira, jurídica, operacional e do cronograma) para avaliar a viabilidade do HELISUR – estudo transversal de base populacional em grande escala dos fatores de risco e doenças cardiovasculares no Suriname. O Suriname é um país sul-americano de renda média de população majoritariamente de origem afro-asiática com alto risco da doença cardiovascular. Participaram do estudo 135 voluntários com 18 a 70 anos de idade. O questionário sobre saúde foi testado em uma unidade básica de saúde e avaliações cardiovasculares não invasivas foram realizadas em um centro de saúde acadêmico. A avaliação cardiovascular consistiu da medida da pressão arterial em posição sentada, supino e em pé, e da medida de parâmetros (endpoints) intermediários como débito cardíaco, resistência vascular periférica, velocidade da onda de pulso e índice de amplificação. Resultados A análise TELOS indicou maior eficiência na adesão às consultas com a comunicação por celular e a necessidade frequente de auxílio de um entrevistador treinado para o preenchimento do questionário. Modificações para melhorar a compreensão das perguntas são recomendadas. Também se demonstrou que o amplo estudo da hemodinâmica central e periférica é viável do ponto de vista técnico e operacional e que os participantes toleram bem o incômodo e o tempo de avaliação. Conclusões Os resultados da avaliação de viabilidade indicam que a avaliação aprofundada do risco cardiovascular em grande escala, incluindo a administração de questionário e estudos de hemodinâmica avançada central e periférica, é viável em uma população de renda média com alto risco.

Zika in Suriname: Emerging virus ­ Established vector

This Power Point presentation by the Suriname Director of Health, addresses the Zika outbreak in Suriname, the progression of the spread of the virus and the response of the Surinamese government with respect to containing the spread of the disease. The presentation outlines steps taken in preparation for an outbreak of Zika, after the virus' first appearance in Brazil in 2015. Strategies adopted at the entomological, epidemiological, surveillance and vector control levels in Suriname are outlined. The presentation also addresses prenatal consultation and monitoring, antenatal monitoring of Zika positive pregnancies, and updating of Aedes material to include Zika-V information for use in schools and other training. Finally, the presentation addresses the drafting of new risk communication strategies and Zika response strategies at the national level, the lessons learned, and the challenges associated with the Zika virus.

Chikungunya Virus Infection after Traveling to Surinam, South America / 대한내과학회지

Chikungunya infection is caused by an arbovirus transmitted by the Aedes mosquito. A 19-year-old man who had traveled to the Republic of Surinam to perform volunteer work complained of a fever, arthralgia, articular stiffness, and a skin rash on both the arm and trunk. Chikungunya fever was diagnosed using a Chikungunya virus specific IgM antibody in an enzyme-linked immunosorbent assay (ELISA) using blood samples obtained during follow-up visits. In this report, we describe a case of imported Chikungunya fever that presented with arthralgia and a skin rash, with islands of normal skin, that occurred following travel to Surinam, South America.

Moving toward universal access to health and universal health coverage: a review of comprehensive primary health care in Suriname / Avanzando hacia el acceso universal a la salud y la cobertura universal de salud: un análisis de la atención primaria de salud integral en Suriname

OBJECTIVE: To provide an overview of comprehensive primary health care (CPHC) development and implementation in Suriname in peer-reviewed literature. METHODS: Building on work funded by the Teasdale-Corti Global Health Research Partnership Program/People's Health Movement, the authors searched MEDLINE, the Cochrane Library, and POPLINE for articles focused on CPHC within the Surinamese context. Two authors independently reviewed abstracts and then jointly reviewed the selected abstracts. The final selection was completed using a data extraction form. RESULTS: The initial search resulted in 1 556 abstracts. The initial review identified 58 articles. Only three of the 58 articles met the inclusion criteria for the final review. The three selected articles provided partial overviews of CPHC in Suriname and examples of its implementation, with a focus on the service delivery network in the interior of the country, which was designed to improve rural access to basic health care services by training community members as service providers. They also included examples of how preparations for health reform in Suriname in the late 1990s and early 2000s, influenced by global neoliberal reforms, led to expectations that disparities in health status, design of health system components, and service provision related to differences in power and historical context (e.g., the influence of medical professionals, political parties/ethnic groups, and wealthier populations concentrated in urban areas) would be addressed. CONCLUSIONS: Given the focus on primary health care in the Americas and the notable developments that have occurred in Surinamese health policy and health care, particularly in health care reform, the paucity of published research on CPHC in Suriname was an unexpected finding that may be partly due to prioritizing research on disease control rather than health policy and systems research. The limited amount of scientific literature on this topic 1) prevents clear understanding of CPHC development and implementation in Suriname and 2) underscores the need to strengthen the national health research system to better inform policies for moving the country toward universal health access and coverage to improve the health of all of its citizens.

OBJETIVO: Proporcionar una visión de conjunto de la implantación de la atención primaria de salud integral en Suriname en la bibliografía arbitrada. MÉTODOS: Aprovechando el trabajo financiado por el Programa de Alianza de Investigación en Salud Mundial Teasdale-Corti/Movimiento de Salud de los Pueblos, los autores efectuaron búsquedas en MEDLINE, la Biblioteca Cochrane y POPLINE de artículos que se centraran en la atención primaria de salud integral en el contexto surinamés. Dos autores analizaron los resúmenes independientemente y a continuación examinaron conjuntamente los resúmenes seleccionados. La selección final se completó mediante el empleo de un formulario de extracción de datos. RESULTADOS: La búsqueda inicial obtuvo como resultado 1 556 resúmenes. El análisis inicial seleccionó 58 artículos. Solo tres de estos 58 artículos satisficieron los criterios de inclusión en el análisis final. Los tres artículos seleccionados proporcionaban un panorama parcial de la atención primaria de salud integral en Suriname y ejemplos de su implantación, se centraban especialmente en la red de prestación de servicios del interior del país, diseñada para mejorar el acceso a los servicios de atención básica de salud en el entorno rural mediante la capacitación de los miembros de la comunidad como proveedores de servicios. También incluían ejemplos de cómo los preparativos para la reforma sanitaria de Suriname a fines de los años noventa y principios de siglo XXI, influidos por las reformas neoliberales a escala mundial, generaron expectativas de que se abordarían las disparidades en el estado sanitario, el diseño de los componentes del sistema sanitario, y la prestación de servicios de atención de salud relacionadas con diferencias de poder y contexto histórico (por ejemplo, la influencia de los profesionales de la medicina, partidos políticos y grupos étnicos, y las poblaciones más ricas concentradas en las zonas urbanas). CONCLUSIONES: Dada la importancia concedida a la atención primaria de salud en la Región de las Américas y el notable desarrollo experimentado por la política de salud y la atención de salud de Suriname, particularmente en la reforma del sector sanitario, la escasa investigación publicada sobre la atención primaria de salud integral en Suriname fue un hallazgo inesperado, que en parte puede ser debido a que se ha priorizado más la investigación sobre el control de enfermedades que la investigación sobre políticas y sistemas de salud. La limitada cantidad de bibliografía científica sobre este tema 1) impide una comprensión clara del desarrollo y la implantación de la atención primaria de salud integral en Suriname y 2) destaca la necesidad de fortalecer el sistema nacional de investigación en salud con objeto de fundamentar mejor las políticas que hagan avanzar al país hacia el acceso y la cobertura universales de salud para una mejora de la salud de todos sus ciudadanos.

Triatominae species of Suriname (Heteroptera: Reduviidae) and their role as vectors of Chagas disease

Nine species of Triatominae, representing three tribes and five genera, are currently known in Suriname. An annotated list of the species based on the collections of the Bureau of Public Health (Suriname), the National Zoological Collection Suriname and the National History Museum Leiden (the Netherlands) is provided. Additionally, the results of several years of opportunistic collection in two domestic environments are presented. The most common species are Rhodnius pictipes Stål, 1972, Rhodnius robustus Larrouse, 1972 and Panstrongylus geniculatus (Latreille, 1811). The significance of the species as vectors of Chagas disease in Suriname is discussed.

Evidence of an increased incidence of day 3 parasitaemia in Suriname: an indicator of the emerging resistance of Plasmodium falciparum to artemether

The emerging resistance to artemisinin derivatives that has been reported in South-East Asia led us to assess the efficacy of artemether-lumefantrine as the first line therapy for uncomplicated Plasmodium falciparum infections in Suriname. This drug assessment was performed according to the recommendations of the World Health Organization in 2011. The decreasing number of malaria cases in Suriname, which are currently limited to migrating populations and gold miners, precludes any conclusions on artemether efficacy because adequate numbers of patients with 28-day follow-up data are difficult to obtain. Therefore, a comparison of day 3 parasitaemia in a 2011 study and in a 2005/2006 study was used to detect the emergence of resistance to artemether. The prevalence of day 3 parasitaemia was assessed in a study in 2011 and was compared to that in a study in 2005/2006. The same protocol was used in both studies and artemether-lumefantrine was the study drug. Of 48 evaluable patients in 2011, 15 (31%) still had parasitaemia on day 3 compared to one (2%) out of 45 evaluable patients in 2005/2006. Overall, 11 evaluable patients in the 2011 study who were followed up until day 28 had negative slides and similar findings were obtained in all 38 evaluable patients in the 2005/2006 study. The significantly increased incidence of parasite persistence on day 3 may be an indication of emerging resistance to artemether.

Carbon dioxide baited trap catches do not correlate with human landing collections of Anopheles aquasalis in Suriname

Three types of carbon dioxide-baited traps, i.e., the Centers for Disease Control Miniature Light Trap without light, the BioGents (BG) Sentinel Mosquito Trap (BG-Sentinel) and the Mosquito Magnet® Liberty Plus were compared with human landing collections in their efficiency in collecting Anopheles (Nyssorhynchus) aquasalis mosquitoes. Of 13,549 total mosquitoes collected, 1,019 (7.52 percent) were An. aquasalis. Large numbers of Culex spp were also collected, in particular with the (BG-Sentinel). The majority of An. aquasalis (83.8 percent) were collected by the human landing collection (HLC). None of the trap catches correlated with HLC in the number of An. aquasalis captured over time. The high efficiency of the HLC method indicates that this malaria vector was anthropophilic at this site, especially as carbon dioxide was insufficiently attractive as stand-alone bait. Traps using carbon dioxide in combination with human odorants may provide better results.

Community-directed risk assessment of mercury exposure from gold mining in Suriname

OBJECTIVES: The overarching objective of this project was to support the indigenous people in Kwakoegron, Suriname, in self-diagnosis of public and environmental health problems. The specific objectives, defined by the people of Kwakoegron were: (1) to determine for themselves if they are at risk of exposure to mercury (Hg) contamination, (2) to measure the extent of the Hg contamination problem, and (3) to initiate an intervention plan. METHODS: Field work was conducted from June 2005 to April 2006. Community members were trained to collect hair samples for analysis using methods designed to maximize sample quality and consistency and minimize cross-contamination. Each hair sample, of approximately 20 mg, was weighed, added to the sample boat, and analyzed immediately without preservation or storage. Technicians educated in analytical chemistry and trained in the operation of the portable Lumex Zeeman Hg analyzer measured the total Hg (THg) for each hair sample. Confidential meetings were held with each person sampled and any questions were answered. Afterwards, a community meeting was held to reflect on the process, outcome, and future needs. RESULTS: Hair samples from 16 of the 22 participants had Hg levels of 2.2-20.2 µg/g THg, exceeding normal THg levels for hair (2 µg/g THg). During the confidential, individual meetings and the followup community meeting, information was shared regarding the Hg levels found, what the numbers meant scientifically, what the potential health effects could be, and how exposure levels might be brought down. At the conclusion of the followup meeting, the Kwakoegron community proposed an intervention plan that had three principle parts: (1) routine analysis of Hg exposure to monitor trends and track the effects of exposure-reduction efforts; (2) routine health assessments to determine the effects of Hg exposure, particularly in children less than 5 years of age; and (3) fish advisories based on fish biology...

OBJETIVOS: El objetivo central de este proyecto fue apoyar al pueblo indígena de Kwakoegron, Suriname, a hacer su propio diagnóstico de los problemas de salud pública y ambiental. Los objetivos específicos, definidos por la población de Kwakoegron fueron: 1) determinar por sí mismos si están en riesgo de exposición a la contaminación por mercurio (Hg), 2) medir la magnitud del problema de la contaminación con Hg, y 3) comenzar un plan de intervención. MÉTODOS: El trabajo de campo se realizó entre junio de 2005 y abril de 2006. Se entrenó a miembros de la comunidad para tomar muestras de pelo para el análisis mediante métodos diseñados para optimizar la calidad y la consistencia de la muestra y minimizar la contaminación cruzada. Cada muestra de pelo, de aproximadamente 20 mg, se pesó, se colocó en el bote de muestras y se analizó inmediatamente sin conservar o almacenar. Un técnico en química analítica entrenado en la operación del analizador portátil de Hg de Lumex Zeeman midió el Hg total (THg) de cada muestra de pelo. Se realizaron conversaciones confidenciales con cada persona muestreada y se respondieron sus dudas. Luego se realizó una reunión con la comunidad para exponer el proceso, los resultados y las necesidades futuras. RESULTADOS: Las muestras de 16 de los 22 participantes tenían niveles de THg de 2,2-20,2 mg/g, superiores a los niveles normales de THg en pelo (2 mg/g). En las conversaciones confidenciales individuales y en la reunión de seguimiento con la comunidad, se informó sobre los niveles de Hg encontrados, su significado desde el punto de vista científico, los posibles efectos para la salud y cómo se pueden reducir los niveles de exposición. En las conclusiones de la reunión de seguimiento, la comunidad de Kwakoegron propuso un plan de intervención que contaba con tres partes principales: 1) análisis periódicos de la exposición al Hg para monitorear la tendencia y los esfuerzos hechos para reducir la exposición; 2)...