Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) Cohort Study: influences of complex environmental exposures on maternal and child health in Suriname.

PURPOSE: The Caribbean Consortium for Research in Environmental and Occupational Health prospective environmental epidemiologic cohort study addresses the impact of chemical and non-chemical environmental exposures on mother/child dyads in Suriname. The study determines associations between levels of environmental elements and toxicants in pregnant women, and birth outcomes and neurodevelopment in their children. PARTICIPANTS: Pregnant women (N=1143) were enrolled from December 2016 to July 2019 from three regions of Suriname: Paramaribo (N=738), Nickerie (N=204) and the tropical rainforest interior (N=201). Infants (N=992) were enrolled at birth. Follow-up will take place until children are 48 months old. FINDINGS TO DATE: Biospecimens and questionnaire data on physiological and psychosocial health in pregnant women have been analysed. 39.1% had hair mercury (Hg) levels exceeding values considered safe by international standards. Median hair Hg concentrations in women from Paramaribo (N=522) were 0.64 µg/g hair (IQRs 0.36-1.09; range 0.00-7.12), from Nickerie (N=176) 0.73 µg/g (IQR 0.45-1.05; range 0.00-5.79) and the interior (N=178) 3.48 µg/g (IQR 1.92-7.39; range 0.38-18.20). 96.1% of women ate fish, respective consumption of the three most consumed carnivorous species, Hoplias aimara, Serrasalmus rhombeus and Cichla ocellaris, known to have high Hg levels, was 44.4%, 19.3% and 26.3%, respectively, and was greater among the interior subcohort. 89% frequently consumed the vegetable tannia, samples of which showed presence of worldwide banned pesticides. 24.9% of pregnant women had Edinburgh Depression Scale scores indicative of probable depression. FUTURE PLANS: Fish consumption advisories are in development, especially relevant to interior women for whom fish consumption is likely to be the primary source of Hg exposure. Effects of potentially beneficial neuroprotective factors in fish that may counter neurotoxic effects of Hg are being examined. A pesticide literacy assessment in pregnant women is in progress. Neurodevelopmental assessments and telomere length measurements of the children to evaluate long-term effects of prenatal exposures to toxicant mixtures are ongoing.

Measurement of Health-Related-Quality-of-Life and Perceived Discrimination: an Indirect Risk Factor Analysis for Pesticide-Induced Suicides in the Eastern Nickerie District

Background and significance: Nickerie with high agricultural activity is burdened by very high suicide rates of 47/100,000 and suicide attempt rates of 207/100,000. Almost 44 % is committed by pesticide ingestion. Interventions, like safe storage and use of pesticides may assist in reducing the number of pesticide-induced suicides. This applies to so-called "impulsive" suicide attempts. To date, local activities on safe pesticide use had limited success by the community at large, making achieving sustainability difficult. Methods: Focus group meetings were held in a needs assessment phase for qualitative data. For quantitative data, two surveys, the SF-36v2 , to measure the health-related-quality-of-life and the SEE survey, to measure the perceived discrimination of the participants, was conducted. Data were analyzed by composing 2x2 tables and calculating odds ratios, chisquare tests and Fisher tests using SPSSv19 software. Results: Age groups 15-30, 30-45 and 45-60 years are at risk for poor mental health. Physical health is poor in Paradise. Low educated people are at risk for poor physical, poor mental and poor overall health. Alcohol and drugs use happen more among low educated participants, age groups 15-29 and above 60 years, in Henar, survivors and males. Awareness is more in age groups 15-44 and above 60 years and high-educated ones. Feelings expressions are more by low educated ones, while less by age group 15-29 years and males. Passive behavior is more among low educated ones, those above 45 years and in Paradise. Feelings of guilt are more among high-educated ones, those of 15-29 years, in Paradise and Nw. Nickerie and females. Attacking behavior is more among 15-44 and above 60 years, in Paradise and Nw. Nickerie and females. Conclusions: Low education is a risk factor for poor physical, mental and overall health. Age is a risk factor for poor mental health. Residence is a risk factor for poor physical health. Low education is a risk factor for alcohol and drugs, not being aware, feelings of guilt and being passive. Age is a risk factor for alcohol and drugs use, feelings of guilt, being passive, feelings expressions and attacking people. Residence is a risk factor for alcohol and drugs use, not being aware, feelings of guilt, being passive and attacking people. Gender is a risk factor for alcohol and drugs use, feelings of guilt, being passive, feelings expressions, and attacking people. Recommendations: Focus should be on mental health care for young and low educated people through enforcement, awareness to break the taboo and reduce other barriers and easy access. Creating different education opportunities to increase the education level and efforts to increase physical health in Paradise and the young; alcohol and drugs use awareness activities among people at risk and considering all observed associations of awareness, being passive and expressing feelings, to tailor intervention strategies can lower the pesticide-induced suicides rates. Training of health ambassadors, creating a "buddy" network, applying e-health by means of electronics and smart phones at short term and long-term phases can result in a decrease of the pesticide-induces suicides in Nickerie.