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Title of Trip Report Study on the knowledge, attitudes and practices of malaria and malaria treatment in the small-scale gold mining sector in Suriname November 2013 Front page image courtesy of M.Heemskerk Study on the knowledge, attitudes and practices of malaria and malaria treatment in the small-scale gold mining sector in Suriname Heemskerk, M and Duijves, C November 2013 Study on knowledge, attitudes and practices of malaria and malaria treatment in the small scale gold mining sector in Suriname This report is made possible by the generous support of the American people through the US Agency for International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-11-00021. The contents are the responsibility of Management Sciences for Health and do not necessarily reflect the views of USAID or the United States Government. About SIAPS The goal of the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program is to assure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes. Toward this end, the SIAPS result areas include improving governance, building capacity for pharmaceutical management and services, addressing information needed for decision-making in the pharmaceutical sector, strengthening financing strategies and mechanisms to improve access to medicines, and increasing quality pharmaceutical services. Recommended Citation This report may be reproduced if credit is given to SIAPS. Please use the following citation. Heemskerk, M., and C. Duijves. 2013. Study on knowledge, attitudes and practices of malaria and malaria treatment in the small scale gold mining sector in Suriname. Submitted to the US Agency for International Development by the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Arlington, VA: Management Sciences for Health. Key Words Malaria, Suriname, KAP study Systems for Improved Access to Pharmaceuticals and Services Center for Pharmaceutical Management Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA 22203 USA Telephone: 703.524.6575 Fax: 703.524.7898 E-mail: [email protected] Web: www.siapsprogram.org ii CONTENTS Acronyms and Abbreviations ................................................................................................... iv Acknowledgments...................................................................................................................... v Executive Summary ................................................................................................................. vii 1. Introduction and Background ............................................................................................ 1 1.1. Introduction ................................................................................................................ 1 1.2. Study objectives ......................................................................................................... 2 1.3. Background to Suriname............................................................................................ 2 1.4. Malaria vectors in Suriname ...................................................................................... 3 1.5. Malaria services in small-scale gold mining areas in Suriname ................................ 4 1.6. Malaria services in small-scale gold mining areas in French Guiana ........................ 7 1.7. Outline of report ......................................................................................................... 9 2. Methods............................................................................................................................ 10 2.1. Sampling .................................................................................................................. 10 2.2. Study design ............................................................................................................. 15 2.3. Protection of Human Subjects and Ethical Review ................................................. 16 2.4. Data analysis ............................................................................................................ 16 2.5. Research team .......................................................................................................... 16 2.6. Study limitations and assumptions........................................................................... 17 3. Results and Discussion .................................................................................................... 19 3.1. Demographic and social profile ............................................................................... 19 3.2. Malaria knowledge................................................................................................... 23 3.3. Experience with malaria .......................................................................................... 29 3.4. Malaria Prevention: Use of bed nets ........................................................................ 33 3.5. Malaria testing ......................................................................................................... 34 3.7. Use of malaria medication ....................................................................................... 39 3.8. Completing treatment............................................................................................... 46 3.9. Medication use (other than malaria) ........................................................................ 47 4. Conclusions and Recommendations ................................................................................ 49 4.1. Conclusions .............................................................................................................. 49 4.2. Recommendations .................................................................................................... 52 References ................................................................................................................................ 58 Annex A. Research Instruments .............................................................................................. 60 Annex B. Selection of OTC Medicines Used by Respondents ................................................ 72 iii ACRONYMS AND ABBREVIATIONS ABS Algemeen Bureau voor de Statistiek (General Bureau of Statistics) ACD Active Case Detection ACT artemisinin based combination therapy ATV All Terrain Vehicle BCC Behavior Change Communication BOG Bureau of Public Health (Bureau Openbare Gezondheidszorg) cabaret Brothel (Por) Centre de Prevención et Prevention and vaccination centre Vaccinación Centre de Santé Health Centre Currutela Gold miners’ village (Por) FG French Guiana Garimpeiro Gold miner (Por) GDP Gross Domestic Product GNI Gross National Income GOS Government of Suriname IMF International Monetary Fund ITBN Insecticide Treated Bed Net KAP Knowledge, Attitudes and Practices MoH Ministry of Health MSD Malaria Service Deliverer MSH Management Sciences for Health MZ Medical Mission Primary Health Care Suriname (Medische Zending) OGS Ordening Goudsector (Regulation Gold Sector), Commission OTC Over-The-Counter (medicine) PAHO Pan American Health Organization PPP Purchasing Power Parity SIAPS Systems for Improved Access to Pharmaceuticals and Services Sranantongo Suriname lingua franca SU Suriname Tourtonnen lab Malaria testing and treatment center in north Paramaribo, in the neighborhood where many Brazilian gold miners stay, shop, hang out or conduct business when they are in the city. USAID US Agency for International Development WHO World Health Organization iv ACKNOWLEDGMENTS Conducting this study would not have been possible without the support and collaboration of many organizations and individuals. The study is a joint effort between the US Agency for International Development (USAID)-supported Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, implemented by Management Sciences for Health (MSH); the Pan American Health Organization (PAHO) and the Suriname Ministry of Health (MoH). We are grateful to the MoH’s Bureau of Public Health (Bureau voor Openbare Gezondheidszorg–BOG), Regional Health Services (Regionale Gezondheids Dienst-RGD), Medical Mission (Medische Zending-MZ) and the Global Fund-supported “Looking for Gold, Finding Malaria” Program for the cooperation, leadership, and direction they provided to make this assessment a success. Health professionals from these organizations helped with survey design, project planning and data collection, and provided insightful comments on the draft report. Specifically, we acknowledge the following local counterparts, stakeholders and partners who contributed at various stages of the study: Dr Marthelise Eersel, Director of Health, MoH Dr. Lesly Resida, Director, BOG Dr. Dayanand Panchoe, Head of Malaria Unit, Anti-malaria Campaign, BOG Mr. Hedley Cairo, Coordinator-Malaria Program, Global Fund Stephen G.S. Vreden, MD, PhD, Consultant Internal Medicine and Infectious Diseases, Academic Hospital Paramaribo Ms Miriam Naarendorp, Pharmacy Policy Coordinator and Head of the Pharmaceutical Inspectorate, MoH Dr. Edwin van Eer, Director, MZ Dr. Malti Sardjeo, Director, RGD Ms. Monique Gonesh Hahn, Pharmacist, RGD Dr. Guillermo Troya, PAHO/WHO Representative, Suriname Dr. Rachel Eersel, Public Health Advisor, HIV/STI, Focal Point CD/IHR, PAHO/Suriname Dr. Gustavo Bretas, Public Health Advisor, Malaria, PAHO/Suriname Dr. Edgar Barillas,
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