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

BACKGROUND: The 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. METHODS: Using 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. RESULTS: In 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. CONCLUSIONS: The 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.