Plasmodium falciparum malaria in Suriname: how targeted interventions in marginalized populations led to elimination

BACKGROUND: Plasmodium falciparum (Pf) was the primary malaria species in Suriname for many decades. Following the introduction of targeted and inclusive interventions malaria incidence in the country decreased. Pf ceased to be the primary prevalent species in 2007. The aim of this study is to describe the interventions and discuss the strategies that contributed to Pf elimination in Suriname. METHODS: National malaria surveillance data from 2000 to 2024 were analyzed, with a focus on Pf. Data were disaggregated to age and sex and country of origin. Interventions aimed at progressing from control to pre-elimination, elimination, and prevention of re-introduction of malaria were assessed and described. RESULTS: Progressing towards elimination, Pf malaria moved from being a disease of the indigenous and tribal communities in the Interior of Suriname to an occupational disease primarily affecting mobile migrants in the remote gold mining sites. The last indigenous Pf case in Suriname was reported in 2018. The national elimination strategy focused on parasite elimination by providing low barrier access to care for all populations at risk. CONCLUSIONS: Suriname eliminated Pf using a targeted and inclusive elimination strategy. Continued importation of Pf into Suriname from neighboring countries in conjunction with a costly elimination strategy in a context of a national economic downfall and a potential decrease in external funding, generate a risk of re-introduction. Elevating the elimination goal to the regional Guiana Shield level, combined with a continuous alertness for and immediate response to imported Pf cases is needed to sustain Pf elimination in Suriname.