title: A National Surveillance Survey on Noncommunicable Disease Risk Factors: Suriname Health Study Protocol.
abstract: BACKGROUND
  Noncommunicable diseases (NCDs) are the leading cause of death in low- and middle-income countries. Therefore, the surveillance of risk factors has become an issue of major importance for planning and implementation of preventive measures. Unfortunately, in these countries data on NCDs and their risk factors are limited. This also prevails in Suriname, a middle-income country of the Caribbean, with a multiethnic/multicultural population living in diverse residential areas. For these reasons, "The Suriname Health Study" was designed.
  
  
  OBJECTIVE
  The main objective of this study is to estimate the prevalence of NCD risk factors, including metabolic syndrome, hypertension, and diabetes in Suriname. Differences between specific age groups, sexes, ethnic groups, and geographical areas will be emphasized. In addition, risk groups will be identified and targeted actions will be designed and evaluated.
  
  
  METHODS
  In this study, several methodologies were combined. A stratified multistage cluster sample was used to select the participants of 6 ethnic groups (Hindustani, Creole, Javanese, Maroon, Chinese, Amerindians, and mixed) divided into 5 age groups (between 15 and 65 years) who live in urban/rural areas or the hinterland. A standardized World Health Organization STEPwise approach to surveillance questionnaire was adapted and used to obtain information about demographic characteristics, lifestyle, and risk factors. Physical examinations were performed to measure blood pressure, height, weight, and waist circumference. Biochemical analysis of collected blood samples evaluated the levels of glucose, high-density-lipoprotein cholesterol, total cholesterol, and triglycerides. Statistical analysis will be used to identify the burden of modifiable and unmodifiable risk factors in the aforementioned subgroups. Subsequently, tailor-made interventions will be prepared and their effects will be evaluated.
  
  
  RESULTS
  The data as collected allow for national inference and valid analysis of the age, sex, and ethnicity subgroups in the Surinamese population. A publication of the basic survey results is anticipated in mid-2015. Secondary results on the effect of targeted lifestyle interventions are anticipated in late 2017.
  
  
  CONCLUSIONS
  Using the data collected in this study, the national prevalence of NCD risk factors will be approximated and described in a diverse population. This study is an entry point for formulating the structure of NCD prevention and surveillance.
authors.affiliation: Department of Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname. Ingrid.Krishnadath@uvs.edu.
authors.forename: Ingrid Sk
authors.identifier: http://orcid.org/0000-0001-7786-8869
authors.initials: IS
authors.lastname: Krishnadath
authors.forename: Christel Cf
authors.identifier: http://orcid.org/0000-0001-9454-5914
authors.initials: CC
authors.lastname: Smits
authors.forename: Vincent Wv
authors.identifier: http://orcid.org/0000-0003-2939-0041
authors.initials: VW
authors.lastname: Jaddoe
authors.forename: Albert
authors.identifier: http://orcid.org/0000-0002-9865-121X
authors.initials: A
authors.lastname: Hofman
authors.forename: Jerry R
authors.identifier: http://orcid.org/0000-0001-5504-0788
authors.initials: JR
authors.lastname: Toelsie
keywords: STEPwise approach to surveillance; Suriname; ethnicity; multistage cluster sample; noncommunicable disease risk factors