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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Martinique is situated in the central arc of the Antilles
, between Saint Lucia to the south and Dominica to the north. It is equidistant
from the coasts of Venezuela , Haiti and the Dominican Republic . It covers
1,130 km2. The capital is Fort-de-France.
Demography:
According to the 1999 census, Martinique has a population of 381,500 inhabitants.
In the 1990s, net migration was negative. The birth rate (14.8% in 1998) hides
a low fertility rate -- 1.9 children per woman in 1997. Martinique 's population
is a mix between the indigenous Amerindians and the Blacks, Whites, and Indians
who settled the island centuries ago. Foreigners are a minority and most immigrants
are from Haiti and Saint Lucia . The population density is high (338 inhabitants
per km2 in 1999) but the population is unevenly distributed. In 1997,
life expectancy at birth was 81.3 years for women and 74.9 for men.
Economy:
Martinique has a growing, albeit still weak, economy that largely depends on
foreign aid. The agricultural sector is small and based on sugarcane and banana
production. Tourism is a key economic sector. Between 1989 and 1997, the per
capita GDP increased an annual 9% to US$12,240 in 1997. Unemployment is at 26%.
Nearly 15% of households fall below the poverty line. Mortality:
Cardiovascular disease, cancer, and external causes of injury are the leading
causes of mortality in Martinique.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children:In
1995, infant mortality fell to its lowest level, 5.8 per 1,000 live births.
In 1998, it was at 8.6 deaths per 1,000 live births. Total perinatal mortality
in 1998 was 14.7 per 1,000 live births. Between 1995 and 1997, there were an
average 40 infant deaths per year, nearly all of them due to conditions originating
in the perinatal period and congenital anomalies.
Schoolchildren and adolescents:Half
of the deaths in this population are due to external causes of injury and half
to cardiovascular diseases and neoplasms. Mental disorders, asthma, and sickle
cell anemia are the main illnesses fully covered by the social security system
in the population under 15 years of age. Their prevalence is stable. Half of
the hospital stays in persons under 15 in the period 1992-1993 were due to three
causes: diseases of the respiratory system (24%), diseases of the digestive
system (18%), and injuries and poisoning (9%). A 1998 survey showed that asthma
and allergies are frequent among young Martinicans.
Adults: In
1995-1997, traffic accidents and other violent deaths represented 77% of all
deaths in males 15-24 years of age, followed by tumors (4%). For females, the
leading causes of death were external causes of injury (31%), principally traffic
accidents. In the age group 25-59, the three leading causes of death in men
were external causes of injury (accidents and suicides, 23%), cardiovascular
diseases (21%), and cancer (21%). In women, the leading causes of death were
neoplasms (34%) and cardiovascular diseases (25%). The total fertility rate
in 1997 was 1.9 children per woman. Over 99% of pregnant women attended at least
one prenatal check-up. In 1993-1997, maternal mortality was at 24 per 100,000
live births. In 1999, there were 30 voluntary abortions per 100 conceptions.
Elderly: In
1997, life expectancy at age 60 was 20.5 years for men and 24.5 for women. During
1995-1997, the three leading broad groups of diseases that contributed to mortality
were: cardiovascular diseases, neoplasms, and diseases of the respiratory system.
5% of people over age 60 have no toilet in their home and only 2% do not have
piped potable water. On average, 2% of people in this age group live in institutions.
Family health:The 1999 census revealed a continuing
trend towards smaller families (2.9 people on average).
Disabled persons: In
2000, 1,500 young people under age 20 were disabled and provided with financial
aid or placement in a specialized facility. The prevalence of disability among
the population under age 19 is 13 per 1,000. The most frequent disorders are
mental (36%) and other psychological disorders (21%). Due to lack of specialized
facilities, some young people must be cared for far from home. In 2000, over
5,500 adults over 20 qualified for a disability allowance.
Analysis by type of health problem Natural disasters:Martinique
is susceptible to meteorological disturbances, mainly cyclones, and to earthquakes
and volcanic eruptions. Risk management is achieved through regular disaster
mitigation awareness campaigns.
Vector-borne diseases:All
cases of malaria are imported. The annual incidence of the disease remains low:
1-5 cases per 100,000 population (57 cases between 1997 and 2000). Three of
every four cases were due to Plasmodium falciparum. No cases of yellow fever
were reported between 1997 and 2000. The annual incidence of dengue was 5 cases
per 10,000 population in 2000, with a seasonal peak in the second half of the
year. There was an unprecedented epidemic of hemorrhagic dengue in 1997, with
9 deaths. Dengue surveillance is carried out through a reference laboratory
that reports the results of serologic tests on a weekly basis. Between 1999
and 2000, DEN-1, DEN-2 and DEN-3 serotypes circulated in Martinique . There
is a small human reservoir of Schistosoma mansoni but no cases of schistosomiasis.
Diseases preventable by immunization:
In 2000, 99% of children age 2 at the time had received the first three doses
of the diphtheria, pertussis, tetanus and poliomyelitis vaccines. Measles is
one of the diseases subject to surveillance by the network of sentinel doctors.
90% of children had received the second dose of the MMR vaccines in 2000. Cases
of measles registered are clinically suspected ones, which affect mainly schoolchildren.
Each year there are a few cases of tetanus (about 10) reported in elderly people.
In 2000, 14,837 cases of influenza were reported. Campaigns to promote vaccination,
which is free for anyone over 65, are conducted. 85% of children age 2 had received
the first dose of hepatitis B vaccine in 2000. The prevalence of hepatitis C
in calculated at 0.5% of the total population.
Infectious intestinal diseases:
In 2000, six outbreaks of infectious food poisoning were reported in Martinique
, affecting 280 people. The most frequently identified serotypes were Salmonella
panama (35%), S. enteritidis (10%) and S. typhimurium (6.5%). The incidence
of viral gastroenteritis is high (5,425 cases in 2000) and epidemics are the
leading cause of diarrhea in Martinique . There were 13 cases positive for hookworm
in 2000 and 43 cases of threadworm.
Chronic communicable diseases:The
trend of tuberculosis observed since 1996 is stabilizing (13 cases in 1996,
18 in 1997, 25 in 1998 and 18 in 1999). Very few cases are imported and most
patients develop the pulmonary form of the disease. Eight new cases of leprosy
were detected in 1999. The active list includes 450 patients.
Zoonoses: 60
cases of leptospirosis were confirmed serologically in 1999 and 43 cases in
2000 for an average incidence rate of 0.14 per 1,000 population.
HIV/AIDS:
The AIDS epidemic in Martinique is a priority public health issue. The use of
the triple drug regimen since 1996 has reduced the number of new cases of AIDS
as well as the number of deaths from AIDS. 50 new infections are estimated to
occur per year. The mode of infection is mainly heterosexual.
Sexually transmitted infections (STI): Martinique only has one STI clinic. Infections
due to mycoplasmas, Gardnerella, Chlamydia, and Candida are those most frequently
diagnosed.
Nutritional, metabolic and genetic diseases:
The improved economic situation has led to a change in eating habits, and diseases
such as obesity, diabetes and hypercholesterolemia, have increased. Each year,
an average of 68 deaths from diabetes are reported (57% in women over 65 with
type 2 diabetes.) Two studies revealed that 10% of the population carried the
sickle cell trait, which is found in 1 of every 300 newborns each year.
Diseases of the circulatory system:Cardiovascular
diseases are the leading cause of mortality in Martinique (37% of female deaths
and 29% of male deaths). They also represent 34% of all hospital admissions
for chronic conditions, particularly hypertension and cerebrovascular accidents.
Malignant neoplasms: These
are responsible for one in four male deaths and one in five female deaths. Between
1991 and 1995, there were, on average, more than 800 new cases of cancer each
year (mostly prostate cancer (42%) and stomach cancer (9.5%) in males and breast
cancer (22.5%) and cervical cancer (17.5%) in women).
Accidents and violence:From
1995 to 1999, there was an average of 52 deaths due to road accidents each year.
During 1995-1997, an average of 33 suicides per year were recorded, the proportion
being higher in the 25-34 age group, and higher in men than women.
Behavioral disorders:An
annual average of 112 deaths from alcohol-related illnesses were registered
between 1995 and 1997 (cirrhosis of the liver, alcoholic psychosis, alcoholism
and neoplasms of the upper-respiratory system). The two specialized centers
providing outpatient treatment for alcoholics treat over 400 patients each year.
In a 2000 survey, 26% of middle school students and 35% of high school students
reported having been drunk at least once. Tobacco consumption in Martinique
is still low, so the effects of smoking on health are much less marked. During
1995-1997, an annual average of 173 deaths (7% of all deaths) was attributable
to tobacco use. In 2000, 6% of middle school students and 10% of high school
students were habitual smokers. In the same year, 15% of middle school students
and 22% of high school students had used an illicit drug at least once (usually
marijuana).
Mental health: In
a 2000 survey, 32% of respondents reported having had one or more psychiatric
disorders. Among the most frequent were isolated episodes of depression within
the previous two weeks (13%) current risk of suicide (11%), general anxiety
during the previous six months (10%), and recurrent depressive disorders (6%).
Hospital care for adults with mental illnesses is provided at the only specialized
hospital on the island.
RESPONSE OF THE HEALTH SYSTEM Health policies and plans Since 1946, French Guiana,
Guadeloupe, and Martinique have formed part of the French Overseas Departments
(FODs). Their political and administrative organization coincides with the rest
of France . As ultraperipheral regions of the European Union, they receive program
funds designed to assist developing European regions. The health policies of
the FODs are fashioned along the lines of the national policy of the Ministry
of Labor and Social Affairs of France (MES). Regional priorities are set during
a conference of health professionals and decision-makers and representatives
of institutions and users.
The five broad priorities of the five-year health
plan defined in 1999 include: perinatology, follow-up and rehabilitation, care
for the elderly, oncology, and development of outpatient surgery. A regional
health conference is organized each year and strategic health programs implemented
in keeping with national priorities.
Health system: The
French State is responsible for general public health, but the competencies
specifically pertaining to health are divided between the State level and the
local administrative units, which draw up and implement local health policies,
undertake health surveillance, and participate in policy development for public
and private hospitals, human resources development, and the organization of
networks of health professionals. The population benefits from a universal health
insurance plan that forms part of the social security system, which enables
the State to cover the cost of medical care for even the poorest sectors of
the population. The system is funded by compulsory contributions, which are
deducted from wages and salaries. Public and private medical care establishments
are key players in the health system, giving unrestricted access to a variety
of primary and secondary medical services. Hospital policy is governed by Regional
Hospital Agencies, whose mission is to define and implement policy on the provision
of hospital care, administer regional budgets, allocate resources, and oversee
the activities of public and private establishments.
Organization of regulatory actions:
A 1998 law created the French Agency for the Safety of Health Products and the
French Food Safety Agency. That law also created the Institute for Health Surveillance
to supervise and monitor the overall state of health of the population, and
the National Committee for Health Safety. Health promotion: The
Martinican Health Education and Promotion Committee is an entity working in
health promotion, along with numerous associations that undertake activities
geared to certain diseases or population groups.
Potable water and sanitation:A
regulatory plan for water management organizes all the uses of water (irrigation,
water for consumption, fishing, and recreational purposes). In general, water
is of good quality and cases of polluted drinking water are few. Domestic wastewater
management is achieved through zoning regulations. Industries, particularly
distilleries, install treatment units.
Solid waste:Almost
the entire population has domestic solid waste collection service. The four
garbage dumps have reached their capacity.
Pollution prevention and control: Few
industries on the island release pollutants into the air. In 2000, an air quality
surveillance network was established in Fort-de-France. Different zoning regulations
have been or are being established regarding the noisiest elements of the transportation
infrastructure and acoustic screens are installed along the noisiest roads.
Disease prevention and control programs: Numerous
prevention activities are carried out at different levels of the health system
and in schools. Vector control activities in Martinique are primarily aimed
at eliminating Aedes aegypti.
Epidemiological surveillance and public health
laboratories:Martinique has a laboratory network
and a network of sentinel doctors. Many diseases are subject to surveillance
(gonococcal disease, chlamydiosis, other STIs, dengue, influenza, gastroenteritis,
measles, chickenpox), and surveillance is based on reports by sentinel doctors
on presumed cases and not on laboratory-confirmed cases.
Specialized services:Functional
rehabilitation is a priority in the 5-year regional plan defined in 1999. As
of 1 January 2000 , there were 140 dentists in Martinique (37 per 100,000 population
). The new five-year plan for the organization of psychiatric health services,
approved in 1999, defined three broad objectives: improve access to medical
care, ensure the continuity of health care, and care for special population
groups. At the end of 2000, a perinatology network was set up to link those
involved in pregnancy, care, and neonatology. In area of geriatry, the need
for medical supplies and equipment is considerable, above all because there
is a shortage of suitable facilities and because demographic changes are increasing
the number of very elderly people. There are five medical-educational institutes
for disabled children, one facility for the hearing impaired, two home health
care and special education services, and a day-care hospital for autistic children.
Health supplies: The
provision of X-ray machines is sufficient. There are also three scanners and
a nuclear magnetic resonance machine in the Fort-de-France hospital.
Health sector financing: The
social entities at the national level play an important role in financing the
social protection, given that local contributions are insufficient to cover
costs of the health services.
External technical cooperation: The
FODs must take complementary measures in certain areas of health planning (for
common diseases for example). The departments also maintain a relationship with
PAHO, mainly through the Caribbean Program Coordination. Some health establishments
coordinate cooperation activities directly with the neighboring states.
