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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 St. Vincent and the Grenadines is a small Eastern
Caribbean State consisting of 30 islands, inlets and cays with a total land
area of 345 km2. These islands are part of the Windward Island chain of the
Lesser Antilles . Most of the land area and 91 % of the country's 1999-estimated
population of 111,638 are on the mainland St. Vincent . The Grenadines extend
south 45 miles and include the inhabited islands of Bequia, Mustique, Myreau,
Canouan, Union Island and Palm Island . 44% of the population resides in urban
and sub-urban communities. Mainland St. Vincent is linked to the Grenadines
by sea as well as air transport. Docking facilities are available on all inhabited
Grenadine Islands , while airport facilities are present on four islands. St.
Vincent and the Grenadines has a tropical climate with an average temperature
of 24-33 oC and are susceptible to hurricanes, tropical storms, volcanic
eruptions and earthquakes. St. Vincent and the Grenadines attained political
independence from Great Britain in 1979, and inherited a Westminster Parliamentary
Democracy system of Government with elections every five years.
Demography:
In 1999 there was an estimated 55,931 females and 55,707 males making up the
population. The under 15 years age group accounted for 37% of the population
and the 65 years and over were 6.5% of the total population. From 1995 to 2000
life expectancy at birth averaged 68.7 years for males and 74.2 years for females.
The crude birth rate continued to decline gradually from 23.6 in 1995 to 19.5
per 1000 population in 1999. Fertility rates was 2.8 children per woman.
Economy:
Growth in real GDP averaged 3.2 % per year during 1997-1999. During this same
period, non-tourism services increased by over 4% on average with major inputs
from the communication, wholesale and retail trade, and the banks and insurance
sectors. The tourism sector grew by 4.5% in 1997, fell in 1998 by 4.2% and increased
again in 1999 by 9.1%. The agricultural sector contributed 12.5% to the GDP
in 1998 and 11.3% in 1999.
Education: There were 21,451 students ages
5-15 years attending 60 government primary schools, 1 for children with special
needs, and 6 private ones. At the secondary level, there were 7,931 students
in 21 schools. Mortality:
There were 3,184 deaths over the period 1996-1999 with an annual average of
798 deaths. The average crude death rate was 7.2 per 1000 population as compared
to 6.5 in 1992-1995. Infant deaths averaged forty-nine per annum over the period
1996 - 1999 while the average infant mortality rate was recorded at 22 per 1000
live births. During 1996-1999, Diseases of the Circulatory System accounted
for 42% (1,333 deaths) of the total deaths, neoplasm's for 16 % (498 deaths
) , external causes for 6.7% (498 deaths) and communicable diseases for 2.2%
(71 deaths).
SPECIFIC HEALTH PROBLEMS
Analysis by population group Children: The
average number of children in the 0-4 years age group was 12,630 or 11.3% of
the average total population for 1996 -1999. The infant mortality rate for that
period ranged from 20.1 to 24.6 deaths per 1,000 live births with an average
of 22. Of 197 infant deaths in the period 1996-1999, 137 or 70 % were neonatal
deaths of which 73 or 53% were less than a day old. From 1996 to 1996, the leading
causes of death among infants were certain conditions originating in the perinatal
period with an average of 29 deaths per year, followed by congenital abnormalities
with 10 deaths per year. There were 45 deaths in the 1-4 years age group from
1996 to 1999. HIV/AIDS and pneumonia were responsible for 8 deaths each and
congenital abnormalities caused 6 deaths. The major diseases affecting this
age group were acute respiratory infections and gastroenteritis. Immunization
coverage in 2000 was 100% for OPV3, BCG and DPT3 and 96% for MMR. No cases of
diseases preventable by immunization were identified for the reporting period.
Between 85% to 88% of children under 5 years had adequate weight for age during
1996-1999, a decrease from 90% in 1992-1995. Obesity continues to increase from
6.8% in 1998 to 9% in 1999 while moderate undernutrition decreased from 7% in
1998 to 6% in 1999.
The 5-9 year-olds:totaled
14,471 or 13% of the total population in 1999. Their common health problems
were visual problems, impacted cerumen, dental caries, viral illnesses, asthma
and tinea corporis. There was an average of 7 deaths per year in this group.
Adolescents: In
1999, adolescents totaled 27,181, representing 24.3% of the total population.
Important problems affecting this population were pregnancies, accidents, drugs
and alcohol abuse. In 1999, mothers ages 10 to 14 years made up .6% of all births
and ages 15 to 19 contributed 20.7%. There was an average of 15 deaths each
year from 1996 to 1999 among adolescents, representing less than 2% of all deaths.
Accidental drowning and submersion" was the major cause of death in this age
group.
Adults: The
age-group 20-59 years accounts for approximately 50% of the total population.
HIV/AIDS and other sexually transmitted diseases, hypertension, heart disease,
diabetes and cancer were important health conditions for adults. In the period
1996-1999 non-communicable diseases were the most important causes of death.
Malignant neoplasms (especially uterus/cervix and prostate cancers), endocrine
and metabolic diseases and immunity disorders each recorded 491 deaths (15%
for each one), followed by ischemic heart disease with 349 deaths (11%), cerebrovascular
disease with 325 deaths(10%) and hypertensive disease with 243 deaths (7.6%).
Communicable diseases, the major contributor septicemia, accounted for 71 deaths
(2.2%). For external causes, accidents contributed 53 deaths and homicide and
injury purposely inflicted by other persons contributed 45 deaths. In 1996-1999
the average maternal mortality rate was of 67.2 per 100,000 live births accounting
for six deaths.
Elderly: The
age-group 60 years and older totaled 9,970 persons or 8.9% of the total population
in 1999. This age group accounted for 25% of all clinic visits. The major diseases
affecting them were hypertension, diabetes, heart disease and cancer. Out of
all deaths, 60% occurred in this age group.
Disabled: In
1999 an estimated 1,274 or 1.2% of the population was disabled or impaired.
This included blindness, mental retardation, deaf/dumb, cerebral palsy, Downs
syndrome, mental illness, Parkinson's disease, epilepsy, senility and deformity
from arthritis. The School for Children With Special Needs provided services
to 118 students.
Analysis by type of health problem Vector Borne Diseases:
In 1998, there was an outbreak of Dengue type II with 62 laboratory-confirmed
cases. In 1999, only one case was confirmed. No deaths were reported.
Immune Preventable Diseases: Immunization
is available for measles, mumps, rubella, diphtheria, pertussis, tetanus, poliomyelitis
and tuberculosis. One case each of Rubella was identified for the years 1996
and 1997, with no cases identified in 1998 and 1999. In 1999 there was rubella
vaccination campaign targeting 20 to 40 year olds. There were no cases of measles
or mumps in the reporting period. Diphtheria, pertussis, and poliomyelitis have
not been identified here for more than a decade. The only case of tetanus was
identified in 1997. Surveillance for Haemophilus influenzae meningitis, which
started in January 1999, identified 6 cases that year, all children. None died.
During 1996-1999, 2.6% of all screened blood samples at the national laboratory
were reported positive for hepatitis B. A Hepatitis B vaccination Programme
to immunize all health care workers was initiated in January 1997, with 80%
coverage currently. Neonates of Hepatitis B positive mothers are also offered
immunization.
Intestinal infectious diseases: The
National Laboratory analyzes more than 4,500 stool samples per year and has
identified during the review period parasites like Hookworms, T.Trichiuris and
Ascaris are seen. During the period under review, 407 samples were positive
for hookworms, 271 were positive for Trichuris trichiura and 106 for Ascaris
lumbricoides.
Chronic communicable diseases: Seven
new cases of tuberculosis were reported during the period of 1996-1999. Males
accounted for 80% of the cases. There were no new cases of Leprosy in 1999.
There was 1 reported case in 1998 and another in 1997.
Respiratory diseases:
Acute Respiratory Infection was the most common communicable disease reported
in 1998 and 1999, accounting for 40.0% of all communicable disease. There were
2500 visits to the Accident and Emergency Department of the Kingstown General
Hospital annually for the treatment of Asthma each year. Children under 10 years
account for 45% of these visits.
Zoonoses: There
were no identified cases of rabies during the review period. During the period
1996-1999, 20 cases of leptospirosis were confirmed. No deaths were reported.
HIV/AIDS:
Since the start of the HIV/AIDS epidemic in 1984 by the end of 1999, a total
of 408 HIV infected cases were identified. Of these, 229 or 56 % developed AIDS
and 223 died. Eighty-four percent of those infected fell into the 15-49 age
group , with the male to female ratio being 1.8:1. In 1998 the prevalence of
HIV in pregnant women was 0.2%. The number of cases of mother-to-child transmission
has increased.
Sexually transmitted infections: The
annual number of gonorrhea cases reported, which is probably underreported,
was 88 during the period 1996-1999. The prevalence of syphilis among pregnant
women the prevalence of syphilis dropped from 5.0 % in 1996 to 3.7% in 1999.
Nutritional diseases: Energy-protein
malnutrition among children age 5 years and younger increased from 4.3% in 1991
to 5.9% in 1999. A survey indicated that Vitamin A and beta-carotene levels
in the target population were within normal range, while 41% of children 1-4
years were iron deficient (serum ferritin levels, 25 ug/dl), and 21 % were deficient
in vitamin E. In the 5-19 age group 19% were iron deficient, while only 2.6
% were deficient in Vitamin E.
Diseases of the circulatory system and diabetes:
Diabetes, hypertension , ischemic heart disease,
cerebrovascular accidents and diseases of the pulmonary circulation and other
forms of heart disease account for 7.9% (683 out of 8,596) of all admissions
to the Kingstown General Hospital. In 1999, from the 68,469 clinic visits 14,049
(21%) were for hypertension, 5,513 (8%) were for the combination of diabetes
and hypertension and 4,858 (7%) for diabetes alone. Hypertension was the leading
cause of clinic visits.
Malignant neoplasms: The
annual average number of malignant neoplasms rose from 35 during 1992-1995 to
50 during 1996-1999. For women, cancer of the cervix was the main cancer site,
with 106 cases in 1996-1999, a 77% increase from 1992-1995. The second most
frequent site was cancer of the breast with 43 cases, 14 more than 1992-1995.
Similarly, among males, the number of cases of prostate cancer doubled from
12 in 1992-1995 to 24 in 1996-1999.
Accidents and violence: There
were 214 deaths from accidents and violence during 1996-1999. Drowning and submersion
accounted for 53 deaths (25%), and homicide and injury purposely inflicted by
other persons accounted for 45 deaths (21 .% ). Deaths from other external causes
accounted for 7% of all deaths. Reports from Kingstown General Hospital showed
that road traffic accidents caused an annual average of 355 casualties.
RESPONSE OF THE HEALTH SYSTEM Health system: Health
services are offered at the primary and secondary levels. 38 health centers
in 9 health districts facilitates the delivery of primary care. Each health
center is required to have a minimum complement of a staff nurse/midwife, a
nursing assistant and a community health aide. The health team also includes
the district medical officer, environmental health officer, family life educator,
social worker and pharmacist. Secondary care is offered at Kingstown General
Hospital . This is a 209-bed referral hospital offering various categories of
specialist care. Acute care, not requiring specialist intervention, is also
provided by 5 rural hospitals with a combined capacity of 58 beds. Acute and
chronic psychiatric care is provided through the Mental Health Center , which
has the capacity to house 120 inpatients. Health insurance coverage is provided
solely by private insurances. The National Health Insurance Programme (NHIP)
was created to provide access to a comprehensive package of health care services
.
Organization of regulatory actions: All
public health care facilities are owned and operated by the Government through
the Ministry of Health, who sets the standards for care and regulates practice
within the health sector. The Ministry of Health, in particularly the Chief
Medical Officer, guides the operations of private health care facilities. All
medical practitioners must be accredited and registered to practice. All nurses
are registered with the General Nursing Council. Pharmaceuticals are supplied
mainly by private pharmacists, who must be registered with the Ministry of Health.
Vehicular exhaust is responsible for most air pollution. Leaded fuel was phased
out in 1999. The country does not accept hazardous waste. The Bureau of Standards,
the Ministry of Agriculture, the Ministry of Fisheries, and the Veterinary Unit
regulate food quality.
Organization of public health care services:
Health promotion services are offered mainly
through the Ministry of Health's Health Education Unit. A network of family
life educators at Youth Guidance Centers carries out school activities. Community
activities are geared primarily toward out-of-school youths. Educational programs
on HIV/AIDS are provided to individuals, communities and institutions. Disease
Prevention and Control Programs There are programs on dengue, targeting areas
with high A. aegypti indices.
Health analysis, epidemiological surveillance
and public health laboratory systems: Most
public and private care providers carry out disease surveillance. All information
is forwarded to the Epidemiological Unit for collation and analysis. Public
health laboratory services are provided by the Kingstown General Hospital Laboratory.
Potable water, excreta disposal and sewerage
services: The Central Water and Sewerage Authority
(CWSA) is the statutory body responsible for water resources including potable
water and the provision of sewerage services. The main source of water is through
surface and underground sources (rivers, stream wells and springs). Rain harvesting
is utilized on the Grenadine Islands . CWSA is responsible for the monitoring
of water quality, while the Public Health Department plays a monitoring and
regulating role. Over 60% of all households are connected to the communal water
system and therefore receive state-disinfected water. All other persons live
within one mile of standpipe and receive potable water. The number of houses
now equipped with septic tanks has increased to over 60%. The number of households
with no facilities or shared facilities accounts for about 1% and pit latrines
are being prevalent among some 39%. Sixty-four percent of all households have
weekly refuse collection service. Topsoil erosion has become a problem due to
deforestation, farming and construction. The CWSA and the Forestry Division
regulates activities relating to soil usage and deforestation. The country is
a party to the Basel Convention. While there is no legislation for implementation
of the convention, the government does not accept hazardous waste. The bureau
of standards regulates food quality together with the Ministries of Agriculture,
Fisheries and veterinary unit.
Organization of health care services:Health promotion services are offered mainly through
the Health Education Unit within the Ministry of Health. The Health Education
Unit continues to air daily health programmes on radio, and produces a wide
range of health promotion audiovisual and graphic materials. The National school
health programme focuses on children 5 - 9 years old. Eleven Family Nurse Practitioners
are assigned to the sixty-six primary schools in the country and the services
provided detect for health defects, administration of treatment and a system
of referrals to specialized services. The education system requires that every
child be comprehensively immunized before entering school. The Government operated
Nutrition Support Programme provides a hot meal for at-risk children in all
primary schools. Some 6,700 children participate in the School Feeding Programme.
The Health and Family Life Education (HFLE) Programme for primary and secondary
schools was re-established in the year 2000 with the appointment of a Health
and Family Life Education Coordinator in the Ministry of Education. Health care
for adolescents is provided mainly by the government operated district health
centers. However, due to the vulnerability of this group, the Ministry of Health
and the Environment delegated specific responsibilities for Adolescent Health
to the National Family Planning Programme in 1999. The objectives for the adolescent
health programmes are aimed at promoting healthy development as well as preventing
and responding promptly to health problems. These programmes are structured
to include adolescents in and out of school. In 1999, adolescent clinics, adolescent
groups and youth guidance centers were established in several communities to
educate and train adolescents in reproductive health, family life and skills
training. Most public and private care providers carry out disease surveillance.
All information is forwarded to the Epidemiological Unit for collation and analyses
in coordination with the Health Information Unit. Through the OECS/ World Bank
Solid Waste Management Project, one major sanitary landfill is located on mainland
St. Vincent . This agreement allows for the development of two major landfills
on main land St. Vincent and three in the Grenadines . Food safety continues
to be a major focus. Food handlers clinic are conducted twice per year at District
Health Centers. These clinics also provide education and information on food
safety. All persons involved in food vending must attend these clinics in order
to be certified.
Organization of individual health care services:
Emergency services are offered at Kingstown
General Hospital and at the 38 health centers. In patient services are provided
at the five district hospitals, and at the main hospital. Each health center
serves 1,200-3,000 persons, and offers acute and ambulatory care. Auxiliary
diagnostic services are offered mainly through the main referral hospital. There
are two privately operated clinical laboratories, which offer services to the
public. Family Planning Services are offered on a daily basis at all health
centers, while child health services, antenatal and postnatal care may be obtained
weekly. Mental Health acute care is available only at the Mental Health Center.
These services are complimented by monthly outpatient clinics in most health
districts, as well as home and community visits. Mental health services are
being integrated in primary care, and ten acute care beds are available at the
main referral center for treatment of the acutely ill Psychiatric patient. The
problem of mother-to-child transmission of HIV has prompted routine testing
of all ante-natal patients and the offering of anti-retro viral drugs to those
testing positive. The Ministry of Health and the Environment with the assistance
of other sectors of Government, the private sector, the NGOs and Churches have
collaborated in providing educational programmes to individuals, communities
and institutions on HIV/AIDS. Measures are in place to upgrade the knowledge
of health care workers so that they can be equipped to provide information and
support to HIV positive individuals, People Working and Living with AIDS (PWLAs)
and their families, as well as the general public. A National AIDS Coordinator
was appointed in November 2000.
Health supplies:
St. Vincent and the Grenadines procure all drugs and equipment from the Organization
of Eastern Caribbean States Pharmaceutical and Procurement Services (OECS-PPS).
Vaccines are access through the Pan American Health Organization (PAHO) revolving
fund.
Human resources: In
2000, the medical practitioners' register included 89 doctors and 5 dental
practitioners. Of these, 56 doctors work in the public sector (51 per 100, 000
population), and 26 work in the private sector exclusively. Seven physicians
were registered employees of Kingstown Medical College . The Nursing Council's
register included 398 trained nurses (362 per 100,000 population ). There were
42 registered nursing aides, 45 community health aides, and 7 nursing tutors.
Nursing training is provided at the Government's St. Vincent 's School of Nursing
. Health care workers also receive training internationally, including in North
America and Europe. The Ministry of Health has endorsed continuing medical education
to improve efficiency and productivity, and has financed organization and hosting
of such activities.
Health sectoral expenditure and financing: From
1995 to 1999 Government expenditure on health amounted to EC$ 31.13 million
per year, 3.9% of the GDP. In 1999, health expenditure amounted to EC$ 37.34
million, 13 % of the recurrent expenditure and 4.2% of the GDP. In 1999, 32.8%
of the budget went to hospital services, 12.2% went to community health services,
and 13.1% to pharmaceuticals. In 1999, user fee collections was 2.21% of total
health expenditure, less than the projected 6%.
External technical cooperation and financing:Financial and technical assistance to development
of the health sector was provided by PAHO, CAREC, CFNI, CDB, CEHI, Kingstown
Medical College, the World Bank, and the governments of Cuba, Japan and Taiwan
specifically in solid waste management, public health, hospital extension, health
education and the training of health personnel, research activities and infrastructural
development.
