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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 The Commonwealth of the Bahamas is an archipelago
of some 700 islands with a land mass of 5,382 sq. miles. Nassau , the capital,
located on New Providence (70%) of the population), and Freeport, located on
Grand Bahama (15%) of the population) contain the largest population. It is
an independent unitary state within the British Commonwealth of Nations, governed
by a parliamentary democracy.
Demography:The 2000 census population was 304,837; 30% is under
15 years and 8% over 65. The dependency ratio was 47.6 in 1998. Life expectancy
at birth was 68.8 years for males and 75.3 for females during 1996-2000. The
M:F sex ratio was 94:100 in 2000. The crude birth rate declined from 20.8 per
1,000 pop. in 1996 to 18.0 per 1,000 pop. in 1999. The total fertility rate
was 2.1 children per woman in 1999.
Economy:Per capita income is estimated at $15,500 for 1999.
There is universal access to all essential social services, including health,
education, and housing. About 35% of the national recurrent budget is allocated
to the social sectors. The unemployment rate in 1999 was estimated at 7.8 %.
Tourism and tourist commerce are the most important, accounting for over 50%
of GDP and 60% of employment. Service industries employ about 80% of the labor
force. In the 1999-2000 fiscal year, US$132.5 million was allocated to health,
which represents 14.8% of the national expenditure. During the period 1996-2000,
health expenditure per capita increased steadily (US$ 355 to US$ 420).
Education:Education
is compulsory to age 14. Tertiary education is provided at the Government-owned
College of the Bahamas and a number of private institutions, which offer both
associate's and bachelor's degrees.
Mortality: In 2000, the crude death rate was 533 per 100,000 pop., averaging 625 per 100,000
for males and 485 per 100,000 for females 1996-2000. For males, communicable
diseases, and diseases of the circulatory system with rates of 140 per 100,000
males were major problems followed by deaths from external causes and neoplasms
with rates of 85, 1996-2000. The number of deaths from external causes was nearly
double that of the previous review period. For females, diseases of the circulatory
system had the highest mortality rate, 143 per 100,000, communicable diseases,
(93) and neoplasms (72). In 2000, diseases of the circulatory system accounted
for 28% of deaths; communicable diseases, 20% malignant neoplasms, 14% and external
causes, 13%.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):The
infant mortality rate dropped from 18.4 per 1,000 live births in 1996 to 15.8
in 1999. Deaths originating in the perinatal period Complication of pregnancy
(COP) dropped from 24 per 100,000 live births in 1996 to 10 in 2000. COP, intestinal
infectious diseases (IID), acute respiratory infections (ARI), HIV/AIDS, injuries,
and child abuse were important. Hypoxia and COP were 50% (153) of total infant
deaths. In 2000, about 10.4% of newborns had low birthweight (< 2,500 g).
In the 1-4 age group, 1996-2000, HIV/AIDS accounted for 18% of deaths (102),
followed by land transport accidents . ARI, injuries, and intestinal and other
infectious diseases represented about 52% (4,694) of hospital discharge diagnoses
in the <5 age group 1996-2000, while slow fetal growth, malnutrition, and
immaturity represented 6%. Children < 5 years accounted for 955 or 43% of
all reported cases of abandonment and neglect and 144 or 26% of reported cases
sexual abuse.
Schoolchildren (5-9 years): For
children aged 5-9, ARI, IID and parasitic diseases, injuries, HIV/AIDS, and
child abuse were priority problems. Land transport accidents (7) and accidental
deaths by fire (7) were 19% of 72 total deaths, 1996-2000. There were seven
(9) registered deaths due to HIV/AIDS, 1996-2000. Injuries were 13% of hospital
discharges (4,789), acute respiratory infection (23%), intestinal and other
infectious and parasitic diseases (17%), bronchitis and asthma (10%), 1996-2000.
Nutritional deficiencies and anemias accounted for five deaths, and 152 hospital
discharge diagnoses. About 31% of child abuse and 32% sexual abuse cases were
reported, 1997-2000.
Adolescents (10-14 and 15-19 years):
Among Adolescents injuries due to violence and land transport accidents, early
onset of sexual activity, teenage pregnancy, child abuse, HIV/AIDS, and alcohol
and drug abuse were important, 1997-2000. ARI, intestinal infectious diseases,
and nutritional deficiencies and anemias were important for morbidity. Diabetes
mellitus was a leading cause of hospital discharge, 1996-2000. Morbidity data
reveal important gender differences, indicating different levels of risk. Among
10-14 year olds, there were 41 deaths; land transport accidents (6), homicides
(4), and HIV/AIDS (2), 1996-2000. Injuries represented 17% of total hospital
discharges (2736), with a M:F ratio of 2.1:1. ARI and IID accounted for 23%,
nutritional deficiencies and anemias (4%) and diabetes mellitus (2%). Diabetes
mellitus was a leading cause of 1247 hospital discharges for females and COP
were 6% of the total. In adolescents 15-19, there were 112 deaths, 1996-2000;
external causes (60%): homicides 42 deaths and land transport accidents 25.
The M:F ratio was 7.4:1 for homicides and 4:1 for land transport accidents.
Injuries accounted for 46% of 1,217 hospital discharges for males, while COP
were 74% of 3,564 for females. There were 331 abortions recorded in the 15-19
age group. Mental disorders, alcohol and drug abuse were leading hospital discharge
diagnoses, 2% of 4,822 hospital discharges, 1996-2000. The M:F ratio was 2.1:1.
There were five deaths due to HIV/AIDS, 1996-2000. About 20% of 3,703 child
abuse cases, 1997-2000 were 12-18 years old, 38% of reported sexual abuse of
children.
Adults (20-59 years):In
adults 20-59 years old there were 3,448 deaths with a M:F mortality ratio of
1.7:1,1996-2000. Although deaths from HIV/AIDS, (36%) are paramount, there are
differences between mortality and morbidity patterns for men and women. Males
leading causes of death were HIV/AIDS, homicides, land transport accidents,
ischemic heart disease and cerebrovascular disease. The M:F death ratio was
1.6 for HIV/AIDS; ischemic heart disease (2.6:1) and cerebrovascular disease(1.8:1),
1996-2000. Females leading causes of death were HIV/AIDS, cancer of the breast,
diabetes mellitus, hypertensive disease and ischemic heart disease. With respect
to morbidity, ARI and parasitic diseases were about 7% of hospital discharges
diagnoses. There were 12,582 reported hospital discharges for men, 1996-2000,
injuries (25%) and HIV/AIDS (7%). Other issues for male adults 20-59 were mental
health, alcohol and drug abuse, homicide, and land transport accidents. Among
female adults, maternal morbidity, abortion, domestic violence, and mental health,
particularly depression were evident. There were 2,215 recorded abortions in
the 20-59 age group. In 1997, of 295 domestic violence victims, 76% were females.
Elderly (60 years and older):
Adults 60 years and over contributed 1,860 deaths with a mortality rate of 633
per 100,000, both sexes, 1996-2000. This age group had the lowest M:F mortality
ratio (0.9:1). The principal causes of mortality among males were ischemic heart
disease, hypertensive disease, cerebrovascular disease, cancer of the prostate,
and diabetes mellitus that contributed 14%, 10%, 10%, 9% and 7% of deaths, 1996-2000.
The principal causes of mortality among females were hypertensive disease, ischemic
heart disease, diabetes mellitus, cerebrovascular disease, and pulmonary heart
disease and circulatory system that contributed 14%, 13%, 13%, 13% and 4%, 1996-2000.
A similar pattern was observed in hospital discharge diagnoses. During 1996-2000,
hypertensive disease, cerebrovascular disease, ischemic heart disease, and diseases
of pulmonary circulation were 31% of all hospital discharge diagnoses (10,457).
Diabetes, ARI, diseases of the urinary system, and diseases of other organs
of the digestive system were also of concern.
Workers' Health: HIV/AIDS,
psychiatric disorders, cardiovascular diseases, arthritis, fractures, and skin
and neurological disorders were the most frequent causes of illness.
Natural disasters:
Hurricane Floyd caused extensive infrastructural damage and property damage,
but no deaths and few injuries. A widespread outbreak of conch poisoning occurred
in New Providence following the hurricane.
Analysis by type of health problem Vector-borne diseases:Malaria
is not endemic, but in 1997, there were 8 imported cases, 1998 (21), 1999, (30)
and 2000 (2). There have been no cases of yellow fever in the Bahamas since
the 1970s, though the vector (Aedes aegypti) is present. There was one confirmed
case of dengue in 1998. Prior to that, the last reported case was in 1996.
Diseases preventable by immunization:
Sustained immunization efforts have substantially reduced cases of these diseases.
The last cases of polio were recorded in the 1960s. As in 1993-1996, there were
no cases of measles, diphtheria, or neonatal tetanus, 1997-2000. Also, there
were no cases of whooping cough, 1997-2000; tetanus - one case in an adult,
1998. Since an outbreak in 1990, there have only been sporadic cases of rubella,
with 7 cases in 1997. A mass vaccination campaign interrupted transmission,
and only two cases were reported in 1998. Data on laboratory-confirmed new cases
of Hepatitis B infection show an increase from 162 in 1996 to 353 in 2000, in
part due to better reporting.
Intestinal infectious diseases:There was no
reported cholera in 1997-2000. There were 305 cases of fish poisoning, 225 cases
of ciguatera, and 787 cases of other food poisoning. Intestinal infections was
the leading hospital discharge diagnosis among children <5 years, and those
aged 5-9 and 10-14. There were 4,162 hospital discharge diagnoses of intestinal
infectious disease (for all age groups) during 1996-2000.
Chronic communicable diseases:TB
cases ranged from 59 in 1996 to 82 in 2000. Over this period, the proportion
of new reported HIV-negative TB cases rose from 25% of 88 in 1997 to 56% of
86 in 2000. Leprosy is not endemic; but a case was diagnosed in 1996.
Acute respiratory infections: There were 239
deaths due to ARI 1996-2000, 59% were elderly, 20-29 year olds (31%) and infants
(5%). ARI was a leading cause of hospital discharge for all age groups 1996-2000.
HIV/AIDS: The
HIV/AIDS mortality decreased from 97 per 100,000 pop. in 1996 to 80 in 2000.
HIV/AIDS was the leading cause of death with 3,810 cases (71% died), 1996-2000.
While cases of HIV declined from 719 in 1994 to around 347 in 1999, deaths increased
with increasing prevalence. The M:F ratio shows HIV risk to males as 1.6 times
greater than for females, 1990-2000. Preventive interventions to reduce mother-to-child
transmission of HIV in 1996 contributed to reductions. In contrast, the increased
death rate from AIDS is due to a cumulative effect from 1989.
Sexually transmitted infections: There
were 1,632 sexually transmitted infections reported 1996-2000. These included
chlamydia (49%), syphilis (26%), gonococcal infection (24%), and congenital
syphilis, (2%).
Nutritional diseases: In
1997, 17% of screened women attending antenatal clinics had hemoglobin levels
of 10 grams or less. Nutritional deficiencies and anemias were among the ten
leading hospital discharge diagnoses in children and the elderly.
Cardiovascular diseases: Cardiovascular
diseases were major causes of mortality, especially among adults aged 20-50
and the elderly. Hypertension, cerebrovascular disease, and ischemic heart disease
were among the leading hospital discharge diagnoses and causes of death during
1996-2000.
Malignant neoplasms: Malignant
neoplasms contributed 1,172 deaths, 1996-2000. Prostate cancer, breast cancer,
and uterine cancer were the major contributors to both mortality and morbidity.
There were 2,036 hospital discharge diagnoses from malignant neoplasm, 1996-2000.
Accidents and violence:
External causes mortality increased, 1996-2000 period; mainly from homicides
and land transport accidents, most affecting male adolescents and young adults.
Injuries ranked high among hospital discharge diagnoses in all age groups. In
2000, murders were 74, fatal accidents (76) and accidents with injury (474).
Child abuse increased.
Mental health: New
cases of drug and alcohol abuse treatment increased, 1996-2000 and was 49% of
the total discharges from the national psychiatric hospital, 1996-2000.
Oral Health:Among
1,060 five-year-old children examined, prevalence of dental caries in their
primary dentition was 58%. The prevalence of dental caries in the permanent
dentition of 12 and 15-year-old schoolchildren was 55% and 61%, respectively.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans: Institutional
reforms to improve the social safety net and domestic and international investment
are in force. Selective public health interventions include prevention of mother-to-child
transmission of HIV, strengthening of maternal and perinatal care, family planning
services, and comprehensive care for those with HIV/AIDS. A Strategic Plan (2000-2004),
outlined five strategic directions: healthy people; healthy environment; maximized
resources; quality service; and health care planning. Priority areas are maternal
and child health, school adolescent health, family planning, health of older
persons, communicable disease prevention and control, chronic noncommunicable
disease prevention and control, food and nutrition, mental health, substance
abuse prevention and control, oral health, rehabilitative services, injury prevention
and control, emergency medical services, disaster preparedness, pharmaceutical
services, tourist health, and HIV/AIDS. Investments were made in health infrastructure
and in human resources. To improve intersectoral collaboration, sustainable
relationships with nongovernmental organizations (NGOs) were established.
Institutional organization of the health sector:
Reorganization of the health system increased
the regulatory role of MOH. The Public Hospitals Authority, created in 1999
defines responsibility for management of hospital care. The MOH, through the
Department of Public Health, is responsible for the provision and management
of primary health care services and the development and implementation of public
health programs. Technical Advisory Committees have given priority to the reorganization
of the Planning Unit and information systems. Bahamas is a member of the Regional
Nursing Body and the Caribbean Medical Examination and has actively developed
common examinations for the regional registration of nurses and physicians.
Health services have been decentralized. Private physicians provide care through
individual practices and the private sector participates in programming with
the National Breast Screening Program.
Modalities of health insurance and their respective
coverage: Government ensures universal access
to essential health services regardless of ability to pay. Private health insurance
is offered and all workers public or private are required by law to participate
in the National Insurance Scheme.
Health care delivery: The MOH regulates and
monitors the national health care system. The Hospitals and Health Care Facilities
Act of 1998, enables MOH to create a Board to oversee licensing of health care
facilities. MOH is responsible for establishing standards, norms, and guidelines
for health care delivery and patient care.
Certification and professional health practice:
Through the Medical Council, Dental Council,
and Nursing Council, the MOH is responsible for regulating these health professionals.
Through the 1998 Health Professions Act, the Ministry also regulates all other
health professions.
Basic health markets:The
Pharmacy Act regulates the dispensing and control of narcotics and psychotropic
substances, but not the registration of imported drugs.
Quality of the environment: The
DEHS monitors and ensures air, water, soil, and housing quality, and monitors
the security of hazardous substances. DEHS has developed a comprehensive solid
waste plan for the establishment of sanitary landfills.
Food: is
regulated jointly by the ministries of agriculture and health.
Health promotion: The
Healthy Schools Initiative is a health promotion activity based on national
planning and programming.
Disease prevention and control programs:A number of disease prevention and control programs
are in place to address communicable, as well as chronic non-communicable diseases.
Health analysis, epidemiological surveillance
and public health laboratories systems: Surveillance
systems, especially for communicable diseases were strengthened. Information
systems and evidence-based decision-making were given priority in the National
Health Services Strategic Plan. The public health laboratories monitor water
and food quality.
Potable water and sanitary excreta disposal:The Grand Bahama Utility Co. provides water and sewerage
services, and the Paradise Island Utility provides water, but private wells
are numerous. The Water and Sewerage Corp. (WSC) provides water services in
New Providence and 13 Family Islands. WSC covers about 16% of the population
in New Providence, the remainder are served by septic tanks. Sewerage services
on the Family Islands are for the most part septic tanks and latrines. Major
hotels and resorts have on-site sewerage treatment and disposal systems.
Municipal solid waste: The Department of Environmental
Health Services (DEHS) in New Providence and the Local Authority in the Family
Islands are responsible for municipal solid waste collection services. DEHS
provides technical support to the Family Islands. Prevention and control of
air pollution is the responsibility of the DEHS that also monitors outbreaks,
eating establishments and food handlers.
Ambulatory, emergency and in-patient services:
Health care services are provided through hospitals and community clinics in
the public and private sectors. Primary health community clinics offer ambulatory
curative and preventive care, and limited inpatient care. The Public Hospitals
Authority is responsible for the Emergency Medical Services. The Bahamas Air
Sea Rescue Association is a non-profit voluntary organization.
Auxiliary diagnostic services and blood banks:
Diagnostic services are offered through the
public health system - some by the private hospital. Laboratories perform many
but not all microbiological and clinical analyses as do a number of small private
laboratories with limited diagnostic capacity. There are three blood banks at
hospitals and one in the private sector. All blood for transfusion is screened
for HIV, for Hepatitis B and C, and Syphilis. Radiological services are offered
in both the public and private sectors.
Specialized services:
Rehabilitation services are offered at hospitals. Community-based rehabilitation
services have grown and provided individual services and helped integrate children
with disabilities in schools. Oral health services are provided in hospitals
and community clinics. The School of Dental Health Service operates in 60 primary
schools and offers preventive services and restorative care. The school health
services offer hearing and vision screening, monitor nutritional status, and
make referrals for treatment. Mental health services are based in Sandilands
Hospital, where inpatient and community services are offered. The Crisis Centre
provides counseling and support for domestic violence, substance abuse. Reproductive
health services are offered at community clinics, family planning clinics, and
the adolescent health clinic. Maternal care is offered throughout the Bahamas.
Health supplies:All
drugs, reagents and related equipment are imported.
Human Resources: In
1996, there were 453 physicians per 10,000 pop. and 667 nurses in the public
sector. Training of health personnel: The Nursing School trains nurses in collaboration
with the College of The Bahamas; most postgraduate training in nursing is done
at the University of the West Indies (UWI). Physicians are trained in the Caribbean
or in North America or the United Kingdom. UWI started a clinical training program
for undergraduate medical students. A policy for training public sector physicians
has been developed for implementation. Out migration of health personnel is
not a problem, rather health professionals are attracted.
Health Research and technology:
Various clinical research was implemented including participation in the Adolescent
Health Survey 1996-2000. The Abbot Study examining the efficacy of the new Protease
inhibitor in children (ABT 378/r) commenced in 1999, and did the U.S. National
Institutes of Health Nevirapine Study.
Health expenditure and financing: In the 1999-2000
fiscal year, US $132.5 million was allocated to health - 14.8% of national expenditure.
Public health expenditure per capita was US$ 420, 1999-2000. The bulk of expenditure
was directed to hospital-based services. The portion of the health budget allocated
to the Public Health Department increased slightly in 2000.
External health technical cooperation and
financing: Technical cooperation and financing
are provided by the Inter-American Development Bank (IDB) and PAHO/WHO. Also,
UNAIDS worked through the Bahamas Theme Group and the PAHO/WHO office in the
implementation of the first UNAIDS grant (1996-1997).
