------------------------------
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 Guyana covers an area of 215,000 km² and is located
along the northeastern coast of South America . It is divided into 10 administrative
regions with Regional Democratic Councils responsible for the delivery of services
to their catchment population. Guyana is rich in natural resources; its economy
is based on agriculture (primarily sugar and rice), gold, bauxite and timber.
Demography:
The estimated mid-year population in 2000 was 743,004 persons. Data from the
1999 Guyana Survey of Living Conditions showed that East Indians accounted for
48% of the population. The next largest ethnic group was Negro/Black accounting
for 27% of the population; Amerindians were estimated to comprise 6.3% of the
population. Females accounted for some 51% of the total population, and for
53% of the population over age 60. Data from the Survey estimated that approximately
30% of the population live in urban areas, and of the 70% that live in rural
areas, 61 % live in coastal areas. The crude birth rate declined from 24.1 per
1,000 population in 1998 to 23.2 in 1999. The crude death rate remained nearly
constant-6.5 in 1998 and 6.6 in 1999. Life expectancy at birth was 64.4 in 1999.
Literacy:
Adult literacy was 98%, with no significant gender difference.
Economy:
The rate of inflation increased from 4.8% in 1998 to 7.4% in 1999. Economic
setbacks have been attributed to several factors, including El Niño (which caused
drought in some parts of the country and adversely affected agricultural output),
and reduced commodity prices on international markets. Thirty-six percent of
the population live in absolute poverty (less than US$510/year) and 19% live
in critical poverty (less than US$364/year).The National Development Strategy
which was drafted in 1996 and revised in 2000 has for its objective the attainment
of the highest economic growth rates possible, the elimination of poverty, and
the diversification of the economy. In 1999, the GDP per capita was US$800.
Mortality: A total of 5,302 deaths were registered
in 1998 and 5,102 in 1999. The male to female ratio in 1999 was approximately
1.47:1. Most of the deaths (18%) occurred in the over 75 age group, followed
by 16% in the 65-74, and 14% in the 55-64 age groups. Children under 5 years
of age accounted for 9.5% of deaths with 71 % of these being children under
one year. In the period 1997-1999, the leading causes of mortality for all age
groups combined were cerebrovascular disease (12.0%), ischemic heart disease
(10.0%), Acquired Immune Deficiency Syndrome (7.0%), underdetermined injury
(6.6%), diabetes mellitus (6.0%), acute respiratory infections (6.0%), diseases
of the pulmonary circulation (6.0%), hypertensive disease (4.8%), intestinal
infections (3.4%), and chronic liver diseases (2.8%).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): There
were an estimated 17,093 live births in 1999, compared to 19,118 in 1998. The
infant mortality rate for 1998 was 23 per 1,000 live births. The neonatal death
rate was 13 in 1999. In 1999, Yellow Fever vaccine was introduced into the routine
immunization schedule for children aged 12-23 months. The coverage in 2000 was
85%. In 1999, there were 280 deaths in the under-1 age group population compared
with 422 in 1998. For the period 1997-1999, hypoxia (21%), intestinal infections
(18%), and other perinatal conditions (13%) were among the leading causes of
death. In 1999, there were 116 deaths in the 1-4 age group compared to 105 in
1998. Infections and trauma played an important role in the mortality of this
age group. In the period 1997-1999, the leading causes of death were intestinal
infectious diseases (21%), acute respiratory infections (17%) and undetermined
injury (13%). In 1999, the main reason for infant visits to outpatient clinics
at hospitals and health centers were acute respiratory infections (56%).
Schoolchildren (5-9 years): In
1999, there were 38 deaths; nine were from communicable diseases and 6 were
due to intestinal infections. There were 5 deaths due to neoplasms and 10 due
to external causes.
Adolescents (10-14 and 15-19 years): There
were 445 deaths in this age group in 1999. Sixteen were from external causes,
of which motor vehicle accidents accounted for four, and there were three deaths
each from suicides, homicides, and undetermined injury. In 2000, the 15-19 group
represented 10% of the population. In 1998 and 1999, 22% and 24%, respectively,
of births occurred in women in this age group. Of the women attending government
family planning clinics in 1998, 12% were under 20 years. In 1999, the leading
causes of death were injury (26%), suicide (22.0%), and motor vehicle accidents
(14%).
Adults (20-59 years): The
total fertility rate was stable at 2.0 children per woman of child-bearing age
between 1997 and 1999. In 1999, 82% of women attended clinic for the first time
after the 12 th week of pregnancy. The maternal mortality rate was
124.6 per 100,000 live births in 1998. The main causes were haemorrhage (27%),
toxemia of pregnancy (21%) and abortion (18%). During 1999, there were 1,813
deaths occurring in this population group. Of these, 22% were due to external
causes, 20% to diseases of the circulatory system, and 9% to communicable diseases.
AIDS was the leading cause of death, accounting for 15% of deaths in that age
group.
The elderly (60 years and older): This
represents 6% of the population, and 53% of them were female. In 1999, this
population group accounted for 16,795 visits to hospitals' outpatient clinics.
The main diagnoses for first visits were hypertension (25%), arthritis/rheumatism
(10%), diabetes (8%), acute respiratory infections (10%), and accidents and
injuries (5%). There were 1,759 deaths in this age group in 1999. The leading
causes of death were chronic non-communicable diseases, including cerebrovascular
disease (15%), ischaemic heart disease (15%), diabetes (9.7%), and hypertensive
disease (9.2%).
Workers health: In
1999, the total number of accidents reported to the Occupational Safety and
Health Division was 2,385, including 2,370 non-fatal accidents. The fatal accidents
ranged from 9 in 1997 to 15 in 1999. Eighty-six percent of the non-fatal accidents
in 1999 occurred in the agriculture sector.
Indigenous groups:The
highest number of Amerindians (about 15,000) were among the Arawaks (or Lokonas
). They are followed by the Makushi ( 7.500 persons), the Wapishana , the Warao
, the Akawaio and the Patamona . The 1999 Survey of Living Conditions shows
that 78% of Amerindians are among the poorest. Some of the health-related problems
they face include malaria (60% of all cases), diarrheal diseases, acute respiratory
infections, teen pregnancy, short child-spacing, tuberculosis, dental caries
and inadequate access to health care. A study conducted in 1997 among the Patamona
and the Wapishana tribes showed that the prevalence of stunting increased with
age, from 17 % at age 7 to 50% at age 13 among the Wapishana tribe while the
figures for the Patamona were 19% and 80%, respectively. However, by age 18,
fewer than 1% of adults have a BMI of less than 18.5kg/m, while 11% and 3% of
adults among Patomona and Wapishana tribes, respectively, were overweight.
Analysis by type of health problem Vector-borne diseases: Malaria
is a major public health problem in Guyana . Plasmodium falciparum is the main
infectious agent transmitted. New cases represent over 90% of the cases detected
each year. In 2000, the number of new cases was 28,267. There were 34 reported
cases of dengue fever in 1998, 6 in 1999, and 25 in 2000. There has been laboratory
diagnosis of Dengue Types 1 and 2 during 1997-2000. However, no cases of Dengue
Haemorrhagic Fever or Dengue Shock Syndrome have been reported. There were 15
reported cases of leptospirosis during 1997-2000.
Diseases preventable by immunization: In 997,
there were 144 confirmed cases of rubella in comparison with 2 cases in 1998.
There were two serologically confirmed cases of Congenital Rubella Syndrome
in 1997, two in 1998, and one suspected case in 1999 but the serological test
for rubella was negative.
Chronic communicable diseases:
In 1997, there were 381 cases of tuberculosis with an incidence rate of 48 per
100,000 population , while the rate in 1999 was 53. Of these, 227 were pulmonary,
8 were relapsed pulmonary, and 34 were extra pulmonary cases. The largest number
of new tuberculosis cases occurred in young adults aged 20-40 with peak incidence
in those aged 25-34. Males were more affected than females, accounting for more
than 70% of reported cases. In 1999, there were 43 new patients diagnosed with
Hansen's Disease and 66 were on treatment.
Acute respiratory infections (ARI): In all
age groups from under 1 to 44, they were the leading reasons for outpatient
visits in 1999. The mortality rates per 100,000 population were 36.5 in 1997
and 41.0 in 1999. ARIs were the third cause of mortality in the under-1 age
group in 1999. They were the second cause of mortality in the 1-4 age group
in the period 1997-1998.
HIV/AIDS: During
1997 and 2000, there were 763 reported cases of AIDS. Females accounted for
39.6% of the cases. Most cases (65%) occurred between the ages 20-44. There
were 24 cases in the 1-4 years age group. In 2000, 97 % of the total reported
cases were due to unprotected heterosexual sex compared to 86% in 1999. By 2000,
AIDS had become the third leading cause of death.
Sexually transmitted infections: Syphilis
was diagnosed in 410 persons in 1998, 315 in 1999, and 534 in 2000. In the period
1997-2000, there were 4 deaths from syphilis. In 1999, 223 pregnant women had
a positive VDRL.
Nutritional and metabolic diseases:Protein-energy malnutrition, iron-deficiency anemia
, and obesity remain the major nutrition-related problems in the population.
The findings of the 1997 national micronutrients survey revealed that anemia
affected 40-55% of children, adolescents and adults. In 1999, there were 118
reported deaths from nutritional deficiencies; twenty-two of these occurred
in infants under 1 year old. In 1999, diabetes mellitus accounted for 4,965
first visits and 13,585 total visits to outpatient clinics. There were 290 deaths,
representing approximately 7% of all deaths. Of these, 4.9% occurred among males
and 9.9% among females.
Diseases of the circulatory system:In the age group 45-64, ischemic heart disease was
the leading cause of death. The mortality rate for males was 271 per 100,000
in 1997 and 262.9 in 1998. For females, they were 127.8 in 1997 and 126.6 in
1998. Cerebrovascular disease was the second cause of death. In the age group
65 and over, cerebrovascular disease was the leading cause of death with rates
of 1,225.9 per 100,000 in 1997 and 1,142.7 in 1998. Ischaemic heart disease
was ranked second. In 1999, there were 199 deaths from hypertensive disease.
Malignant neoplasms: During
1997, 1998 and 1999, there were 370, 359, and 348 deaths, respectively from
malignant neoplasms. In men, cancer of the prostate was the leading cause of
death accounting for 11% of cancer mortality. For women, cancer of the cervix
uteri was the main cause of death, representing 13% of all cancer mortality.
Next in rank for all cancers were those of the stomach (8.8%), breast (8.9%),
colon (6.9%), and lung and trachea (6.4%).
Accidents and violence:
In 1997, there were 611 deaths attributed to external causes, 619 in 1998, and
595 in 1999. Suicides accounted for 13% of deaths, accidental falls for 12%,
and motor vehicle accidents for 9.7%. Emerging and re-emerging diseases : In
1999, there was an outbreak of equine encephalitis. Twelve deaths were reported.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:Some elements of the Draft National Plan that was
developed for the period 1995-2000 have been implemented. These relate to the
prevention of blindness, malaria prevention and control, nutrition, and HIV/AIDS.
The plan sought to incorporate the work of both private and public health sectors
with the objectives of strengthening and expanding primary health care; improving
secondary care in the hospitals; improving tertiary care at Georgetown Public
Hospital ; and strengthening the general management of the health sector.
Health sector reform strategies and programs:Guyana has embarked on its Health Sector Reform Programme
, which proposes the separation of institutional direction and regulation functions
for health care provision. A restructured Ministry will emphasize policy development;
allocation of resources and developing sustainable financing; performance evaluation;
regulation; research and development; and objective setting. In 1998, the Government
initiated the Health Sector Policy and Institutional Development Programme.
The Health system:The
Ministry of Health has overall responsibility for the population's health, including
policy formulation, standard setting, and monitoring and evaluation. The Ministry
of Local Government is responsible for financing and providing services at the
regional level. The National Insurance Scheme provides some health benefits
to employed persons. The private sector functions independently, and NGOs are
actively involved in health care delivery.
Developments in health legislation: There
is a new impetus to pass legislation to support the reforms. Legislation was
passed to establish the Georgetown Public Hospital Corporation and make it a
semi-autonomous agency. Legislation to amend the Medical Practitioner Act was
approved by Parliament in 2000.
Decentralization of health services: In 1986,
the regions assumed responsibility for health care within their boundaries.
Regional Health Officers report administratively to the Regional Executive Officers,
but receive technical and professional guidance from the Ministry of Health.
The national referral hospital in Georgetown now functions as a semi-autonomous
body with its own board. The private sector provides approximately half of all
curative services, some of which (like Mammography) are not available in the
public sector. Most private sector services are provided in the capital and
other urban centers.
Health insurance: The
National Insurance Scheme operated a social insurance program for employees.
The Scheme provides sickness (not employment related), maternity, medical care,
and job-related injury benefits. Medical coverage is provided, on a reimbursable
basis, for selected services. Some employers provide additional contributory
or non-contributory insurance for their employees. In other cases, individuals
purchase health insurance from private insurance companies.
Organization of regulatory actions: The
Ministry of Health is responsible for the regulation of health policies and
legislation, the establishment and enforcement of standards for the delivery
of health care, and the protection of public health. The Ministry's Directorate
of Standards and Technical Services is responsible for the development of standards,
as is the Bureau of Standards and the Pharmacy and Poison Board. The Environmental
Protection Agency has overall responsibility for the protection of the environment.
Certification and professional health practice:
Professional councils such as the Guyana Medical
Council, the Dental Council, and the Guyana Nursing Council regulate professional
health practice. Continuing medical education is required for annual registration
of doctors. Guyana is involved in CARICOM efforts to establish common standards
and measures for accreditation within the Caribbean Region.
Basic health markets: The
Director of Procurement is responsible for procuring drugs and medical supplies
and for setting quality standards.
Environmental quality: Guyana
established its Environmental Protection Agency in 1996. The Agency is charged
with managing Guyana 's diverse physical environment. It has been delegating
functions to other agencies involved in environmental management, such as the
Geology and Mines Commission, the Guyana Forestry Commission, the Ministry of
Local Government, and the Ministry of Health.
Food quality:
A number of agencies have regulatory responsibility for food quality. Guyana
's six municipalities have various by-laws to monitor food processing and food
service sectors in their respective areas.
Organization of public health care services:The Ministry of Health has endorsed the principles
and strategies in the Caribbean Charter for Health Promotion.
Disease prevention and control programs: The
priorities include maternal and child health, the Expanded Program on Immunization
(EPI), HIV/AIDS and other STIs , malaria, and chronic non-communicable diseases.
Health analysis, epidemiological surveillance,
and public health laboratory systems: The Epidemiology
Division of the Ministry of Health has overall responsibility for disease surveillance.
However, the system faces logistical and communications challenges . The surveillance
system for the EPI is the most developed in the country.
Potable water, excreta disposal and sewerage
services: Drinking water coverage in all areas
of the country is estimated to be 70% with 54% of households having piped water.
Quality remains an issue. Sanitation coverage throughout the country has been
estimated at 90%, with 18% having access to flush systems and 80% using pit
latrines.
Solid waste services:Local
government bodies are responsible for solid waste management in Guyana . In
1997, refuse collection in Georgetown was privatized.
Food safety: The
Environmental Health Department, within the Ministry of Health, is responsible
for ensuring that proper standards are maintained by the food protection and
control services at the regional level.
Food aid programs:
Food supplements are distributed to pregnant women and young children attending
public health clinics in selected high-risk communities. A number of community-based
organizations are involved in implementing on-site feeding programs.
Organization of individual health care services: Health
services are provided at five different levels in the public sector. There are
3,274 hospital beds (4.4 beds per 1,000 population) in the private and public
sectors.
Auxiliary diagnostic services and blood banks:
Laboratories exist at the regional and national
levels. In the public sector, blood for transfusion is screened for hepatitis
B and C, HIV, malaria, and syphilis.
Specialized services: Reproductive
health care is provided by the public, private and nongovernmental sectors.
The Safe Motherhood Initiative is also being implemented. The number of public
facilities offering dental care on a daily basis increased from 14 in 1997 to
22 in 2000, and dental education activities have been increased. The psychiatric
hospital provides in- and outpatient care. The Rehabilitation Services have
been strengthened.
Health supplies: Although
there is a local drug manufacturer, most of the drugs used in Guyana are imported.
Guyana does not produce any vaccines or biologicals . Vaccine cold chain facilities
exist at all levels of the health services.
Human resources: In
the public health sector, staff vacancy rates range between 25% and 50% in most
categories. There is a continuing loss of trained personnel from the public
to the private sector and to other countries. From 1997 to 1999, the number
of physicians ranged from 3 to 4 per 10,000 population . During the period 1997-1999,
nurses ranged from 7 to 15 per 10,000 population , pharmacists were approximately
2 per 10,000 pop., and dentists remained at 0.4 per 10,000 pop.
Health sector expenditure and financing:Government health expenditure in 1997 was US$ 19,318,104
or US$ 26 per capita; however, the distribution of resources among establishments
was not equitable.
External technical cooperation and financing:
Financial support for Guyana 's health sector
is channeled through the national budget. The main donor agencies include the
IDB, the European Union, CIDA, PAHO, UNICEF, and UNDP. In 1997, external funding
covered approximately 12% of total government spending on health, 15% of public
sector needs, and some 10% of total private and public health expenditures.
