------------------------------
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 Saint Kitts and Nevis is situated in the northern
section of the Leeward Islands in the Eastern Caribbean Sea . Volcanic in origin,
Saint Kitts (176 km2) and Nevis (93 km2) are separated
at their closest point by a 3 km channel. The islands are particularly vulnerable
to hurricanes, and airports and sea ports were damaged due to three major hurricanes,
1996-1999. The twin Island State attained full political independence in 1983.
The Federal Parliament, located in Saint Kitts, is the highest legislative decision
making body and is responsible for foreign affairs and national security. The
Nevis Island Administration is responsible for the conduct of its domestic affairs.
The secession of Nevis from the Federation has been a point of contention between
the islands. Public service arrangements in Nevis parallel those in Saint Kitts.
Each Ministry of Health acts as an executive arm of Government, with responsibility
for promotion of health. Saint Kitts and Nevis have separate annual budgets
that are approved by each island's statutory entity. The Government's goal is
to optimize resource use to generate sustainable growth while ensuring equity.
Demography: Saint Kitts and Nevis had a population
growth rate of 6.2%. In June 2000, the estimated population was 40,410, males
(50.5%) and females (49.5%). The dependency ratio was 65%. Forty percent of
the population was under 20 years of age and 11% were older than 60 years. There
were 4,275 births during 1996-2000. The average crude birth rate, 1996-2000
was 21 per 1,000 population. The average annual fertility rate was 2.6 children
per woman (age 15 to 49 years).
Economy: Saint Kitts and Nevis small, open
economy produces a narrow range of goods and services, including sugar, clothing,
electronic parts, food, and beverages. Tourism and related services, and to
a lesser degree, light manufacturing, have become very important. Government
services, banking, insurance, construction, tourism, and wholesale and retail
trade have emerged as leading contributors to GDP. As a result of this diversity,
the economy achieved sustained levels of growth, 1996-2000. Per capita income
in Saint Kitts and Nevis was US$ 6,993 in 2000. Food is imported due to low
level of local crop and livestock production and a growing tourist industry.
According to a 1999-2000 survey, Saint Kitts' unemployment rate was 5.6% and
Nevis ' was 8.6%. About 31% of the population was considered poor --60% of the
poor were females. Unemployment among the poor was minimal, and government subsidies
in the health sector facilitated access to health care. Education:
Literacy in the islands is estimated at 98%. About 98% of primary school students
continue on to secondary school. In 1999-2000, 721 males and 823 females were
enrolled in preschool. An integrated tertiary level education system provides
academic, vocational, and professional training; local college registration
was 422 students. The Ministry of Gender Affairs promoted continuing education
and training for women who have dropped out of formal education due to pregnancy.
More students have been accessing training in institutions other than the University
of the West Indies (UWI), particularly in the U.S. and Cuba.
Mortality:In
1996-2000, there were 2,031 deaths, males (1,054) and females (977). The crude
death rate averaged 10 per 1,000 population, 1996-1999.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): The
infant mortality rate was 24.1 deaths per 1,000 live births, 1996 and 12.7 in
1999. There were 87 infant deaths, 1996-2000. RDS, asphyxia, and congenital
abnormalities were causes of infant death (12) in 2000. There was one infant
reported with meningococcal meningitis, 2000. The main causes of the 20 deaths
among 1-4 year olds were acute respiratory infections and gastroenteritis, 1996-2000.
In 2000, deaths were due to acute respiratory infection (2), gastroenteritis
(1), and cerebral palsy (1). Low birthweight remains a concern. About 10% of
babies born in 1999 had low birth weight. Gastroenteritis and acute respiratory
infections were the main causes of illness among children 0-4 years; 254 cases
were reported in 1999. Gastroenteritis, acute respiratory conditions and asthma
were main causes of hospital admissions.
Schoolchildren (5-9 years):Children
age 5-9 years were about 10% of the population in 2000. There were four deaths:
neurological conditions (2), drowning (1) and septicemia (1), 1996-2000. The
main causes of morbidity were gastroenteritis and acute respiratory infections
(ARI). There were 335 cases of gastroenteritis, 1999-2000; ARI (25)
Adolescents (10-14 and 15-19 years):
Adolescents age 10-19 years comprised 20% of the population in 2000. There were
11 deaths in the 10-14 years age group: cancer (2), homicide (2), drowning (1),
suicide (1), 1996-2000. There were 15 deaths in the 15-19 years age group: motor
vehicle accidents (3), homicides (3), electrocution (1), 1996-2000. A survey
of 341 students, 1998-1999, showed problems of nutrition, drugs, violence, sexuality,
and abuse. Of students surveyed, 96 % claimed not to have used cocaine, tobacco,
marijuana, heroin, or cigarettes, but 46% reported using alcohol once or a few
times. Teenage pregnancy rates remain relatively high.
Adults (20-59 years): Of
the 397 deaths recorded in the 20-59 years age group between 1996 and 2000,
232 were males and 165 females. The leading causes of the 86 deaths in 1996
were cancer (14 deaths), myocardial infarction (10), accidents/injury (9), and
stroke (7); overall, deaths were evenly distributed by sex. In 2000, there were
71 deaths in this age group (41 males), with a similar pattern of leading causes.
AIDS with seven deaths was also an important cause of death in 2000. Breast
cancer was the most common cancer (5 deaths in 2000) in this age group. Hospitalizations
indicate that the top five causes of morbidity for the period 1996-1999 were
diabetes, hypertension, heart disease, gastroenteritis, and pneumonia. Alcohol
abuse and asthma were also significant causes of morbidity. Oral contraceptives
were chosen by 48% of users, injectables by 22%, and the intrauterine device
by 10%. Approximately 20% of clients utilized other methods, mainly condoms.
Elderly (60 years and older):Persons
age 60 years and older were 11% of the population in 2000. There were 1,505
deaths among 60-79 year olds, 1996-2000. In 2000, of 265 deaths main causes
were stroke (15), cancer (22), myocardial infarction (18), congestive cardiac
failure (10), and pneumonia (7). Leading causes of death of those 80 years and
over were stroke, myocardial infarction, septicemia, cancer, and pneumonia.
Chronic communicable diseases and their sequelae are important causes of morbidity.
The Social Security Scheme provides a pension for needy elderly persons, even
if they did not contribute.
Worker s' health: In
2000, the Ministry of Health assessed work place health and safety. Of 4,473
social security claims in 1999, 511 were injury claims made by 322 persons.
The disabled: In
1996-2000, an early detection and intervention program for the disabled was
introduced; 68 persons were registered. A special education unit in both islands
helps 112 students aged 4-20 years. Seventeen teachers and 12 assistants are
employed. The mildly disabled at 15 years of age receive job training and then
are integrated into the workforce. The Ministry of Education employs some severely
disabled. About 30 persons were registered with the Saint Kitts Society for
the Blind and Visually Impaired.
Analysis by type of health problem Natural disasters: There
were four major hurricanes and flooding in the capital, 1996-2000. In 1998,
Hurricane George caused five deaths and an estimated US$ 402 million in damage.
In 1999, Hurricanes caused an estimated US$ 46 million in damage. Periodic ashfalls
from volcanic eruptions of Montserrat have been associated with an increased
incidence of respiratory problems and eye and skin irritation.
Vector-borne diseases: There
were 18 cases and one death from dengue fever, 1996-2000. In 1999, there was
one imported case of malaria. No cases of yellow fever, Chagas' disease, plague,
or schistosomiasis were recorded, 1996-2000.
Immune preventable diseases: Average
coverage for DPT, OPV, and MMR vaccines among children < 1 year of age was
over 99%, 1996-2000. In 1997, BCG vaccination was introduced for newborns; coverage
was 100%, 1998-2000. Pentavalent vaccine for diphtheria, pertussis, tetanus,
hepatitis B, and Haemophilus influenzae type b was introduced in 2000; coverage
was 12%. No cases of diphtheria, whooping cough, or poliomyelitis were reported,
1996-2000. Suspected cases of measles (29) were reported, but not confirmed,
1997-2000. Cases of rubella (1) and mumps (2), hepatitis (10) were recorded,
1996-2000. In 1997, hepatitis B vaccination was reintroduced with 98% coverage,
1998-2000. A mass rubella vaccination campaign in 2000 achieved 88% coverage
among 16,900 adults 15-39 years of age. In 1996, there was one death due to
tetanus.
Intestinal infectious diseases:There
were no reports of cholera, 1996-2000. A 1997 survey of 250 primary school students
showed Trichuris infection in 27%.
Chronic communicable diseases:There
were two cases of TB reported in 1996 and 12 in 1997. In 1998-1999, five new
TB cases were reported, but none in 2000. No cases of leprosy were reported,
1996-2000.
Acute respiratory infections: There
were 339 cases of acute respiratory infection among children under 5 years and
74 cases in the other age groups, 1997-2000. In 2000, there were 47 hospital
admissions for asthma.
Zoonoses: No
cases of rabies were reported, 1996-2000. Seven cases of leptospirosis were
reported.
HIV/AIDS: In
1996-1997, there were 58 HIV positive cases recorded. There were 16 males and
18 females with AIDS and 26 deaths recorded 1998-2000. One death was due to
a child under age 5 years of an HIV positive mother.
Sexually transmitted infections: In 1999-2000
there were 288 cases (115 males, 173 females) of genital discharge syndrome,
22 cases of genital ulcer syndrome, 10 cases of chlamydia, 14 cases of syphilis,
and 2 cases of gonorrhea reported.
Nutritional and metabolic diseases:About 1,832 children under 5 years were assessed in
child health clinics each year, 1996-2000. Severe malnutrition levels were 0.1%
or below. Mild to moderate malnutrition is decreasing, while obesity is increasing.
Of 946 children assessed in 1999, the exclusive breastfeeding rate among infants
age 4 months and less was 78%. A survey of 353 workers conducted in 2000 showed:
diabetics (8%), abnormal lipid levels, (66%) and overweight (66%). Diabetes
accounted for 98 female and 47 male admissions of the total 3,114 in 2000.
Diseases of the circulatory system:Cardiovascular disease, particularly hypertensive
heart disease, is a major cause of morbidity and mortality. In 2000, deaths
due to stroke (51), myocardial infarction (47), and heart failure (47) comprised
41% of all deaths, with a M: F mortality ratio of .99. Over 60% of deaths due
to stroke were females. There were 248 admissions for hypertension, ischemic
heart disease, and other forms of heart disease, 2000. A survey found that 50%
of men and women were hypertensive.
Malignant neoplasms:Cancer
accounted for 14% (282) of deaths 1996-2000. The prostate was the main cancer
site in male and breast cancer most common among females. Other common cancer
sites were: colon, stomach, cervix, uterus, and pancreas.
Accidents and violence: There
were 455 violent crimes, 1999-2000, wounding (86%), murder (3%). Hospital admissions,
1998-2000, indicate that of 3,677 admissions, less than 2 % were due to stabbing
and gunshots. Almost 3000 motor vehicle accidents occurred, 1998-2000. There
were 308 hospital admissions due to accidents, 2000.
Oral health: There
were 6,779 visits to the Saint Kitts Dental Unit in 2000, with 3,106 extractions
and 1,668 restorations. There were 2,417 dental visits in Nevis in 2000, with
682 extractions and 892 restorations.
Mental health: Registered
psychiatric patients in Saint Kitts averaged 224, 1996-2000. Schizophrenia was
the most common diagnosis, (85), substance abuse (54). A drug abuse education
project helped 30 schools and 1,500 had graduated from the program in 2000.
RESPONSE OF THE HEALTH SYSTEM Health sector reform strategies and programs:
Health reform measures have been adopted
to achieve better utilization of resources, to facilitate the capacity to
deliver quality health services, and reorient the health sector towards primary
health care; two main hospitals, and 17 health centers have been refurbished.
Equipment on both islands has been upgraded, making available mammography
and ultrasonography services. The Ministry of Health's (MOH) recurrent
expenditure has almost doubled. Much emphasis was placed on HIV/AIDS, health
promotion, data collection and utilization, surveillance, environmental health,
and disaster preparedness programs. An emergency medical service; a modernized
and fully equipped eye clinic; an intensive care unit; and a telehealth service,
with teleradiology and continuing medical education components, were instituted,
1997-2000.
Institutional organization: The
MOH and Environment is responsible for implementing the Government policies
and programs. MOH is divided into three programs: Policy Development and Information
Management; Community based Health Services; and Institution based Health
Services. Nevis has a great deal of autonomy in health matters at the local
level. A MOH heads the Health Ministry of Nevis.
Health legislation: Legislation focused on
health reform, 1996-2000. The Saint Kitts and Nevis Solid Waste Management
Corporation Act was passed in 1996, and in 2000, an amendment to the Litter
Act was passed. Drafts of the Saint Kitts and Nevis Mental Health Act and
the Public Health Institutions Management Bill were prepared. Preliminary
work was done towards modifying the Pharmacy Act, certain aspects of the Public
Health Act, and the Medical Act.
Health insurance: There
is no national health insurance scheme. However, the Social Security Scheme
fulfills some health insurance functions, providing injury benefits. Workers
are required to contribute to the scheme. Large employers, including the Government,
provide health insurance for their employees. Public sector employees insurance
benefits include drugs, preventive care screening, psychiatric care, hospital
confinement including costs for care and travel abroad.
Organization of regulatory actions:Regulatory mechanisms are being revised and implemented.
The Bureau of Standards was established in September 2000; its objectives
limit deceptive practices among businesses and protect consumers' health.
The Medical Board regulates the registration and conduct of doctors, opticians/optometrists,
dentists, and pharmacists, and oversees the ethical review of clinical and
research practices. The Local Nursing Council regulates the nursing service.
Government is a member of the Caribbean Association of Medical Councils.
Health promotion: The
Health Promotion Unit was upgraded in 2000 to include programs in nutrition
surveillance, noncommunicable diseases, and HIV/AIDS. The Unit's main aims
are to raise public awareness of and knowledge of health issues and promote
changes in the physical and social environment. The Healthy Lifestyles project,
is one of the Unit's activities. The MOH is assisting the Ministry of Education
in refining the Health and Family Life Education Program. The Health Promotion
Unit developed extensive partnerships with local NGOs, particularly in the
HIV/AIDS Prevention and Control Program. A campaign to increase men's awareness
of preventable diseases and practices was begun. Attention to the elderly
was also provided from a focus group.
Disease prevention and control: Pap
smear screening is available at no cost. Prostate specific antigen testing
and mammography are available and are actively promoted. An Aedes aegypti
control program is countrywide. The average household index was high at 8.7%
in 2000. In 1999, MOH began the AIDS Strategic Initiative for 2000-2004. The
initiative calls for counseling, pharmacotherapy, and as necessary, home and
hospital care. A situation and response analysis of the National AIDS Program
was conducted in 2000.
Epidemiological surveillance:
Although epidemiological surveillance is inadequate, efforts include: a chronic
disease needs assessment in Saint Kitts in 2000 with 353 workers that provided
information for planning. -- of those surveyed 8% had diabetes and hypertension
(50%). A surveillance program for acute flaccid paralysis and rash/fever illness
is ongoing. The Public Health Laboratory Information System (PHILIS) is used
and data linked to CAREC. Laboratory work for the Bureau of Standards analyzes
water quality for the Public Health Department.
Excreta disposal and sewerage services:
Households with piped water were about 94%
in 2000. The Public Works Department in the Ministry of Communications and
Works manages the water supply system. Water is chlorinated routinely, but
rural areas still do not have chlorinated water. The Public Health Department
in the MOH monitors water quality. The septic tank system is the most common
method of sewage disposal; pit latrines serve only 1.4% of households. About
95% of households have a water closet/septic tank. There are 17 wastewater
treatment plants in the country. The Solid Waste Management Corporation was
established by an Act of Parliament in 1997. It constructs landfills, manages,
collection, storage, transportation, disposal, and treatment of solid and
ship generated waste.
Food aid:A
food aid program was initiated in 1996; comprised of school feeding and targeting
prenatal women, nursing mothers, and children. Some 6,000 students are fed
per year.
Organization of individual health care services: Primary
health care is delivered through 17 health centers (11 in Saint Kitts and
6 in Nevis ). Services include MCH care, school health, family planning, and
mental health, chronic illnesses. Environmental health services are also provided.
Public health officials provide community health services, but private physicians
also deliver some primary care. J.N. France Hospital is the main referral
hospital, but suffered serious damage from hurricanes; reconstruction was
ongoing, 1996-2000. The number of beds fell from 150 in 1998 to 79 in 2000,
but there were around 3,000 admissions each year, 1998-2000. Alexandra Hospital
, a 54 bed facility in Nevis , provides major specialties service with 1,344
admissions in 2000. There are two rural hospitals on Saint Kitts with a combined
32 beds. Community health promotion efforts have improved prenatal care. In
1997, specialist obstetric care was introduced at the community level. All
deliveries are in hospitals; breastfeeding is actively promoted. District
nurses regularly visit the 30 nurseries, 39 preschools, and 8 daycare centers.
Through the school program students receive medical examinations and a preventive
dental care as of 1999. Family planning users received cervical cancer screening.
The elderly are exempted from user charges in the public health sector. Public
institutional geriatric care is provided by a 100 bed home, in Saint Kitts,
and by the 24 bed geriatric wing in the main hospital of Nevis . There are
three private geriatric facilities: a 17-bed facility in Saint Kitts, and
2 facilities in Nevis with a total of 42 beds. In 2000, a community assistance
program for the elderly was initiated. In 2000, there were seven psychiatric
beds, with 51 admissions in the main hospital. In 1998, a nonprofit body provided
support to psychologically challenge. Diabetes clinics were held monthly at
district health centers and hypertension clinics at the district level.
Health supplies:No
pharmaceuticals were produced locally; both islands participate in the OECS
Pharmaceutical Procurement Service. In 2000, Government spent US$ 444,444
on drugs and vaccines -- a national formulary regulates purchases. The private
sector includes six registered pharmacies -- importation of drugs and pharmaceuticals
follow WHO standards.
Human resources: In
1998, emergency medical technicians became available. There were 37 medical
doctors, 4 dentists, 8 dental auxiliaries, 198 nurses, 65 nursing assistants/community
workers, 10 pharmacists/pharmacy technicians, 12 laboratory technologists
or technicians, 5 radiographers/technicians, 21 emergency medical technicians,
3 nutritionists/dietitians, 4 health educators, 17 environmental health officers,
2 veterinary officers, and 11 veterinary assistants were working in the public
sector, 2000. In the private sector there were 11 pharmacists, 5 dentists,
and 9 doctors. Seven regional medical specialists visit on a monthly basis.
An in-service education department was established in 2000 to train nurses;
this is separate from the Nursing School. Distance training linked to Dalhousie
University in Canada provides continuing medical education. There are three
offshore medical schools and each has at least two places for local students.
There is also an offshore school of veterinary medicine, where in 2000 four
scholarships were for local students.
Health sector expenditure and financing:
Recurrent expenditure on health averaged
9.2% of total recurrent disbursements over the period 1996-2000. Expenditure
on health represented an average of 3.1% of GDP, 1996-2000. Per capita expenditure
on health increased steadily, from US$ 189 in 1996 to US$ 268 in 2000. The
Social Security Scheme provides sickness and disability benefits to all workers
External technical and financial cooperation:
The European Union funded health sector redevelopment
and improvement of hospitals. Assistance for hospital repairs and improvements
also came from the World Bank, USAID, CDB, PAHO, and DFID. The World Bank
and CDB have helped fund the Solid Waste Management Project. Technical collaboration
has been maintained with CAREC, PAHO, UNDP, and UNICEF; AIDS, diabetes and
hypertension were important areas of technical assistance.
