Antigua and Barbuda
Official Name: Antigua and Barbuda
Capital City: Saint John's
Official Language: English
Surface: 440 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: AG
UN 3 digits Code: ATG
UN Country Code: 28


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.


    Antigua and Barbuda is comprised of the habited islands of Antigua and Barbuda and the uninhabited island Redonda, located in the Eastern Caribbean's Leeward Islands group. They comprise a land mass of 440 km2. Antigua and Barbuda became independent from Great Britain in 1981. The government is based on a British Westminster model. It is governed by an elected Parliament that represents majority and opposition parties. Elections are held every 5 years. Barbuda 's affairs are run mainly by the Barbuda Council, which was set up by an act of Parliament in 1976.

    Demography: The 1999 estimated mid-year population was 70,856. The crude birth rate was 21.6 per 1,000 population in 1997. The average crude birth rate for the period 1996 - 1999 was 19.8 per 1,000 population. In 2000, life expectancy was 72.3 years for males and 76.4 years for females. Antigua and Barbuda attract many immigrants primarily from other Caribbean islands, most of whom seeking employment.

    Economy: Tourism is the most important contributor to the Gross Domestic Product (GDP), followed by the financial sector, wholesale and retail trade, construction, and government services. GDP increased steadily from US$ 460.4 million in 1996 to US$ 565 million in 1998. The external debt was US$ 384 million in 1999, and increase from US$ 246 million in 1996. At the end of fiscal year 2000, the total outstanding consolidated public sector debt consisted of US$ 400 million external obligations and US$ 100 million in domestic debt. The country's inflation rate in 2000 was close to 0%, down from 3.4% in 1998.

    Education: The adult literacy rate in 1998 was 88%. There is free compulsory education for children ages 5 to 16 years. In 2000, Antigua State College expanded to include the School of Nursing and the School of Pharmacy . The local center for the University of the West Indies , an institution jointly operated by the English-speaking Caribbean Governments provides continuing education.

    Mortality: The crude death rate was 6.4 per 1,000 population in 1997. During 1996 - 1999 period, 63.5% of deaths occurred in the age group over 65 years and 13.6% of the deaths in the age group 15 - 49 years. In 1999, almost 55 % of the deaths occurred in males. The leading causes of death during this time period included neoplasms, diseases of the circulatory system and accidents.

    Analysis by population groups
    Children (0-4 years): The infant mortality rate, which was 25.3 per 1,000 live births in 1996, fell to 14.5 and 12.4 respectively in 1997 and 1998. In 1999, the infant mortality rate rose to 21.1 per 1,000 live births. The perinatal mortality rate was 29.2 per 1,000 deliveries in 1996, declining to 18.8 in 1997, dropping further to 18.4 in 1998, and rising to 23.8 per 1,000 deliveries in 1999. Of the infant deaths that occurred in 1996 - 1999, 69 % were early neonatal and 11% were late neonatal deaths. The leading cause of neonatal deaths in 1999 were conditions originating in the perinatal period (57%), pneumonia (18%), congenital anomalies (7%), external causes (7%) and other diseases of the respiratory system (7%). In the year 2000, children aged 0 - 4 years accounted for 10.4% of the total population. In 1999, a total of 84.8% of all mothers were breastfeeding their children at 3 months age. During the period 1996-1999, there were a total of 15 deaths in the 1-4 year old age group. The causes of these deaths were pneumonia (3), congenital anomalies (3), accidents including accidental poisoning (4), acquired immune deficiency syndrome (1), intestinal infection (1) and diseases of the nervous system (3). The most common health problems seen among children in the 1-4 year age group attending health clinics for the period 1996-1999 included acute respiratory infections, diarrheal diseases, injuries and skin infections. Malnutrition as determined by weight-for-age on the Caribbean Growth Chart was at relatively low levels. The number of children under five year old with mild to moderate malnutrition was 73 in 1997, 72 in 1998, and 51 in 1999. The figures for severe malnutrition are even lower with only 2 children in 1997, 1 in 1998 and 3 in 1999. Of concern is the fact that in this age group in the years 1997, 1998 and 1999 there were 311, 266, and 243 children respectively who were classified as being overweight.

    Schoolchildren (5-14 years): In 1998, only 63% of 5-year-old children received their health assessment prior to entry into primary school. In 1999 it improved to 77%.

    Adolescents (10-19 years): Adolescents represented 18.6% of the estimated population for 1996-1998. In 1996, the Adolescent Health Survey identified that the primary issues affecting the health status of this age group were violence and gang-related incidences, drug abuse, and sexual and reproductive health concerns. The survey indicated that during the 12 month period prior to the survey 15.8% of the students had been involved in acts of vandalism, 8.3% had stolen something, 8.8% had been involved in fights where weapons were used, and 10 % had been gang members. The most common drug reportedly used by adolescents were alcohol, tobacco, marijuana and cocaine. As reported 7.8% used cigarettes, 36.7% used alcohol, 6.1% used marijuana and 1.8% used cocaine. Approximately 10 % had been sexually abused in the prior 12 months. This sexual abuse was predominantly reported in the 10 to 14 year old age group. Suicide was reportedly attempted at least once by 9.6%, the majority being females. Thirty percent of the students surveyed admitted to having had sexual intercourse; of these, 12.9% indicated that they were forced into the act.

    Adults (20-59 years): In 1998, the population aged 20-59 years old was estimated at 35,484, roughly 50% of the total population. Reports from the community clinics indicated that the main conditions for consultation by adults were hypertension, diabetes mellitus, injuries, heart disease and acute respiratory infections. Reasons for first clinic visits included diabetes, hypertension, accidents and injuries, heart disease and drug abuse, including alcohol. Twice as many females as males utilize the Adult Health Service. In 1998 the leading cause of death in the 45 - 59 year old age group was heart disease, followed by malignant neoplasms and conditions related to alcohol and drug dependency.

    Elderly (60 years and older): The estimated population 60 and older in 2000 was 4,172 persons, of these 2,479 were women and 1,693 were men. Of the persons over sixty years of age, 599 were over eighty years old. The health conditions found to be affecting this group included malignant neoplasms, cerebrovascular disease, heart disease, diabetes, and hypertension. These chronic, non-communicable diseases accounted for the majority of cases seen in community clinics. Many patients also had related risk factors of obesity, alcoholism and smoking. Hemiplegia and blindness due to cataracts, glaucoma, and diabetes were common causes of disability among the elderly.

    Family Health: The Citizens Welfare Division offers specialized and professional welfare services geared to promote and maintain family stability and meet needs of persons coping with personal crisis and other family and social problems. The Directorate of Gender Affairs, a division of the Ministry of Health, is responsible for managing services for abused women, giving counsel and support for victims in an attempt to deal with these problems. The Collaborative Committee for the Promotion of Emotional Health in Children is a nonprofit organization that addresses the needs of emotionally disturbed and abused children and their families. During 1999, the center saw a total of 66 cases, ranging in ages between 3 and 24 years. Behavioral disorders were cited as the most frequent problem, with a total of 22 children seen for this cause; other cases seen at the center were due to slow learning (11), child abuse (6), and truancy (5).

    Analysis by type of health problem
    Natural Disasters: Hurricanes and tropical storms are the most common natural disaster. In October 1998, Hurricane George killed 2 and injured 34 in Antigua. Damages to public facilities, agriculture and fisheries, the environment, health, tourism, education, churches, homes and businesses totaled US$74 million. In 1999, hurricanes José and Lenny ravaged Antigua in October and November. There was one death and 13 persons injured. Over 3,500 homes were damaged or destroyed. Damages to homes, the environment, roads and bridges, health, utilities, agriculture and fisheries and businesses were US$92 million.

    Vector-borne Diseases: In 1997 there were 10 confirmed cases of dengue on the island. In 2000, there were 11 confirmed cases of dengue due to Type 3 virus. There were no Dengue Hemorrhagic Fevers or Dengue Shock Syndrome. There were no reported cases of malaria in 1997 and 1998 and 1 confirmed case in 1999.

    Vaccine Preventable Diseases: Vaccines against diphtheria, pertussis, measles, mumps, rubella, tetanus and polio are routinely given as part of the Child Health Services. In July 2000, the pentavalent vaccine that includes hepatitis b and Haemophilus influenza type b, was introduced. Immunization coverage against diphtheria, polio, tetanus, measles, mumps, rubella in children under 5 years old was 99% in 1999. There have been no cases of acute flaccid paralysis, fever with rash or measles for the period 1996-2000. In 1999, there were 4 reported cases of mumps and 5 in 2000. The Ministry of Health embarked on a rubella immunization campaign in September 1999, which aimed to immunize all adults between the ages of 20 and 30 years against the Rubella virus using the measles, mumps, and rubella vaccine. From the campaign's inception to March 2000, a total of 9,250 doses of the vaccine have been given. During 1999, three cases of tetanus occurred. All three cases were males and included one fatality. During 1999, there were 17 cases of hepatitis b infection reported to the Epidemiology Service.

    Cholera and other intestinal infectious diseases: The country remains cholera free. In the first quarter of 1997 there was an outbreak of gastroenteritis due to rotavirus which affected 2,000 persons. More than 50% of those affected were under the age of 10 years old. In 2000, there were four confirmed cases of typhoid. The ages of the cases ranged from 3 months to 43 years.

    Chronic communicable diseases: There have been no new cases of leprosy since 1995. Between 1996 and 1999 there were 16 cases of tuberculosis 6 in 1996, 3 in 1997, 4 in 1998, and 3 in 1999. BCG vaccine is not routinely given as part of the immunization schedule. There was no evidence of co-infection of tuberculosis and AIDS.

    Acute Respiratory Infections: Acute respiratory tract infections ranked as the leading communicable disease in 1998 and 1999. In 1999, there was an outbreak of acute respiratory tract infections with 1,344 cases. In 1996 and 1997 there were two episodes of Legionnaires ' disease identified, both traced to defective water heating systems.

    Zoonoses: Antigua and Barbuda continues to remain free of rabies and other zoonoses.

    HIV/AIDS: Acquired Immune Deficiency Syndrome (AIDS) began to rank as one of the top 10 leading causes of death in 1999. The cumulative total of HIV notifications from 1985 to the end of 1999 was at 271. In that time period, 85 persons died from AIDS. Most of the notified cases of HIV were distributed among the 25 - 29 year old age group. In 1998, there were 5 new AIDS cases reported, and 3 deaths. In 1999, there were 14 reported new cases of AIDS and 10 deaths were attributed to HIV related illnesses. The AIDS annual incidence rate was 209 per 1,000,000 population in 1999. The male to female ratio of AIDS cases was 2.5:1. A study conducted in 1997 among pregnant women revealed an HIV prevalence rate of 0.9 %.

    Sexually transmitted infections (STI): For the period 1996-1999, STIs ranked among the 5 leading communicable diseases each year. According to the Health Information Division there were 1,629 STIs cases for the period. STI clinic services have shown a decline in attendance, from an average of 19.3 patients per week in 1996 to 9.3 per week in 1999.

    Nutritional and metabolic diseases: A 1996 micronutrient study, revealed that 1 % of children 1-4 years old had vitamin A and beta-carotene deficiencies; more females were more affected with vitamin A deficiencies and levels improved with age. 62 % of the children surveyed were found to have vitamin E levels below the normal range. In 1999, the Chronic Disease Register recorded a total of 713 diabetic patients accounting for 4,332 clinic visits.

    Cardiovascular diseases: Diseases of the circulatory system accounted for 180 (37.7%) of all deaths in 1998, and 190 (37.3%) in 1999.

    Malignant tumors: Malignant neoplasms were one of the leading causes of death in 1999, with 73 deaths. For 1998 and 1999 the prevalent sites were prostate, stomach, colon, liver and lungs and breast.

    Accidents and violence: During 1996-1999 were 37 fatal motor vehicle accidents, which caused 43 deaths and 87 injuries. The total number of motor vehicle accidents for the period was 3,922 with the highest number (1,562) occurring in 1996.

    Oral health: A Health Situation Analysis conducted by the Ministry of Health and Home Affairs in 1996 reported that dental disease was one of the most common conditions, identified in approximately 10% of 5- and 10- year old children. Response of the Health System

    National health plans and policies: In 1997, the Government approved the National Health Policy for the 1997 - 2001 period. It reiterates the Government's commitment to the universal provision of health services as a right but calls for creative approaches to health care financing. In 2000, the Ministry of Planning, Implementation and Public Service Affairs was mandated by the Cabinet to produce a four-year National Strategic Development Plan for the period 2001-2004.

    Organization of the health system: The Ministry of Health oversees the public health care system, regulation and delivery of services. The Chief Medical Officer is the chief technical advisor to the Ministry and is responsible for coordinating health services delivered in hospitals and health centers. Antigua is divided into six geographically determined Medical Districts, each of which is served by a government-appointed District Medical Officer responsible for providing medical services to residents. Primary Health Care Service in the district includes maternal and child health, health education, environmental sanitation, community mental health, nutrition, diabetic and hypertensive screening and care, communicable disease control and surveillance and home visitation.

    Organization of health regulatory actions: As part of ongoing decentralization efforts, Parliament enacted the Hospital Boards Act in 1999, which was implemented in 2000. Health services in Barbuda are regulated and organized by the Barbuda Council. Private services are limited to Antigua where there are private practitioners who offer ambulatory services.

    Public health care services: The Directly Observed Treatment, Short course (DOTS) program for tuberculosis prevention is supervised by the Nurse Epidemiologist and the Medical Officer of Health. The AIDS Secretariat, along with the National AIDS Committee, continues education and condom distribution in the HIV/AIDS Prevention and Control Program. The Central Board of Health monitors the water supplied both by the Antigua Public Utilities Authority and that which is stored by private residents.

    Individual health care services: Holberton Hospital , a 141-bed facility is the only public acute health care institution. Many patients travel abroad for magnetic resonance imaging (MRI) and treatment options such as radiotherapy and chemotherapy. Residents of Barbuda are served by the Hannah Thomas Hospital , an 8-bed mainly outpatient facility. In Antigua there are three dentists, a dental auxiliary and one dental hygienist. Community Health Services are provided through a network of nine Health Centers and 18 satellite clinics or sub-centers. The health services are centrally managed and operated. During 1999, construction began on four new health centers on the island. The government in 1998 initiated collaborative efforts with the government of Cuba in an attempt to augment the number of health care personnel at the Holberton Hospital . In 1997, based on a decision by the Barbuda Council, a resident physician was employed at the Hannah Thomas Hospital in addition to the visiting volunteer physician. Training for health personnel was accessed locally, regionally and internationally.

    Health sector expenditure and financing: From 1996 to 1999 the Ministry of Health expended about 12-14% of the national budget. The health expenditure per capita was US$ 312 in 1998. The amount disbursed for overseas treatment for a period of eighteen months ending in December 2000, was approximately US$1 million.

    External technical cooperation and financing: Grants through the Ministry of Health increased from US$ 2.5 million in 1999 to US$ 4 million in 2000. The Caribbean Environmental Health Institute (CEHI), the Caribbean Epidemiology Center (CAREC), Pan American Health Organization (PAHO), and other United Nations Organizations all provided additional assistance.