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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 Cayman Islands is a British Overseas Territory
comprising three islands: Grand Cayman, Cayman Brac, and Little Cayman. It has
an area of 250 km˛ in the western Caribbean Sea, about 240 km south of Cuba
and 290 km west of Jamaica. George Town, the capital city, is located on Grand
Cayman, the largest and most populous island. According to the 1999 census,
the population of the Cayman Islands was 39,020 ( Grand Cayman 37,083 or 95%;
Cayman Brac 1,822 or 4.7% and Little Cayman 115 or 0.3%). The Governor, representative
of the Queen of the United Kingdom, heads the territorial Government, and presides
over the Executive Council in a politically stable government.
Demography:
Estimated population in 2000 was 41,800. Census data showed a 53% increase between
1989 and 1999. The under 15 years population was 19.5% and 8.3% were 60 years
and older. The majority (62.2%) of the population is between 20-59 years of
age. The census revealed that only 53% of the population were Caymanians, a
reduction from 69% in 1989. While the birth rate has declined from 18.0 per
1,000 population in 1991 to 16.3 in 1996 and 15.1 in 2000, the population has
been increasing sharply. This is attributed to the rapid increase in the number
of foreign work permit holders and their dependents living in the Cayman Islands
. This has placed increasing demands on infrastructure including health care
provision. The life expectancy at birth in 1999 was 75.0 years for males and
79.0 years for females. The crude birth rate in 2000 was 15.1 per 1,000 population,
showing a downward trend from 16.3 in 1996. The annual growth rate for the past
decade (1991-2000) was steady, ranging from 3.9% to 5.3%, with an average of
4.5%.
Economy:
The economy is strong, underlined by a constant exchange rate over the past
two decades at CI $ .80 to US$ 1.00. GDP estimates 1997 were US$ 1,157 million
in 1999 prices, while in GDP growth in 2000 was about 4.5% down from the five-year
average of 5.0%. At the end of 1999 the aggregate consumer price index (CPI)
stood at 182.1. The size of the labor force was 21,820 persons in 1998 with
an unemployment rate of 3.9%; it was 4% in 2000. Growth in the economy was fueled
largely by successes in finance and tourism, the two main sectors of the economy.
Annual recurring government expenditure nearly doubled from US$ 163 million
in 1995 to US$ 317 million in 2000.
Education: Schooling is free and compulsory for all children
between 5 and 16 years old. Health care is provided free of charge to all school
children. Adult literacy rate is about 98%.
Mortality:
The crude death rate has remained steady between 3.3 to 3.5 per thousand population,
1996-2000. Death registration is 100% and based on resident population including
work-permit-holders and dependents. Important broad groups of death were circulatory
system (41 %), neoplasms (23 %), and external causes (11 %), 1996-1999. There
were about 25,000 hospitalizations 1996-2000 with an average of 5000 hospitalizations
per year. Of these 84 % were at the Cayman Islands Hospital . The other major
groups of causes for hospitalization were diseases of the digestive system (11
%); diseases of the genitourinary system (7 %); diseases of the respiratory
system (7 %); and diseases of the circulatory system (7 %).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):
Infant deaths varied from 0 to 7 per annum, 1991-2000; four infant deaths, 1998
and none, 1999-2000. The average infant mortality rate was 5.9 per thousand
live births, 1996-2000. Nine out of 17 infant were neonatal deaths; 10 attributed
to pre-maturity, and two to congenital anomalies, 1996-2000. There were 5 stillbirths
in 1996, 3 in 1998 and 8 in 2000. The proportion of infants with low birth weights
(<2500g) has averaged of 6.9%, 1996-1999.
Schoolchildren (5-9 years): here
was one death among children 1 to 4 years of age, 1996-1999. About 24% of hospitalizations
at the Cayman Islands Hospital during 1996-1999 were under 5 years of age. 58%
of these admissions were newborn infants as nearly all deliveries take place
in the hospitals. Admissions included 1,490 children under 5 years of age. Main
causes for admission were: diseases of the respiratory system (26%), certain
infectious and parasitic diseases (15%), diseases of the digestive system (14%)
and diseases of the genitourinary system (7%). School health screenings (627)
in 2000, revealed students had (3 doses) of DPT and Polio vaccines; and 99.7%
at least one dose of MMR vaccine (96% had two doses); 96.3% had four doses of
DPT and Polio vaccines. Children tested for anemia were 482 and only one child
had Hb less than 10 gm. One child in the age group 5-9 years acquired HIV through
mother-to-child-transmission and died of AIDS. A total of 578 children were
hospitalized. Principal causes of admission were diseases of the respiratory
system (21%) and diseases of the digestive system (19%). Gastroenteritis contributed
62 admissions.
Adolescents (10-14 and 15-19 years):One death due to malignant neoplasm of the liver and
one due to infantile hemiplegi occurred among 10-14 year-olds 1996-1999. Hospitalizations
in this age group were 316. Main causes for admission were external causes (23%),
diseases of the respiratory system (13%), and diseases of the digestive system
(16%). The proportion of teenage mothers (15-19 years) declined from 8.4% in
the 1992-1995 to 5.5%, 1996-1999, when three births occurred to females less
than 15 years of age. All 8 deaths among the 15-19 year-olds were male, 1996-1999;
six due to motor vehicle accidents and two due to homicides. In this period,
there were 548 hospitalizations. Among females principal reasons for admission
were: normal delivery (31%), other obstetric causes (20%), genitourinary diseases
(8%), and diseases of the digestive system (8%). For males they were due to
external causes (35%) and diseases of the digestive system (17%). There were
no suicides. Conditions related to pregnancy, childbirth and the puerperium
accounted for 18% of hospitalizations.
Adults (20-59 years):Mothers
between 20-44 years delivered 99% of live births, 1996-1999. There were 93 deaths
among the 25-59 year-old age group, 9.4 per 10,000 population (19.2%), 1996-1999.
Males comprised 70% of deaths in this age group of which there were cardiovascular
diseases (18), neoplasms (16) and external causes (23). For females were: cardiovascular
diseases (7), neoplasms (6) and external causes (10). During 1996-1999, 48%
of hospitalizations were in the 20-59 year- old age group. While 73% of these
were females (3,800), 24 % of the female hospitalizations were for normal delivery
and management of obstetric causes (28%); genitourinary diseases (14%) and diseases
of the digestive system (12%). Among males, main causes of admission were diseases
of the digestive system (21%), external causes (20%), diseases of the circulatory
system (12%) and mental and behavioral disorders (6%). A national drug and alcohol
survey in 2000 revealed that alcohol and tobacco were by far the most commonly
used substances. Approximately 3.5 % reported using marijuana in the last year,
and 2.9% reported having ever used cocaine.
Elderly (60 years and more):In
1999 8.3% of the population was 60 years of age and older. A survey in 2000
revealed that of those aged 60 years and over 18% were current smokers. During
the 1996-1999 period, 75% of all deaths occurred in this age group leading causes
of death were: diseases of the circulatory system (47%) and neoplasms (24%).
During this period 17% of hospitalizations were for persons 60 years and older;
females accounted for 54% of admissions. Their main admission causes were diseases
of the circulatory system (25%), diseases of the digestive system (14%) diseases
of the respiratory system (13%), diseases of the eye (12%), external causes
(8%), diseases of the genitourinary system (7%), diseases of the musculoskeletal
system (6%) and neoplasms (6%). Among males main admissions causes were diseases
of the circulatory system (19%), diseases of the digestive system (12%), diseases
of the respiratory system (9%), diseases of the eye (7%), diseases of the genitourinary
system (6%), neoplasms (5%), external causes (5%), and diseases of the musculoskeleton
system (4%).
Family health: The
marriage rate in 1998 was 8.0 per 1,000 population . Teenage mothers constituted
10 % of new mothers during this period and a parenting program for young parents
was ongoing. Workers' health : Occupational health hazards are minimal; there
are no major industries using heavy equipment, and no major accidents in the
construction industry. Compulsory schooling precludes employment of children
under sixteen years old.
The disabled: About
52 disabled children attended a special public education facility. The common
conditions of the handicap among these children were: mentally challenged (24),
genetic disorders (5), cerebral palsy (7) and mental retardation (3). Eighty
children are in an early intervention program.
Analysis by type of health problem Natural disasters:Hurricane
Mitch occurred in 1997, but damage was minimal.
Vector-Borne diseases: Dengue,
yellow fever, and malaria are not endemic. No Aedes aegypti mosquitoes have
been found since 1996. There have been few cases of malaria since 1995, but
12 were reported in 1997. Imported dengue cases ranged from one to four in the
same period.
Diseases preventable by immunization: There
were 7 cases of whooping cough among children 5-10 years in 1999. During 1997
there was an outbreak of rubella with 78 cases, and 7 in 1998 and 10 cases in
2000. There are about 2-4 cases of mumps reported each year, but none in 2000.
Reported cases of Hepatitis B were 2 in 1998, one each in 1999 and 2000. There
were three reported cases of Hepatitis C in 1998 and none in 1999 and 2000.
All blood for transfusion is screened for HIV, VDRL, Hepatitis B & C, and
Human T Lymphotropic Virus type I HTL.
Cholera and other intestinal diseases:There is no cholera. Reported cases of gastroenteritis
among children under 5 years were 155 in 2000. There were no epidemics of food
borne illness during 1996-2000. Food poisoning cases occur sporadically, especially
due to ciguatera; 13 cases were reported in 2000. Amoebiasis and ankylostomiasis
are not endemic.
Chronic communicable diseases: There
were three TB cases in 1998, 2 in 1999 and 5 in 2000. None of the TB cases had
HIV co-infection, 1996-2000. There were no cases of leprosy. Acute respiratory
infections: About 5% of deaths were due to acute respiratory tract infections
(ARI)- all aged 60 years and over, 1996-1999. During this period 2% of hospitalizations
were due to ARI.
Zoonoses: Rabies
is not endemic in the Cayman Islands . One case of human leptospirosis was confirmed
in 1998 and one in 2000.
HIV/AIDS:From
1985- 2000, there were 54 HIV positives; 29 developed AIDS and 23 died. There
were 15 new HIV infections and 10 AIDS cases during 1996-1999. Sexually transmitted
infections: There were reported cases of gonococcal diseases (138) and syphilis
(146 cases) in 1999.
Nutritional and metabolic diseases:The percentage of newborns weighing less than 2,500g
at birth averaged 7%, 1996-1999. Obesity among children and adults is a cause
of concern.
Cardiovascular diseases: Diseases
of the circulatory system accounted for 41% of deaths or 133 per 100,000, 1996-1999
- among males it comprised 38% and among females 43% . Ischemic heart diseases
were 47% of these deaths, and cerbrovascular disease 17%. These conditions were
reponsible for 7% of hospital admissions, 1996-1999.
Malignant neoplasms:Malignant
neoplasms were 110, a mortality rate of 74 per 100,000, 1996-1999, where trachea,
bronchi & lungs contributed 23%, prostrate (15%) and female breast 11%.
However, neoplasms accounted for only 1.6% of hospitalizations, 1996-1999. A
total of 606 neoplasms were diagnosed, 1992-2000, female (283) and male (323).
Neoplasms of the skin accounted for 42% of cases.
Accidents and violence: Traffic
accidents were 124 per 10,000 population in 1999 compared to 330 in 1995. There
were 28 fatal accidents 1995-1999. A seat belt law was introduced in 1998. The
incidence of assaults: 4.2 per 1000 population in 1995 and 7.2 in 1999. External
causes contributed 11% of deaths of which 29% were due to motor vehicle accidents
and accidental drowning (27%). External causes accounted for 8% of hospitalizations,
1996-1999.
Mental disorders:Mental
and behavioral disorders accounted for 2% of hospitalizations 1996-1999. Thirteen
patients were sent abroad for psychiatric care in the year 2000. Oral health:
The decayed, missing, or filled teeth index (DMFT) of the 12-year old age group
was 0.9 in 1999. The DMFT for 5 and 6 year olds was 2.1 in 1998. Reemerging
diseases: There were three cases of meningococcal meningitis (1 in 1999 and
2 in 2000).
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:Major achievements of the Strategic Plan for Health
were: construction of a 124 bed hospital (1999) in Grand Cayman, construction
of new health centers in the four districts (1995-97), legislation of health
insurance law (1997) and development of quality assurance programs.The National
Youth Policy approved in 2000 promotes healthy lifestyles for youth.
Health sector reform: In
2000, the Health Services Department (HSD) is responsible for all Government
health care services. In 1997, health insurance coverage for employees and their
dependents was made mandatory.
Institutional organization of the health systems:HSD provides all public health care. The department
operates two hospitals, a public health unit, four district health centers and
a general practice clinic at the Cayman Islands Hospital , a dental clinic (including
school dental services), the Lions Eye Clinic and a clinic in Little Cayman
. A private hospital with 18 beds opened in 2000 and various private outpatient
clinics provide health care locally. Primary health care is provided through
the district health centers. In 1999 general practice services were transferred
to the community health services. The Government operates the 124 bed Cayman
Islands Hospital in Grand Cayman and the 18- bed Faith Hospital in Cayman Brac,
the only two in-patient facilities. In 2000 a center for inpatient substance
abuse clients was opened. An Intersectional Committee oversees an Emergency
Relief Plan.
Health legislation: The
Health Insurance Law enacted in 1997 provides health insurance organized through
their employer for all employees and their dependents. The National Drug Council
Law enacted in 1997 provides for the establishment of the National Drug Council.
Private health sector: An
18 bed private hospital was commissioned in the year 2000 and there are 19 private
outpatient health care facilities. There were 41 doctors in full time private
practice, providing family health or specialized treatment. Private physicians
use public hospital services.
Health insurance: Basic
health insurance covers emergency care, hospitalizations and few outpatient
services. Additional health insurance is provided by private companies, but
regulated by government. In 2000, the Government contracted a health insurance
company to provide health insurance to all its employees and their dependents.
Regulatory actions: Construction
of any facility requires planning approval with referral to the Environmental
Health Department and appropriate health professionals.
Certification: Only
licensed health professionals are eligible to practice. An increase in health
professionals over the years has led to draft legislation to develop professional
councils to regulate practices.
Basic health markets: Drugs
and other medical equipment are not manufactured. The Pharmacy Law revised in
1999 provides controls for the importation and dispensing of drugs. Approval
of the Health Practitioners' Board is required for the use of drugs and medical
equipment not produced in the USA or UK .
Environment:The
Department of Environmental Health (DEH) has the responsibility of monitoring
and ensuring quality of the environment. DEH provides management of solid and
hazardous waste and monitors water quality and conducts campaigns on awareness
of waste reduction/recycling; food safety; cistern care; rodent control; anti-
littering; and hurricane preparedness information. The DEH laboratory monitors
accommodations and food premises, and monitors recreational water.
Food: The
DEH food surveillance program monitors imported food containers. Animal regulations
(2001 revision) provide measures for controlling the importation of animals
and meats. The Environmental Health Laboratory is equipped for food analysis
and monitoring.
Health promotion:The
National Strategic Plan for Health provides for the development of programs
to encourage community and self help. Health promotion activities target disease
prevention, healthy lifestyle, health skills, and the environment. A wellness
assessment survey was carried out among the Health Services Staff in 2000.
Disease prevention and control:Government
offers immunizations to resident children. The 18-month DPT booster was introduced
in 1999. In 1999, laboratory confirmation of suspected cases of rubella was
initiated. As of 1997 Hepatitis B vaccine has been part of the Childhood Immunization
Schedule.
Epidemiological surveillance:Notifiable
diseases are under surveillance. Laboratory samples for testing for dengue,
measles, sero-grouping of meningococcal meningitis etc, samples are sent to
CAREC or to a lab in the U.S.A.
Water and sewerage:The
Water Authority (WAC) protects the water and sewage infrastructure. In addition,
WAC approved private companies provide potable water. Population with piped
water supply was to 90% in 2000 up from 70 % in 1995. Water quality is monitored
by companies and by DEH. WAC operates a sewage system for tourist hotels, while
all other sewage treatment and disposal is through septic tanks or soak-away
fields. Septage collection services are available privately and excreta are
treated at WAC's treatment plant. Excreta disposal is available to 99.5%
of population.
Solid waste:
Residential solid waste collection occurs 2-3 times per week. All three Islands
have sanitary landfills. DEH has provided a recycling project since 1995. Infectious
waste is collected from hospitals and medical offices and incinerated.
Patient services: There
are strategically located ambulance services. Services offered through district
health centers include daily treatment by nurses, and clinics by doctors in
the areas of general practice, psychiatry, nutrition counseling, child welfare,
health education, and drug counseling. There are a total of 32 outpatient health
care facilities (13 public and 19 private).
Diagnostic services:All
public and private hospitals have radiological and laboratory facilities. Services
include the addition of two-CT Scans and one MRI unit. There are four mammography
units. Blood Banking facilities are at government hospitals; all blood donations
are screened.
Mental health: Mental
Health Service is offered via outpatient and inpatient clinic services. Psychiatric
inpatient acute care was provided to 135 patients in 2000.
Eye care:There
are two full time ophthalmologists in public service and four in private practice.
Laser treatment was introduced in 1999.
Decompression:
A decompression chamber for diving emergencies is located at the Cayman Islands
Hospital .
Reproductive health:Prenatal
and postnatal care and family planning services are including PAP Smears, achieving
91% of the target in 1999. Emergency contraception is made available at all
health centers during the year 2000.
Health supplies: All
drugs, reagents and equipment are imported. Vaccines are procured through PAHO's
Revolving Fund. The national formulary includes all essential drugs.
Human resources: Human
resources per 10,000 population were: 20 physicians; 7 midwives; 63 nurses;
4 pharmacists; 3 dentists; and 7 community health nurses. Local training is
available for practical nurses and emergency medical technicians. There is no
unemployment for Caymanian health professionals. Opportunities for continuing
education are provided locally as well as overseas.
Health research and technology: In
1999 research on gene localization of non-progressive cerebella ataxia was initiated
with a US institution. Health needs assessment was conducted in 2000. Oral health
screening was conducted among 5 and 6 year olds in 1998 and 12 year olds in
1999. Access to scientific documentation is readily available through the Internet
and international organizations.
Financing: The
health sector expenditure rose from 9.9% of the total government expenditure
in 1994 to 14.8% in the year 2000. Per capita government health expenditure
in 2000 was US$ 1143 compared to US$ 552 in 1995.
External health technical cooperation and
financing:PAHO, CAREC and CFNI provide support
for training in the form of fellowships and workshops. This funding amounts
to US$ 25,000 per annum. There is no external funding for health care delivery
in the Cayman Islands .
