Saint Kitts and Nevis
Official Name: Saint Kitts and Nevis
Capital City: Basseterre
Official Language: English
Surface: 196.24 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: KN
UN 3 digits Code: KNA
UN Country Code: 659


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.


    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.

    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).

    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.

    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.

    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.