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Country Health Profile.
Data updated for 2001Guadeloupe Health Situation Analysis and Trends Summary Country Chapter Summary from Health in the Americas, 1998.
GUADELOUPEGENERAL SITUATION AND TRENDSSocioeconomic, Political, and Demographic Overview The French Department Guadeloupe have been part of France since 1946. Even though it is located in the Region of the Americas, it is given special protection and granted structural funds from Europe devoted to assist developing European regions. Guadeloupe is an archipelago of eight inhabited islands; the two largest, separated by a sound, are Basse-Terre and Grande-Terre. The other islands include Les Saintes and Marie Galante to the south, Désirade to the east, and the French section of Saint Martin and Saint Barthélemy some 230 km to the north. The population of the Department remained stable during the 1960 and 1980 decades. Considerable migration to France occurred during this period, mainly as a consequence of lack of work, followed by a vigorous, although declining birth rate. Since the mid-1980s, and coinciding with declining employment rates in France, adults and retirees have returned to the Department. The 1990 census showed an average annual population growth of 2.1% in Guadeloupe for the 1982–1990 period. This growth continues, and in 1996 the population density was 248 inhabitants per km2. Population estimates in 1996 were 422,090 inhabitants, the population younger under 15 years representinh 26.5%. In 1994, life expectancy in Guadeloupe was 80.2 years for women and 72.7 for men. Immigration from neighboring developing countries accounts for part of the growing population. Guadeloupe, being a free port with a thriving tourism industry, has had a four-fold increase in the number of inhabitants in the past eight years; half of the population is foreign. Since 1986 fiscal incentives have set forward the public works, construction and hotel industries. Unemployment rates in Guadeloupe were 27% in 1986, 26.1% in 1993, 26.1% in 1995, and 29.3% in 1996. Registered unemployed and underemployed persons account for half of the active population of the Antilles. On the basis of the 1990 census, a survey conducted by the National Institute of Statistics and Economic Studies (INSEE) defined the high-risk population as households occupying makeshift accommodation without water in or near their dwellings and those with an unemployed head of family. An estimated 22 % were considered to be high risk in Guadeloupe. Table 1 presents socioeconomic indicators for this French Department. Table 1 Socioeconomic Indicators of Guadeloupe, 1982 and 1990
(a) These figure do not include dwellings equipped with individual septic tanks. (b) Dwellings having fewer rooms than the number of occupants. Source: National Institute of Statistics and Economic Studies (INEEE), 1982 and 1990 reports.
Morbidity and Mortality Profile Among the specific health problems affecting Guadeloupe is a high prevalence of sexually transmitted viral infections and an endemic level of dengue with epidemic outbreaks. Among noncommunicable diseases, there is a high prevalence of sickle cell anemia and a high frequency of diabetes, hypertension, and their complications (particularly chronic kidney failure). With the exception of cervical and prostate cancers there is a low incidence of malignant tumors. Traffic accidents contribute enormously to years of potential life lost (YPLL). In 1995 there were 5,383 deaths in Martinique, Guadeloupe and French Guiana. The most recent information on death causes is for 1993, since mortality reports are prepared by the National Institute of Health and Medical Research in Paris, independently from mortality data extracted by INEEE from birth, marriage and death registries. Based on YPLL, infectious and parasitic diseases are the fourth most frequent death cause for both sexes; accounting for 6% to 7% of YPLL. In Guadeloupe, AIDS accounts for 6.5 % of deaths in infants under 28 days old. Guadeloupe is the Department of France most seriously affected by problems during the perinatal period. The most frequent causes of death in the perinatal period are anoxia and other respiratory diseases. Injury and poisoning (particularly road traffic accidents) are the primary cause of death among men, contributing to over one-third of YPLL among the male population. Among women, these two causes rank third in Guadeloupe. While cardiovascular disorders are the largest contributor to mortality, their importance should be viewed in light of the late age at which death occurs. These disorders occupy second place in YPLL. The malignant tumors rank first as a cause of death among women in terms of YPLL. Among men, cancers rank second as a cause of death (13% of YPLL) in Guadeloupe.
SPECIFIC HEALTH PROBLEMS Analysis by population groups Health of Children Child health in Guadeloupe has improved considerably in the 1992–1996 period. This improvement is most marked in regard to infant mortality. Perinatal mortality has dropped to an average rate of 10.1 per 1,000 live births over the 1994–1996 period, but the stillbirth rate remains high (7.4 per 1,000). The number of infant deaths between 7 and 28 days has stayed the same (1.9 per 1,000) in this period. Infant mortality has dropped from 10.4 per 1,000 in 1992 to 7.9 per 1,000 in 1995. The main causes of infant mortality are conditions arising in the perinatal period (50%), congenital anomalies (16%), and infectious and parasitic diseases (12.5%). Child mortality in the 1–4-year age group during the 1987–1992 period was due to accidental causes in 42% of cases. This percentage is essentially the same for both sexes. Other causes of death were infections (12.6%) and malformations (12.3%). At 3 years of age, 77% of children were enrolled in kindergarten and underwent health examinations. During the 1994–1995 school year, 1.4% of the children examined had language problems requiring specialized treatment. Out of every 1,000 children, 8 suffer from confirmed hearing impairment and 18 from confirmed sight impairment (7 had confirmed strabismus). Half of deaths in the 5–14-year age group are caused by accidents: 47% among girls, and 52% among boys. Tumors are the next most common cause of mortality in this age group (11.5%), followed by diseases of the nervous system (9.3%). Health of Adolescents and Young Adults Teenagers and young adults (ages 15 to 24) represent 16% of the population in Guadeloupe. This group has a 48 % unemployment rate. In the 15–19-year age group, 86% are registered in schools. A study of deaths for the 1987–1990 period shows that 2.7% occur in this age group. With an annual average of 62 deaths, the mortality rate for this group is 0.7 per 1,000 (1.2 per 1,000 among men and 0.3 per 1,000 among women). Traffic accidents cause 1 in 3 deaths in this age group. They are followed in descending order by: ill-defined and other accidents and their late effects (28%), tumors (7.3%), and diseases of the circulatory system and disorders of the nervous system and the respiratory tract. Teenagers are most affected by accidents involving two-wheeled vehicles with, respectively, 37% of deaths and 47% of serious injuries on average per year. The 15–24-year age group also accounts for a high proportion of automobile accident victims (21% of deaths and 26% of seriously injured). A study conducted in 1993–1994 at the University Hospital in Pointe-à-Pitre revealed 71 admissions for attempted suicide among teenagers aged 15–19 years. The risk factors identified included a previous history of psychological problems (42%), frequent failure at school (50%), a high incidence of broken families (76% were children of divorced couples), and a history of attempted suicide by close relatives (7.5%). Past incest or rape were other risk factors frequently reported. Repeated suicide attempts are widespread (30% of cases), with recurrences within an average of 4.5 months. Illnesses fully covered by the health insurance scheme during the 1989–1991 period accounted for 4% of all hospital admissions in this age group. The main cause of admissions was mental disorders (46% of cases), followed by congenital and valvular heart disease (7.6%), hemoglobinopathy (7.5%), and diabetes and progressive scoliosis (6.2%). In 1992, 5.4% of pregnancies occurred in girls under 18 years of age. However, between 1982 and 1992 the fertility rate dropped from 45 to 29 per 1,000 in the 15–19-year age group and from 149 to 98 per 1,000 for the 19–24-year age group. Health of Adults The principal medical causes of deaths among adults between ages 15 and 60 for the 1987–1990 period were cardiovascular disorders (33%), tumors (19%), trauma (12%), ill-defined causes (7%), diseases of the digestive system (6%), and diseases of the respiratory system (5%). The order of causes differs for the 15–34-year-old age group: accidental causes, road traffic and other accidents are the first two causes of death, followed by suicides and HIV infection. Eight hundred deaths occurred before the age of 65 in the 1987–1990 period. The main causes of these premature deaths are accidents, diseases of the circulatory system, and tumors. About one-half of these deaths were avoidable: 228 by a change in high-risk behavior, and 196 with better screening and/or proper attention by the health system. The hospital morbidity survey conducted in 1992–1993 in the short-term facilities shows hypertension, diabetes, and alcoholism to be the diseases most frequently associated with hospitalization. Health of Older Adults At the time of the 1990 census, inhabitants age 60 and older represented 11.7% of the total population; in 1995, this sector of the population was 12.3%. Virtually everyone age 60 and over lives at home, due to the protection provided by the traditional lifestyle and the existence of a state home care policy. Cardiovascular disorders are the main cause of mortality (43%), followed by tumors (20%) and ill-defined morbid conditions (9%). Diabetes and hypertension account for 56% of coverage for chronic illnesses, followed by cancer, cerebrovascular accidents, and progressive chronic arteriopathy. Reproductive Health The fertility rate in Guadeloupe fell by 27% between 1984 and 1994. Rates for women in the 15–19- and 20–24-year age groups dropped by one-third, and in the 25–29-year age group by one-quarter. The fertility rate has remained constant among women 30 and older. Data from family planning and education centers show that 75 % of the clients used oral contraceptives, 8% an intra-uterine device (IUD), and 17% other methods. The perinatal mortality survey conducted in 1984–1985 suggests an abortion rate of 26% among the female population of childbearing age. In 1994, the abortion rate was 30 per 100 conceptions. The maternal mortality rate was 51.4 per 100,000 live births for the 1987–1990 period. Health of the Family The most salient characteristic of the Guadeloupan family is the role played by single-parent families (one-third of all families); in 86% of cases a woman is the head of household. One-third of children under age 17 are brought up in single-parent families. Special measures seek to encourage child care while parents are at work (help in opening day-care centers and financial assistance for parents using registered care providers); to provide needy families with financial assistance for their children’s basic needs; and to enable children to attend school at an early age. Health of the Handicapped In 1992, a random sample from the Departmental Commission for Special Education records shows that moderate and slight mental retardation were the most common disabilities (a rate of 5.1 and 4.8 per 1,000, respectively), followed by peripheral motor disabilities (1.3 per 1,000), extensive motor disabilities (1.2 per 1,000), and multiple disabilities (1.2 per 1,000). Analysis by Type of Disease Communicable Diseases Vector-Borne Diseases. There are 4–5 imported cases of malaria in Guadeloupe every year. There were serious outbreaks of dengue fever in the second half of 1992 and 1994. Dengue-2 virus was isolated in 1994. Seven cases of dengue hemorrhagic fever were recorded in 1995, three of them fatal. Seropositivity is more than 30% during epidemic outbreaks. The only form of schistosomiasis encountered is Schistosoma mansoni (intestinal bilharziasis). | ||||||||||||||||||||||||||
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