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—from Epidemiological Bulletin, Vol. 24 No. 1, March 2003—
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Figure 1: Population structure, by age and sex, Guyana,
2000
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In 1999, the GDP per capita was US$800. The rate of inflation increased from
4.8% in 1998 to 7.4% in 1999. Economic setbacks have been attributed to several
factors, including El Niño (which caused drought in some parts of the
country and adversely affected agricultural output), and reduced commodity prices
on international markets. Thirty-six percent of the population live in absolute
poverty (less than US$510/year) and 19% live in critical poverty (less than
US$364/year).The National Development Strategy which was drafted in 1996 and
revised in 2000 has for its objective the attainment of the highest economic
growth rates possible, the elimination of poverty, and the diversification of
the economy.
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Figure 2: Gross Domestic Product, annual growth (%),
Guyana, 1991-2000
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A total of 5,302 deaths were registered in 1998 and 5,102 in 1999. The male to female ratio in 1999 was approximately 1.47:1. Most of the deaths (18%) occurred in the over 75 age group, followed by 16% in the 65-74, and 14% in the 55-64 age groups. Children under 5 years of age accounted for 9.5% of deaths with 71% of these being children under one year. In the period 1997-1999, the leading causes of mortality for all age groups combined were cerebrovascular disease (12.0%), ischemic heart disease (10.0%), Acquired Immune Deficiency Syndrome (7.0%), underdetermined injury (6.6%), diabetes mellitus (6.0%), acute respiratory infections (6.0%), diseases of the pulmonary circulation (6.0%), hypertensive disease (4.8%), intestinal infections (3.4%), and chronic liver diseases (2.8%).
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Figure 3: Estimated mortality, by broad groups of
causes and sex, Guyana, 1995-2000
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Specific health problems
By population group
Children (0-4 years): There were an estimated 17,093 live births in 1999,
compared to 19,118 in 1998. The infant mortality rate for 1998 was 23 per 1,000
live births. The neonatal death rate was 13 in 1999. In 1999, Yellow Fever vaccine
was introduced into the routine immunization schedule for children aged 12-23
months. The coverage in 2000 was 85%. In 1999, there were 280 deaths in the
under-1 age group population compared with 422 in 1998. For the period 1997-1999,
hypoxia (21%), intestinal infections (18%), and other perinatal conditions (13%)
were among the leading causes of death. In 1999, there were 116 deaths in the
1-4 age group compared to 105 in 1998. Infections and trauma played an important
role in the mortality of this age group. In the period 1997-1999, the leading
causes of death were intestinal infectious diseases (21%), acute respiratory
infections (17%) and undetermined injury (13%). In 1999, the main reason for
infant visits to outpatient clinics at hospitals and health centers were acute
respiratory infections (56%).
Schoolchildren (5-9 years): In 1999, there were 38 deaths;
nine were from communicable diseases and 6 were due to intestinal infections.
There were 5 deaths due to neoplasms and 10 due to external causes.
Adolescents (10-14 and 15-19 years): There were 445 deaths
in this age group in 1999. Sixteen were from external causes, of which motor
vehicle accidents accounted for four, and there were three deaths each from
suicides, homicides, and undetermined injury. In 2000, the 15-19 group represented
10% of the population. In 1998 and 1999, 22% and 24%, respectively, of births
occurred in women in this age group. Of the women attending government family
planning clinics in 1998, 12% were under 20 years.
Adults (20-59 years): The total fertility rate was stable
at 2.0 children per woman of child-bearing age between 1997 and 1999. In 1999,
82% of women attended clinic for the first time after the 12th week of pregnancy.
The maternal mortality rate was 124.6 per 100,000 live births in 1998. The main
causes were haemorrhage (27%), toxemia of pregnancy (21%) and abortion (18%).
During 1999, there were 1,813 deaths occurring in this population group. Of
these, 22% were due to external causes, 20% to diseases of the circulatory system,
and 9% to communicable diseases. AIDS was the leading cause of death, accounting
for 15% of deaths in that age group.
The Elderly (60 years and older): This represents 6% of
the population, and 53% of them were female. In 1999, this population group
accounted for 16,795 visits to hospitals’ outpatient clinics. The main
diagnoses for first visits were hypertension (25%), arthritis/rheumatism (10%),
diabetes (8%), acute respiratory infections (10%), and accidents and injuries
(5%). There were 1,759 deaths in this age group in 1999. The leading causes
of death were chronic non-communicable diseases, including cerebrovascular disease
(15%), ischaemic heart disease (15%), diabetes (9.7%), and hypertensive disease
(9.2%).
Workers health: In 1999, the total number of accidents
reported to the Occupational Safety and Health Division was 2,385, including
2,370 non-fatal accidents. The fatal accidents ranged from 9 in 1997 to 15 in
1999. Eighty-six percent of the non-fatal accidents in 1999 occurred in the
agriculture sector.
Indigenous groups: The highest number of Amerindians (about
15,000) were among the Arawaks (or Lokonas). They are followed by the Makushi
(7.500 persons), the Wapishana, the Warao, the Akawaio and the Patamona. The
1999 Survey of Living Conditions shows that 78% of Amerindians are among the
poorest. Some of the health-related problems they face include malaria (60%
of all cases), diarrhoeal diseases, acute respiratory infections, teen pregnancy,
short child-spacing, tuberculosis, dental caries and inadequate access to health
care. A study conducted in 1997 among the Patamona and the Wapishana tribes
showed that the prevalence of stunting increased with age, from 17% at age 7
to 50% at age 13 among the Wapishana tribe while the figures for the Patamona
were 19% and 80%, respectively. However, by age 18, fewer than 1% of adults
have a BMI of less than 18.5kg/m, while 11% and 3% of adults among Patomona
and Wapishana tribes, respectively, were overweight.
By type of health problem
Vector-borne diseases: Malaria is a major public health problem in Guyana.
Plasmodium falciparum is the main infectious agent transmitted. New cases represent
over 90% of the cases detected each year. In 2000, the number of new cases was
28,267. There were 34 reported cases of dengue fever in 1998, 6 in 1999, and
25 in 2000. There has been laboratory diagnosis of Dengue Types 1 and 2 during
1997-2000. However, no cases of Dengue Haemorrhagic Fever or Dengue Shock Syndrome
have been reported. There were 15 reported cases of leptospirosis during 1997-2000.
Diseases preventable by immunization: In 1997, there were
144 confirmed cases of rubella in comparison with 2 cases in 1998. There were
two serologically confirmed cases of Congenital Rubella Syndrome in 1997, two
in 1998, and one suspected case in 1999 but the serological test for rubella
was negative.
Chronic communicable diseases: In 1997, there were 381 cases of tuberculosis
with an incidence rate of 48 per 100,000 population, while the rate in 1999
was 53. Of these, 227 were pulmonary, 8 were relapsed pulmonary, and 34 were
extra pulmonary cases. The largest number of new tuberculosis cases occurred
in young adults aged 20-40 with peak incidence in those aged 25-34. Males were
more affected than females, accounting for more than 70% of reported cases.
In 1999, there were 43 new patients diagnosed with Hansen’s Disease and
66 were on treatment.
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Figure 4: Vaccination coverage among the population
under 1 year of age, by vaccines, and tetanus toxoid coverage for women
of childbearing age, Guyana, 2000
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Acute respiratory infections (ARI): In all age groups from
under 1 to 44, they were the leading reasons for outpatient visits in 1999.
The mortality rates per 100,000 population were 36.5 in 1997 and 41.0 in 1999.
ARIs were the third cause of mortality in the under-1 age group in 1999. They
were the second cause of mortality in the 1-4 age group in the period 1997-1998.
HIV/AIDS: During 1997 and 2000, there were 763 reported cases of AIDS. Females accounted for 39.6% of the cases. Most cases (65%) occurred between the ages 20-44. There were 24 cases in the 1-4 years age group. In 2000, 97% of the total reported cases were due to unprotected heterosexual sex compared to 86% in 1999. By 2000, AIDS had become the third leading cause of death.
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Figure 5: AIDS incidence, by sex, with male-female
ratio, Guyana, 1994-1999
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Sexually transmitted infections: Syphilis was diagnosed
in 410 persons in 1998, 315 in 1999, and 534 in 2000. In the period 1997-2000,
there were 4 deaths from syphilis. In 1999, 223 pregnant women had a positive
VDRL.
Nutritional and metabolic diseases: Protein-energy malnutrition,
iron-deficiency anaemia, and obesity remain the major nutrition-related problems
in the population. The findings of the 1997 national micronutrients survey revealed
that anemia affected 40-55% of children, adolescents and adults. In 1999, there
were 118 reported deaths from nutritional deficiencies; twenty-two of these
occurred in infants under 1 year old. In 1999, diabetes mellitus accounted for
4,965 first visits and 13,585 total visits to outpatient clinics. There were
290 deaths, representing approximately 7% of all deaths. Of these, 4.9% occurred
among males and 9.9% among females.
Diseases of the circulatory system: In the age group 45-64, ischemic heart disease
was the leading cause of death. The mortality rate for males was 271 per 100,000
in 1997 and 262.9 in 1998. For females, they were 127.8 in 1997 and 126.6 in
1998. Cerebrovascular disease was the second cause of death. In the age group
65 and over, cerebrovascular disease was the leading cause of death with rates
of 1,225.9 per 100,000 in 1997 and 1,142.7 in 1998. Ischaemic heart disease
was ranked second. In 1999, there were 199 deaths from hypertensive disease.
Malignant neoplasms: During 1997, 1998 and 1999, there
were 370, 359, and 348 deaths, respectively from malignant neoplasms. In men,
cancer of the prostate was the leading cause of death accounting for 11% of
cancer mortality. For women, cancer of the cervix uteri was the main cause of
death, representing 13% of all cancer mortality. Next in rank for all cancers
were those of the stomach (8.8%), breast (8.9%), colon (6.9%), and lung and
trachea (6.4%).
Accidents and violence: In 1997, there were 611 deaths
attributed to external causes, 619 in 1998, and 595 in 1999. Suicides accounted
for 13% of deaths, accidental falls for 12%, and motor vehicle accidents for
9.7%.
Emerging and re-emerging diseases: In 1999, there was an
outbreak of equine encephalitis. Twelve deaths were reported.
The Response of the Health System
National health policies and plans
Some elements of the Draft National Plan that was developed for the period 1995-2000
have been implemented. These relate to the prevention of blindness, malaria
prevention and control, nutrition, and HIV/AIDS. The plan sought to incorporate
the work of both private and public health sectors with the objectives of strengthening
and expanding primary health care; improving secondary care in the hospitals;
improving tertiary care at Georgetown Public Hospital; and strengthening the
general management of the health sector.
Health Sector Reform Strategies and Programs
Guyana has embarked on its Health Sector Reform Programme, which proposes
the separation of institutional direction and regulation functions for health
care provision. A restructured Ministry will emphasize policy development; allocation
of resources and developing sustainable financing; performance evaluation; regulation;
research and development; and objective setting. In 1998, the Government initiated
the Health Sector Policy and Institutional Development Programme.
The Health System
The Ministry of Health has overall responsibility for the population’s
health, including policy formulation, standard setting, and monitoring and evaluation.
The Ministry of Local Government is responsible for financing and providing
services at the regional level. The National Insurance Scheme provides some
health benefits to employed persons. The private sector functions independently,
and NGOs are actively involved in health care delivery.
Developments in Health Legislation: There is a new impetus
to pass legislation to support the reforms. Legislation was passed to establish
the Georgetown Public Hospital Corporation and make it a semi-autonomous agency.
Legislation to amend the Medical Practitioner Act was approved by Parliament
in 2000.
Decentralization of Health Services: In 1986, the regions
assumed responsibility for health care within their boundaries. Regional Health
Officers report administratively to the Regional Executive Officers, but receive
technical and professional guidance from the Ministry of Health. The national
referral hospital in Georgetown now functions as a semi-autonomous body with
its own board. The private sector provides approximately half of all curative
services, some of which (like Mammography) are not available in the public sector.
Most private sector services are provided in the capital and other urban centers.
Health insurance: The National Insurance Scheme operated
a social insurance program for employees. The Scheme provides sickness (not
employment related), maternity, medical care, and job-related injury benefits.
Medical coverage is provided, on a reimbursable basis, for selected services.
Some employers provide additional contributory or non-contributory insurance
for their employees. In other cases, individuals purchase health insurance from
private insurance companies.
Organization of regulatory actions
The Ministry of Health is responsible for the regulation of health policies
and legislation, the establishment and enforcement of standards for the delivery
of health care, and the protection of public health. The Ministry’s Directorate
of Standards and Technical Services is responsible for the development of standards,
as is the Bureau of Standards and the Pharmacy and Poison Board. The Environmental
Protection Agency has overall responsibility for the protection of the environment.
Certification and professional health practice: Professional
councils such as the Guyana Medical Council, the Dental Council, and the Guyana
Nursing Council regulate professional health practice. Continuing medical education
is required for annual registration of doctors. Guyana is involved in CARICOM
efforts to establish common standards and measures for accreditation within
the Caribbean Region.
Basic health markets: The Director of Procurement is responsible
for procuring drugs and medical supplies and for setting quality standards.
Environmental quality: Guyana established its Environmental Protection Agency
in 1996. The Agency is charged with managing Guyana’s diverse physical
environment. It has been delegating functions to other agencies involved in
environmental management, such as the Geology and Mines Commission, the Guyana
Forestry Commission, the Ministry of Local Government, and the Ministry of Health.
Food quality: A number of agencies have regulatory responsibility
for food quality. Guyana’s six municipalities have various by-laws to monitor
food processing and food service sectors in their respective areas.
Organization of public health care services
The Ministry of Health has endorsed the principles and strategies in the Caribbean
Charter for Health Promotion.
Disease Prevention and Control Programs: The priorities
include maternal and child health, the Expanded Program on Inmunization (EPI),
HIV/AIDS and other STIs, malaria, and chronic non-communicable diseases.
Health Analysis, Epidemiological Surveillance, and Public Health
Laboratory Systems: The Epidemiology Division of the Ministry of Health
has overall responsibility for disease surveillance. However, the system faces
logistical and communications challenges. The surveillance system for the EPI
is the most developed in the country.
Potable water, excreta disposal and sewerage services:
Drinking water coverage in all areas of the country is estimated to be 70% with
54% of households having piped water. Quality remains an issue. Sanitation coverage
throughout the country has been estimated at 90%, with 18% having access to
flush systems and 80% using pit latrines.
Solid waste services: Local government bodies are responsible
for solid waste management in Guyana. In 1997, refuse collection in Georgetown
was privatized.
Food safety: The Environmental Health Department, within the Ministry of Health,
is responsible for ensuring that proper standards are maintained by the food
protection and control services at the regional level.
Food aid programs: Food supplements are distributed to
pregnant women and young children attending public health clinics in selected
high-risk communities. A number of community-based organizations are involved
in implementing on-site feeding programs.
Organization of Individual Health Care Services
Health services are provided at five different levels in the public sector.
There are 3,274 hospital beds (4.4 beds per 1,000 population) in the private
and public sectors.
Auxiliary diagnostic services and blood banks: Laboratories exist at the regional
and national levels. In the public sector, blood for transfusion is screened
for hepatitis B and C, HIV, malaria, and syphilis.
Specialized services: Reproductive health care is provided
by the public, private and nongovernmental sectors. The Safe Motherhood Initiative
is also being implemented. The number of public facilities offering dental care
on a daily basis increased from 14 in 1997 to 22 in 2000, and dental education
activities have been increased. The psychiatric hospital provides in- and outpatient
care. The Rehabilitation Services have been strengthened.
Health supplies
Although there is a local drug manufacturer, most of the drugs used in Guyana
are imported. Guyana does not produce any vaccines or biologicals. Vaccine cold
chain facilities exist at all levels of the health services.
Human resources
In the public health sector, staff vacancy rates range between 25% and 50% in
most categories. There is a continuing loss of trained personnel from the public
to the private sector and to other countries. From 1997 to 1999, the number
of physicians ranged from 3 to 4 per 10,000 population. During the period 1997-1999,
nurses ranged from 7 to 15 per 10,000 population, pharmacists were approximately
2 per 10,000 pop., and dentists remained at 0.4 per 10,000 pop.
Health sector expenditure and financing
Government health expenditure in 1997 was US$ 19,318,104 or US$ 26 per capita;
however, the distribution of resources among establishments was not equitable.
External Technical Cooperation and Financing
Financial support for Guyana’s health sector is channeled through the national
budget. The main donor agencies include the IDB, the European Union, CIDA, PAHO,
UNICEF, and UNDP. In 1997, external funding covered approximately 12% of total
government spending on health, 15% of public sector needs, and some 10% of total
private and public health expenditures.
Return to Index
Epidemiological Bulletin, Vol. 24 No. 1, March
2003