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—from Epidemiological
Bulletin , Vol. 25 No. 3, September 2004— Country Profiles: VenezuelaGeneral situation and trends It has a land area of 916,446 km2, a population estimated at 24,896,379 inhabitants
in 2000; 33.2% of the population is under the age of 15 and 6.5% is over 60
(Figure 1). The annual demographic growth rate was 2% from 1996-1999. In 1999,
the general mortality rate was 4.7 per 1,000 population. The birth rate dropped
gradually from 25.6 per 1,000 population in 1996 to 24.3 per 1,000 population
in 1999. The total fertility rate fell slightly, from 3 children per woman
in 1996 to 2.8 in 1999. Net migration was positive in 1996 (74,099) and negative
the following two years, with figures of -306,574 and-730,107, respectively.
According to the last census of the indigenous population (1992) and forecasts
for 2000, the indigenous population numbered 371,815 people (1.5% of the total
population). Economic performance over the last decade has been slow in terms of growth,
marked by a recurrence of inflationary recessive episodes. GDP was estimated
in US$ 2,647 per capita in 1998 (adjusted for purchasing power parity); Figure
2 shows the GDP annual growth. 30% of the national budget was earmarked to
pay the foreign debt. The population living in poverty, according to the index
of unmet basic needs, stood at 49% between 1996 and 2000, and the percentage
of the population living in extreme poverty, at 21.7%. The global unemployment
rate fell from 14.5% in the second semester of 1999 to 13.2% during the same
period of 2000; male unemployment in the same semester and years fell from
16.1% to 14.4%, while female unemployment fell from 13.6% to 12.5%. Formal
employment slid from 50.1% in the second semester of 1998 to 47.0% in the same
semester of 2000. Lack of security for citizens and petty crime are priority
problems for the Government and society alike. In 2000, 7,908 people died due
to assaults. In 1997, Venezuela ranked 48th in the human development index,
and 61st in 1999. Life expectancy was of 74.7 years for women and 68.9 years
for men in the period 1990-1995, and in 1995-2000, it was 75.7 and 69.9, respectively.
In 1998, there was a difference of nearly 10 years of life expectancy between
the most developed and the least developed states (73.6 in the Federal District
and 63.9 in Amazonas). A political, legal, economic, and social transition
was initiated in 1999, aimed at implementing a new development model intended
to strengthen the democratic system, create a fairer society, and consolidate
an efficient economy within the framework of globalization. Only 25% of the eligible population is enrolled in intermediate, diversified, and professional education. Illiteracy among people over 10 years of age in 1998 was 6.2% (5.5% for males and 7.0% for females). From 1995-1999, the mortality rate by broad groups of causes was 162.3 per
100,000 population for diseases of the circulatory system, 63.8 per 100,000
for malignant neoplasms, 55.3 per 100,000 for external causes, 53.6 per 100,000
for communicable diseases, and 22.4 per 100,000 for certain conditions originating
in the perinatal period. Figure 3 shows the estimated mortality by groups of
causes and sex. Specific health problems Health of adults (20-59 years): Maternal mortality declined between 1940 and 2000, dropping from 172.4 per 100,000 live births to 59.0 per 100,000 in 2000. Nevertheless, the 1980s saw a reversal in the maternal mortality trend. The most important causes of death were complications of pregnancy, childbirth, and the puerperium (50%); edema, proteinuria, and hypertensive disorders (35%), and pregnancy ending in abortion (14%). Most of the causes are avoidable, considering that over 90% of deliveries occur in institutional settings. Health of the elderly (60 years and older): This population accounted for 6.5% (46% men) of the total population in 2000. The population in this group is expected to triple by 2025. In 1998, the leading causes of mortality in this group were heart diseases (32%), malignant neoplasms (18%), cerebrovascular diseases (12%), and diabetes (8%). The risk of death due to these causes is higher in men, except in the case of diabetes. Health of the workers: Occupational hazards in the 1990s have increased as a direct result of informal employment, the use of inadequate premises, and because homes are used as centers of production. The most frequent occupational diseases are industrial deafness (work-related hypoacusis), and other conditions associated with noise and vibrations, chemical poisoning, and musculoskeletal disorders. It is estimated that 10% of the population has some degree of physical or mental disability or handicap. Health of indigenous groups: The indigenous peoples live in conditions of vulnerability, social exclusion, and extreme poverty. In 1992, more than 50% of these communities lacked potable water and excreta disposal services; 65% lacked access to schools and 72.8% of the rural outpatient ambulatory services in the indigenous villages had no physician. The leading conditions are tuberculosis, malaria, parasitosis, malnutrition, diarrheal and respiratory disorders. Analysis by type of health problem Vector-borne diseases: The malaria transmission zone covers 23 % of the country’s surface area. It is inhabited by 720,000 people. In 2000, 30,234 autochthonous cases of malaria were reported, 38.3% more than in 1996 (21,852). They were primarily concentrated in Sucre, Bolivar and Amazonas states, which accounted for 91.5% of the cases. Classic dengue and hemorrhagic dengue fever behaved endemo-epidemically nationwide. Serotypes 1, 2, and 4, have circulated simultaneously in recent years; serotype 3 has circulated since 2000. The highest incidence was recorded in 1998 with 37,586 cases reported; in the following years the number of cases gradually declined reaching 21,101 cases in 2000 (18,915 dengue classic and 2,186 hemorrhagic dengue fever). In 2000, indices of infestation by Aedes aegypti in dwellings and warehouses remained high (20.7% and 10.3%, respectively). No cases of yellow fever between 1980 and 1997 were reported. However, in 1998; there was an outbreak in a Yanomami village that led to 15 cases and four deaths. Chagas disease is considered a risk for some 6 million people living in 198 municipalities in 14 federal entities, in a territory of 101,488 km2. Insecticide application and improved dwellings conditions reduced the prevalence of Chagas disease, which was around 45% in the 1950s, to less than 10% in the 1990s. Some 18.3% of the population at risk of contracting onchocerciasis in the Region lives in Venezuela, which is the country with the third highest incidence of the disease. Cutaneous leishmaniasis is endemic throughout the country, and is more frequent in male agricultural workers aged 15-44 years. In 2000, 92% of the 2,528 cases recorded were the localized cutaneous form. Diseases preventable by immunization: The last confirmed case of poliomyelitis
was reported in 1989, and immunization against polio achieved coverage of 86%
in 2000 (Figure 4). Although no cases of measles had been recorded since 1997,
in 2000, an outbreak was reported in Zulia state with 22 confirmed cases. In
2000, 12,609 cases of rubella and 6,044 of mumps were reported. In 2000, an
84 % coverage was attained in children under 1 year of age with the MMR (against
measles, mumps and rubella) vaccine. Intestinal infectious diseases: In 1997, there was a Cholera epidemic with 2,551 cases, for an incidence rate of 11.2 per 100,000 population. In 1988, the incidence dropped to 1.3 per 100,000 population and, in 1999, it was 1.6 per 100,000 population. Chronic communicable diseases: Bacillary pulmonary tuberculosis and the other forms of tuberculosis have varied little in recent years. The respective rates recorded were 15.6 and 26.1 per 100,000 population in 1991 and 15.0 and 25.2 per 100,000 in 2000, respectively. Leprosy ceased to be a public health problem in 1997. Its prevalence in 2000 was 0.6 per 10,000 population. The problem persists in Cojedes, Portuguesa, Barinas, Apure, and Trujillo states. Zoonoses: Between 1991 and 2000, the annual average of human rabies cases dropped from three to one case. The cases recorded in those years occurred in the metropolitan area of Maracaibo. HIV/AIDS: During 1983-1999, 8,047 cases and 4,726 deaths were reported, and underreporting was estimated at around 80%. According to information from UNAIDS, 62,000 people throughout the country were HIV carriers in 1999. In analyzing the cumulative incidence, clearly the most frequent mode of transmission is sexual, which account for 90.3% of the cases, followed by transmission by blood, accounting for 4.3%. There is a marked predominance of HIV/AIDS cases among males, although the proportion of females is rising. Nutritional and metabolic disorders: The groups most affected by general malnutrition in 2000 were children under two years of age (11.7%), 2-6 years (22.4%) and 7-14 years (24.4%). Twenty-four percent of the preschool-age children attending public schools have a nutritional deficit. The prevalence of overweight in the population under 15 years of age rose from 8.5% in 1990 to 11.3% in 2000. The prevalence of iron deficiency anemia in pregnant women was 41% and in children under 3 years it was 51%. Mortality due to nutritional deficiencies affected the age group of children under 1 year the most, at a rate of 60.3 per 100,000 live births. In 1999, Diabetes mellitus was the fifth leading cause of death overall (5.5%), but fourth (7.4%) for women. The mortality rate that year was 23.8 per 100,000 population (22.9 for males and 26.9 for females). Diseases of the circulatory system: Diseases of the circulatory system were the leading cause of death in 1999 (21%); over half were due to acute myocardial infarction. One in 10 deaths was due to hypertensive diseases. Ischemic diseases have been increasing. The highest-risk group is 40 to 60 years old. Malignant neoplasms: Malignant neoplasms were the second leading cause of death in 1999 (14.3%), with malignant neoplasms of the digestive system, mainly the stomach, predominating in both sexes. In women, cervical cancer is the second leading cause (13.1 per 100,000 females), and the highest risk is in women aged 25-64 years (202.6 per 100,000 females). The second leading cause is breast cancer (8.8 per 100,000 females). In men, cancer of the bronchus and lung ranked second (11.4 per 100,000 males), followed by prostate cancer (11.0 per 100,000 male). Accidents and violence: In 1999, accidents and violence accounted for 12.5% of total deaths. Accidents (all types) were the fourth leading cause of death (7.5%) that year, with a rate of 32.8 per 100,000 population (51.0 for males and 16.1 for females), including 60% of motor vehicle accidents. In 1999, 5% of deaths were due to suicides and homicides, making them seventh in general mortality and fourth for males. Mortality due to this cause is increasing, mostly due to homicides (16.9 per 100,000 population in 2000). Foodborne diseases: Between 1996 and 2000, a 63% increase could be seen in the number of outbreaks, and foodborne cases of diseases quadrupled. In 56.4% of cases, the contaminating agent was identified (Staphylococcus aureus in 72.8% of cases and high levels of histamine in 14.7% of cases). In 2000, half the cases occurred in homes and 22.8% in schools. Response of the health system Health sector reform Health system Organization of the sanitary regulation actions Organization of the public health services Organization and operation of the individual health care services Health supplies Human resources: Research and health technology Health sector expenditure and financing External technical and financial cooperation in
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