SPECIFIC HEALTH PROBLEMS
Analysis by population group
Children (0-4 years): The infant mortality rate in 1999 was approximately 16 deaths per 1,000 live births, which is generally regarded as an underestimate. There were 941 certified deaths among children age 5 years and younger. Conditions originating in the perinatal period were the most important cause of mortality for this age group (67% of deaths). Congenital defects accounted for 9.1%, communicable diseases 5.0%, external causes 2.8%, and HIV/AIDS 2.2%. Homicides (10 deaths) and transport accidents (7 deaths) were the largest contributors to deaths due to external causes. Other leading causes of death included influenza, pneumonia, and nutritional deficiencies. Acute respiratory tract infections, poisoning, unintentional injuries, gastroenteritis, and violence were among the leading hospital discharge diagnoses.
Schoolchildren (5-9 years): The main problems among approximately 1,200 children seen in government-operated child guidance clinics in 1999 include attention deficit, adjustment, and conduct disorders. Data from the accident and emergency departments indicated that schoolchildren accounted for 20% of accidental laceration, 14% of burns, and 10% of poisonings. In 1999, this age group accounted for 11% of cases of sexual assault and 6% of injuries inflicted with blunt objects. The number of children who lived on the streets increased; most of these children are boys.
Adolescents (10-14 and 15-19 years): One in every five Jamaican is an adolescent. They accounted for only 2% of deaths in 1999. The major causes of hospitalization were injuries, respiratory diseases, including asthma, and neoplasm. Adolescents accounted for 23% of intentional injuries and 20% of accidental injuries treated at accident and emergency departments. Injuries and respiratory diseases were also the main causes of deaths occurring in hospitals. Among the 15-19 years age group, obstetrical conditions among females and intentional injuries among males were the leading causes of hospital admissions. Injuries, cardiovascular diseases (associated with rheumatic heart disease) and HIV/AIDS were the leading causes of death. Adolescents age 10-19 years accounted for 53% of cases of sexual abuse seen in accident and emergency departments. Rates of HIV infection were three times higher in adolescent girls than boys, while AIDS was among the five leading causes of death in this age group.
Adults (20-59 years): In 1999, the prevalence of hypertension and diabetes was high among women age 20-59 years. Diabetes accounted for one of every nine deaths, and the rate of diabetes among women increased from 51.8 per 100,000 population in 1990 to 59.9 per 100,000 population in 1999. Breast and cervical cancers were leading causes of cancer mortality in this group. The Women's Crisis Centre's profile of abused women showed that sexual assault was reported by 59% of respondents and physical assault with or without a weapon by 90%. Of those injured, only 26% reported the incident to the police. In 2000, maternal mortality was estimated at 110 deaths per 100,000 live births. Complications such as hypertension in pregnancy and postpartum hemorrhage were the main causes of maternal mortality. In 2000, syphilis and hemoglobin testing were carried out on 75% and 74% of women attending clinics at health centers, respectively. The level of syphilis in the prenatal population declined from 6% in 1996 to 2 % in 2000. The prevalence of anemia in pregnant and lactating women remained high at 15 % but these levels may also reflect pre-pregnancy levels, as testing is done at the first prenatal visit. Of the 1,925 prenatal attendees, 1.2 % tested positive for HIV. The highest number of positive cases (36%) was in the age group 20-24 years. The Constabulary Statistical Department reported that 100 women were victims of homicide. 50% of women of reproductive age were current users of a family planning method. In 1999, cardiovascular diseases and diabetes mellitus were among the leading causes of hospital admission and death among adult males. Injuries were the leading causes of morbidity among men age 20-44 years. Men accounted for over 60% of all intentional injuries seen at accident and emergency departments. Cancer of the prostate, trachea, bronchus and lung, and stomach were the five most common causes of cancer death among males. Accidental injuries and motor vehicle accidents were also more common in men.
Elderly (60 years and older): In 1999, cardiovascular disease were the leading cause of admission among persons 60 and older, followed by diabetes mellitus. The leading cause of hospital deaths in 1999 was cardiovascular disease, followed by diseases of the respiratory system. In 2000, persons age 60 years and older accounted for 9.7 % of the population. The main non communicable diseases affecting the elderly were hypertension, arthritis, overweight, and diabetes.
Workers Health: In 1999, the Ministry of Labor monitored factories whose workers comprised 5% of the employed labor force. The Ministry reported 223 accidents from these factories, for an accident rate of 4.8 per 1,000 workers. The case fatality rate among these workers was 2.2 deaths per 100,000 in 1999.
The Disabled: Almost 10% of the population was disabled with physical disability ranking as the highest type (29%). Persons with visual disability accounted for 12%, multiple disabilities 14%, mental illness 8%, and mental retardation 5%.
Analysis by type of health problem
Natural Disasters: Between 1996 and 2000, the major disasters in Jamaica were floods in the parishes of Portland and St. Mary.
Vector-borne diseases: An outbreak of dengue occurred in 1998 with 1,509 reported cases. In 2000, there were 25 cases. No indigenous cases of malaria were reported; however, there were 7 imported cases.
Diseases preventable by immunization: Immunization coverage in 2000 was 94% for BCG, 86% for DPT, 86% for polio, and 88% for MMR. During 1996-2000, there were 15 cases of congenital rubella. There were 36 laboratory-confirmed cases of hepatitis B infection in 1996 and 174 in 2000.
Respiratory diseases: Respiratory tract infections accounted for 12% of all visit to accident and emergency departments of hospitals in 1999, with asthma accounting for 49% of these visits.
Zoonoses: In 2000, 24% of samples were seropositive for Leptospira, compared to a seropositivity rate of 51% in 1998.
HIV/AIDS: The national incidence of AIDS in 2000 was 352 per 1,000,000 population. The main mode of transmission was heterosexual (61% of cases). The cumulative number of AIDS cases from 1982-2000 was 5,099 for a male to female ratio of 1.6:1. The case fatality rate was 61%. There were 414 cases in children with a case fatality rate of 54%.
Sexually transmitted infections: There were 17 cases of congenital syphilis in 1999 compared to 36 cases in 1996.
Cardiovascular diseases: In 1999, cardiovascular disease was the second leading cause of death for a rate of 84.6 per 100,000 population. It was the leading cause of death among hospital inpatients, accounting for 33% of deaths.
Malignant neoplasms: There were 2,407 deaths due to malignant neoplasms in 1999 (93.2 per 100,000). Among males, prostate cancer caused 30% of cancer deaths, lung 17%, and stomach 9% with death rates of 28.9, 15.9, and 9.1 per 100,000 respectively. Among females, breast cancer caused 18% of deaths, cervix uteri and other unspecified uteri 14%, colon and rectum 8%, with death rates of 15.8, 12.9, and 7.1 per 100,000 population respectively.
Accident and violence: In 1999, three surveyed hospitals documented more than 12,000 injuries in a 6-month period. Injuries accounted for 17% of hospital discharge diagnoses (excluding obstetrics) in 1999. Violence related injuries accounted for 49% of injury visits at accident and emergency departments. 3 % of all visits to the accident and emergency departments were for accidental injuries and 2% for motor vehicle accidents.
Emerging and re-emerging diseases: There were 17 cases of Haemophilus influenzae meningitis during 1999-2000, 75% of the cases were children between the ages of 6 months and 5 years.
Mental Health: In 2000, schizophrenia accounted for 49% of patients seen at mental health clinics.