Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697647722377.pdf (Bahamas)
10.6 TuBERCuLOSiS Table 24.

Status of Tuberculosis cases, BAHAMAS, 2004 – 2008 Characteristics Male Female Bahamian Non-Bahamian Culture +ve Culture -ve Culture Unk Ex-Pulmonary Pulmonary Smear +ve Smear –ve Smear Unk.
Dead Total New TB cases 2004 # % 2005 # % 36 76.7 34 70.8 14 29.8 32 68.1 16 33.3 2006 # % # % 28 58.3 20 41.7 26 54.2 22 45.8 40 83.3 0 0 8 16.7 6 12.5 42 87.5 34 81.0 5 11.9 3 7.1 7 14.6 48 45 2008 # % 36 73.5 13 26.5 32 65.3 11 34.7 47 95.9 2 4.1 0 0 5 11.1 44 89.8 34 77.3 9 20.4 1 2.3 7 8.2 49 46 Source: Department of Public Health The Tuberculosis (TB) incidence rate hovered around 15 per 100,000 population for the period under review; prevalence was estimated at between 3-8 per 100,000 population (Fig.
20).

TB cases were more likely to be male and Bahamian (Table 24).

Direct Observed Therapy Short-Course(DOTs) coverage in 2007 was 100%.

On average, 18.7% of the new smear positive cases died and 25% defaulted, so that the success rate was only 63%.

Of those smear-positive patients who were re-treated, the success rate increased to 71% but the death rate also increased to 21%.

There was one multi-drug-resistant case during the period 2004-08.
HIV prevalence in the TB population was at least 10 times higher than in the general population (Fig.

20).

During 2008, the HIV co-morbidity rate in female TB cases was less than 25%, but during the remainder of the time period co-morbid rates between the sexes differed little, ranging over the review period from 25% to 55% (Table 25).

42 Annual Report of the Chief Medical Officer Fig.
20. incidence and prevalence of TB and co-morbid Hiv, Bahamas, 1990-2008 Source: WHO Country TB database 35 35 30 30 25 25 20 20 15 15 , 0 0 0 0 0 1 r e p e t a R 40 35 30 25 20 15 10 5 , 0 0 0 0 0 1 r e p e t a R , 0 0 0 0 0 1 r e p e t a R 15 10 5 0 ) e l a c s x g o l ( t n e c r e P 101.5 101 100.5 1990 1995 2000 2005 1990 1995 2000 2005 Bahamas Incidence (all) Notiﬁed New and Relapse HIV Prevalence in TB HIV in General Population , 0 0 0 0 0 1 r e p t n e c r e P 6 5 4 3 2 1 1990 1995 2000 2005 1990 1995 2000 2005 Bahamas Prevalence (all forms) Mortality excluding PLWHA Mortality including PLWHA t n e c r e P 80 60 40 20 0 1990 1995 2000 Bahamas New ss(+) Retreatment 2005 1994 1996 1998 2000 2002 2004 2006 Bahamas Treatment Success Rate MInistry of Health, Commonwealth of The Bahamas 43 Table 25.
Distribution of Tuberculosis cases by co-morbidity with Hiv and sex, Bahamas, 2004 – 2008 year Morbid State Male Female TOTAL 2004 2005 2006 2007 2008 All TB 36 11 47 TB/Hiv 15 42% 5 45% 20 43% All TB 34 14 48 TB/Hiv 14 41% 6 43% 20 42% All TB 39 25 64 TB/Hiv 21 54% 11 44% All TB 28 20 TB/Hiv 8 29% 5 25% All TB 36 13 TB/Hiv 14 39% 3 23% 32 50% 48 13 27% 49 17 35% Source: Surveillance Unit, Department of Public Health 10.7 NON-COMMuNiCABLE DiSEASES & iNjuRiES Of all non-communicable diseases, hypertension may be the most prevalent and the condition generating the greatest need for health care.
Not only is hypertension the leading cause of mortality, it is, after injuries, also the next leading non-infectious condition responsible for hospital discharges followed by diabetes, with which it is frequently a co-morbid condition, especially among the elderly (Fig.

21).

Fig.

21.
21).

Fig.

21.

Selected conditions as percentages of total discharges (excluding deliveries) from Princess Margaret and Rand Memorial hospitals, 2004 – 2008 s e g r a h c s i D l a t o T f o % 14 12 10 8 6 4 2 0 Hypertension Ischaemic H.D.

AIDS Slow Fetal Growth Injuries and Poisonings Diabetes Stroke A.R.I.
2004 2005 2006 Year 2007 2008 Sources: Health Information & Research Unit; Statistics Unit, Public Hospitals Authority The register of 65+ year olds with hypertension and/or diabetes yielded prevalence rates of 620 and 252 per 10,000, respectively, for these two medical conditions in this age set.

Hypertension is the principal reason for a majority of new clients seeking care at health centres (Table 26).

Diabetes was the second leading diagnosis among new clients.
Significant numbers of new clients also attended the health centres for treatment of injuries, either road traffic injuries (RTI) or industrial accidents, and mental health conditions, as well as for arthritis.

44 Annual Report of the Chief Medical Officer Table 26.
New cases attending Primary Health Clinics for selected non- communicable conditions Condition Hypertension Diabetes Mellitus Arthritis RTIs Industrial Accidents Schizophrenia Epilepsy Sickle Cell Anaemia Alcohol Dependence Mental Retardation Source: Public Health Department The need for dialysis as a result of the complications associated with hypertension and diabetes is another major component of the utilization of health services.
There were 139 persons on dialysis at the Princess Margaret Hospital in 2007, the vast majority of whom were hypertensive, with and without diabetes (Fig.

22).

The other conditions present in dialysis patients were diabetes only, systemic lupus erythematous (SLE) and polycystic kidney disease (PKD).

Fig.

22.
Fig.

22.

Patients on dialysis at Princess Margarget Hospital by underlying condition, 2007 Hypertension Hypertension with Diabetes Diabetes SLE PKD Other 2007 Source: Dialysis Unit, Princess Margaret Hospital Although not reflected in hospital discharge statistics, cancers are a major cause of ill-health.

As seen earlier (Page 13), neoplasms of the prostate and breast rank among the top ten causes of mortality in males and females, respectively.
Data from the Princess Margaret Hospital show that the most common sites are indeed breast and prostate, followed by colon/rectum and uterus/ovary (Fig.

23).

MInistry of Health, Commonwealth of The Bahamas 45