Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698829537356.pdf (Saint Kitts and Nevis)
NEVIS ISLAND ADMINISTRATION MINISTRY OF HEALTH STATISTICAL REPORT 2011 1 | P a g e © Ministry of Health, Nevis 2011 All rights reserved Short extracts of this publication may be copied or reproduced for individual use without permission, provided the source is fully acknowledged.
More extensive reproduction or storage in a retrieval system in any form or by any means – photocopying, electronic, mechanical, recorded or otherwise requires the prior written permission of the Permanent Secretary, Ministry of Health, Nevis.
Published by the Ministry of Health Charlestown Nevis Telephone: (869) 469-5521 ext Fax: (869) 469-5629 Website: www.moh.gov 2 | P a g e 4 5 6 7 10 10 11 11 12 TABLE OF CONTENTS Page Acknowledgement Acronyms and Abbreviations List of Tables & Figures 1.0 Background 1.1 Health Profile 2.0 Performance of Ministry of Health Strategic Objective 2.1 Core Functions 2.1.2 Accomplishments – 2011 2.1.3 Projections – 2012/2013 2.1.4 Regulations and Legislations 2.1.5 Health Professionals 3.0 Health Status 3.1 Health Indicators 4.0 Public Health 4.1 Registrar General 4.3 Health Promotion 4.4 Community Health Nursing 4.4.1 Mental Health 4.5 Oral Health Services 4.6 Environmental Health 5.0 Hospital Services GLOSSARY 13 14 24 37 52 55 58 59 72 3 | P a g e ACKNOWLEDGEMENT Health Information enables managers to monitor and evaluate health care programs, services and policies.
It also enables decision makers to make maximum use of scarce resources, be it human, financial or otherwise in the implementation of interventions.

It is therefore paramount that crucial health information be accessible and disseminated in a timely manner to facilitate decision making.

We at the Health Promotion Unit are proud to present the Ministry of Health Statistical Report for 2011.
The staff at the Health Promotion Unit is extremely grateful to all those who have contributed to its completion and production.

Your continued cooperation and support have helped us to provide a more detailed and invaluable report which once used as intended, can play a major role in the reduction of morbidity and premature mortality on the island of Nevis.
4 | P a g e ACRONYMS AND ABBREVIATIONS ANC ART ARV BSS Antenatal Clinic NACHA National Advisory Council on HIV/AIDS Antiretroviral Treatment NACU Nevis AIDS Coordination Unit Antiretroviral Medicines NAS National AIDS Secretariat Behavioural Surveillance Survey NeHAC Nevis HIV/AIDS Committee CAREC Caribbean Epidemiology Centre NGO Non-Governmental Organization CARICOM Caribbean Community & Common NSP National Strategic Plan Market CCT CHD Clinical Care Team OECS Organization of Eastern Caribbean States Community Health Department PAHO Pan American Health Organization CHRC Caribbean Health Research Council PANCAP Pan-Caribbean Partnership on AIDS FACTTS Facilitating Access to Confidential Testing, Treatment & Support PLWHA People Living with HIV/AIDS Faith-Based Organizations PMTCT Prevention of Mother to child Transmission Family Health International GFATM Global Fund for AIDS, Malaria and TB PSI SAT Population Services International Self-Assessment Tool GoSKN Government of St Kitts & Nevis SNHAG Saint Kitts/Nevis HIV/AIDS Group Health Promotion Unit STI Sexually Transmitted Infection Health Management Information System SW Sex Worker HIV Sentinel Surveillance TA Technical Assistance International Labour Organisation UNAIDS Joint United Nations Programme on HIV/AIDS FBO FHI HPU HMIS HSS ILO LMIS Laboratory Management Information System MOE Ministry of Education MOH Ministry of Health MSM Men who Have Sex with Men UNGASS United Nations General Assembly Special Session on HIV/AIDS University of the West Indies
 Voluntary Counselling and Testing World Bank UWI VCT WB 5 | P a g e List of Tables & Figures Tables Table 1 Communicable Diseases by Age Range (pg 8) Table 2 Intentional and Unintentional Injuries (pg 9) Table 3 Summary of Health Indicators (pg13) Table 4 Monthly Births in Nevis (pg15) Table 5 Live births and still births in Nevis by Month (pg15) Table 6 Teenage Births by Month and Age (pg16) Table 7 Teenage Births by Age and Birth Order (pg16) Table 8 Break down of Births Cases (pg 17) Table 9 Registered
 Deaths in Nevis by Parishes (pg 18) Table 10 Registered Deaths by Age (pg18) Table 11 Registered Deaths by Category (pg19- 20) Table 12 Incidence Cases of Neoplasm (pg21) Table 13 Neoplasm/Cancers Deaths (p21) Table 14 Marriages by Parishes (pg22) Table 15 Marriages by Place of Marriage (pg22) Table 16 Marriages by Age Range (pg23) Table 17 Care and Treatment for HIV/AIDS (pg29) Table 18 Person Counselled and Tested for HIV (pg31) Table 19 PMTCT (pg32) Table 20 HIV Education Session (pg 32) Table 21 Blood Safety (pg33) Table 22 Number of HIV Tests Performed (pg33) Table 23 Number of Clients served at Alexandra Lab by Parish (pg33) Table 24 Number of Clients served at Alexandra Lab by Month (pg33) Table 25 Condom Distribution (pg34) Table 26 Non- Communicable Diseases (pg39) Table 27 Registered Diabetic Patients (pg40) Table 28 Diabetes general statistics (pg40) Table 29 Diabetic Patients by Age Range and Gender (pg41) Table 30 Registered Hypertensive Patients (pg42) Table 31 Hypertension general statistics (pg42 Table 32 Hypertensive Patients by Age Range and Gender (pg43) Table 33 District Medical Officers Clinic (pg44) Table 34 Eye Care Attendance and Procedures (pg45) Table 35 Attendance at Ante Natal Clinics (pg46) Table 36 Pap smear per age range (pg47) Table 37 Attendance at Post Natal and Family Planning Clinics (pg47) Table 38 Attendance at Child Health Clinics (pg48) Table 39 Attendance at Toddlers Clinic (pg48) Table 40 EPI Coverage per Health Centre
 (pg49 Table 41 Overall EPI Coverage (pg49) Table 42 School Health Activities (pg50) Table 43 Age Range of New Mental Health Clients (pg53) Table 44 Diagnoses of New Mental Health Clients (pg53) Table 45 Dental Health Statistics by Services Rendered (pg57) Table 46 Dental Health Statistics by Patient (pg57) Table 47 Food Handlers Report (pg58) Table 48 Ten Leading causes of Hospitalization (pg66) Table 49 Hospital Admissions (pg62) Table 50 Hospital Discharges (pg62) Table 51 Inpatient Days (pg63) Table 52
 Outpatient Census (pg64) Table 53 Theatre Cases (pg64) Table 54 Breakdown of Theatre Cases (65) Table 55 Minor Day Operations (pg66) Table 56 Radiology Statistics (pg66) Table 57 Ultra Sound (pg67) Table 58 Types of X-Ray (pg67) Table 59 Types of Ultra Sound (pg67) Table 60 Rehab Therapy Statistics (pg68) Table 61 CT Scans/ICU (pg69) Table 62 Pharmacy Statistics (pg69) Table 63 Asthma Cases (pg70) Figures Figure 1 School Health Education Sessions (pg25) Figure 2 Group Health Education Sessions (pg25) Figure 3 Group Health Education Sessions by Age (pg26) Figure 4 School HIV/AIDS Education Sessions (pg26) Figure 5 HIV/AIDS Reported Cases (pg28) Figure 6 HIV/AIDS Reported Cases by Age Range (pg28) Figure 7 VCT Test Done by Parish (pg30) Figure 8 VCT Tests Done by Month (pg31) Figure 9 VCT Tests Done by Age Range (pg31)) Figure 10 Condom Distribution (pg34) Figure 11 Diabetic Patients by Age and Gender (pg 41) Figure 12 Hypertensive Patients by Age Range and Gender (pg43) Figure 13 Pap Smear Per Health Centre (pg47) Figure 14 Age Distribution of Pap Smear Clients (pg47) Figure 15 Mental Health Client Admissions (pg54) Figure 16 Age Distribution of Pap Smear Clients (pg70) 6 | P a g e 1.0 BACKGROUND 1.1 Health Profile Nevis is a developing country located in the Caribbean Sea, positioned near the Northern end of the Lesser Antilles.
Divided into five (5) Parishes, the country has an estimated population of twelve thousand six, hundred and ninety (12,690).

The island is divided into two Health Districts and Health Care Services are accessible to all as six Health Centres are strategically located throughout the island.

The Alexandra Hospital, a 52 bed facility is the only hospital on the island.
It offers a wide range of services in surgery, internal medicine, obstetrics and gynaecology, paediatrics, emergency medicine, along with other support services.

The health care facilities throughout the island are manned by a cadre of qualified and professional staff.
Births During the year 2011 there was a total of one hundred and thirteen (113) births, sixty – five (65) males and forty – five (45) females as compared to one hundred and twenty- four , sixty – three (63) male and sixty – one (61) female in 2010.

The crude live birth rate stands at 8.6% compared to 9.8% in 2010.

Single women accounted for 65% of these births while married women accounted for 33% and the other 2% of women were separated from their partner.
Of these 113 births, four (4) were still born as compared to one (1) 2010.

Teenage births as a percentage of total births stands at 10.6% Fetal and Infant Deaths Of the total deliveries in 2011, four (4) were stillbirths, three (3) more than what was recorded in 2010.

Still birth rate for 2011 was 35.4% compared to 8.1% in 2010.

No infant deaths were recorded, thus a decrease in the infant mortality rate of 16.3% in 2010 to zero in 2011.

No neonatal deaths were recorded for 2011.


Deaths There were 96 (58M/38F) registered deaths in 2011 compared to 91 (48M/43F) in 2010.

This indicated a slight decrease in the crude death rate of 7.4 per 1,000 population for 2011 as compared to 9.8 per 1,000 population in 2010.

The parish of St. Paul accounted for 64% of the total deaths; this is so because some of these deaths occur in the hospital which is the St. Paul parish.
The 60+ age group accounted for 77.9 % of the overall deaths when compared to 69% in 2010.

Deaths in children 1-4 years remained at one for both years.

Marriages There were 98 marriages registered for the period under review; (6 more than the previous year).

Thirty one (31%) of these marriages were performed in non-religious ceremonies (by the Magistrate).

The natural increase rate per 1000 population for the island was 1.4% as compared to 2.6% in 2010.
This figure does not take into account migration into and out of the country.

Morbidity 7 | P a g e The leading causes of hospitalization were hypertension and diabetes.

The number of diabetic and hypertensive patients registered at health centres now stands at 523 and 504 respectively.

Of those figures 23 were newly diagnosed cases of diabetes and 41 newly diagnosed cases of hypertension.

There were also twenty – seven (27) newly diagnosed cases of cancers on the island.
There were three (3) new cases of HIV/AIDS reported.

Of the communicable diseases, Gastroenteritis, Acute Respiratory Tract Infection and Dengue were the most common.

Intentional and unintentional injuries are other indicators of concern.
There were fourteen (14) cases of domestic violence, one hundred and eight (108) cases of physical assault, twelve (12) cases of gunshot injuries, twenty – one (21) cases of stabbing / slashing injuries and one hundred and six (106) cases of motor vehicular accidents seen at the Alexandra Hospital Out Patient Department.

The status of health is determined by three (3) fundamental factors, namely, genetics (predisposition), the environment in which we live and our life choices.
The onus is therefore on individuals to take good care of themselves, and for us to work towards a healthier and more productive nation.
WEEKLY REPORTED COMMUNICABLE DISEASES - CLASS 3 DISEASE SUMMARY BY AGE DISEASE SEX < 1 YRS 1-4 5-9 10 -14 15-19 20-49 50 - 64 65+ TOTAL GRAND TOTAL ACUTE RESPIRATORY INFECTION <5YRS ACUTE RESPIRATORY INFECTION >5YRS CHICKEN POX DENGUE GASTROENTERITIS <5YRS GASTROENTERITIS >5YRS HEPATITIS B SYPHILIS TUBERCULOSIS Table 2: Displays the reported cases of communicable diseases for 2011 by gender and age Breakdown of Dengue Cases * Total Confirmed Dengue Cases - 8 (M - 3 / F – 5) * Total Suspected Dengue Cases - 27 (M - 16 / F – 11) * Total Negative Dengue Cases - 2 (M - 2) * Total Dengue Deaths - 2 (M - 1 / F - 1) *There were three positive cases of Hepatitis B which were indentified in the antenatal survey.
Contact tracing was done for two antenatals.

Contacts of the third migrated.

There was a male Tuberculosis fatality in the fifty plus age group.

The required screening and contact tracing were done.
INTENTIONAL & UNINTENTIONAL INJURIES - 2011 8 | P a g e Month Gunshot Injuries Stabbing/Slashin g Injuries Domestic Violence Physical Assault Sexual Assault January February March April May June July August September October November December 1 1 Male 0 Female 0 Male Female 2 2 Male Female 1 1 Male Female 1 Male 1 Female 1 1 Male Female 1 Male Female 1 1 Male Female 2 2 Male Female 0 Male Female 0 Male Female 2 2 Males Female 12 3 3 Male 0 Female 0 Male Female 0 Male Female 3 3 Male Female 1 Male 1 Female 3 3 Male Female 6 Male Female 2 2 Male Female 0 Male Female 0 Male Female 1 Male 1 Female 2 2 Males Female Motor Vehicle Accidents 16 9 Male 7 Female 0 Male Female 6 2 Male 4 Female 6 3 Male 3 Female 8 5 Male 3 Female 6 1 Male 5 Female 18 Male Female 13 5 Male 8 Female 8 6 Males 2 Females 4 1 Male 3 Female 10 5 Male 5 Female 11 5 Male 6 Female 106 2 0 M 2 Female 0 Male Female 1 Male 1 Female 0 Male Female 0 Male Female 4 Male 4 Female 1 Male Female 1 Male 1 Female 0 Male Female 3 1 Male 2 Female 1 Male 1 Female 1 Male 1 Female 14 12 7 Male 5 Female 0 Male Female 7 5 Male 2 Female 5 Male Female 7 2 Male 5 Female 10 5 Male 5 Female 10 Male Female 14 11 Male 3 Female 15 9 Males 6 Females 5 3 Male 2 Female 10 8 Male 2 Female 13 9 Males 4 Female 108 2 0 M 2 Female 0 Male Female 4 Male 4 Female 3 Male 3 Female 1 Male 1 Female 2 Male 2 Female 5 Male Female 2 Male 2 Female 0 Male Female 1 Male 1 Female 1 Male 1 Female 0 Male Female 21 21 Total Table 3: Highlights the reported cases of intentional and unintentional
 injuries for 2011 by gender OUT PATIENT DEPARTMENT - ALEXANDRA HOSPITAL 2.0 PERFORMANCE OF MINISTRY OF HEALTH 9 | P a g e Strategic Objective - The strategic objective of The Ministry of Health is to coordinate the management of the Nevis Island Health Strategy, by providing a full spectrum of exceptionally high quality healthcare services, programmes and leadership as required to promote, prevent, protect, and preserve the health and well-being of the people of Nevis.
2.1 Core Functions         country  Set standards for the delivery of healthcare on Nevis Guide the development of health policy and legislation Provide access to quality primary and secondary essential healthcare services Ensure that human resources are available to effectively deliver all services offered by the Ministry of Health and its service institutions Conduct surveillance of disease conditions or other threats to public health Monitor and evaluate health services on Nevis Advocate for the multisectoral approach to health care delivery Prepare statistical reports and other documents which reflect the disease burden in the Coordinate the health sector response to disasters 2.1.2 Accomplishments – 2011 The Ministry of Health has recorded tremendous success in the past year despite the challenges of financial and human resource constraints.
These accomplishments will continue to facilitate the growth of various programmes in the next three years and beyond.

Some of these highlights include: Introduction of Family Planning and Post natal services at The Brown Hill Medical Facility.

  Employment of a trained Counsellor to the staff at the Psychiatric Unit.

 Validation of the local effort for certification of the elimination of Measles, Rubella and Congenital Rubella Syndrome by representatives of the Pan American Health Organization.
(PAHO).

 Continued support for eye care.

Cataract and pterygium surgeries performed for forty two (42) patients and six (6) patients respectively, through the visiting United States Eye Care Programme, held April and November 2011.

 One hundred percent (100%) of primary schools screened for Sealant Programme as part of Dental Health Services.
 One hundred percent (100%) of cruise ships and 95% reefer containers were monitored at point of entry, in accordance with International Health Regulations (IHR).

 Monitoring and inspection of all carcasses slaughtered at the abattoir to ensure that such meat is fit for human consumption.

 Consolidation of the HIV/AIDS and Health Promotion Units to promote better coordination of all health promotion activities.
2.1.3 Projections – 2012/2013 10 | P a g e  Ensuring the availability, accessibility and affordability of health services through the development of a variety of initiatives including the construction of a new public health facility in Cotton Ground and expansion of the Environmental Health Division.

 Exploration of alternatives for health financing.
 Expansion of educational and promotional initiatives geared towards behaviour change, as well as data collection, analysis and dissemination in an effort to promote evidenced based programme planning.

 Collaboration with other government departments, NGOs and donor organizations to  facilitate planning, implementing and evaluating health services.

Introduction of the Chronic Care Model of care for the management of Diabetes and other chronic illnesses.
 Continued training of healthcare workers, community group leaders and clients in the prevention and management of chronic diseases.

 Ensuring the delivery of quality health services through the provision of adequate infrastructure and trained proactive health care workers.
2.1.4 Regulations and Legislations The Ministry of Health operates under the following Acts: · Medical Act · Public Health Act · Lunacy Act · Registered Nurses and Midwives Act Category Table of Health Professionals Government Employed Quantity 11 | P a g e Hospital Medical Chief of Staff Hospital Administrator Surgeon Specialist Gynecologist Internist Pediatrician Medical Officer/Doctor Anesthesiologist Director of Institutional Nursing Services/Matron Asst.

Director/ Matron Nurse Manager Asst.
Nurse Manager Staff Nurse Nurse Anesthetist Student Nurse ( at CFBC) Registered Nurse Nursing Assistant Nursing Attendant Radiographer Physiotherapist + Rehab therapist Pharmacist Pharmacist (Student) Laboratory Supervisor Medical Technologist Phlebotomist / Lab Assistant Medical Records Staff (untrained) Emergency Medical Technicians Orderly Auxiliary Staff Secretary / Clerk Public Health Medical Officer of Health Health Services Administrator Psychiatrist Supervisor of Public Health Nurses Public Health Managers District Midwife/Nurse Community Health Workers Clinic Attendant Psychiatric Nurse HIV/AIDS Co-ordinator Dentist (1 General + 1 Oral Surgeon) Dental Assistant Dental Hygienist Dental Nurse Principal Environmental Health Officer District Environmental Health Officer (trained) District Environmental Health Officer (untrained) Vector Control Officer Health Educator Monitoring & Evaluation Officer Surveillance Officer Data Entry Clerk Administration Health Planner Secretary/Clerk Solid Waste Operation Manager 3.0 HEALTH STATUS 1 1 2 1 1 1 3 1 1 1 3 6 18 2* | P a g e The Ministry has sought to enhance the quality of life of the people and ensure access to adequate health care.
With this in mind, a set of indicators (Table 1) is used to measure progress.
3.1 Health Indicators 2010 - 2011 Summary of Health Indicators 2010 12,530 2011 12,690 Health Indicators TOTAL POPULATION ESTIMATE TOTAL BIRTHS TOTAL LIVE BIRTHS CRUDE LIVE BIRTH RATE per 1000 POPULATION TWIN BIRTH TOTAL STILL BIRTH STILL BIRTH RATE TOTAL TEENAGE BIRTHS TEENAGE BIRTH AS % OF TOTAL BIRTHS TOTAL DEATHS CRUDE DEATH RATE per 1000 POPULATION TOTAL NEONATAL DEATHS NEONATAL DEATH RATE per 1000 LIVE BIRTHS TOTAL PERINATAL DEATH (7 days + stillbirths) PERINATAL DEATH RATE per 1000 BIRTHS INFANT MORTALITY INFANT MORTALITY RATE per 1000 LIVE BIRTHS TOTAL DEATHS IN CHILDREN 1-4 YEARS TOTAL MATERNAL DEATH MATERNAL DEATH RATE per 1000 LIVE BIRTHS FERTILITY RATE TOTAL MARRIAGES CRUDE MARRIAGE RATE per 1000 POPULATION NATURAL INCREASE NATURAL INCREASE RATE per 1000 POPULATION Table 3 : Shows health indicators as variables used to measure the health progress on the island of Nevis *NB: Rates based on Projected Population estimates from Stat/Planning Unit SKB.
2.6 4.0 PUBLIC HEALTH | P a g e 4.1 Registrar General The Registrar General Department (RGD) is the main repository of Vital Statistics for the island of Nevis.

However, there are five District Registrars strategically located throughout the island that are responsible for recording events (deaths and marriages) that occur within their district.
Responsibility for filing births lies with the Matron of the Alexandra Hospital or with the physician or midwife who may have delivered a client outside of the hospital setting.

The practice of delivery outside of the hospital setting is no longer the norm.

Funeral Directors are legally charged with filing deaths and fetal death records.

These documents are then submitted to the District Registrars who in turn forward them to the Registrar General Department.
The records are then sent to the Registrar General Department in St. Kitts.

The following report therefore summarizes data compiled from the original records that were filed with the Registrar General Department for the calendar year 2011.

Rates were calculated based on the midyear population estimate (12,690) that was provided by the Department of Statistics in St. Kitts.
The information in this report: births, deaths, marriages, are limited to events occurring on the island of Nevis and are based on the parish/district where the event occurred.

Certificates Issued Birth Certificates-1468 est.
Death Certificates-284 Marriage Certificates-186 (religious ceremony) + 15(civil ceremony) Permit for Burial- 88 14 | P a g e Monthly Births in Nevis-2011 QUARTE R 1st 2nd 3rd 4th Total GENDER MONTH January February March April May June July August September October November December MAL E 3 3 3 5 10 3 3 7 10 9 6 3 FEMAL E 2 2 3 2 2 3 7 2 6 7 9 3 TOTA L 5 5 6 7 12 6 10 9 16 16 15 6 SINGL E 5 4 4 5 7 4 8 5 10 6 12 3 MARRIE D 0 0 2 1 5 2 2 3 6 10 3 3 65 48 113 73 37 MARITAL STATUS DIVORCED 0 0 0 0 0 0 0 0 0 0 0 0 0 SEPERATE D 0 1 0 1 0 0 0 1 0 0 0 0 3 Table 4: Highlights the no.
of live births in Nevis by Month, Gender and Marital Status Live Births and Still Births by Month-2011 QUARTER 1st 2nd 3rd 4th MONTH January February March April May June July August September October November December Live Births 5 5 5 7 11 6 10 9 14 16 15 6 Still Births 0 0 1 0 1 0 0 0 2 0 0 0 4 Males Table 5: Outlines the no.
of live births and still births as recorded in Nevis in 2011 Grand Total 109 Total Births 5 5 6 7 12 6 10 9 16 16 15 6 113 Year 2010: Live Births Still Births Neonatal Deaths Total Births 123 62M/61F 1 M 1 M 124 63M/61F Widowed 0 0 0 0 0 0 0 0 0 0 0 0 0 16 25 35 37 15 | P a g e Teenage Births by Month and Age Month 2011 January February March April May June July August September October November December Total Teenage Births TOTAL 1 0 0 1 0 2 3 1 2 1 1 0 QUARTER 1ST 1 M + 0F = 1 2ND 3 M + 0 F =3 3RD 3 M + 3 F =6 4TH 1 M + 1 F =2 12 8 Males + 4 Females Table 6 : Underscores the no.
of teenagers that gave birth in 2011 categorized by Month and Age Previous Year 2010: Teenage Deliveries 13 ( 4 M + 9 F) Age Range 15 & Under 16-19 20-24 25-29 30-34 35-39 40+ Unknown Total Teenage Births by Age and Birth Order Number of Pregnancies 7th 6th 8th 1st 2nd 3rd 4th 5th Total 9th Unknown Table 7 : Identifies the pregnancy cases classed by the age range of the mother and birth order of the child 16 | P a g e BREAK DOWN OF BIRTH CASES - 2011 Total Number of Cases for 2011 Total Number of Normal Deliveries Total Number of Caesarean Section Total Number of Breech Deliveries Total Number of Forcep Assisted Deliveries Total Number of Ante-partum Hemorrhage Total Number of Post-Partum Hemorrhage Total Number of Eclampsia Total Number of Pre-Eclampsia Total Number of Laceration Total Number of Episiotomies Total Number of Bilateral Tubal Ligation Total Number of Medical Inductions Total Number of Born Before Arrival Total Number of Mature Births Total Number of Pre-mature Births Total Number of Post Mature Births Total Number of Dysmature Births Total Number of Breech Presentation Total Number of Twins Total Number of Congenital Abnormalities Total Number of Transfers (to JNF Hospital) Total Number of Non-Nationals Total Number of Female Babies Total Number of Male Babies Total Number of Live Births
 Total Number of Still Births (Fresh) Total Number of Births Total Number of Single Women Total Number of Married Women Total Number of Separated Total Number of Divorce Women Total Number of Unbooked Cases Total Number of Syntocinon Augmentation Total Number of Neonatal Deaths Table 8: Gives a breakdown of birth cases for the year | P a g e PARISH ST. PAULS ST. THOMAS ST. JAMES ST. GEORGES ST. JOHNS Registered
 Deaths in Nevis by Parish - 2011 1st QUARTER F M 8 9 2nd QUARTER F M 5 11 3rd QUARTER M 8 F 7 4th QUARTER M 8 F 5 PARISH TOTAL F M QUARTERLY TOTAL 16 13 16 Table 9: Displays the no.
of registered deaths in Nevis divided by parish Registered Deaths in Nevis by Age Group - 2011 Age Groups First Quarter Second Quarter Third Quarter Fourth Quarter Total 1 1 - 1 day 1 - 6 days 7 - 27 days 1 - 2 months 3 - 5 months 6 - 8 months 9 -11months 1 year 2 years 3 years 4 years 5 - 9 years 10 - 14 years 15 - 19 years 20 - 24 years 25 - 29 years 30 - 34 years 35 - 39 years 40 - 44 years 45 - 49 years 50 - 54 years 55 - 59 years 60 - 64 years 65 - 69 years 70 - 74 years 75 - 79 years 80 - 84 years 85 - 89 years 90 - 94 years 95 - 99 years 100 years + Not Stated Total Table 10: Displays the no.
of registered deaths in Nevis divided by age group Male Female Male Female Male Female Male Female Male Female GRAND TOTAL 61 3 7 12 12 95 Grand Total | P a g e Registered Deaths by Category Nevis 2011 CODE DISEASE MALE FEMALE TOTAL 0.OO Symptoms, signs and Ill Defined Conditions Sub Total 1.OO Communicable Diseases 1.02 1.06 Sub Total Pulmonary Tuberculosis Septicemia 2.OO Neoplasm 2.02 2.03 2.03 2.03 2.04 2.1 2.11 2.11 2.14 2.14 Sub Total Colon Gastrointestinal Tract Liver Pancreas Lung Prostate Vulva Ovary Malignant of Independent Site Carcinomatosis 3.OO Disease of the Circulatory System 3.02 3.02 3.02 3.02 3.02 3.03 3.03 3.03 3.03 3.05 3.06 3.07 3.07 3.07 3.07 Sub Total Hypertensive Heart Disease Hypertension Hypertensive Renal Failure Left Ventricular Failure Hypertensive Heart Failure Myocardial Infarction Coronary Artery Disease Ischemic Heart Disease Anteroseptal Myocardial Infarction Cardiopulmonary Arrest Congestive Cardiac Failure Cerebral Infarction Subarachnoid Haemorrhage Intracerebral Haemorrhage Cerebrovascular Accident 1
Certain Conditions Originating in the Perinatal Period Sub Total 5.OO External Causes 0 0 0 5.01 5.1 Motor Vehicle Accident - Unspecified Exposure to Unspecified Factor Causing Fracture 1 0 0 1 1 1 19 | P a g e 5.12 5.13 5.13 5.13 Sub Total Gun Shot Wounds Drowning Hanging - Unspecified Stab Wounds 6.OO ALL OTHER DISEASES Diabetes Complications Malnutrition Alzheimer's Disease Huntington's Disease Epilepsy Bowel Obstruction Pulmonary Fibrosis Pulmonary
 Edema Alcoholic Cirrhosis Peptic Ulcer Gastrointestinal Heamorrhage Necrosis of Intestine Hyperplasia of Prostate Pemphigus Vulgaris Rheumatoid Arthritis (with involvement of other organs and systems) Sickle Cell Anemia with Crisis Decubitus Ulcers 6.01 6.02 6.04 6.04 6.05 6.06 6.06 6.06 6.08 6.09 6.09 6.09 6.11 6.14 6.14 6.14 6.14 Sub Total Grand Total Table 11: Displays the no.
of registered deaths in Nevis broken down by the cause of death *The Underlying Cause of Death is Diseases of the Circulatory System and All Other Diseases | P a g e Incidence Cases of Neoplasm 2011 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Unknown Grand Total Code Type C539 Cervix C189 Colon C229 Liver C349 Lung C61 Prostate C80 Unknown Primary 14 e l a M 0 3 1 1 14 0 2 2 Grand Total 0 8 Table 12: Pinpoints the cases of neoplasm in males and females grouped by age range *Source: Pathology Lab- Alexandra Hospital 0 0 0 0 0 0 7 2 5 2 2 0 0 1 0 0 0 0 19 8 27 Parish St. James St. John St.Paul Neoplasm/Cancer as Registered Death Certificate - 2011 Type Ovary / Liver Vulva Ovary Liver / Colon Prostate Liver Prostate / Metastatic Pancreas Colon Carcinomatosis Lung/ Multiple Metastatic Head Pancreas TOTAL Male Female Total 13 Table 13: Highlights the various types of neoplasm/cancer as registered deaths by parish and gender 21 | P a g e Marriages by Parish MONTH ST PAULS ST JOHNS 1 Banns +15 License 0 2 0 1 4 1 0 1 1 2 3 1 16
 January February March April May June July August September October November December TOTAL Tables 14: Specifies the no.
of marriages by parish 6 Banns +22 License 3 1 2 2 4 3 0 3 3 0 3 4 28 ST JAMES 0 Banns +16 License 1 2 0 1 3 0 2 1 0 0 5 1 16 ST THOMAS 1 Banns + 28 License 4 1 1 2 3 4 3 4 0 2 3 2 29 ST GEORGES 3 Banns +4 License 1 1 0 1 1 0 1 1 0 0 2 1 9 TOTAL 11 Banns + 85 License =96 9 7 3 7 15 8 6 10 4 4 16 9 98 Marriage by Place of Marriage PLACE OF MARRIAGE Anglican Baptist Church of Christ Church of God Hotel (Magistrate) Hotel ( Pastor) Jehovah Witness Magistrates Office Methodist New Testament Church Other (Beach, Residence, etc) Pentecostal Roman Catholic Seven Day Adventist Wesleyan Holiness Church of God of Prophesy Total ST PAULS ST JOHNS ST JAMES 0 0 0 3 3 5 0 2 0 ST THOMAS 1 0 0 0 7 9 0 0 0 ST GEORGES TOTAL 4 1 1 3 18 19 0 12 3 7 11 6 6 5 1 1 98 Tables 15: Specifies the no.
of marriages by parish Previous Year 2010: Registered Marriages = ( 13 Banns + 79 Licenses) 22 | P a g e Marriage by Age Range -2011 Male/Husband 15- 19 20- 24 25- 29 30- 34 Female/Wife 40- 44 45- 49 35- 39 50- 54 55- 59 60- 64 65- 69 Total 1 3 5 1 1 5 11 15-19 20-24 25-29 30-34 1 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 1 7 15 23 12 12 15 6 5 2 0 0 0 0 Total 1 10 20 21 18 12 11 3 1 1 0 98 Table 16: Underscores the no.
of marriages by age range and gender in Nevis for 2011 23 | P a g e 4.3 Health Promotion Health Promotion is the process of enabling persons to increase control over the determinants of health and thereby improve their health”.

HEALTH PROMOTION IS CARRIED OUT BY PEOPLE AND WITH PEOPLE, NOT ON OR TO PEOPLE.

The Health Promotion Unit is a support service in the Ministry of Health.
It provides educational support to all health and medical programme activities, including planning and implementing interventions.

As such, the activities of this unit are dependent, in part, on the activities and programs in other Units and Departments.

The Unit operates under the Caribbean Charter for Health Promotion: Its primary function is to promote healthy living and lifestyle that would enhance health and well being.
The Unit consists of 3 sub-programs, namely:  Health Education and Promotion  Health Information Management  HIV /AIDS Coordination 24 | P a g e Health Education and Promotion Programs For 2011, this Unit concentrated on projects and programs in schools and communities.

 School Health Programs.

This program commenced in January 2011(Term 2) in all Primary Schools.

The aim of the program is to provide a forum where children can discuss the health issues that affect them.
Issues included chronic diseases including HIV, sexual health, healthy eating, active living, substance use and abuse, healthy environment, emotional and social health.

A 45 minute session, once per month was scheduled for lessons.

Principals chose classes based on their health needs.

In most schools, Grade 6 was scheduled but Grades 4 and 5 were also selected.

In September, new classes were selected.


A total of fifty- one (51) sessions were conducted and 611 students (297 boys, 314 girls) benefited from the program.

The program continues in 2012.

Figure 1: Illustrates no.

of participants by school who attended the school health education sessions held by the Health Promotion Unit  Community Health Programs.

For 2011, we continued our focus on sensitizing the community on the Food based guidelines.

This was launched in 2009 and widely distributed in 2010.
However, there were still some communities, namely church groups that chronic disease.

were not visited.

in domestic violence and Sessions were also conducted Figure 2: Illustrates no.

of participants who attended the group health education sessions held by the Health Promotion Unit 25 | P a g e Figure 3: Depicts no.

of participants, categorized by age, who attended the group health education sessions held by the Health Promotion Unit Figure 4: Depicts no.
of participants, categorized by groups/clubs, who attended the group health education sessions held by the Health Promotion Unit Walking Group Initiative.

(Community) Physical activity initiatives are ongoing.

The walking groups were piloted by the Unit for the inaugural Caribbean Wellness Day (2nd Saturday in September 2008).

For 2011, a total of 11 monthly hikes took place in Gingerland on the 1st Saturday of every month.
Areas hiked include the Water Source, Saddle Hill, Peak Haven, Hamilton Estate, St George‟s Parish Shoreline and 5 mile island walks.

Eleven (11) Monthly Wellness Walks were organized in Gingerland.

The sports Department also organized walks in the Charlestown area on the first Thursday of each month.

Walking group initiative (Church).

Church organizations have been organizing monthly/quarterly moonlight walks and evenings or morning walks as part of promoting healthy lifestyles of the congregations.
These walks usually end with exercises and/or health screening.

Observance of International Health Days.

The Unit coordinates activities to commemorate International Health Days.

These included health screenings, messages for children, and community and workplace awareness through education and media presentations.

For 2011, these health days were highlighted with activities.
 World Health Day April 7th  Caribbean Nutrition Day June 1st  Caribbean Wellness Day 2nd Saturday in September  World Diabetes Day November 14th  World AIDS day December 1st 26 | P a g e Support to Community Health Departments Support for preventive work was given to the Environmental Health Department, Dental Health Department and Community Health Nursing.

The Unit continued to play an integral role in the management of chronic disease programs at all health centres.
Health Educators facilitated monthly discussions and training in self management of diabetes and hypertension.

Sessions were also conducted at Men‟s Wellness Clinics held quarterly.

Health Information Management During 2011, the Unit made significant progress in the collection and collation of data.

The management team comprises a Surveillance Officer, a Monitoring and Evaluation (M&E) officer and three data collection and entry clerks.
Data is collected weekly, monthly and quarterly from all health institutions, including private doctors.

The M&E officer evaluates programs and projects.

Monthly and quarterly reports are generated and an Annual Health Report is compiled and disseminated.

Data entry clerks also provide secretarial services for departments in health.

Media presentations Building alliances with the media is an important role in Health Promotion.
During the year, the Unit used the media for information campaigns to raise awareness of health issues and help promote healthy choices and sound decision-making by members of the public.

The unit continues to: 1.

Publish weekly health articles in local newspaper 2.

Use the media for international health day campaigns 3.

Facilitate weekly TV health program - Our Health matters 4.

Design and produce reading materials - pamphlets, flyers, posters – with local printing and designing agencies.
Staff Training All members of staff were involved in local and overseas training, consultations and meetings for 2011.

These were organized by Ministries of Health St Kitts and Nevis, Ministry of Human Resources, Labour Department, Social Services Department, University of Miami, Pan American Health Organization (PAHO) and other International agencies.

Areas of training included:  Use of the Chronic Care Model- A Treatment Tool.

– University of Miami, PAHO and CARMEN School – Miami – 6th -11th March.
 Risk Communication Training – PAHO - St Kitts - Sept 14-15th  National Action Plan for NCD‟s - Ministry of Health, St Kitts – Sept 13-14th  Capacity Building for Health Promoting Advocacy and Actions- Ministry of Health, St Kitts- 26th May.

 Consultation on “HIV /AIDS in the Workplace – International Labour Organization.
(ILO) and Labour Department- St Kitts – 24th -25th August  “Women at Work” training – Department of Social services, Nevis – 8th March  Consultation on Public Service Act – Human Resource Department, Nevis - 17th February  Orientation Workshop for new staff – Human Resource Department, Nevis - 9th March.

 Introduction to “Grand Aides” program – Ministry of Health, Nevis - 12th August  Prospective on the Treatment of Cancers.
- Ministry of Health, Nevis – February 25th 27 | P a g e HIV /AIDS Programming The HIV/AIDS epidemic in Nevis is generalized with an HIV prevalence of less than one percent.

Since the first case of AIDS was reported in 1987, there has been a decrease in the annual incidence of both AIDS cases and AIDS- related deaths in Nevis.

Data suggests that, over the past few years, HIV/AIDS cases are outstanding in persons 25- 49 years old.

This leads to the loss of a significant number of years of potential life.
Figure 5: Portrays the no.

of HIV/AIDS reported cases from 1987-2011 sorted by year and gender Figure 6: Represents the no.

of HIV/AIDS reported cases from 1987-2011 categorized by age group and gender The major exposure category for HIV-infection in Nevis is heterosexual contact and the male to female ratio of AIDS cases is currently 1:1, which is consistent with a true heterosexual epidemic where males and females are equally affected.
28 | P a g e HIV/AIDS Activities for 2011 The Nevis HIV/AIDS Coordinating Unit is dedicated to reducing the spread and impact of HIV/AIDS on individuals, families and the community.

The purpose of the unit is to develop and implement multidimensional, coordinated strategies to prevent the disease as well as high risk behaviour while effectively using available resources through research, planning, coordination and evaluation.

The HIV/AIDS Coordinating Unit is geared towards managing HIV/AIDS holistically.
This involves prevention, treatment, care and support, advocacy, surveillance and research and programme coordination and management.

For each of the programme areas, activities/achievements are provided and key indicators are presented in tabular form.
Care, Treatment and Support Background The aim of the Nevis HIV/AIDS care and treatment programme is to provide comprehensive care, treatment and support for all people living with HIV/AIDS which includes psychosocial support, home-based and palliative care, nutrition and adherence counselling, provision of risk reduction strategies, management of opportunistic infections and free antiretroviral treatment.

Treatment for HIV/AIDS has been available free of charge.
Currently, there are both first- and second line HIV/AIDS medications available for both adults and children.

Care and Treatment Indicator Female Male Number of persons in care 7 9 Number of persons on Antiretroviral treatment (First Line) 3 6 Number of persons on Antiretroviral Treatment (Second Line) 3 2 Table 17: Shows the no.

of persons who are receiving care and treatment for HIV/AIDS *No.

of persons in care – 16 *No.


of persons receiving care – 14 29 | P a g e Counselling and Testing (C&T) Background Counselling and testing (C&T) for HIV is universally recognized as an effective and important strategy in any response to HIV/AIDS.

It plays a very important role in both prevention and care.

By making persons aware of their HIV status, those who are HIV negative can take the necessary precautions so as to preserve this status.
For those who test positive, they can be referred to appropriate follow-up services where they can access appropriate care.

This year saw two (2) VCT Days and one VCT outreach: Regional Testing Day which was held in June a total of one hundred and three (103) persons were tested (Males – 39 Females – 64), increase of 87%.

National testing Day held in December where a total of thirty – six (36) persons were tested a decrease of 25%.

Counselling and Testing Figure 7: Shows the no.


of Voluntary Counselling & Testing (VCT) done in 2011 by parish 30 | P a g e Figure 8: Shows the no.

of Voluntary Counselling & Testing (VCT) done in 2011 by month and gender Figure 9: Shows the no.

of Voluntary Counselling & Testing (VCT) done in 2011 by age range Number of persons Counselled & Tested Male Female Unknown Gender Total 2010 43 77 0 120 Table 18: Gives a comparative look at the no.
of VCT participants for 2010 and 2011 2011 81 163 0 244 31 | P a g e 020406080100120JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDECFemale033146852032621Male2001139110210015No.
of Clients Number of VCT Clients served by Month for 20110102030405060< 1415-1920-2425-2930-3435-3940-4445-4950-5455+02171667911491243830241212976Age and Sex of Clients served for 2011 (VCT)MaleFemale Risk Reduction / Prevention PMTCT ( Prevention of Mother to child Transmission) Indicator 2010 74 2011 91 Number of new pregnant woman attended Antenatal clinic in the last 12 months Table 19: Gives a comparative look at the no.
of new pregnant women who attended antenatal clinic in 2010 and 2011 Education Background Sexual Health Education continues in the Primary schools, Charlestown Secondary and the Nevis Sixth Form College.

In the Primary Schools, kindergartens to Grade 6 were exposed to interactive sessions on HIV/AIDS basic information.
The 5th Forms of the Charlestown Secondary School and the Nevis Sixth Form College (6A and 6B) participated in interactive sessions on Sexually Transmitted Infections (STIs) and HIV/AIDS and Assertive Communication.

The Boys Club of Hanley‟s Road, Gingerland, participated in a lecture/discussion on STIs and HIV/AIDS and Behaviour Change Communication.

This group consists of adolescent males and young adult males in the Gingerland area.
CATEGORY Boys Girls TOTAL GENDER School Education Sessions 184 206 390 Group Education Sessions Table 20 HIV Education Session * No.

of school education sessions – 8 * No.


of group education sessions – 10 75 49 124 32 | P a g e Blood Safety Indicator 2010 2011 Percent of transfused blood units in the public sector screened for HIV Table 21: Shows the percentage of transfused blood units in the public sector screened for HIV in 2010 and 2011 100% 100% Number of HIV Tests Done (Avalon & Alexandra Lab) YEAR Male Female Unknown Total 2010 328 530 32 890 2011 304 560 27 891 Table 22: Shows the no.
of HIV test that were done at Avalon and the Alexandra Hospital Lab in 2010 and 2011 Number of Clients served at Alexandra Lab by Parish per month, 2011 St. John St. George St. James St. Thomas St. Paul Unknown Total Month January February March April May June July August September October November December Total 221 Table 23: Records the no.
of clients served at the Alexandra Lab by parish per month in 2011 Age of clients served at Alexandra Lab per month 2011 Month January February March April May June July August September October November December <14 15 - 19 1 0 1 1 0 2 2 1 2 0 0 0 3 5 9 2 6 7 15 1 7 2 5 6 20 - 24 10 4 8 6 10 24 30 8 8 9 2 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60+ Unknown Total - 2 - 3 1 2 3 0 4 4 1 2 - - - - - - - - - - - - 39 33 44 38 52 129 107 36 46 44 30 59 12 10 Total 102 Table 24: Records the no.
of clients served at the Alexandra Lab by age per month in 2011 110 131 46 56 33 55 68 10 24 22 0 657 33 | P a g e Condom Distribution Background Condom distribution continued and specialized Behaviour Change Communication (BCC) campaigns were developed to increase use.

The unit also continued to supply health centres, service deliver points and the general public with male and female condoms.

Information, Education and Communication (IEC) materials were also distributed to the general public.
Condom Distribution 15,507 2010 Indicator No.

of male condoms distributed No.

of female condoms distributed No.

Of dental dams distributed No.

Of lubricants distributed Total Condoms Table 25: Underlines the no.

and type condoms distributed in 2010 and 2011 *Condom distribution increased by 21.5% in 2010 *Condom distribution decreased by 43% in 2011 328 146 653 15,535 2011 8808 112 3 239 8920 Figure 10: Illustrates the no.
of condoms distributed in 2009, 2010 and 2011 34 | P a g e Capacity Building Workshops  Health Systems Strengthening & Private Sector Assessment Stakeholder Meeting – A meeting was held in St. Kitts to gather feedback regarding the validity of the assessment‟s findings and to prioritize the report‟s recommendations.
 Contact Investigation Stakeholders Meeting – This meeting was held in St. Lucia to address the efforts to strengthen the contact tracing/investigation programmes as a strategy for preventing transmission of sexually transmitted infections (STIs), including HIV.

The Medical Officer of Health and a Community Health Nurse attended this meeting.

 Caribbean Regional HIV Prevention Summit- The Health Educator along with the HIV/AIDS Coordinator attended this summit in Nassau, Bahamas.
 Advanced Monitoring & Evaluation Workshop - The HIV/AIDS Coordinator attended this workshop which was held in Jamaica.

 PEPFAR Health Systems Strengthening Meeting in St. Kitts The HIV/AIDS Coordinator and the Health Services Administrator attended this meeting.

 HIV Clinical Care and Treatment Guidelines Meeting - This meeting was held in St. Lucia and the Medical Officer of Health attended.
 Specialized Skills Building Workshop - The Health Educator took part in this workshop which was held in Trinidad.

 Training – of – Trainers Workshop - The Medical Officer of Health and a Community Health Nurse attended this workshop in St. Lucia.

 Updated HIV Clinical Care and Treatment Guidelines Meeting – This meeting was held in Antigua and the Medical Officer of Health attended.
Training  EQA In HIV Serology Training for Laboratory Quality Assurance - The Lab Manager took part in one week training in Barbados.

 Cultural Approaches to HIV Prevention Education and Empowerment Programmes – This workshop was held in St. Lucia and Ms. Dyann Hobson attended.

 Outcome Evaluation Training - The HIV/AIDS Coordinator and the Surveillance Officer attended this one week training in St. Lucia.
35 | P a g e Achievements With the new addition in staff – Ms. Eldina Farrell as Education and Communication officer - the office was able to increase its outreach activities in the workplace, community and schools.

The staff of the HIV Unit continues to work untiringly despite limited human and financial resources and cooperation.
The HIV Unit acknowledges the work of partners, service delivery persons, and stakeholders in making the HIV response functional and forward moving in helping to mitigate the spread of HIV and assist persons who are living with or affected by the virus.

Challenges The HIV/AIDS response was met with some challenges which affected some of the targets set for 2011.

One of the main challenges experienced was the unavailability of test kit to conduct community outreach and workplace sessions.
The limited supplies of test kits greatly impacted the outreach programme.

The Outreach testing programme reached 198 persons who got counselled and tested compared to 2010 where 103 persons were tested.

No outreach programmes were conducted from August to November due to limited supplies of test kits.

On the National Testing Day, test kits were restricted since the hospital laboratory only had kits for emergency use.
The Nevis HIV response had a target of 360 persons reached through VCT outreach programmes.

The programme fell short with only 244 persons reached.

A consistent supply of test kits is important for the programme to increase its testing outreach, so persons could know their status.

The target for 2012 is 432 for Nevis.

This is a target the Unit would like to achieve.


Inadequate condom stock was another challenge that impacted the consistent distribution of male condoms to various clients and distribution points.

The office depends solely on Caribbean HIV AIDS Alliance (CHAA) for its supply of condoms, dental dams, lubricants, and female condoms.

There was a significant decrease condom distribution due to stock out.
In 2010 there was an increase by 21.5% (which includes female condoms, lubricants, and dental dams), but in 2011 there is a decrease of 43% in distribution.

36 | P a g e 4.4 Community Health Nursing Community health nursing in collaboration with the community focuses its attention on serving the population in their homes, in schools and in the workplace.

The department strove to keep abreast current health trends and issues in order to enhance their knowledge, training, skills and professional growth.
Workshops, seminars and symposiums were used to accomplish the continual medical education.

In spite of reduced human and other resources, the department was able to achieve its slated goals.

This achievement was a direct result of the staffs‟ collaborative efforts and vigilance to improve the quality of care given through client health education and health promotion.

Staffing  Ms. Donna Hill joined the staff as a Registered Nurse and is attached to the Psychiatric Unit.
 Ms. Treese Liburd was transferred from Alexandra Hospital to community and works as a Nursing assistant.

 Ms. Caroline Huggins former Clinic Attendant is now deceased.

The post was filled by Ms. Yonette Nelson.
The Staff comprised of: 1 Supervisor Community Health Nursing   4 Community Nurse Managers  4 District Nurse Midwives  1 Mental Health Manager  1 Registered Nurse attached to Psychiatric Unit  1 Psychiatric Assistant  7 Community Health Workers  1 Nursing Assistant  6 Clinic Attendants    1 Chauffeur / Orderly for Psychiatric Unit 1 Maintenance Worker 1 Store Assistant Services provided:  Maternal and Child Health  Antenatal, Postnatal and Family Planning, Child Health  School Health  Minor Treatment  Home Visiting  Diabetic and Hypertensive Clinic  Eye Care Programme  Voluntary Counselling & Testing for HIV/Aids  District Medical Officers clinic  Men‟s Health  Mental Health 37 | P a g e Capacity Building Nursing staff participated in the following workshops:  Mass Casualty Management  Regional Training for National Co- Ordination of Drug Information network  HIV Contact tracing  TB/ HIV training of trainers  The Diabetic Foot  Infant Growth and Nutrition  Readiness to respond in Disaster  Clinical Management of Dengue Fever   Sexually Transmitted Infections Training of trainers Strengthening Events Allegedly Attributed to Vaccination or Immunization Achievements  Combermere Health Centre was the recipient of a new refrigerator  „Protect your family, protect yourself‟ was the theme for vaccination week in the Americas.
MMR 2nd doses were offered to clients 2- 49 years.

 A third year psychology student was attached to mental Health for a period of two months.

 Workplace Outreach screening was conducted at Agriculture Department, Charlestown Post office and New Castle Fire Hall.

Screening was conducted for cholesterol, Blood sugar and Blood pressure.

 The development Bank donated a gate for the Butlers health centre.
 One Personal Digital Assistant (PDA) was sourced by Ministry of Health  Men‟s wellness Clinic was launched at Brown Hill Health centre.

 Two health centres accommodated three pupil midwives over a four week period while they acquired Obstetric experience in the environment of the Community.

This was a partial fulfilment of the post basic Midwifery Programme.

 During Diabetic month, nursing staff participated in screening for Diabetes and Hypertension at eight venues throughout the island.
38 | P a g e Non- Communicable Diseases Presented at Health Centres 2011 DISEASES Brown Hill Butlers Charlestown Combermere Cotton Ground Gingerland TOTAL Abdominal Pain Alcoholism Arthritis Asthma Diabetes Gastritis/GE Handicap - Mental Handicap - Physical Head Ache Hearing Impairment Helminthiasis Hypertension Menstrual Ophthalmic Problem Other Injuries 190 154 680 Pyrexia Respiratory Conditions (chr.)
Seizure Disorder Sickle Cell Skin Disorder Urinary Symptoms Visual Impairment Vomiting Male Female Total 120 170 229 187 349 357 Gender 427 405 832 131 205 336 202 235 437 533 804 1337 1583 2065 3648 Table 26: Highlights non-communicable diseases presented at all the Health Centre throughout the island of Nevis in 2011 39 | P a g e Registered Diabetic Patients at Health Centres Nevis Over A 4 Year Period Health Centre 2007 2008 2009 2010 Charlestown Brown Hill Gingerland Butlers Combermere Cotton Ground F.N Home Yearly Total M 42 13 48 12 14 14 4 147 F 102 36 110 29 36 21 5 339 M 39 16 50 11 11 16 10 F 101 37 110 31 36 23 6 M 42 19 48 10 12 16 10 153 344 157 F 109 34 108 30 35 25 8 349 M 46 23 54 9 13 16 6 F 113 33 113 32 36 26 5 167 358 Table 27: Displays the no.
of registered diabetics as catalogued at all the Health Centres throughout the island of Nevis over a period of four years Year: 2011 486 497 506 525 GENDER DEATHS TREATMENT NEW CASES OLD CASES Health Centre M F otal g. T e R Charlestown 51 105 156 Brown Hill 22 38 60 Gingerland 57 107 164 Butlers Combermere Cotton Ground 10 12 33 35 43 47 N TIO C E J IN 30 18 37 1 14 T DIE 8 5 5 4 9 L A R O 118 37 122 38 24 14 43 21 99 36 142 57 57 107 164 9 12 32 32 41 44 6 3 3 0 1 E 2 P Y T 150 57 161 43 46 1 6 2 0 0 41 17 16 9 7 17 6 TOTAL F. N. Home 24 34 2 5 34 Grand Total 7 * NB: Deaths included in Centre Registered Total Table 28: Displays the no.
of registered diabetics; diabetes related deaths; diabetic treatment ,and old and new registered cases of diabetes as catalogued at all the Health Centres throughout the island of Nevis in 2011 13 F.N.
Home - Flamboyant Nursing Home st. e G 0 0 0 0 0 0 0 0 0 40 | P a g e Diabetic Patients By Age And Gender - 2011 AGE RANGE Charlestown F M Brown Hill Gingerland F M M F M Butlers Combermere F. H Age Total F M F M F M 01 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 90 - 99 100 + Not Stated Total Table 29: Displays the no.
of diabetic patients by age range and gender Figure 11: Illustrates the no.
of diabetic patients by age range and gender Cotton Ground M 0 0 0 1 8 3 2 3 0 0 0 0 1 1 4 3 8 4 3 0 0 17 0 24 10 4 0 1 35 F 3 3 13 39 77 50 75 66 17 0 4 2 10 13 43 30 47 23 4 0 0 176 4 347 47 41 12 523 41 | P a g e Registered Hypertensive Patients at the Health Centres Nevis Over A 4 Year Period HEALTH CENTRE Charlestown Brown Hill Gingerland Butlers Combermere Cotton Ground F.N.Home 2007 2008 2009 2010 M 42 13 48 12 14 14 4 F 102 36 110 29 36 21 5 M 27 24 25 11 9 16 11 F 69 38 87 29 42 38 7 M 36 22 29 5 16 17 11 F 70 41 92 16 44 40 4 M 39 23 45 7 18 15 0 F 78 42 108 18 51 41 0 147 339 123 310 136 307 147 338 Yearly Total Table 30: Underscores the no.
of hypertensive patients as catalogued at all the Health Centres throughout the island of Nevis over a period of four years 433 486 443 485 YEAR: 2011 GENDER HEALTH CENTRE M F al ot g. T e R Charlestown 40 89 129 Brown Hill 22 41 63 Gingerland 46 103 149 Butlers 9 17 26 DEATHS NEW CASES OLD CASES TREATMENT L A T O T M 1 1 3 2 F 2 3 7 1 M 4 0 9 1 F 17 21 1 5 1 1 14 2 M 36 22 37 8 F 72 40 98 16 L A T O T L A R O T DIE 108 127 62 0 135 127 24 26 0 0 18 0 0 0 0 0 66 18 48 57 16 41 14 5 9 160 344 504 Combermere Cotton 0 2 Ground 0 0 F. N. Home Total 18 16 Table 31: Underscores the no.
of registered hypertensive patients; hypertensive related deaths; hypertensive treatment and old and new cases of hypertension *NB: Deaths Included in Centres‟ Registered Total F.N.
Home: -Flamboyant Nursing Home | P a g e HYPERTENSIVE PATIENTS BY AGE RANGE AND GENDER AGE RANGE 01 - 09 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 90 - 99 100 + Not Stated Charlestown M 0 0 3 1 6 13 9 3 3 0 0 2 F 0 0 1 3 16 22 16 12 14 3 0 2 Brown Hill Gingerland M 0 M 0 F 0 F 0 Butlers Combermere M 0 F M 0 0 F 0 Cotton Ground M 0 F. H Age Total F 0 F M 0 0 F M Total 129 63 149 26 66 57 14 504 Table 32: Displays the no.
of hypertensive patients by age range and gender Figure 12: Illustrates the no.

of diabetic patients by age range and gender 43 | P a g e District Medical Officers Clinic The District Medical Officers clinic was accessed by clients on a weekly basis.

Non communicable diseases such as diabetes and hypertension were commonly seen among the middle-aged and the elderly clients, while seasonal respiratory conditions affected all ages.
Clinic Charlestown Gingerland Brown Hill Butlers Cotton Ground Combermere 2011 Total 2010 Total Sessions Patients Seen 45 46 42 42 50 45 270 257 222 769 231 466 323 281 2292 2094 Table 33: Shows the no.

of health sessions held and the no.


of patients seen at the District Medical Officers Clinic in 2010 and 2011 District Medical Officers Clinic While the population density in Charlestown is greater than that of some rural districts, utilization of the urban health centre is not as predominant as in other the districts.

Possible contributory factors include easy access to private physician offices and the socio-economic background of the clients.
Minor Treatment All health centres accommodated a range of daily activities that included measuring blood pressure and blood sugar levels throughout out the year.

Tuberculin tests were done on Mondays, Tuesdays and Fridays at Charlestown Health centre.

Other activities included urine testing, dressing and counselling.

Clients were also referred to doctors when necessary.
Home Visits Home visiting is an extension of care in the home setting and enabled health care providers to treat patients who were physically unable to attend clinic sessions.

Apart from the routine follow up of care, visits were prioritized as the need arose.

44 | P a g e Nevis Eye Care Programme Ophthalmologists of the U.S.A in alliance with Nevis Island Administration continued biannual clinics.

Both visits spanned a four week period.


Consultation was free but a small fee was attached for pteryguim and cataract surgeries.

Eye drops were sourced by Nevis Island Administration as well as donations by other pharmaceutical companies of the USA through the Nevis Eye Care programme.

All health centres were accessed by glaucoma patients for free supplies of eye drops.
In spite of the availability of eye medication and education some clients remained noncompliant and therefore are at a greater risk of acquiring advanced glaucoma.

A significant number of patients with diabetes and glaucoma accounts for the bulk of patients seen at every session.

Other outstanding activities are included in the following table.

Eye Care Attendance and Procedures 2011 Total Pt.


Visit Diabetic Laser Pterygium surgery Glaucoma Laser Cataract surgery April - May Oct – Nov. Total 624 794 1418 5 11 16 5 0 5 14 12 26 0 49 49 Table 34: Highlights the no.

of patients that received eye care treatment or underwent some form of surgery Men‟s Health Men‟s Health clinic was launched at Brown Hill Health Centre.

The three health centres now enable more men to play an active role in achieving and maintaining healthy lifestyles.
Sessions were held at Gingerland clinic on alternate months and quarterly at both Brown Hill and Butler‟s health centres.

A men‟s health fair was the highlight at the Gingerland clinic.

Prisoners of her Majesty‟s prison were part of group sessions at Butlers.

A total of five hundred and three (503) men were in attendance during eleven sessions.
45 | P a g e Family Health Antenatal Visits The total number of sessions for the year 2011 remained constant; however there were marked contrasts in both the sessions and the number of new clients for Combermere health centre.

The numbers were increased by 64% and 82% respectively.

New Antenatal patients who accessed the services offered at the health centres in 2011 increased by 20% when compared to the 2010 statistics.
A prevalence study of Hepatitis B infection among Antenatals was also conducted and three (3) blood samples tested positive.

The necessary investigations and follow-ups were done.

Attendance at Ante Natal Clinics 2011 Health Centre‟s # Sess.

Pts.

Reg.

New Old <12 wks 12 – 20 wks 20+ wks New Att.

Re- visit Tot Att.

Iron Folic Acid # Ref.


to Dr. Ch/Town 21 B/Hill G/Land B/Lers 25 25 13 C/Ground 17 C/Mere Total 112 115 98 17 19 45 34 98 363 461 2844 2721 98 Table 35: Expresses the no.
of pregnant females who made antenatal visits to the Clinics throughout Nevis in 2011 Post-natal Visits Reproductive health services are offered at five health centres.

This has boosted accessibility and availability for services and family planning supplies.

Consequently a higher percentage of clients attended the Pap smear screenings and as such increased their chances of surviving cervical cancer.

Six high grade squamous intraepithelial lesions (HSIL) were in the 35 and over age group.
All low grade squamous intraepithelial lesions (LSIL) were in the 20 – 34 age range.

Table 37 below provides further details for the pap smears performed at the clinics.

46 | P a g e Pap smear per age range 2011 Clinics Total 15 – 19 20 – 24 25 – 29 30 – 34 35 – 39 40 – 44 45 – 49 50+ Neg.
LSIL HSIL HPV Ch/Town 290 10 34 41 44 39 34 28 60 280 G/Land B/Lers C/Mere 41 7 19 Brown Hill 35 41 7 19 35 Total 393 14 57 55 61 55 42 29 80 382 6 0 0 0 1 7 4 0 0 0 0 4 0 0 0 0 0 0 Table 36: Expresses the no.
of females who had Pap smear screening completed at Clinics throughout Nevis in 2011 Figure 13: Pap smear screening by Health Centre 2011 Figure 14: Pap smear screening by age range Attendance at Post Natal and Family Planning Clinics Postnatal Family planning Clinic # of sess # del # p/n att.
Charlestown Gingerland Combermere Butlers Brown Hill 30 10 8 0 8 41 12 10 0 11 41 12 10 0 11 Total 56 74 74 # ref to Dr. 0 0 0 0 0 0 # of sess new /re adm. Re- visit # physic exam # ref to Dr. oc inj Iud other Table 37: Shows the no.
of individuals who made post natal and family planning visits to the Clinics throughout Nevis in 2011 47 | P a g e 145755615541298015 -1920 -2425-2930 -3435 -3940 -4445 -4950+ Early Childhood Growth & Development Growth and development, nutrition and immunization of children 0-5 yrs formed part of primary intervention in child care at all health centres.

The number of obese infants has shown a consistency for the past three years.

This reflects an average of 37 or 7%.


The goal of exclusive breastfeeding for the first six months of life is yet to be achieved as a high percentage, however, health education on child feeding practices continues.

Toddlers maintained good attendance.

Toddlers three years and over are committed to attend pre- school but also share this commitment with attendance at Toddlers clinic for follow up of immunization and continuous monitoring of nutrition, growth and development.
Attendance at Child Health Clinics Clinics # on Reg.

Sess.

New Charlestown 189 Brown Hill Gingerland Butlers Combermere Cotton Ground Total 2010 92 111 11 46 60 509 513 24 24 24 24 12 24 132 133 55 32 31 3 18 23 162 175 Table 38: Records 2011 Child Health Clinic attendance in Nevis Old 134 60 80 8 28 37 347 338 Clinics # on Reg.

Charlestown Brown Hill Gingerland Butlers Combermere Cotton Ground Total 2010 236 136 141 23 64 65 665 672 Attendance at Toddlers Clinic Old New Sess.
8 8 9 8 4 8 45 42 62 44 40 5 10 16 177 155 174 92 101 18 54 49 488 516 Table 39: Records 2011 Toddlers Clinic attendance in Nevis Re-Visit Total Att.

950 396 539 77 231 278 2471 3127 985 428 570 80 249 301 2613 3302 Re-Visit Total Att.
394 193 227 51 171 113 1149 1135 456 237 254 56 181 129 1313 1290 48 | P a g e Clinics DPT Polio MMR BCG Hep.B Penta-Valent EPI Coverage per Health Centre 2011 Charlestown Brown Hill Gingerland Butlers Combermere Cotton Ground T able 40: Show EPI (Extended Programme on Immunization) coverage per Health Centre Antigen Polio DPT MMR Hep.B BCG Pentavalent MMR 2nd Overall EPI Coverage with 4yr Comparison 2008 2009 2010 88% 86% 100% 83% 90% 82% - 100% 100% 100% 100% 100% 100% - 85% 89% 95% 89% 75% 89% - 82% 96% 86% 40% 73% 81% 2011 84% 83% 97% 83% 100% 83% 81% Table 41: Gives a comparative look at the overall EPI (Extended Programme on Immunization) over the span of four years 49 | P a g e Adolescent Growth & Development School Health School children entering primary and secondary schools, as well as those leaving school received their necessary physical examinations and immunizations.
Other primary school students received rapid inspection.

Health education and counselling formed vital aspects in guidance for the adolescents.

The integration of dental health into the school programme has made strides in prophylaxis and treatment to combat dental cavities.

Community Health nurses assisted in the continuation of the global school health survey which involved students 13-15 yrs of all high schools.

The checking of Body Mass Index (BMI) formed part of the activities.
School Health Activity c i n i l C s s e s # t c e f e d l a u s i V p a C a e n T i s m a x e # s e i t i v a C l a t n e D t s a e r B .

m a x E y t i s e b O O M D o t f e R p u .


l l o f # t p D o i l o P R M M B p e H T D Br/Hill 8 266 5 Ch/town 19 781 36 Cotton/Grd Butlers C‟mere G/land BSt Bst 15 0 0 5 12 2 0 BST Total 42 1512 48 13 131 31 87 19 11 39 164 38 131 2 3 4 Table 42: Shows the no.
of physical exams and immunization shots given to students entering primary and secondary schools 50 | P a g e Recommendations  Cotton Ground Health centre should be relocated as soon as possible  There is the need for Internet service, a printer and surge protector at Charlestown Health centre.

 Human resources need to be urgently addresses to maintain client satisfaction and alleviate „staff burn out‟  The Washing machine and dryer at Charlestown need to be installed.
Goals  To boost the attendance of respective Hypertensive and Diabetic association meetings  To initiate Men‟s health clinic at Combermere health centre  To increase the number of Pap smears to all age groups  To increase in service education 51 | P a g e 4.4.1 MENTAL HEALTH Introduction The Nevis Mental Health Unit soldiers on in its task to achieve and assist in the maintenance of client mental stability and to educate the general public on all matters regarding mental health through various forms of media.
We strive to improve the delivery of mental health care in the Nevisian Community.

Although we have a long way to go in regards to matters of mental health in Nevis, we have undoubtedly made strides in this domain.

Various researches done by credible bodies have undoubtedly highlighted the instantaneous need for ministers of government, professionals and the general public on a whole to push or stress the importance of mental wellness to every aspect of an individual‟s life.
As the emotional, physical and financial impact of mental illness is becoming more evident, not only to the victims of the illness but relatives, friends and the general public, it is apparent that we must put systems in place to address this prevalent issue.

There are a few things that can be done in the Nevisian Community.

Human resource is our most valuable resource and as such it is paramount that trained professionals be a working presence.
The implementation of proper statistical acquisition and a viable database is crucial so as to consistently determine the epidemiology of mental illnesses not only in Nevis but by extension the Caribbean.

It is important that we think beyond the borders of St Kitts and Nevis as this would drive us to elevate our level of performance and dedication to the health of our people.

Overview of the Unit In the Ministry of Health, the Nevis Mental Health Unit falls under Community Health Services.
Although the physical location of the Unit is upstairs the pharmacy in the Alexandra Hospital, the Mental Health Unit is Community based.

Nurse Jenevie Daniel is the supervisor of Community Health nursing and the Mental Health Unit.

The Psychiatric staff continued to perform their duties to the best of their abilities.
Monthly staff meetings were held to determine whether individual and group objectives have been met, to plan projects, to foster greater team cohesion and to determine whether the mental health of workers are at an appropriate, functional level.

To assist in the maintenance of good mental health among staff, the group went on outings together and issues that may affect the mental health were discussed.

The unit saw the addition of one female nurse at the end of the year.
No other changes were made regarding staff.

Dr Sharon Halliday continued to be the Consultant Psychiatrist at the Unit and for the entire federation of St Kitts-Nevis.

Nurse C. Meredith Amory Field persisted in performing her duties as the Psychiatric Nurse Manager and Ms Stevee Jones maintained her role as the Counsellor at the Unit.
Mrs Lesa Browne persevered in her duties of the Nurses‟ Aide; Mr Cuthbert Clarke continued to double as the driver and orderly of the Psychiatric Unit and Nurse Donna Hill who initially started observing at the unit in September 2011, officially began work from the 1st November 2011.
The specific objectives of the unit for 2011 were:  To continue public awareness of mental health issues  To assist in the maintenance of wellness among the clients  To encourage the clients to realize the importance of attending Occupational Therapy sessions  To increase and maintain cohesion among the staff  To continue in service training 52 | P a g e REGISTERED MENTAL HEALTH CLIENTS FOR 2011 Number of new clients: 55 (33 M + 22 F) 421 (201 M + 220 F) Number of old clients: Number of clients imprisoned: 12 (11 M + 1 F) Total Registered clients at the end of 2011: Number of clients released: 4 (3 M + 1 F) Number of clients in prison: 8 (8 M) Number of deceased clients: 11 (7 M + 4 F) 476 (234 M + 242 F) AGE RANGE 01 – 09 10 – 19 20 – 29 30 – 39 40 – 49 50 – 59 60+ Not Stated MALES - 3 8 3 2 7 8 2 FEMALES - 1 5 5 3 2 6 - Table 43: Gives the age range of new mental health clients DIAGNOSIS Panic Disorder Depression Alcohol Dependence Attention Deficit Hyperactive Disorder Major Depression Adjustment Disorder with Depressed mood Depression, para suicide Paranoid Schizophrenia Generalized Seizures Psychosis 2nd to Medical Condition Huntington‟s Chorea Bipolar Depression, Generalized anxiety Severe major Depression with psychoses Alcohol & marijuana abuse Schizophrenia with substance abuse Dementia with depression Schizophrenia Drug induced Psychosis Alcohol dependence; generalized seizure Schizophrenia Depression; mental retardation; generalized seizure Generalized anxiety disorder with brief marijuana
 induced psychosis Brief psychotic attack Dementia Conduct Disorder Depression 2nd to Medical Condition Schizoaffective Marijuana induced psychosis Antisocial Personality Undiagnosed Total Table 44: Gives the diagnoses of new mental health clients TOTAL - 4 13 8 5 9 14 2 FEMALES 1 3 - - 1 2 1 1 1 - - 1 1 - - - 1 - - - - - 3 1 - 1 - - 3 21 TOTAL MALES - - 6 1 - 1 1 1 - 1 1 - - 1 1 1 1 1 1 1 1 1 1 - 1 - 1 1 9 34 53 | P a g e Figure 15: Illustrates the mental health client admissions from 2007 – 2011 categorized by gender CHALLENGES The year 2011 was undoubtedly filled with its challenges.
Financially, the Unit was unable to fund a number of projects that would have greatly assisted in Mental Health Promotion.

As a result of limited gas in the Unit‟s vehicle, clients were unable to attend Occupational Therapy and visits were limited.

Due to limited staff, the work load for the existing staff was demanding.

We also experienced technological setbacks as a result of the absence of an in house computer and printer.
54 | P a g e 20072008200920102011Male2120291432Female2523253322Total46435447540102030405060No.

of ClientsMental Health Client Admissions from 2007 -2011 4.5 Oral Health Services Mission Statement and Goals and Objectives Mission Statement: “To provide healthy smiles for healthy living through the delivery of high quality primary oral health care” Goals and Objectives: 1.

To improve school based prevention programs a.

Strengthen grade one program b.


Strengthen school leavers program c. Strengthen and extend Smiles to Shine TDB program d. Reintroduce and maintain Fluoride Program 2.

To improve access to oral health education programs for children as well as adults a.

Develop appropriate grade level oral health educational presentations throughout both public and private schools.

b.

Provide community based oral health education presentations throughout the community 3.
To improve the integration of oral health prevention and education into general health a.

Advocate for oral health screening to become a routine part of medical examinations (for school leavers, toddlers, pregnant women, etc.)

b.

Utilize existing community networks to identify and educate patients with systemic diseases that relate to oral health Introduction 2011 was a challenging year for the Dental Unit with many obstacles.
Many of these obstacles prevented us from functioning at our highest capacity in most areas.

However, there were areas that showed improvements, especially in our caries index that showed a 35.35 percentage drop from last year.

This Annual Report captures the progress we have made so far and the work ahead of us.

Although oral health is an essential part of our daily lives it is very often taken for granted.
Our ability to speak, smell, taste, chew, smile and convey our feelings through facial expressions are all enhanced by good oral health.

Over the past year we expanded our dental programs, concentrating on community outreach.

During 2011 a dental chair and a digital x-ray machine were purchased for the Charlestown Dental Unit.

This should greatly enhance our quality of service provided to the general public.
55 | P a g e Dental Unit Staff  1 Oral and Maxillofacial Surgeon/ Senior Dental Officer  1 General Dentist  1 Dental Hygienist  1 Dental Nurse  2 Dental Assistants  2 Secretaries/Receptionists Staff Assignments In addition to duties performed at the dental facilities staff members are assigned to schools to facilitate dental health education sessions and also monitor the dental health of the students.
The schools had to be reassigned among staff members since Dr Aravind is no longer a part of the staff.

See below for assignment.
Primary Schools Dr. R. Archibald: St. Thomas Primary, Charlestown Primary and Lyn Jeffers Primary Dr. V. Brookes: Joycelyn Liburd Primary, St. John‟s Primary and Charlestown Preparatory H. Sutton: St. James Primary and VOJN Primary R. Wilkinson: Belle Vue Primary, Ivor Walters Primary and Montessori Academy Pre-Schools Dr. R. Archibald: Vern N‟ Llew Pre-school, Lyn Jeffers and Maude Smith Pre-school Dr. V. Brookes: Gingerland Pre-school, Maude Cross Preparatory and Alfa Learning Center H. Sutton: Naomi Pre-school and St. Thomas Pre-school R. Wilkinson: Charlestown Pre-school, V & J‟s Pre-school and Montessori Academy High Schools Charlestown Secondary School Lyn Jeffers Secondary School Gingerland Secondary School 56 | P a g e DENTAL STATISTICS 2011 (by Services Rendered) Charlestown Gingerland Combined Total MONTH Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec n o i t c a r t x E 25 27 36 38 11 22 15 52 16 13 12 12 s g n i l l i F 77 63 68 74 34 56 56 68 28 51 28 34 s i x a l y h p o r P 41 17 43 23 15 41 47 42 24 88 6 31 TOTAL 279 637 418 27 22 209 13 22 139 17 22 6 80 35 7 * r e h t O 5 2 9 1 0 0 0 0 0 4 1 0 n o i t c a r t x E 10 13 19 50 15 2 2 7 14 0 7 8 s g n i l l i F 43 23 16 48 47 17 11 2 61 59 44 15 s i x a l y h p o r P 2 11 31 19 0 0 0 2 s t n a l a e S 0 0 0 0 0 0 0 10 22 27 34 1 12 9 0 ' .
S T C R .

3 0 0 0 3 0 4 3 1 0 0 1 ' .

S T C R .

2 6 0 6 8 1 1 0 0 0 0 1 s n o i t a n m a x E i 11 18 0 0 47 19 19 5 78 108 35 38 r e h t O 1 0 0 0 1 0 0 0 2 3 4 0 n o i t c a r t x E 35 40 55 88 26 24 17 30 13 19 20 s g n i l l i F 120 86 84 122 81 73 67 70 89 s i x a l y h p o r P 43 28 74 42 15 41 47 44 40 110 115 72 49 7 43 s t n a l a e S 0 0 1 0 0 0 0 11 22 34 9 1 ' .

S T C R .
5 6 0 6 11 1 5 3 1 0 0 2 r e h t O 6 2 9 1 1 0 0 0 2 7 5 0 15 599 22 147 386 121 75 25 378 11 426 1023 539 78 40 33 Table 45: Presents the 2011 dental statistics sorted by services rendered DENTAL STATISTICS 2011 (by Patient) Charlestown Gingerland Combined MONTH Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total M 47 39 66 32 28 42 42 19 13 12 13 37 8 Adults Children F Total Boys Girls Total Total Patients M 11 24 17 20 7 2 7 2 8 12 14 5 Adults Children F Total Boys Girls Total Total Patients TOTAL Table 46: Presents the 2011 dental statistics sorted by services patient 57 | P a g e 4.6 Environmental Health FOOD HANDLERS REPORT 2011 MONTH FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER TOTAL NEW ID AMOUNT 87 97 97 105 369 375 51 152 97 179 1735 256 FOOD HANDLERS PER DISTRICT GINGERLAND CHARLESTOWN COTTON GROUND COMBERMERE 8 12 12 2 FOOD HANDLERS ATTENDANCE PER DISTRICT GINGERLAND CHARLESTOWN COTTON GROUND COMBERMERE MEAT CERTIFICTAE LIQUOR LICENCE
 372 958 351 54 CERTIFICATE/LICENCE TEMPORARY FOOD HANDLERS ID Table 47: Highlights all the Food Handlers information for 2011 58 | P a g e 5.0 Hospital Services Medical Component The staff complement includes: Dr. John Essien – Medical Chief of staff and OBGYN specialist.
He is assisted by Dr. Bardales.

Dr. C Rawlins & Dr. Alexander Racovets – Surgeon specialists Dr. G Liburd - Anaesthesiologist –private with support from the two nurse anaesthetists.

Dr. Benjamin Luy –joined staff as Anaesthesiologist, employed from Philippines Dr. Patrick Dias – volunteering his services at OPD for two or three days per week.

Dr. Ravi Shankar - the interim doctor in charge on the Medical Ward and also did calls at OPD.
He also substitutes as the Medical chief of staff when Dr. Essien goes on vacation.

Dr. Limonte - Paediatrician and conducted outpatient clinic on Mondays at OPD.

Dr. S. Halliday – Visiting psychiartrist who conducted OPD clinics and the management of clients on the medical ward.
Dr. William Junez – visiting orthopaedic surgeon from Cuba, renamed Dr. Ravein Dr. J. Huggins – visiting dermatologist from St.Kitts conducted clinics at OPD on Thursdays from 8AM Other visiting specialists continued services during the year in the following specialties  Orthopaedic and Neurology – C.M.M  Dermatology - Dr. Cooper  Urology – Dr. Thwaites conducted free prostate cancer screening, did clinics on Thursday and surgeries on Fridays.

Biopsies were also done at OPD.

 Dr S Amory.


No colon screening was done by Dr. Amory during the year.

 Opthalmology.

Ms. Marainella Ivenes, Ophthalmologist, joined the team from Cuba to replace Dr. Francisca whose contract expired.

 Dr. Argawal joined the staff at A& E /OPD FNH - Flamboyant Nursing Home  There was a high occupancy rate throughout the year.
An addition to the staff of a New Nurse Manager as the former nurse manager was returned to the hospital on instructions from the ministry of health.

 An assistant nurse manager was also transferred to the home from community nursing.

A staff nurse was also employed.

Two workers were sent from the Ministry to work at the home, no training in the care of the elderly.

On the job training was arranged for them and they were called resident attendants.
 One nursing attendant resigned her post to immediate effect.

 Two members of staff Mrs. A David and Ms Ramla Hanley successfully completed an attachment course in Canada – facilitated by the Circle of Care organization.

 The kitchen staff was increased with an additional cook.

 The residents benefitted from various donations from private and corporate sector partnerships.
59 | P a g e Achievements  One nurse successfully completed studies in anaesthesia and resumed duties at the hospital – attached to the anaesthetic team in the OR  Three nurses were identified and commenced training in the fifteen (15) months midwifery program at CFBC  One additional nurse joined that group a little later after she applied for study leave.

 Six (6) nurses participated in a ten (10) week ICU course- internally conducted by Dr. G. Liburd.
 Addition to the staff of one Registered nurse after she successfully completed three years of training.

 Execution of a Simulation Exercise – A drag race event crash – Activity by Nurses & EMT‟s done in collaboration with the Disaster Management Department.

 Completion of the revision of Procedure Manuals for the Medical & Surgical Units.

 Utilization of the Orientation handbook for New graduates.
 New graduate completed her orientation process for the medical unit & evaluation /appraisal time completed by nurse manager in charge of unit.

 A team of nurses, EMT‟s & Ambulance driver covered the “mini-Olympics” – Inter Primary sports competition IPSC.

 One person has successfully completed training as an EMT at the JNF general hospital.

 Facilitation of eleven (11) prospective health care workers, (from the two high schools)?
some nurses to a job attachment program organized by the Social Development Department.

 The Resident gynaecologist – Dr. Bardales conducted Pap smear screening for 35 persons.

Staff members were encouraged to take care of themselves through this staff health program.

 The additional use of the Ford ambulance that was returned from the repair shop  Fully functional triage room at A&E and utilization of new forms.

 New nurse manager at the Flamboyant Nursing home and two additional staff nurses.
 Acquisition of additional supplies to be utilized for patient care.

 Resumption of the pre-Christmas hospital programme in collaboration with Hospital Auxillary Group (H/A).

60 | P a g e Community Involvement Members of staff – Nurses and nursing assistants visited work places and conducted screenings.

Screenings for non-communicable diseases (NCDs) were also performed at the Charlestown Social Security office for staff members.
Staff members also provided medical support for various community events such as:  Drag race  Horse race   School sports Inter – primary schools championship Members of staff are involved in various community organizations and provide health tips on the local radio stations.

The mentorship programme continues with students at the High schools, encouraging them to be a part of the nursing profession.

Representation was also made at the War Memorial service in honour of ex service men.
Staff members also provided home care to senior citizens located in different areas throughout the island.

Philanthropy The hospital was the beneficiary of several gifts and tokens from well wishers during the year.

These came from both private and corporate sectors and include the following:  A cheque of EC $5000.00 from the management of the Nevis Co-operative Credit Union.
 Donation of glucometer strips from the management of Social Security  Container of equipment & supplies from Global Links through Mrs M Parry, director of the Development Project Foundation Inc.  Donation of gown/patients robes from Mt.

Pelier Plantation Inn  Donations of equipment and supplies from Global Faith Alliance.
 Operating theatre supplies and scrubs from Dr. Thwaites  Donations from the Maternal Health Funds  Food supplies from various churches through their harvest thanksgiving services.

We express our gratitude to all those who contributed towards the care of our patients.
61 | P a g e TEN LEADING CASES OF HOSPITALIZATION Jan - Dec 2011 DISEASE Hypertension Diabetes Mellitus Gastric Enteritis Inguinal Hernia Chronic Cardiac Failure Left Ventricular Failure Symptomatic Uterine Fibroids Anemia Prostate Cancer TOTAL UPON DISCHARGE RANK % OF TOTAL ADMISSION 119 70 22 22 21 19 15 15 13 11.9 7 2.2 2.2 2.1 1.9 1.5 1.5 1.3 Cerebro Vascular Accident 13 Table 48: Highlights the leading cases of hospitalization at the Alexandra Hospital (*NB: Data taken from Hospital Discharges) 1.3 10 HOSPITAL ADMISSIONS - 2011 MEDICAL MONTH JANUARY FEBRUARY MARCH APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER NOVEMBER DECEMBER TOTAL Table 49: Catalogues the Alexandra Hospital admissions in 2011 sorted by ward Previous Year 2010: Total Hospital Admission = 981 (Med – 342 + Surg – 341 + Paed – 116 + Obst – 182) Total M 2 38 7 32 7 29 9 20 7 36 10 28 1 34 4 37 6 33 5 27 8 35 33 3 69 382 OBSTETRIC 8 9 14 11 22 10 16 13 18 17 20 15 173 PAEDIATRICS F 1 1 11 6 6 6 3 2 5 5 1 3 50 SURGICAL F 20 17 13 7 20 16 17 17 17 16 18 12 190 Total 3 8 18 15 13 16 4 6 11 10 9 6 119 Total 33 27 26 28 25 27 25 23 24 37 31 18 324 F 20 17 13 12 12 19 14 11 11 20 13 8 170 M 13 10 13 16 13 8 11 12 13 17 18 10 154 M 18 15 16 13 16 12 17 20 16 11 17 21 192 TOTAL MALE 33 32 36 38 36 30 29 36 35 33 43 34 415 TOTAL MONTHLY FEMALE 49 44 51 36 60 51 50 43 51 58 52 38 583 TOTAL 82 76 87 74 96 81 79 79 86 91 95 72 998 HOSPITAL DISCHARGES 2011 PAEDIATRICS Total MONTH 3 JANUARY 8 FEBRUARY 15 MARCH 12 APRIL 15 MAY 15 JUNE 6 JULY
 3 AUGUST 9 SEPTEMBER 8 OCTOBER 13 NOVEMBER 7 DECEMBER TOTAL 114 Table 50: Catalogues the Alexandra Hospital discharges in 2011 by ward.
Previous year 2010 : Total Hospital Discharges = 979 (Med – 338 + Surg – 342 + Obst - 181 F Total M Total M 19 32 15 30 16 32 11 23 15 22 11 29 16 25 21 23 19 29 14 29 14 33 25 16 196 323 OBSTETRIC 8 8 13 14 18 12 17 13 19 16 18 19 175 SURGICAL F 20 17 15 8 19 15 18 19 14 16 14 15 190 MEDICAL F 22 19 16 12 13 19 13 11 14 19 16 8 182 M 10 11 16 11 9 10 12 12 15 10 17 8 141 TOTAL MALE 32 33 37 30 33 31 32 35 39 28 39 37 406 TOTAL FEMALE 50 45 54 38 56 51 50 44 51 55 53 45 592 MONTHLY TOTAL 82 78 91 68 89 82 82 79 90 83 92 82 998 62 | P a g e Month January Monthly Average February Monthly Average March Monthly Average April Monthly Average May Monthly Average June Monthly Average July Monthly Average August Monthly Average September Monthly Average October Monthly Average November Monthly Average December Monthly Average Yearly Average Ward Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst Med Surg Paed Obst INPATIENT DAYS - 2011 Discharges Inpatient Days 5
Average Length of Stay (Days) Table 51: Shows the Alexandra Hospital 2011 inpatient days 63 | P a g e OUT PATIENT CENSUS - 2011 H T N O M s e s a C f o .
o N w e N f o .

o N s e s a C f o .

o N s e s a C g n n r u t e R i e c i l o P f o .

o N s e s a C g n i r u t u S f o .

o N s g n i s s e r D f o .

o N P / B f o .

o N 1067 1210 1478 1213 1248 1318 1425 1449 1557 1532 1472 1150 16,119 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Total Table 52: Displays the Alexandra Hospital 2011 outpatient census *NB: New Cases + Returning Cases + Police Cases (which are also new case) = No.
of Cases f o .

o N s n o i t c e j n I 397 378 451 386 415 478 492 424 458 387 464 498 5,228 P .

O .

P f o .

o N 2 2 2 1 0 2 6 4 2 4 1 3 29 s l a r r e f e R f o .

o N 35 11 26 23 29 41 49 15 31 43 25 24 352 f o .


o N s l l a C e c n a l u b m A 17 18 30 17 19 16 20 16 27 9 18 21 228 s e l a M f o .

o N 589 567 732 568 542 552 592 853 817 925 735 708 8,180 s e l a m e F f o .
o N 478 643 746 645 706 766 833 596 740 607 837 442 8,039 Total cases for the previous year 2010: 12,947 (7,026 new cases + 5,6225 returning cases + 288 police cases) ALEXANDRA HOSPITAL THEATRE 2011 DETAILS MONTH TOTAL Number of Surgical Cases Number of Surgical Operations Number of Major Cases Number of Minor Cases Number of Males Cases Number of Female Cases Number of Emergency Cases Number of Cases Done Under General Anaesthesia (G.A) Number of Cases Done Under Local Anaesthesia (L.A) Number of Cases Done Under Spinal Anaesthesia Number of Cases Done Under Sedation Number of Epidural JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Table 53: Gives details of the Alexandra Hospital Theatre cases for 2011 64 | P a g e BREAKDOWN OF THEATRE CASES General Surgery Abdomioplasty Above Knee Amputation Adhesiolysis Appendectomy Breast Biopsy Burr Hole Incision Circumcision Closed Reduction Colon biopsy Colonoscopy Dental Extraction Diagnostic Laparascopy Foreign Body Removal Gastroscopy / Gastric Biopsy Granuloma Excision Haemorrhoidectomy Hemicolectomy Hydrocelectomy Hysterectomy Incision & Drainage (I & D) Ingunial Herniorrhaphy Kidney
 Stone Removal Laparascopic Cholecystectomy Laparotomy Lipoma Excision Lithotripsy Open Cholecystectomy Open Reduction & Internal Fixation (ORIF) Peritoneal Lanuage Polypectomy POP Application Skin Lesion Excision Sphincterotomy Tendon Repair Thyroidectomy Toe Amputation (Hallux Amputation) Umbilical Herniorrhaphy Ventral / Epigastric Herniorrhaphy Wedge / Resection of Toenail Wound Closure Wound Debridement Gynaecology Eye Surgery Intraoccular Lens Implantation Pterygium Excision Lateral Tarsal Strip
 (LLETZ) (LEEP) Bilateral Tubal Ligation Caesarean Section Cervical Biopsy Dilation & Curettage (D & C) Endometrial Biopsy Myomectomy Ovary & Fallopian Tube Biopsy RRPC Salpingectomy Salpingo Oophrectomy Total Abdominal Hysterectomy Table 54: Gives a detailed breakdown of the 2011 theatre cases as presented by the Alexandra Hospital Cysto Lithrotripsy Cystouretoscopy Cytoscopy Orchiedectomy Radical Prostatectomy Testicular Mass Excision TURBT (Transurethral Resection of Bladder Tumour) TURP (Transurethral Resection of the Prostate) Urology Total 9 10 28 4 35 9 2 1 24 3 2 4 Total Total 47 6 1 Total 6 8 11 2 4 0 0 10 65 | P a g e MINOR CASES (DAY CASES) - 2011 WARD GENDER MONTH Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Paediatric M F 0 0 0 2 1 0 2 2 1 2 0 0 1 0 2 7 2 4 2 2 2 1 1 1 14 21 TOTAL Table 55: Highlights the minor day cases for 2011 35 Surgical F 4 7 9 9 10 13 3 6 11 14 39 5 130 M 2 3 5 2 6 3 0 7 5 2 21 0 56 186 RADIOLOGY M 2 5 5 4 8 3 0 14 9 4 22 1 77 F 4 7 10 11 11 13 4 8 13 16 41 6 144 221 TOTAL 6 12 15 15 19 16 4 22 22 20 63 7 221 MONTH Patient Gender IN OUT Male Female Total > 1 19-Jan 20-49 50-64 65+ Not stated Age Range Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 129
TOTAL 199 1833 989 1043 2032 22 369 791 421 341 Table 56 : Gives shows the statistics for radiology for 2011 3 14 3 9 18 8 5 2 2 5 14 5 88 66 | P a g e ULTRA-SOUND 2011 Gender Total MONTH Patient IN OUT Male 14 5 13 7 11 7 7 6 2 2 10 8 11 5 9 3 13 8 9 9 15 11 14 3 128 74 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL Table 57: Breaks
 down ultra sounds by gender and age range Female > 1 0 0 1 1 0 0 0 0 0 0 2 0 4 Age Range 1-19 20-49 6 3 8 4 0 1 6 2 5 6 2 1 44 15 16 19 21 9 7 20 21 22 30 23 18 221 50-64 14 3 8 6 2 1 8 7 7 6 16 9 87 65+ Not stated 7 1 3 1 0 2 8 6 10 9 6 7 60 3 8 12 6 3 21 4 6 4 5 4 2 78 Category Upper Limb Lower Limb Upper Girdle Lower Girdle Chest Abdomen Spine Facial Bone Skull Sinuses Barium Enema Other TOTAL TYPES OF X-RAYS Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total Table 58: Highlights the various types of x-rays TYPES OF ULTRA SOUND Category Abdomen Pelvic Obstetric Testicular Thyroid Renal Prostate Breast Abd.
& Prostate Pel.
& Obstetric Pelvic & Abd Other TOTAL Table 59: Highlights the various types of ultrasounds Jan Feb Mar Apr May Jun 6 11 9 0 2 0 0 1 0 0 2 4 35 Jul Aug 8 15 9 13 5 7 0 0 3 1 4 6 1 0 1 1 0 0 2 0 0 3 9 2 42 48 Sep Oct Nov Dec Total | P a g e Rehab Therapy Statistics – 2011 Month January February March April May June July August September October November December TOTAL SERVICE GENDER In Patient 10 8 30 4 3 3 2 3 3 1 1 2 Out Patient Male Female <17 7 17 7 7 1 4 3 0 11 7 7 4 AGE 17 - 61 26 36 42 34 30 26 31 22 35 43 41 33 TOTAL PATIENTS 53 73 65 57 49 51 53 59 59 68 63 52 >62 20 20 16 16 18 21 19 37 13 18 15 15 70 656 289 413 75 399 228 702 New Returning Total Pts Therapy Physical Therapy Month Cases Cases January February March April May June July August September October November December 24 20 23 14 16 15 21 18 24 34 23 15 24 43 34 40 28 35 28 37 28 29 33 30 Visits 202 271 211 204 176 201 206 210 222 203 204 201 Speech Occupational Neuro-Med Ortho-Surg Cardio Pul TOTAL 389
52 53 57 55 49 1 2 2 0 2 3 1 1 0 0 0 0 TOTAL 389 Table 60: Presents the Alexandra Hospital Rehab Therapy Statistics for 2011 2511 247 17 42 135 587 12 68 | P a g e No.
of Patients sent for CT SCAN No.

of Patients in ICU CT SCANS 3 0 1 1 2 2 2 3 1 1 1 1 18 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOTAL Table 61: Presents the no.

of patients sent for CT Scans Pharmacy Statistics Alexandra Hospital-2011 Month January February March April May June July August September October November December Total Table 62: Presents the Alexandra Hospital Pharmacy Statistics for 2011 * N.B: New & Repeated Prescription included in total.
Total 2576 2325 2652 2648 2333 2605 2196 2065 2003 2017 2094 2407 27921 3 0 2 2 2 1 1 1 2 1 3 1 19 69 | P a g e Month St. John St. George St. James St. Thomas St. Paul ASTHMA CASES January February March April May June July 0 0 M (age) M (age) F (age) F (age) 0 0 M (age) M (age) F (age) F (age) 2 12 1 Male 1 Female 5 Males 7 Females 3 2 Male 1 Female 21 10 Males 11 Females 3 Females 2 Males F (age) 10 7 Males 2 8 4 5 Males 4 Males 10 3 Females F (age) 5 1 Male 4 Males 6 Females 4 Females August September October 7 5 5 Males 2 Females 2 Females 3 Males 9 9 3 Males 5 Males 6 Females 4 Females 13 5 Males 2 0 M (age) F (age) 0 M (age) F (age) 1 1 Male F (age) 7 2 Males 5 Females 8 5 Males 3 Females 4 4 Males F (age) 4 1 Male 3 Females 3 2 Males 1 Female 3 1 Male 2 Females 1 0 M (age) F (age) 0 M (age) F (age) 2 2 Males F (age) 2 2 Males F (age) 6 3 Males 3 Females 1 1 Male F (age) 1 1 Male F (age) 2 2 Males F (age) 1 1 Male F (age) 1 1 Male 8 Females 2 Females 1 Female November 4 9 M (age) 4 Females 6 Females 3 Males December 9 5 Males 17 7 Males 10 Females 104 0 M (age) F (age) 6 1 Male 2 M (age) 2 Females 4 2 Males Total Table 63: Highlights the reported cases of asthma cases for 2011 by gender 4 Females 57 5 Females 37 2 Females 22 OUT PATIENT DEPARTMENT - ALEXANDRA HOSPITAL Unknow n 11 5 M 6 F Total 11 5 M 6 F 0 M (age) F (age) 0 19 19 M (age) M (age) M (age) F (age) F (age) F (age) 20 10 Males 10 Females 14 8 Males 6 Females 0 3 1 Male M (age) 2 Female F (age) M (age) M (age) F (age) F (age) 0 0 0 0 45 M (age)
 M (age) F (age) F (age) 5 0 F (age) 3 Males M (age) 2 Females 1 1 M (age) 1 Female 0 2 M (age) 1 Male 1 Female F (age) 1 Male F (age) 9 0 7 Males M (age) 2 Females 6 F (age) 0 3 Males M (age) 3 Females 2 F (age) 0 2 Males M (age) F (age) F (age) 13 0 9 Males M (age) 4 Females 41 F (age) 31 25 Males 20 Females 22 17 Males 5 Females 22 8 Males 14 Females 19 13 Males 6 Females 31 17 Males 14 Females 23 9 Males 14 Females 17 5 Males 12 Females 49 24 Males 25 Females 292 70 | P a g e Challenges Opportunities
 for Improvement  Decrease in the number of nurse midwives  Decrease in the quota of Nursing Assistants   The incompletion of piped gases and suction which leads to inadequate amounts of gauges for the Inadequate quantities of Vital sign monitors on the units for patient care.
oxygen cylinders  Nurses not being able to acquire the required amount of material for uniforms  Not enough Emergency Medical Technicians EMT‟s  More security on the night shift for staff  Customer service issues  Absence of a seamstress on the compound.

Recommendations  The completion of piped gases and vacuum  Computers for all units/ wards  Air conditioning Units for all units/ wards  Employment of additional EMT‟s.
 Employment of additional orderlies  Accommodation for student nurses in St. Kitts  Employment of registered nurses / midwives  Posting of a security guard at OPD during the hours of 10 pm and 6 am  Refurbishing of the old nurses home to be utilized as a source of income 71 | P a g e GLOSSARY  Crude Birth Rate (CBR): Total number of live births in a given year X 1,000 divided by the estimated mid year population in that year.
 Crude Death Rate (CDR): Total Number of Deaths in a given year X 1,000 divided by the estimated mid year population in that year.

 General Fertility Rate (GFR): Number of live births in a given year X 1, 000 divided by the number of females within the fertility age group (15 – 44).

 Natural Increase Rate: Total live births subtract total deaths occurring during the year x 1,000 divided by the estimated mid year population for that year.

 Age Specific Death Rate (ASDR): (Rate in children 1-4 yrs.)
Total number of deaths in age group 1-4 X 1,000 divided by the population of children in that same age group.

 Infant Mortality Rate (IMR): Total number of deaths to infants under 1 year of age in a given year X 1,000 divided by the total number of live births in that year.

 Still Birth Rate: Total number of stillbirths in a given year X 1,000 divided by total birth (live +Stillbirths) in that year.

 Neonatal Death Rate: (Children born alive & died before age 28 days of age).
Total number of neonatal deaths X 1,000 divided by total number of live births in that same year.

 Maternal Death Rate: (Maternal death is the death of a woman while pregnant or within 42 days after termination of pregnancy, regardless of the length and site of the pregnancy, due to complications of the pregnancy, delivery and puerperium but not due to accidental or incidental causes).

Total number of women who died X 1,000 divided by the number of live births.
 A Hospital: is any medical facility with an organized medical and professional staff and beds available for continuous hospitalization of patients formally admitted to it for medical observation, care, diagnosis, or surgical or non-surgical treatment.

 Hospital Discharges: is the formal release of a hospitalized individual due to conclusion of the hospital stay, either by death, return home or transfer to another institution.

 Patient Days: Total in-patient days for the year.
 Average Length of Stay: Patient Days divided by total discharges  Percentage Occupancy: Patient Days X 100 divided by 52 (beds) X 365.

 Bed Turn-Over Rate: Total discharges divided by 52 (total beds) 72 | P a g e