Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694840135694.pdf (Mauritius)
CENTRAL STATISTICS OFFICE Ministry of Finance and Economic Development 2000 HOUSING AND POPULATION CENSUS REPUBLIC OF MAURITIUS ANALYSIS REPORT VOLUME VI – HEALTH & QUALITY OF LIFE, MORBIDITY AND MORTALITY June 2004 (Price: Rs 250) FOREWORD The Central Statistics Office conducted a Housing and Population Census in year 2000.

Census 2000 was the seventeenth for the Island of Mauritius and the seventh for the Island of Rodrigues.
A series of table reports covering housing and living conditions, demographic and fertility characteristics, economic characteristics, educational characteristics, household characteristics, geographical and migration characteristics and disability was published during the following year.

Analysis and evaluation of the census data are currently being carried out and the results published in a series of analytical reports.
The present report is the sixth of the series and covers health & quality of life, morbidity and mortality.

The chapter on living conditions, environment and quality of life includes a subsection on burden of disease.

It is hoped that the report will be useful to the public in general and to policy makers, planners and researchers in particular.

I would like to thank all staff who contributed in one way or another in the preparation of this report.
A special thanks goes to the Chief Health Statistician and staff of the Ministry of Health and Quality of Life for their contribution.
H. Bundhoo Director of Statistics Central Statistics Office Ministry of Finance and Economic Development Port Louis June 2004 Contact person: Mr Chettun K. Arianaick Statistician - Demography Unit Central Statistics Office LIC Centre Port Louis Tel: 2133074 Fax: 2114150 Email: cso@mail.gov.mu : cso_demography@mail.gov.mu 2 Census 2000 - Health & Quality of life, Morbidity and Mortality CONTENTS Page CHAPTER 1 - Health 1.1 Introduction 1.2 Health Policy 1.3 Health delivery system 1.4 Health services 1.5 Health personnel 1.6 Medical supplies 1.7 Activities carried out in government hospitals (Island of Mauritius) 1.8 Activities carried out in government hospital and health centres in Rodrigues Some achievements during the recent years Plan for the future 1.9 1.10 CHAPTER 2 - Living condition, environment and quality of life 2.1 2.2 2.3 Introduction The housing situation The environment The Environment Protection Act 2.3.1 Air quality 2.3.2 Solid waste 2.3.3 2.3.4 Waste water Preventive health CT-Scan 2.4 2.5 Haemodialysis 2.6 2.7 Occupational Health 2.8 2.9 2.10 NCD surveys 2.11 2.12 Community based rehabilitation programme Survey on nutrition Survey on knowledge, attitudes, beliefs and practices (HIV/AIDS) Burden of disease study CHAPTER 3 - Morbidity Introduction Sources of morbidity statistics in Mauritius and their limitations 3.1 3.2 3.3 Morbidity patterns (Island of Mauritius) 3.4 Morbidity in Rodrigues Census 2000 - Health & Quality of life, Morbidity and Mortality Incidence of cancer (Island of Mauritius) 3.5 3.6 HIV/AIDS cases CHAPTER 4 - Mortality 3 Page 43 46 Infant mortality Child mortality Introduction Trends in mortality level 48 4.1 48 4.2 49 4.3 Differentials by age and sex 51 4.4 Deaths by cause 4.5 Death rates due to diseases of the circulatory system by age and sex 53 54 4.6 57 4.7 58 4.8 Maternal Mortality 58 4.9 Old age mortality 60 4.10 67 4.11 69 4.12 72 4.13 Mortality differentials by sex 72 4.14 Mortality differentials by age 72 4.15 Mortality differentials by region Life table mortality measures Life expectancy at birth by sex Life expectancy at selected ages by sex Annex : Population Census questionnaire 73 Symbols and abbreviations - Nil … Not available .. Not applicable Percentages have been rounded to one decimal place.
Consequently rounding errors may occur in some of the tables.
4 Census 2000 - Health & Quality of life, Morbidity and Mortality LIST OF TABLES page Table 1.1 - Health Institutions, Island of Mauritius - 1990 & 2000 Table 1.2 - Health Institutions, Island of Rodrigues - 1990 & 2000 Table 1.3 - Selected health manpower statistics as at end of year 1990 and 2000 Republic of Mauritius Table 1.4 - Summary of work performed in government hospitals, 1990 and 2000 Island of Mauritius 9 10 11 14 Table 1.5 - Deliveries in government general hospitals, 1990 – 2000, Isl.
of Mauritius 15 Table 1.6 - Deliveries by type in government general hospitals, 1990 - 2000 Island of Mauritius Table 1.7 - Admissions in hospital/health centres, 2000 - Island of Rodrigues Table 1.8 - Deliveries in hospital/health centres, 2000 - Island of Rodrigues Table 1.9 - Out-patient attendances, 1990 & 2000 - Island of Rodrigues Table 2.1 - Report on NCD Mobile Service (Caravane de Sante) Period covered: 22nd March 2001 to 30th June 2003 Table 2.2 - Immunisation coverage in the Republic of Mauritius, 1990 & 2000 Table 2.3 - New cases of occupational and work related diseases seen at occupational health clinics by sex - 2000 Table 2.4 - Activities of the CBR programme in 2000 Table 2.5 - Appliances delivered under the CBR programme in 2000 Table 2.6 - Prevalence of selected diseases by sex, Island of Mauritius 1987, 1993 and 1998 (adult population aged 30 years and above) Table 2.7 - Percentage distribution of DALYs by sex and group of diseases Table 2.8 - Ranking of the ten most prominent diseases by sex Table 3.1 - General hospital discharges (including deaths) by I.C.D.
chapter, 1990 & 2000 - Island of Mauritius 16 16 17 17 26 27 29 29 29 31 33 34 36 Census 2000 - Health & Quality of life, Morbidity and Mortality Table 3.2 - Principal causes of general hospital discharges (including deaths) by sex - 2000 - Island of Mauritius Table 3.3 - Principal causes of first attendances for the treatment of common diseases and injuries at mediclinics, area health centres, community health centres and mobile dispensaries - 2000 Island of Mauritius Table 3.4 - Principal causes of discharges from hospital and health centres, 2000 - Island of Rodrigues Table 3.5 - Principal causes of first attendances at community health centres for the treatment of common diseases and injuries, 2000 Island of Rodrigues Table 3.6 - Incidence of cancer in the Island of Mauritius, 1989 -1996 Table 3.7 - Incidence of cancer in the Island of Mauritius, 1997 -1998 5 Page 37 39 41 42 44 45 Table 3.8 - Statistics relating to notification of HIV/AIDS cases and death, 1987-2000 47 Table 3.9 - Statistics relating to HIV tests carried out during period 1987 - 2000 Table 4.1 - Crude death rate and infant mortality rate, 1951-2000 Table 4.2 - Death rates by age group and sex, Republic of Mauritius and Island of Rodrigues - 1990 & 2000 Table 4.3 - Cause specific death rates by sex, Republic of Mauritius and the Island of Rodrigues - 1990 & 2000 Table 4.4 – Selected principal causes of deaths, Island of Mauritius - 1990 & 2000 Table 4.5 - Death and death rates by sex due to diseases of the circulatory system Republic of Mauritius - 1990 & 2000 Table 4.6 - Newborns treated (as in-patients) at the Neonatal Intensive Care Unit – year 2000 Table 4.7 - Principal causes of infant deaths, Republic of Mauritius - 1990 & 2000 Table 4.8 - Child mortality rate - 1952 - 2000 47 49 51 52 53 54 56 57 57 6 Census 2000 - Health & Quality of life, Morbidity and Mortality Table 4.9 - Principal causes of child deaths, Republic of Mauritius - 1990 & 2000 Page 58 Table 4.10 - Maternal mortality rate, Republic of Mauritius - 1972 - 2000 Table 4.11
 - Deaths by cause among deceased aged 60 years and above Republic of Mauritius, 1990 & 2000 Table 4.12 - Abridged life table by sex - Republic of Mauritius, 1999 - 2001 Table 4.13 - Abridged life table by sex - Island of Mauritius, 1999 - 2001 Table 4.14 - Abridged life table by sex - Island of Rodrigues, 1998 - 2002 Table 4.15 - Expectation of life by sex, Republic of Mauritius, 1972 - 2000 Table 4.16 - Life expectancy by age and sex at each census and sex differences in life expectancy, Republic of Mauritius, 1972-2000 Table 4.17 - Percentage increase in expectation of life by age, Republic of Mauritius, 1972 - 2000 Table 4.18 - Adjusted death rates by region, Republic of Mauritius, 2000 LIST OF FIGURES Fig.
3.1 - HIV/AIDS cases registered among Mauritians, during period 1987 to 2000 Fig.

3.2 - HIV/AIDS cases registered among Mauritians, during period 1987 to 2000, by mode of transmission Fig.

4.1 - Male and female death rates, Republic of Mauritius - 2000 Fig.

4.2 - Infant mortality rates, selected years - Republic of Mauritius Fig.

4.3 - Evolution of the pattern of mortality by sex between 1990 and 2000 Republic of Mauritius Fig.
4.4 - Difference between male and female life expectancy by age, Republic of Mauritius - census years 1972 - 2000 58 59 61 63 65 67 70 70 72 46 46 50 55 68 71 Census 2000 - Health & Quality of life, Morbidity and Mortality 7 Chapter 1 - Health 1.1 Introduction The World Health Organisation (WHO) defines health as a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.

This chapter gives an overview of the health situation in Mauritius.
It provides information on health facilities, personnel and supplies.

1.2 Health Policy Health is recognized by the Government as a fundamental human right.

As such, health care is provided free of charge in all public health institutions.

The general policy of the Government in the health sector is to promote total human development through the enhancement of the quality of life of each and every citizen.
The target “Health for all by the year 2000” having been largely achieved, the objective, now is to consolidate the process already initiated, and the adoption of an integrated approach to health planning and health delivery.

This takes into account non- communicable diseases, the increasing demand for better quality services and high- tech medicine, and the need for greater efficiency in the use of health services.
Rapid industrialisation and economic growth in the past decades have brought major changes in the lifestyle of the population.

The growing epidemic of non- communicable diseases (NCDs) in the Republic of Mauritius has placed health education high on the agenda of policy makers.
The shift from curative to preventive service is being consolidated in order to stem down diseases like diabetes, hypertension and heart diseases as well as the related risk factors such as alcohol, smoking and high consumption of salt, sugar and fatty foods.
The main objectives of the government in respect to health are as follows: - Developing a comprehensive health service in order to meet the health needs - of the population; Investigating the influence of physical environment and psychosocial domestic factors on the incidence of human diseases and disability; - Planning and carrying out measures for the promotion of health; - Instituting and maintaining measures for the prevention of diseases including the epidemiological surveillance of important communicable diseases; - Providing better facilities for the treatment of diseases, including mental diseases, by maintenance of hospital and dispensary services; - Making provisions for the rehabilitation of the disabled; - Controlling the practice of medicine, dentistry and pharmacy; and - Initiating and conducting operational bio-medical health studies of diseases of major importance in the country.
8 Census 2000 - Health & Quality of life, Morbidity and Mortality 1.3 Health delivery system The government health service delivery is based on a regionalized system characterised by a network of accessible health care delivery institutions at primary, secondary and tertiary levels.

The primary health care addresses the main health problems in the community through the provision and promotion of health and preventive, curative and rehabilitative services.
The network consists mainly of Area Health Centres and Community Health Centres.

These peripheral units are the first points of contact and patients are referred from these centres to hospitals whenever required.

The services provided at the primary health centres include maternal and child health care, family planning, immunisation programme, treatment of common diseases and injuries, and health promotion.
The secondary health care services are delivered through five regional (Sir Seewoosagur Ramgoolam National hospital, Jawaharlall Nehru hospital, Victoria hospital, Flacq hospital and Dr Jeetoo hospital) and three district (Mahebourg hospital, Souillac hospital and Long Mountain hospital) general hospitals as well as through four specialised hospitals (ENT hospital, S. Bharati hospital, Brown Sequard hospital and Poudre d'Or hospital ).
The different services provided include accident and emergency services, general medecine, general and specialised surgery, gynaecology and obstetrics, chest medecine, orthopaedics, traumatology, paediatrics and intensive care services.

Radiotherapy services are provided at Victoria Hospital.

The "Service d'Aide Medicale d'Urgence" (SAMU) which operates on a 24 hour basis is attached to the accident emergency departments of each regional hospital.
Each of the specialised hospitals delivers care in only one speciality as follows: Brown Sequard hospital in psychiatry, Poudre d'Or hospital in pneumology, S. Bharati hospital in opthalmology, ENT hospital in otorhinolaryngology (i.e.

ear, nose and throat) and the Cardiac Centre mainly in cardiology.

The tertiary health care services include high tech medical care such as open-heart surgery, renal transplant, neurosurgery, vitreo-retinal surgery, haemodialysis, etc.
The Central Health Laboratory, the Virology Unit, and the Blood Bank provide support services.

A wide range of health care services, including the services of medical practitioners, pharmacies and laboratories is also provided in the private sector.

Sugar Estates provide primary health care to their employees and members of their families.

The public and private health sectors operate on a collaborative manner rather than a competitive one.
1.4 Health services Table 1.1 gives a brief picture of the availability of different health services in the Island of Mauritius.

A major development is the opening of a Cardiac Centre in December 1997.

Also, increases were noted in the number of dental clinics from 22 Census 2000 - Health & Quality of life, Morbidity and Mortality 9 in 1990 to 40 in 2000 and in that of private nursing homes from 8 in 1990 to 13 in 2000.
Table 1.1 - Health Institutions, Island of Mauritius - 1990 & 2000 Type of facility 1990 2000 Number Number Number Number Regional hospital District hospital Specialised hospital Cardiac Centre Dispensary service point 2/ Maternal and child service point Dental Clinic Chest Clinic Social hygiene Clinic National Day Care Centre for the immuno-suppressed Private Nursing home Sugar Estate Dispensary of units 3 4 4 - of beds 1,554 318 1,032 - 127 - 137 - 22 - 1 - 1 - - 215 25 - 8 - of units 5 31/ 4 1 of beds 2,548 152 1,066 53 1343/ - 140 - 40 - 1 - 1 - 1 - 13 572 26 - 1/ Flacq hospital which was a district hospital has been upgraded to a regional hospital 2/ includes 8 day-care service beds at Dr Y. Cantin Community Hospital in 2000 3/ including one Community Hospital and 2 Mediclinics.
The out-patient departments of all hospitals provide minor curative services as well as maternal and child health care, and family planning services.

These services are also provided by 134 other health institutions namely the Community Hospital (one), the Mediclinics (two), the Area Health Centres (23) and the Community Health Centres (108) located all around the Island of Mauritius.
Out of the 26 Area Health Centres in 1990, one was converted into a Community Hospital (Black River) and two others into mediclinics (L'Escalier and Belvedere) during the last decade.

These three centres provide additional services such as X-ray facilities.

In 2000, there were 40 dental clinics in government general hospitals, Community Hospital, Mediclinics and Area Health Centres compared to 22 in 1990.
The Chest Clinic situated near the Dr. A. G. Jeetoo Hospital in Port Louis is the only institution of its kind.

The clinic provides for services to detect pulmonary tuberculosis among the population.

A Social Hygiene Clinic, located near Dr. Bouloux AHC at Cassis, provides for treatment to patients suffering from sexually transmitted diseases.
Since the end of 1999, a new clinic, namely the National Day Care Centre for the Immuno-Suppressed, situated in the same complex, provides care to people with the HIV infection as well as those suffering from AIDS.

The number of beds in government health institutions and private nursing homes has significantly increased over the last decade.

Increases of 31.5% and 166.0% respectively were noted.
The expansion was more important in the private sector as a result of higher demand as more persons can now afford the personalized care of the 10 Census 2000 - Health & Quality of life, Morbidity and Mortality private nursing homes and improvement in the living standards of the population.
to sophisticated medical equipment following The number of centres providing basic health care services drastically increased during the period 1983 to 1990 with the opening of about 80 centres following the setting up of the community based health system all around the country.

The number, which was 164 in 1990, has remained unchanged since then.
tests (biochemistry, haematology, virology, microbiology and Pathological parasitology) are conducted mainly at the Central Laboratory found at the Victoria Hospital.

The other four regional hospitals also provide for laboratory services.

During the year 2000, these laboratories carried out more than five million pathological tests, representing more than 80% increase over the 1995 figure.
It should be mentioned that the Public Health Laboratory found at Roche Bois, which used to carry out tests for the detection of malaria, was closed down at the end of 1996.

Tests for the detection of malaria are now performed at the Central Laboratory.

The Food Analysis Laboratory of the Government Analyst Division found at Réduit is responsible for carrying out tests for food toxicology; it also covers tests on pesticides, water and pharmaceutical products.
In the Island of Rodrigues, health facilities are provided mainly by the public sector.

One general hospital (Queen Elizabeth Hospital) and two health centres (La Ferme and Mont Lubin) provide for in-patient facilities with a total of 171 beds at the end year 2000 (Table 1.2).

Out-patient care facilities are available at these three institutions as well as at the Community Health Centres which numbered 13 in 2000.
The latter also provide for maternal and child health, and family planning services besides services for the treatment of common diseases and injuries.

Dental services are available only at the general hospital and at the two Health Centres.

A system of mobile dispensaries serves the population in remote and scattered areas.
Table 1.2 - Health Institutions, Island of Rodrigues - 1990 & 2000 Institution 1990 2000 Number Number Number Number of units of beds of units of beds Hospital (Queen Elizabeth) Health Centres (La Ferme and Mont Lubin) 1 2 108 50 1 2 107 64 Community Health Centres 10 - 13 - Health Offices (Port Mathurin) 1 - 1 - Dental Clinics (Hospital and Health Centres) Expanded Programme on Immunization 3 - 16 - 3 - 17 - 1.5 Health personnel At the end of 2000, there were 1,080 doctors in the Republic of Mauritius compared to 857 in 1990.
The doctor to population ratio improved from 1:1,244 in 1990 to 1:1,105 in 2000.

Census 2000 - Health & Quality of life, Morbidity and Mortality 11 Table 1.3 - Selected health manpower statistics as at end of year 1990 and 2000 Republic of Mauritius Grade A.
Doctor Employed by Ministry of health - of which specialists In private practice Total B. Dentist Employed by Ministry of health In private practice Total C. Pharmacist Employed by Ministry of health In private practice Total D. Qualified nurse and midwife 1990 2000 Number Population per grade Number Population per grade 521 (158) 336 857 37 96 132 9 118 127 1,244 8,074 8,392 6631/ (224) 417 1,080 47 99 146 17 278 295 1,105 8,172 4,045 434 2,7482/ Employed by Ministry of Health 1/ excluding 23 doctors (included in figure in private practice) working under the " Bank of Doctors" scheme 2/ excluding 58 nurses working under the "Bank of Nurses" scheme 2,768 385 In 2000, 663 doctors or 61.4% were employed in the public sector, the number of specialists being 224 (Table 1.3).
In 1990, 521 doctors or 60.8% were in the public sector and the number of specialists was 158.

As a solution to the shortage of doctors and qualified nurses in the public service, the Ministry of Health & Quality of Life decided to create a "bank of doctors' and a "bank of nurses".

In 1999, 35 doctors from the private sector were providing their services on a temporary basis in the government hospitals under this scheme.
However, in 2000, there were only 23 such doctors as the Ministry recruited more doctors to work on a permanent basis.

With the first intake of students of the SSR medical school now in their final clinical training years, and with the support from France and UK in producing generalists and specialists, the prospects for sustained growth in medical staff are more assured.

Nurse training is also expanding and becoming more specialised.
Through regional collaboration, courses for other health professions are being established while a dental school and dental hospital are being developed.

In 2000, around 20 doctors of whom 12 were specialists, were recruited from overseas, mainly from India.

This decision was taken mainly to cater for the shortage 12 Census 2000 - Health & Quality of life, Morbidity and Mortality of specialists in different fields such as anaesthesia and neurosurgery.
The number of foreign doctors recruited has continued to increase after the year 2000.

The number of dentists at the end of 2000 was 146 compared to 132 in 1990.

However, the dentist to population ratio indicates that increase in the number of dentists is slow in pace as compared to population growth (1:8,074 in 1990 compared to 1:8,172 in 2000).

The number of dentists in the public sector in 2000 was 47 compared to 37 in 1990.
There were 295 pharmacists at the end of 2000, of whom 17 were employed in the public sector and 278 in the private sector.

The pharmacist to population ratio was 1: 4,045 as compared to 1: 8,392 at the end of 1990 when there were 9 pharmacists in the public sector and 118 in the private sector.

The increase (from 9 to 17) in the number of pharmacists in the public sector during the last decade was mainly due to the modernisation of the pharmaceutical departments of the government hospitals.
On the other hand, the 135.6% increase in the number of pharmacists working in the private sector is mainly explained by the rapid growth in the commercialisation of pharmaceutical products.

At the end of 2000, the number of nurses and midwives in the public sector was 2,748 with an additional 58 nurses working under the “Bank of Nurses” scheme.

This scheme was set up in 1999 because of the shortage of qualified nurses in the public sector.
The bank of nurses constitutes mainly of nursing officers already employed by the Ministry of Health & Quality of Life, but were ready to work during the days they were off duty.

Comparatively, the number of nurses and midwives in the public sector was 2,768 in 1990.

In spite of the increase in the number of patients visiting government health institutions during the last decade, the number of nurses employed in the public sector has remained more or less the same.
The main reason was high staff turnover: there has been high demand for nurses by the private nursing homes which increased from 8 in 1990 to 13 in 2000, and also by foreign countries such as the United Kingdom.

In Rodrigues, the number of doctors in post increased from 8 in 1990 to 18 in 2000.

The doctor to population ratio was 1: 4,700 in 1990 and 1: 1,988 in 2000.

Specialists in various fields from the Island of Mauritius visit the island on a regular basis.
The number of nurses and midwives went up from 85 in 1990 to 114 in 2000.

At the end of 2000, there were three dentists, six dispensers, three laboratory technicians, two radiographers and two health inspectors in post in the island.

1.6 Medical supplies Medicines are dispensed free of charge in the public health services.
The Ministry of Health & Quality of Life has a list of about 600 essential medicines, which it procures mostly through open international tender, the share of the two local manufacturers being limited.

The private sector imports some 5,000 pharmaceutical products through wholesale pharmacies.

In order to minimize the risks of counterfeit, importation takes place directly from suppliers abroad.

In 2000, there were 29 wholesalers and around 200 retailers with 295 registered pharmacists.
The wholesale Census 2000 - Health & Quality of life, Morbidity and Mortality 13 and retail prices incorporate profit mark-ups; the wholesaler is allowed a mark-up of 14% and the retailer mark-up of 27%.

Total import of medicines in 2000 was around one billion rupees.

Health care is also provided, on a very limited scale, by other systems like ayurvedic, homeopathy and other traditional medicines.
It is to be noted the pharmacy department of the Ministry of Health has instituted full control on the entry and the conditions of import of health supplements, herbal medicines, and neutraceuticals, especially those addressing athletes, as stipulated in the provisions of the Pharmacy Act 1983 and the Food Act 1998.

New procedures have been established to regulate the prescriptions of psychotropic and dangerous drugs while pharmaceutical products received by individuals through parcel post are controlled.
Also, advertisements on medicines are done under control.

1.7 Activities carried out in government hospitals (Island of Mauritius) At the end of 2000, 3,819 hospital beds were available in the public sector.

They were distributed as follows: 2,548 beds in the 5 regional general hospitals, 152 beds in the 3 district general hospitals and 1,119 beds in the 4 specialised hospitals, the Skin Diseases Infirmary and the Cardiac Centre.

(Table 1.4).
(Table 1.4).

In 2000, the number of admissions in the government health establishments was 204,673, representing an increase of 44.8% over the 1990 figure of 141,367.

The total number of surgical operations performed in 2000 was 36,293 on in-patients and 40,621 on out-patients.

The corresponding figures in 1990 were 23,047 and 46,272 respectively.
In 2000, the total number of attendances at the out-patient departments of hospitals was 2,680,003 compared to 1,696,668 in 1990, that is an increase of 58.0% during the inter-censal period.
Table 1.4 - Summary of work performed in government hospitals - 1990 and 2000 Island of Mauritius Hospital Number of admissions 1990 2000 as at end of year 2000 1990 In-patients1/ Out-patients out-patients departments 1990 2000 1990 2000 1990 2000 Number of beds Number of operations performed on Number of attendances at Dr. A.G. Jeetoo (P.Louis) 29,445 41,453 S.S.R.N.

(Pamplemousses) 2/ 29,569 36,622 Long Mountain Flacq (Central Flacq) 3/ J. Nehru (Rose Belle) 4/ Mahebourg Souillac Victoria & P.M.O.C.
(Quatre Bornes) Sub-total (general) Brown Sequard (psychiatry) (Beau Bassin) Poudre D'or (chest) S. Bharati (eye) (Moka) E.N.T.
Centre (Vacoas) Cardiac Centre (Pamplemousses) 6/ 1,575 7,541 915 21,342 -- 27,394 10,782 9,132 6,052 7,335 420 463 43 91 -- 91 93 530 535 23 282 518 83 46 6,794 5,504 - - -- 109 - 5,860 7,009 18,647 12,124 8,803 433,870 534,685 7,925 286,135 436,756 - 730 970 58,051 57,892 3,673 4,935 116 - 1,924 4,176 101,206 240,825 -- 2,563 1,528 7,282 2,409 2,099 -- -- 485 4,003 5,181 2,592 54 53 38 -- 53 59 63 53 - 79 1,805 2,884 -- - 137 2,744 1,703 704 - - - - 1,443 3,560 73 -- 960 - 44,500 67185/ 90,932 83,815 83,186 27,773 139,004 140,656 -- 24,643 1 4 C e n s u s 2 0 0 0 - H e a l t h & Q u a l i t y o f l i f e , M o r b i d i t y a n d M o r t a l i t y Total 141,367 204,673 2,904 3,819 23,047 36,293 46,272 40,621 1,696,668 2,680,003 1/ including examinations under anaesthesia 4/ The hospital became operational in December 1990 2/ including Skin Diseases Infirmary 5/ attendances at Chest Clinic, Port-Louis 6/ The centre became operational in December 1997 3/ The hospital was upgraded to a regional hospital in 1998 Census 2000 - Health & Quality of life, Morbidity and Mortality 15 Table 1.5 - Deliveries in government general hospitals Island of Mauritius Live births Still births Total % of which low1/ birth weight No.
No.

No.
% over total births registered 78.7 81.5 82.9 82.9 83.8 84.2 84.1 83.7 83.9 84.9 86.3 Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 1/ birthweight of less than 2,500 grammes The number of deliveries in government hospitals decreased from 17,438 (17,138 live births and 300 still births) in 1990 to 16,962 (16,747 live births and 215 still births) in 2000.
However, the proportion of deliveries in these hospitals over births registered increased from 78.7% to 86.3% during the period 1990-2000.

The percentages of low birth weight (less than 2,500 grammes) among live births in government hospitals increased from 8.2% in 1990 to 14.3% in 2000.
16 Census 2000 - Health & Quality of life, Morbidity and Mortality Table 1.6 - Deliveries by type in government general hospitals Island of Mauritius Normal delivery Instrumental Caesarean Year 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 By midwife By doctor Total No.

% of total No.
% of total Total … … … … … In 2000, the percentage of deliveries by caesarean section in government hospitals was 27.2.
As shown in table 1.6, this percentage which was only 12.8% in 1990 has continuously increased since then.

Activities carried out in government hospital and health centres in 1.8 Rodrigues At the end of 2000, there were one general hospital with 107 beds and two Health Centres with 64 beds in the Island of Rodrigues (Table1.2).

The number of admissions in these institutions was 9,538 while the number of attendances at the out- patient departments was 117,336.
Some 784 live births and three still-births occurred in the maternity sections of the three centres during the year 2000.

Some 83 or 10.6% of the live births had a birth weight of less than 2,500 grammes.
Table 1.7 - Admissions in hospital/health centres - 2000 Island of Rodrigues Number of admissions Institution Male Female Total Queen Elizabeth Hospital 2,373 3,588 5,961 Mont Lubin Health Centre 738 1,131 1,869 La Ferme Health Centre 694 1,014 1,708 Total 3,805 5,733 9,538 Census 2000 - Health & Quality of life, Morbidity and Mortality 17 Table 1.8 - Deliveries in hospital/health centres - 2000 Island of Rodrigues Institution Queen Elizabeth Hospital Mont Lubin Health Centre La Ferme Health Centre Number of deliveries Live births Still births Total 742 19 2 1 23 - 744 20 23 Total 784 3 787 In 2000, there were 13 Community Health Centres with 32,981 attendances (Table 1.9).
Table 1.9 - Out-patient attendances - 1990 & 2000 Island of Rodrigues Institution Queen Elizabeth Hospital Mont Lubin Health Centre La Ferme Health Centre Community Health Centres Total 1990 23,564 16,295 16,807 36,778 93,444 2000 65,258 29,451 22,627 32,981 150,317 1.9 Some achievements during the recent years The overall health status of the population of the Republic of Mauritius has considerably improved over the last few decades.
Life expectancy at birth increased from 61.0 for males and 65.9 for females in 1972 to 68.2 and 75.3 respectively in 2000.

Infant mortality rate, defined as the number of infant deaths in a year per 1,000 live births during the year, has gradually declined from 65.1 per 1000 live-births in 1972 to 15.9 in 2000.

The number of hospital beds in the public sector goes up from 2,904 in 1990 to 3,819 in 2000, that is an increase of 31.5%.
A new regional hospital for the southern region of Mauritius, namely the Jawaharlal Nehru Hospital became operational at Rose-Belle in December 1990.

This has greatly reduced the pressure on Victoria Hospital, which was providing for advanced treatment to patients from Souillac and Mahebourg Hospitals.

The district hospital at Flacq has been upgraded into a regional hospital.
As a result, patients residing in the eastern part of the island need no longer be transferred to SSRN Hospital for advanced treatment.

Various improvements have been brought to most of the existing infrastructure of the hospitals during the last decade.

Two Area Health Centres, one at L’Escalier and the other one at Belvédère, were upgraded to Medi-Clinics and the Dr.Y.Cantin Area 18 Census 2000 - Health & Quality of life, Morbidity and Mortality Health Centre was upgraded to a Community Hospital.
All the three centres are now equipped with modern facilities.

Various services involving new technology have been introduced at the hospital level.

Laparoscopic surgery is now routinely undertaken at Victoria Hospital while litrotripsy services (crushing renal stones) are available at SSRN and J. Nehru Hospitals.

SSRN Hospital has been equipped with the necessary medical instruments to carry out mammography.

Haemodialysis services are available at the main regional hospitals.
Cardiac surgery is performed on a full time basis at the Cardiac Centre located near the SSRN Hospital.

The service of invasive cardiology with angiography and angioplastry is also available at the centre.

Among other improvements in the public health sector noted during the last decade, is the Neonatal Intensive Care Service for newborns launched in May 1999.

This service, which was initially located at Victoria Hospital, has been extended to SSRN Hospital.
It has been unanimously recognised that this new service has largely contributed to reducing infant mortality during the past few years.

The Infant Mortality Rate, which stood at 20.4 in 1990, decreased drastically to 14.3 in 2001.

Another major achievement is the setting up of a SAMU service.

This service provides medically equipped vehicles for the transportation of patients to hospitals in emergency cases.

Doctors, nurses and life-saving devices are readily available on board these vehicles.
A National Day Care Centre for the Immuno-Suppressed (NDCCI) became operational in December 1999.

The NDCCI provides for various services to people living with HIV/AIDS as well as to those requesting voluntary testing and counseling as regards the infection.
The centre, to which an AIDS physician is attached, also coordinates activities in connection with the “Prevention of Mother to Child Transmission” and provides for “post-exposure prophylaxis” services to health care workers involved with HIV/AIDS patients.

Furthermore, the Blood Bank at Victoria Hospital has been equipped with sophisticated testing equipments with a view to preventing HIV transmission by blood and its products.
Another recent achievement is the coming into force as from 1st January 2000 of the Food Regulations 1999 made under the Food Act 1998.

The new legislation, which provides for the modernisation and consolidation of the law, replaced the Food and Drugs Act of 1940, and all Regulations made under it.

The Food Regulations have been worked out according to international norms and standards.

They provide for more effective and efficient protection for consumers.
It is expected that these regulations will reduce the current levels of sickness, disability, morbidity resulting from food related diseases and poisoning.

The introduction of the Mental Health Care Act 1998 has been a major milestone in the development of the mental health programme in the Republic of Mauritius.

Mental health services have been decentralised to general hospitals.
Census 2000 - Health & Quality of life, Morbidity and Mortality 19 1.10 Plan for the future Responding to the evolving aspirations of the population and the needs of the health sector, a new plan of action is being currently studied.

The Action Plan aims at ensuring that the country has the necessary health services and the capacity to deliver them in the most cost-effective way.

Health services will be more efficient with results approaching those achieved in many developed countries.
The Action Plan proposes the introduction of the following: • 24-hour family doctor service • High technology services to tackle the complications arising from diabetes and hypertension including new and extended cardiac surgery programme, transplant programme, extended joint replacement surgery, spinal injury and extended neurosurgical services and complex eye surgery renal dialysis programme, • National Institute for Non Communicable Disease • National oncology centre • Health promotion and preventive medicine services for every community • Patients' Charter system to protect consumer interests • Information system with a smart card for tracking and improving the quality of treatment, linked to the present carnet de santé • Staff retention, productivity scheme and quality improvement programme • Better maintenance and repair of buildings and equipment • Special development support for Rodrigues and the outer islands • Improvements in dental services to promote better dental health and extend existing services Proposals for the following developments have been made for Rodrigues: • A mental health facility • A SAMU service • A family doctor service • The NCD programme • Maternal and Child Health Service to be strengthened to reduce infant mortality • Paediatric services to be strengthened • Specialist orthopaedic services will be available • Development, renovation and maintenance of buildings and equipment • The extension of medical education programme for other professionals • Patients linked through the patient information service to the National Complaints Commission and their own regional service • Further decentralisation of operational management to promote local decision-making on local matters and local management of operational budgets • Rationalisation of the services at Mont-Lubin and La Ferme Area Health Centres 20 Census 2000 - Health & Quality of life, Morbidity and Mortality With a view to creating a sustainable health service fit for the 21st century, the Action Plan has set out key health sector targets as follows: Increase in expectation of life at birth to above 75 years • • Reduce infant mortality rate to single figure within the next five years (i.e below 10 infant deaths per thousand live births) • Maintain maternal mortality rate below 20 per hundred thousand live births • Perinatal mortality rate (still births and deaths within the first week) to below 20 per thousand live and still births.
Service targets have also been set: • Double the number of open heart operations • Save 500 lives a year from end stage renal failure • Halve the amputation rate among diabetic patients • Provide decent hospital and community services for those who are mentally ill • Provide hospitals with modern facilities (Jeetoo, Victoria, Brown Sequard, ENT, Mahebourg, Souillac, Poudre d’Or and Long Mountain) • Provide a 24 hour family doctor service to everyone • • Increase health personnel by 3,900 Improve the effectiveness and efficiency of preventive and curative clinical services and financial and general management The Plan will identify and pursue consumer targets including the reduction of waiting time, improvement in privacy, better quality of reception and ‘hotel’ services, protection of patients’ human and civil rights, the establishment of informed consent as a basis for all clinical intervention, and the involvement of the community in planning and evaluation of health services.
One of the implications of the Action Plan will be to raise the resource commitment to the health sector from its current level of about 2.8% of GDP to beyond 3%.

The Action Plan proposes a 75% increase in the health budget, the commitment of Rs 4 to 5 billion for capital schemes for the replacement, improvement and expansion of services, and the employment of a further 3,900 professional, technical and supporting staff.
Several options for funding the Action Plan are proposed; they are: • • Increase in the state budget Introduction of health insurance with monthly contributions from employers, employed people and self employed • Conversion of National Savings Fund (NSF) • Extra incentives to expand the private sector • Health taxes on tobacco and alcohol • Efficiency drive within the existing services, and • Charges for services provided.
Census 2000 - Health & Quality of life, Morbidity and mortality 21 Chapter 2 – Living condition, environment and quality of life 2.1 Introduction The type of environment one lives in enhances the quality of life.

The immediate concerns are housing conditions – the quality and the availability of facilities, the environment as well as sanitation and hygiene.

2.2 The housing situation The housing conditions of the population have improved considerably during the past decade.
Thus, the proportion of residential buildings made of concrete walls and roof increased from 70.6% in 1990 to 86.3% in 2000 while the percentage of households living in improvised dwellings decreased from 1.6% in 1990 to only 0.7% in 2000.

In 2000, amenities needed for a healthy life were available to most households.

Electricity was available to 99.0% of households compared to the already high figure of 96.9% ten years ago.
The percentage of households having their water supply from fountains, wells, and rivers dropped from 10.5% in 1990 to 1.8% in 2000.

Only 1.0% of households did not have bathroom facilities compared to 5.5% in 1990.

About 88.8% of households had flush type of toilet compared to 62.8% in 1990, while those having pit latrines dropped from 36.5% to 11.0%.

Kitchen facilities were available to 99.2% of households.

About 88.5% of them had their kitchen inside while the remaining outside.
Households are now using cleaner sources of energy for cooking purposes.

Thus, in 2000, 91.5% were using gas for cooking purposes compared to 50.3% in 1990.

In contrast, the percentage of households using wood and charcoal dropped from 26.3% in 1990 to 4.5% in 2000.

There has been a marked improvement in the method of refuse disposal, this having a direct bearing on the health of individuals.
Census 2000 figures show that 91.5% of households had their refuse collected by authorized collectors compared to 47.1% at the 1990 Census.

Conversely, the proportion of households who dumped their refuse on the roadsides or in the backyard decreased from 30.6% to 2.6% during the same period.

The degree of overcrowding, as measured by the average number of persons per room used for living purposes decreased from 1.2 in 1990 to 0.9 in 2000, indicating improvement in the living conditions of the population.
2.3 The environment 2.3.1 The Environment Protection Act At the national level, numerous policy measures have been devised to improve the environment and enhance the quality of life.

22 Census 2000 - Health & Quality of life, Morbidity and Mortality The Environment Protection Act (EPA) which provides for the legal framework for the protection and management of the environment of the country was passed in 1991.

Under the Act, the Department of Environment was established.
The Department, which is now part of the Ministry of Environment, is responsible for all environmental issues, including those relating to coastal and maritime management.

The EPA 2002 was proclaimed towards the end of 2002 and replaces the EPA 1991.
The Act pledges “every person in Mauritius shall use his best endeavours to preserve and enhance the quality of life by caring responsibility for the natural environment of Mauritius.” The new Act contains features that are geared to institutional strengthening for the enforcement of environmental law, better management of coastal zones and for sustainable development.
The act also establishes standards and guidelines for radioactive emission, and built-up environment and landscape, and provides for pollution control regulations.

Some of the measures undertaken to improve our environment and thus to enhance the quality of life are described below.

2.3.2 Air quality Poor air quality is the result of human activity.

Mauritius has witnessed a rapid industrialisation coupled with an increase in the number of motor vehicles.
This has resulted in an increase in air pollution more specifically in areas with dense traffic and in the vicinity of industries.

Other sources of atmosphere pollution are cane burning during the harvest season and burning of household, commercial and industrial solid waste.

Air pollution can cause irritation of skin, eye, nose and throat and may result in more serious respiratory problems such as bronchitis, pneumonia and asthma.
Following an assessment of the air quality carried out in 1993 across the island, several measures have been taken to curb down the level of atmospheric pollution.

In 2002, the Road Traffic Regulations were promulgated and provide the necessary legal framework for the control of vehicle emissions; road traffic officers have been empowered to enforce the regulations and issue notices and contraventions.
The use of unleaded petrol by motor vehicles was introduced while all new and imported second-hand petrol driven vehicles and certain types of existing vehicles must be fitted with catalytic converters so as to reduce emissions of toxic gases.

The enforcement mechanism provided by the EPA has enabled the control of air pollution from other sources.
Thus, the imposition of some types of dust arrestors in the coal fire boilers and asphalt plants, of water sprayers at stone crushing plants and of the application of industrial air pollution abatement technology has contributed in the reduction of air pollution.

2.3.3 Solid waste It is estimated that about 1,200 tonnes of solid waste are produced daily.

On the average, a person generates about 0.7 kg of solid waste daily and this figure is expected to go up to 0.9 kg by year 2010.
The type of waste generated has changed in the advent of new materials and technology.

Thus, around 70 million plastic bottles, 250 million plastic bags and 13 million aluminium cans are put on the market Census 2000 - Health & Quality of life, Morbidity and mortality 23 annually.

Currently, about 92% of households are serviced by refuse collectors, and the remaining either dump their refuse on the road sides or in the backyard or use ash pits to dispose of.
Household and commercial solid wastes are collected by local authorities and are brought to the only landfill of the island, Mare Chicose Sanitary Landfill, either directly or through four transfer stations where they are compacted.

The landfill receives daily 1,000 tonnes of waste against 300 tonnes as planned originally, with as consequence a reduction in the life span of the landfill.
A feasibility study on environmental solid waste management was conducted in 1999 and recommends various scenarios for solid waste disposal in the short, medium and long term.

From a national strategic point of view, it was felt that a diversified approach for waste disposal involving landfilling and incineration together with minimisation measures and recycling be adopted.
The overall objective is to reduce the generation of waste as well as the environmental impact to ensure that the health of the population and the quality of the environmental resources are not adversely affected.
Following the promulgation of the Environment Protection (Polyethylene (PET) Bottle Permit) Regulations in 2001, the aim of which is to develop 'product responsibility' in the bottlers for the proper management of the bottles even after it has been sold, a PET bottles recycling project was set up by the association of bottlers.

Bins have been placed at strategic places around the country for the collection of the PET bottles.
Until now, about 60 tonnes of bottles have been collected and exported for recycling.

Furthermore, a local company is currently recycling some 45 tonnes of plastic waste annually.

The recycled plastic is used for the manufacture of refuse bags, plastic furniture, and other products.

Measures have also been taken to ban the manufacture and import of some type of plastic carry bags.
Plastic bags, besides being non-biodegradable, contain, if coloured, harmful toxic metals like chromium and copper, which may cause allergies.

Since 1997, some paper recycling is also carried out by a local company.

The company produces mainly corrugated cardboard boxes.

2.3.4 Waste water The domestic and industrial wastewaters also present serious problems to the health of the population.
Currently, only 20% of households, mostly in the urban regions of Port Louis and Plaines Wilhems, are connected to the sewerage network.

The current system provides only preliminary treatment before discharge into the sea.

The remaining 80% of households have recourse mostly to absorption pits or septic tanks leading to an increase in the water usage and in the risk of polluting nearby surface or underground water.
In 1994, the National Sewerage Master Plan, which aims at connecting at least 50% of households to the sewerage network by 2010 and 80% by 2020, was adopted.

Many components of the Plan are currently being implemented.

Among which is the Grand Baie Sewerage Project which aims at providing sewerage facilities in the regions from Trou aux Biches to Cap Malheureux as well as the St Martin Sewerage Treatment Plant which is being upgraded.
Treated water from these plants will be used for 24 Census 2000 - Health & Quality of life, Morbidity and Mortality irrigation while studies have been carried out for the use of treated sludge as fertilisers in sugar cane fields.

2.4 Preventive health Prevention of illnesses and the spread of communicable and non-communicable diseases is an important element of the health services.
The government, in addition to the curative health facilities mentioned in the preceding chapter, provides for services to promote health through a number of programmes and activities.

The Health Inspectorate Division of the Ministry of Health & Quality of Life carries out a number of activities to raise awareness on the control of communicable diseases and to maintain sanitary standards.
The activities include talks to school children and to members of the public on personal and environmental hygiene, disinfections, pest control, control over places where food is sold, examination of foods offered in restaurants or public places, inspection at the central abattoir, and visits to educational, commercial and industrial establishments.
During the year 2000, 62,261 inspections were carried out and 3,939 notices were served in connection with non- compliance with standards as stipulated in the Food Act.

All incoming planes and ships require clearance from the Health Inspectorate before disembarking passengers while passengers from certain countries at risk are put under surveillance for malaria and other infectious diseases.

Furthermore, some ships are subject to rat extermination operations.
In order to control the spread of infectious diseases, the staff of the Health Inspectorate Division spray DDT to kill adult mosquitoes and larviciding abate(temphos) to kill larvae on stagnant water.

The Non-Communicable Disease Programme, which coordinates all activities aimed at controlling the NCDs, is based on two axes.
The first one is the early detection of diseases such as diabetes mellitus, hypertension, and breast and cervical cancer through the ongoing screening programme carried out throughout the island by the “Caravane de Santé”.

The main objectives of the NCD mobile service are to: a) screen people for NCD's, which include diabetes, hypertension, problem of vision, obesity and breast and cervical cancer.
b) give each citizen a health card with details of his/her health status including results of the NCD's test; c) educate the community on risk factors for NCDs and behavioural changes needed to cope with changing patterns of diseases.

The NCD mobile service comprises five caravanes in Mauritius and one in Rodrigues.

The "Caravane de Sante" which was launched in March 2001, has visited more than 180 localities in Mauritius up to end of June 2003.

Some 132,983 persons have been screened.


More than 30,000 women aged between 35 and 60 years have been screened for breast and cervical cancers.

Census 2000 - Health & Quality of life, Morbidity and mortality 25 About 7,947 new cases of diabetes and 25,557 new cases of hypertension have been recorded (Table 2.1).

It has also been noted that more than 70% of persons screened are not doing physical exercises at all.
The results of the smears reported up to date, indicate that 670 cases of smears are abnormal.

All these women have been recalled for treatment.

Out of the 31,832 women screened for breast cancer, 964 were detected with disorders.

Table 2.1 - Report on NCD Mobile Service ( Caravane de Sante) Period covered: 22nd March 2001 to 30th June 2003 Total Male Female % of population screened No.

% of population screened No.

% of population screened No.
Population screened 132,983 49,266 83,717 s e s a c w e N s e s a c d l O Number of new cases with Diabetes Mellitus (DM) 7,947 6.0 3,511 7.1 4,436 5.3 Number of new cases with Hypertension (HBP) 25,557 19.2 11,450 23.2 14,107 16.9 Number of new cases with both DM and HBP (included above) 2,433 1.8 1,229 2.5 1,204 1.4 Number of cases with overweight and obesity 65,788 49.5 21,649 43.9 44,139 52.7 Persons already following treatment for DM 11,778 8.9 4,144 8.4 7,634 Persons already following treatment for HBP 17,635 13.3 5,425 11.0 12,210 Number of persons not doing exercises 94,272 70.9 27,548 55.9 66,724 9.1 14.6 79.7 2 6 C e n s u s 2 0 0 0 - H e a l t h & Q u a l i t y o f l i f e , M o r b i d i t y a n d m o r t a l i t y Census 2000 - Health & Quality of life, Morbidity and mortality 27 The second axis of the NCD programme is health promotion.
It aims at raising awareness on the risk factors, such as smoking and alcohol consumption, at encouraging the practice of physical exercises and at adopting a healthy nutritional habit.

The Health Promotion Programme reached 95,819 persons between March 2001 and June 2003.
The Maternal and Child Health Division of the Ministry of Health & Quality of Life, as well as NGO's (Non-Governmental Organisations) like Action Familiale and the Mauritius Family Planning Association provide advice and various services to the population in the field of family planning.

Antenatal services are available in hospitals and in most of the places where primary health care services are provided.
Care is provided to expecting women from the first contact with the health system, usually the third month of pregnancy, to the time of delivery.

The school health service consists mainly of visiting and screening students of all primary schools and of some pre-primary schools.

A group of nursing staff, sometimes accompanied by a doctor, examines the students in order to detect any health problem such as nits and lice, underweight and dental problems.
The dental health service, besides being involved in the curative activities, also works for the prevention of dental and periodontal diseases.

In this context, preprimary and primary schoolchildren as well as expectant and nursing mothers are screened on a regular basis.

The immunization programme is another important branch of the preventive health services.
The programme, in force since 1960, covers vaccines against poliomyelitis, tuberculosis, measles, mumps, rubella, diphtheria, pertussis, tetanus and hepatitis B.

Vaccines against diseases such as yellow fever, influenza, typhoid fever, and meningitis are done under request.

In 2000, the coverage of immunizations against tuberculosis (BCG) was 88% of total registered livebirths, and that against Diphtheria, Poliomyelitis and Whooping Cough (DPT) was 88%.
Coverage against Measles (MMR), and Hepatitis B introduced in 2000 was 84% and 88% respectively.
The corresponding figures for BCG, DPT and MMR in 1990 were 87%, 85% and 76% respectively Tabel 2.2 - Immunisation coverage in the Republic of Mauritius, 1990 & 2000 Disease (vaccine) Coverage rate per 100 registered live births 1990 2000 Tuberculosis (BCG) Diphtheria, poliomyelitis and whooping cough (DPT) Measles (MMR) 87 85 76 Hepatitis B (Hep) .. 1/ 1/ was not covered by the Expanded Programme on Immunisation prior to year 2000 88 88 84 88 28 Census 2000 - Health & Quality of life, Morbidity and Mortality 2.5 Haemodialysis Haemodialysis services are now available free of cost in the public sector.
At the end of the year 2000, there were 114 patients on dialysis in the three regional hospitals.

The total number of dialysis sessions performed in these centres amounted to 12,466 for the year 2000.

The corresponding figures in the private establishments were 379 patients for 49,628 sessions.

On average, a patient needs 3 sessions per week.

2.6 CT-Scan CT-Scan service which was not yet available in government hospitals in 2000, is now available at the Sir Seewoosagur Ramgoolam and Victoria hospitals.
Prior to the availability of the service in hospitals, all patients in need were referred to various private establishments and all costs were borne by the Ministry of Health and Quality of Life.

In 2000, 4,598 requests to have access the CT scan services in private clinics were made from patients of the nine government hospitals.
The highest number came from Victoria Hospital with 1,160 requests, accounting for 25.2 % of the total requests, followed by SSRN Hospital with 1,063 requests or 23.1%, Dr Jeetoo Hospital with 913 requests or 19.9 %, J. Nehru Hospital with 518 requests or 11.3% and Flacq Hospital with 512 requests or 11.1%.

The four specialised hospitals altogether made 432 requests.

The overall positivity rate of the CT-Scan tests for all hospitals was 62.9 %.
The positivity rates for the five regional hospitals ranged from 57.4 % to 71.2 % with an average rate of 64.7 % while that for the four specialised hospitals was 45.6%.

2.7 Occupational Health Another component of preventive health is the provision of services as regards occupational and work related diseases in out-patients clinics.

People working in environment where the risks of developing health problems are high, are regularly screened at different sites around the Island of Mauritius.
In 2000, the total number of attendances at these clinics was 3,640, of whom 3,035 were males.

During the same year, 201 persons were detected as new cases of occupational and work related diseases.
Census 2000 - Health & Quality of life, Morbidity and mortality 29 Table 2.3 - New cases of occupational and work related diseases seen at occupational health clinics by sex - 2000 Condition Backache Contact dermatitis Musculoskeletal pain ( other than backache) Noise induced hearing loss Occupational/work related asthma Allergic rhinitis Stress related symptoms Upper respiratory tract irritation Pesticide poisoning/overexposure Chemical intoxication (other than solvents) Organic toxic syndrome (solvents) Chronic obstructive lung disease Total Number of cases Male Total 49 48 29 16 12 12 10 7 7 5 3 3 201 38 43 22 16 8 10 5 7 7 5 2 2 165 Female 11 5 7 - 4 2 5 - - - 1 1 36 2.8 Community based rehabilitation programme The Community Based Rehabilitation (CBR) Programme of the Ministry of Health & Quality of Life which came into operation during the early 90's provides supportive services for the rehabilitation of disabled persons.
These services consist mainly of visits to disabled persons by the CBR programme staff in their home and to institutions involved in the rehabilitation or care of such persons.

Disabled persons in need of support are referred to various government specialised agencies as well as NGO's for care, assistance and supply of supportive appliances.

During the year 2000, 1,885 new cases were identified by the CBR Programme; this brings the total number of persons covered by the Programme to 8,040.
Table 2.4 - Activities of the CBR programme in 2000 Type of activity Visits to disabled persons Referrals to specialised agencies Visits to institutions Appliances delivered No.

23,387 4,327 1,540 873 Table 2.5 - Appliances delivered under the CBR programme in 2000 Type of appliances No.
Walking aids Wheelchairs Adapted appliances Splints/calipers Hearing aids Artificial limbs Other appliances 367 228 119 73 21 31 34 30 Census 2000 - Health & Quality of life, Morbidity and Mortality 2.9 Survey on nutrition A survey on Nutrition in Mauritius and Rodrigues was conducted in 1995 by the Ministry of Health and Quality of Life with the collaboration of the World Health Organisation (WHO) and the United Nations Children’s Fund (UNICEF).The objective of the survey was to assess the general nutritional status of the child, adult and pregnant woman in relation to micronutrient content.
The results showed that anaemia due to iron deficiency was practically non-existent in children, adult and pregnant women in Mauritius, but was still a problem, though minimal, in children of Rodrigues.

There was no evidence of micronutrient malnutrition related to vitamin A, iodine and iron.

The prevalence of exclusive breastfeeding was 12.2 weeks in Mauritius and 17.7 weeks in Rodrigues.

About 98.1% of surveyed mothers considered breast milk as the best food for newborns.
However for reasons such as insufficiency of milk and refusal of children, only 89% of the mothers reported to have breastfed their child.

The nutritional status of the adult Mauritians was similar to the affluent countries.

About 39% of the adult Mauritians were obese or overweighed.

The figures for India and China were 3.5% and 8.2% respectively whereas the corresponding figures for France and U.S.A were 32.4% and 55.2% respectively.
2.10 NCD surveys Non-communicable disease (NCD) surveys were carried out in the Republic of Mauritius in 1987, 1992 and 1998 using comparable methodology and criteria at all three surveys.

The surveys were conducted among a sample of adult population aged 30 years and over in the islands of Mauritius and Rodrigues.

For better comparison of results, age-standardised prevalence rates have been calculated to remove the effect of change in the age structure of the population.
In 1998, the age-standardised prevalence rate of diabetes among the surveyed population was 19.5% compared to 16.9% in 1992 and 14.3% in 1987, showing continuous increase.

One out of 5 persons surveyed had Type 2 diabetes (non-insulin dependent) and one out of 6 had impaired glucose tolerance (increased risk of developing diabetes).
It was also found that the control of diabetes among those who had the disease was poor, that is, the glucose level in their blood was high due to non-intake of prescribed drugs or non-conformity to appropriate dieting regime.

The 1998 survey results indicate that the number of persons with hypertension increased by 20% compared with the 1987 survey results.

The overall hypertension prevalence rate, which decreased from 30.2% in 1987 to 26.2% in 1992 rose in 1998 to reach a level of 29.6%.
A similar trend is noted in the crude prevalence of high cholesterol.

Thus, among the male population the rate decreased from 56.4% in 1987 to 33.8% in 1992 and rebound to 49.7% in 1998.

The corresponding figures among the female population for the years 1987, 1992 and 1998 were 52.9%, 31.7% and 37.6% respectively.

Census 2000 - Health & Quality of life, Morbidity and mortality 31 Based on the survey results, cigarette smoking is seen to decrease continuously for adults aged 30 years and above.
The crude prevalence rate for males, which was 57.9% in 1987, fell to 47.3% in 1992 and 42.0% in 1998.

The corresponding figures for females for the years 1987, 1992 and 1998 were 7.0%, 4.8% and 3.3% respectively.

However, among youngsters the perception is that cigarette smoking is on the increase.

According to a study conducted by the Mauritius Institute of Health in 2000 among students aged 11-20 attending secondary colleges, it was found that 19% of them were smokers.
Table 2.6 - Prevalence of selected diseases by sex, Island of Mauritius - 1987, 1992 and 1998 Adult population aged 30 years and above 1.

Age standardised prevalence rate Disease/ sex 1987 Year 1992 1998 Diabetes mellitus Male Female Both Sexes Impaired Glucose Tolerance Male Female Both Sexes Hypertension Male Female Both Sexes Obesity & Overweight Male Female Both Sexes 2.
Crude prevalence rate Disease/ sex 1987 Year 1992 1998 High Cholesterol Male Female Both Sexes Abusive alcoholic Consumption Male Female Both Sexes Cigarette Smoking Male Female Both Sexes 56.4 52.9 54.5 18.2 2.1 9.6 57.9 7.0 30.6 33.8 31.7 32.7 14.4 1.6 7.5 47.3 4.8 24.3 49.7 37.6 42.9 15.9 0.5 7.2 42.0 3.3 20.2 The prevalence of asthma measured at the 1998 NCD Survey was 3.8% in the adult population.
About 73% of them had used inhalers.

32 Census 2000 - Health & Quality of life, Morbidity and Mortality 2.11 Survey on knowledge, attitudes, beliefs and practices (HIV/AIDS) The National AIDS Control and Prevention Programme (NACP) was established in the 1987.

The aim of the programme is to sensitise the population through educational activities on the primary prevention of HIV infections.
The activities include training of medical and paramedical staff, awareness sessions among girls and women, and educational programme in secondary schools.

Particular attention is given to sex workers, sailors, drug addicts, prison inmates, homosexuals and workers of the tourist sector.

In 2001, government approved a multi-sectoral National HIV/AIDS strategic plan for 2001 to 2005 and its implementation has already started.
Some of the objectives of the strategic plan are to generate an environment conducive to effective HIV/AIDS control, to reduce new HIV infection among high risk groups, to reduce mother to child transmission of HIV and to provide care and support to people infected and affected by HIV.

It should be noted that as from 1987, HIV antibodies screening among blood donors is mandatory in order to assure safe blood transfusion.
A household based survey on the Knowledge, Attitudes, Beliefs and Practices related to HIV/AIDS in the Republic of Mauritius was conducted from October 1996 to February 1997.

The aim of the community based survey was to formulate recommendations in view of increasing the knowledge and strengthening the preventive practices against the transmission of HIV/AIDS infection in the population.
Some findings of the study are given below: (a) (b) (c) (d) 1.4 % of the respondents of the Island of Mauritius had sexual intercourse with non-regular partners; the corresponding figure for Rodrigues was 10.0%.

1.0% of the respondents in Mauritius did not use condoms as a protective measure with non-regular partners compared to 7.6% in Rodrigues.

Respondents who had heard of AIDS had some knowledge on the disease and were aware of the danger it represents to humanity.
In fact, 92.7% of the respondents in Mauritius and 81.2% of the respondents in Rodrigues had a fairly appreciable knowledge on the disease.

In Mauritius, 5.4% of the respondents had never heard about condoms whereas 11.7% had never seen one.

The corresponding figures in Rodrigues were 9.1% and 19.2% respectively.

(e) In Mauritius, 9.4% of respondents did not know if one can contact a disease through sex as compared to 9.1% in Rodrigues.
Census 2000 - Health & Quality of life, Morbidity and mortality 33 2.12 Burden of disease study A national burden of disease study for Mauritius for the year 1993 was carried out in 1995 and updated in 1998.

The burden of disease study used a methodology developed by Dr Murray and colleagues for the Global Burden of Disease (GBD) Study.

The study measured the combined impact of incidence of death and disability on health in DALYs (Disability Adjusted Life Years).
The two components of DALY are the YLL (years of life lost due to premature mortality) and the YLD (years lived with a disability).

For Mauritius, the mortality data for 1993 were adjusted using data of years 1989 to 1993.

The morbidity data were those available or estimated for year 1993.
The diseases were divided into three groups, namely: • • • Communicable Diseases, Maternal and Neonatal Conditions Non-communicable Diseases Injuries The results of the 1993 burden of disease study in Mauritius showed that 61.2% of DALYs was due to deaths that occurred in 1993 and the remainder due to disabling outcomes of diseases.

Males contributed to 58.4% (84,719 DALYs) of the total burden and females to 41.6% (60,297 DALYs).
The percentages of DALYs among the males and among the females in each of the three groups of diseases, namely, Communicable Diseases, Maternal and Neonatal Conditions; Non-communicable Diseases and Injuries, are given below: Table 2.7 - Percentage distribution of DALYs by sex and group of diseases Group of diseases Communicable Diseases Maternal and Neonatal Conditions Non-communicable Diseases Injuries Male Female Both Sexes 14 74 12 16 76 8 15 75 10 Total 100 100 100 The study shows that a high proportion, about 75%, of the DALYs were due to the non-communicable diseases.
The percentage was nearly similar for males and for females.

DALYS due to “Communicable Diseases, Maternal and Neonatal Conditions” are mainly attributable to neonatal conditions.

As regards the burden of diseases due to injuries, DALYS for males was found to be 50% higher than for females.

In the injury group, road traffic accidents and suicides predominated among men while among women suicides were the most important factor.
34 Census 2000 - Health & Quality of life, Morbidity and Mortality Table 2.8 - Ranking of the ten most prominent diseases by sex Both Sexes Male Female Disease Ischaematic heart disease Depression Stroke Diabetes Alcohol abuse Low birth weight Road traffic accidents Liver cirrhosis Suicide Hypertensive heart disease % of % of % of DALYs Rank DALYs Rank DALYs Rank From the table above, ischaemic heart disease, stroke and diabetes were important contributors to the burden of diseases in both men and women.
It is worth mentioning that depression was the first contributor for women while it was the seventh for men.

It must be pointed out that the Burden of Disease in Mauritius reflected the 1993 health status of the population of the country taking into consideration the preventive and curative services already in place.

The study confirmed that non-communicable diseases especially cardio-vascular diseases constitute the most important health problem in Mauritius.
One of the priorities of the Ministry of Health & Quality of Life is to improve the measures to prevent or treat hypertension and diabetes, which are the main causes of cardio-vascular diseases.

Census 2000 - Health & Quality of life, Morbidity and Mortality 35 Chapter 3 - Morbidity 3.1 Introduction Morbidity statistics are an important complement to mortality statistics in the study of the health status of the population of a country.
Mortality statistics are useful but they do not reveal the whole burden of ill-health in a country.

There are diseases that are responsible for a lot of suffering and absorb a large amount of health resources, but do not occupy a prominent place in mortality statistics as they do not often lead to death.

A study of morbidity in addition to mortality provides a much more comprehensive picture of the health scene than the study of mortality alone.
3.2 Sources of morbidity statistics in Mauritius and their limitations The main sources of morbidity statistics in Mauritius are, as in many other countries, hospital in-patient data and records of first attendances at dispensaries.

Another important source is the notification of communicable diseases to the sanitary authorities.

Other sources are from the school health services, occupational health unit, epidemiological surveillance, HIV/AIDS Unit, etc.
The main weaknesses of morbidity statistics are comparability over time as diagnostic means improve (e.g laboratories, X-ray facilities, high tech equipment).

In spite of these difficulties, valuable information on the evolution of morbidity patterns can be gathered from an examination of data from the sources mentioned above.

It should be noted that the distribution of out-patient attendances by cause is not available.
In 2000, a total of 204,673 cases was treated as in-patients in government hospitals and 27,131 in private clinics.

The corresponding figures for 1990 were 141,710 and 16,986 respectively.

First attendances at dispensary service points, can also give an indication on the patient morbidity situation.

3.3 Morbidity patterns (Island of Mauritius) The principal causes of general hospitals discharges for the years 1990 and 2000 are given in Table 3.1.
A large percentage (17.0%) of cases was due to complications of pregnancy, childbirth, and the puerperium.

The percentages for the diseases of the circulatory, genitourinary, respiratory and digestive systems were 9.2%, 7.3%, 6.9% and 6.8% respectively.

The group “ Injury and poisoning” represented some 11% of the discharges.

Women who delivered normally constituted 6.6% of all cases treated as in-patients in government general hospitals in 2000.
Some 1.3% of all cases were for complications of abortion and a further 9.1% for other complications of pregnancy, childbirth and the puerperium so that in all, about one sixth of all cases treated in general hospitals were in connection with pregnancy, childbirth and the puerperium.
“Heart diseases” (excluding “Hypertensive diseases”, “Acute rheumatic fever” and “Diseases of pulmonary circulation”) were responsible for 4.2% of cases treated, while “bronchitis (chronic and unspecified), emphysema and asthma” were responsible for 2.6%.

Table 3.2 gives further details.
36 Census 2000 - Health and Quality of life, Morbidity and mortality Table 3.1 - General hospital discharges (including deaths) by I.C.D.1/ Chapter - 1990 & 2000 Island of Mauritius ICD Chapter (1975 Revision) 1 Infectious and Parasitic diseases 2 Neoplasms 1990 2000 Number % Number % 4,385 4.0 7,310 4.2 1,386 1.3 3,780 2.2 3 Endocrine, nutritional and metabolic diseases, and immunity disorders 3,957 3.6 7,194 4.1 4 Diseases of the blood and blood-forming organs 938 0.9 1,379 0.8 5 Mental disorders 1,562 1.4 4,713 2.7 6 Diseases of the nervous system and sense organs 1,571 1.4 1,934 1.1 7 Diseases of the circulatory system 8 Diseases of the respiratory system 9 Diseases of the digestive system 10 Diseases of the genitourinary system 10,279 9.4 16,028 9.2 7,298 6.7 12,021 6.9 8,370 7.6 11,768 6.8 6,779 6.2 12,718 7.3 11 Complications of pregnancy, childbirth and the puerperium 24,616 22.5 29,565 17.0 12 Diseases of the skin and subcutaneous tissue 3,640 3.3 5,934 3.4 13 Diseases of the Muskeletal system and connective tissue 3,727 3.4 7,838 4.5 14 Congenital anomalies 302 0.3 751 0.4 15 Certain conditions originating in the perinatal period 2,963 2.7 4,080 2.4 16 Symptoms, signs and ill-defined conditions 13,268 12.1 27,520 15.9 17 Injury and poisoning 14,392 13.2 19,018 11.0 Total 109,433 100.0 173,551 100.0 1/ International Statistical Classification of Diseases, Injuries and Cause of Death, Revision of 1975 Census 2000 - Health and Quality of life, Morbidity and mortality 37 Table 3.2 - Principal causes of general hospital discharges(including deaths) by sex - 2000 Island of Mauritius Cause (I.C.D.
1975 Revision) Male No.

Female No.

Both Sexes No.

% 1.

Complications of pregnancy, childbirth, and the puerperium 2.

Delivery without mention of complications 3.

Heart diseases 1/ 4.

Abdominal pain 5.

Ill-defined intestinal infections (colitis, enteritis, gastro- enteritis, diarrhoea) 6.

Diabetes mellitus 7.

Acute respiratory infections (excluding pneumonia and influenza) 8.

Hypertensive disease 9.


Bronchitis (chronic and unspecified), emphysema and asthma Intracranial and internal injuries, including nerves 10.

Ankylosing spondylitis and other dorsopathies 11.

Gastritis and duodenitis 12.

Fractures 13.

Cellulitis and abscess 14.

15.

Chest pain 16.

Rheumatism, excluding the back 17.

Alcohol dependence syndrome 18.

Noninflammatory disorders of vagina 19.

Poisonings and toxic effects 20.

Abortion 21.

Malaise and fatigue 22.

Cerebrovascular disease 23.


Pyrexia of unknown origin 24.

Nausea and vomiting 25.

Nephritis, nephrotic syndrome and nephrosis 26.

Convulsions 27.

Dyspnoea and respiratory abnormalities 28.

Open wound and injury to blood vessels 29.

Renal colic 30.

Gastrointestinal haemorrhage 31.

Diseases of male genital organs 32.

Anaemias 33.

Benign neoplasm of uterus 34.

Hypoglycaemia 35.

Hernia of abdominal cavity 36.
Urinary tract infection, site not specified 37 Appendicitis 38 Epilepsy 39 Haemorrhoids 40 Nondependent abuse of alcohol 41 Burns All other causes TOTAL - - 3,651 3,461 3,250 2,527 2,496 1,810 2,233 2,516 2,371 2,589 1,955 2,087 1,549 1,358 2,394 - 1,140 - 967 1,240 1,108 916 1,025 1,233 887 1,215 1,020 1,011 1,228 378 - - 1/ excluding "Hypertensive disease", "Acute rheumatic fever" and "Diseases of pulmonary circulation" Note: The above table is based on data received on in-patients from the regional and district hospitals.
38 Census 2000 - Health & Quality of life, Morbidity and Mortality Statistics by cause of attendance are not available for those attending out-patient departments of hospitals, but are available only for Area Health Centres, Community Health Centres and mobile dispensaries.

These statistics provide a fairly good picture of the morbidity situation characterising the first contact of the public with the health system.

Table 3.3 reveals that influenza topped the list with 22.4% of first attendances in 2000.
In second place was superficial injury, contusion and crushing with intact skin surface, with 5.7%.

In third place was abdominal pain and colic with 5.4%, followed by gastritis and duodenitis with 5.3% and symptoms involving head and neck with 4.3%.
Census 2000 - Health and Quality of life, Morbidity and mortality 39 Table 3.3 - Principal causes of first attendances1/ for the treatment of common diseases and injuries at mediclinics, area health centres, community health centres and mobile dispensaries - 2000 (excluding area and community health centres functioning as the unsorted out-patient department of a hospital) Island of Mauritius Cause (I.C.D.

1975 Revision) Male Female B.Sexes No.

First attendances 1.

2.


Influenza Superficial injury, contusion and crushing with intact skin surface 3.

Abdominal pain and colic 4.

Gastritis and duodenitis 5.

Symptoms involving head and neck 6.

Infectious colitis, enteritis, gastro-enteritis, diarrhoea 7.

Laceration and open wound 8.

Diseases of the eye and adnexa 9.

Diseases of the ear and mastoid process 10.

Pyrexia of unknown origin 11.

Symptoms involving respiratory system and other chest symptoms 12.
Chronic diseases of tonsils and adenoids 13.

Hypertensive disease 14.

Rheumatism, excluding the back 15.

Diseases due to helminths 16.

Diabetes mellitus 17.

Acute bronchitis and bronchiolitis 18.

Fractures, dislocations, sprains and strains 19.

Scabies 20.

Chronic bronchitis, emphysema and asthma 21.

Avitaminoses and other nutritional deficiency 22.

Anaemias 23.

Symptoms involving urinary system 24.

Arthropathies and related disorders 25.
Ankylosing spondylitis and other dorsopathies All other causes 112,076 135,054 247,130 TOTAL 581,165 622,412 1,203,577 1/ Excluding attendances after normal working hours at certain health centres % 22.4 5.7 5.4 5.3 4.3 4.1 3.7 3.5 2.4 2.1 2.0 2.0 1.8 1.7 1.5 1.5 1.4 1.4 1.4 1.3 1.2 1.0 1.0 0.8 0.7 20.5 100.0 40 Census 2000 - Health & Quality of life, Morbidity and Mortality 3.4 Morbidity in Rodrigues In 2000, the number of discharges at Queen Elizabeth Hospital, Mont Lubin and La Ferme Health Centres was 9,145 (Table 3.4).
The main causes of discharges were “complications of pregnancy, childbirth and the puerperium” (14.3%), “acute respiratory infections” (4.9%), “abdominal pain” (4.1%), “bronchitis-chronic and unspecified, emphysema and asthma” (4.0%), “hypertensive disease” (3.8%), “diabetes infections (colitis,enteritis,gastro-enteritis, diarrhoea)” (3.7%).
“ill-defined intestinal mellitus” (3.7%) and In the same year, the principal causes of first attendances at area and community health centres which numbered 16,021 (Table 3.5) were “symptoms involving respiratory system and other chest diseases” (5.9%), “influenza” (5.8%), “abdominal pain and colic” (5.4%), “symptoms involving head and neck” (4.9%), ”gastritis and duodenitis” (4.4%), and “ill-defined intestinal infections - colitis, enteritis, gastro- enteritis, diarrhoea” (3.9%).
Scabies were responsible for 1.2% of first attendances compared to about 9.5% in 1990 when scabies was the principal cause for first attendances.

This is an indication that environmental hygiene and sanitation have improved during the past decade.

Census 2000 - Health and Quality of life, Morbidity and mortality 41 Table 3.4 - Principal causes of discharges from hospital and heath centres - 2000 Island of Rodrigues C ause I.C.D.1975 revision 1.
Complications of pregnancy, childbirth and the puerperium Ill-defined intestinal infections (colitis, enteritis, gastro- enteritis, diarrhoea) 2.

3.

Bronchitis (chronic and unspecified), emphysema, and asthma 4.

Acute respiratory infections 5.

Delivery without mention of complications 6.

Hypertensive disease 7.

Diabetes mellitus 8.

Abdominal pain 9.

Heart diseases 1/ 10.

Non-inflammatory disorders of vagina 11.

Cellulitis and abscess 12.

Pyrexia of unknown origin 13.

Gastritis and duodenitis 14.


Nausea and vomiting 15.

Convulsions 16.

Poisonings and toxic effects 17.

Rheumatism, excluding the back 18.

Fractures 19.

Appendicitis 19.

Ankylosing spondylitis and other dorsopathies 21.

Superficial injury 22.

Dyspnoea and respiratory abnormalities 23.

Malaise and fatigue 24.

Symptoms involving urinary system 25.

Cerebrovascular disease 26.

Symptoms involving head and neck 27.

Chest pain 28.

Epilepsy 29.

Non-dependent abuse of alcohol 30.


Neurotic disorders 31.

Disorders of eye and adnexa 32.

Anaemias 33.

Open wound and injury to blood vessels 34.

Abortion 35.

Alcohol dependence syndrome 35.

Gastrointestinal haemorrhage 37.

Symptoms involving cardiovascular system 38.

39.

Gout 40.
39.

Gout 40.

Alcoholic psychoses All other causes Inflammatory disease of breast T otal Discharges Male Female - 1,308 152 196 228 - 131 96 210 90 - 121 83 99 94 99 61 98 85 38 74 87 81 47 44 19 59 44 65 38 19 33 10 25 - 23 28 10 - Total No.
% 1/ excluding "Acute rheumatic fever", "Hypertensive disease" and "Diseases of pulmonary circulation" 42 Census 2000 - Health and Quality of life, Morbidity and mortality Table 3.5 - Principal causes of first attendances at community health centres for the treatment of common diseases and injuries - 2000 Island of Rodrigues Cause I.C.D.1975 Revision First attendances Male Female B.sexes No.
% 1.

Symptoms involving respiratory system and other chest diseases 2.

Influenza 3.

Gastritis and duodenitis 4.

Abdominal pain and colic 5.

Symptoms involving head and neck 6.

7.

Superficial injury, contusion and crushing with intact skin surface Ill-defined intestinal infections (colitis, enteritis, gastro-enteritis, diarrhoea) 8.

Diseases due to helminths 9.

Bronchitis (chronic and unspecified), emphysema, and asthma 10.

Pyrexia of unknown origin 11.

Diseases of the eye and adnexa 12.


Laceration and open wound 13.

Chronic diseases of tonsils and adenoids 14.

Diseases of the ear and mastoid process 15.

Acute bronchitis and bronchiolitis 16.

Scabies 17.

Avitaminoses & other nutritional deficiency 18.

Anaemias 19.

Rheumatism, excluding the back 20.

Symptoms involving urinary system 21.

Fractures, dislocations, sprains and strains 22.

Diseases of teeth and supporting structures 23.

Arthropathies and related disorders 24.


Hypertensive disease 25.

Ankylosing spondylitis and other dorsopathies 26.

Symptoms involving heart 27.

Diabetes mellitus 28.
Burn All other causes Total Census 2000 - Health & Quality of life, Morbidity and Mortality 43 3.5 Incidence of cancer (Island of Mauritius ) Figures relating to the incidence of cancer, that is new cases diagnosed, in the Island of Mauritius, obtained from the National Cancer Registry are given in Tables 3.6 and 3.7 for the periods 1989 to 1996 and 1997 to 1998 respectively.
From 1989 to 1996, there were 7,442 new cases of cancer, that is an annual average of 930.

About 41.6% were males.

For the period 1997 to 1998, 2,484 new cases were diagnosed, that is an annual average of 1,242.

The percentage of males was 46.2%.

The 33.5% increase in the annual average figure should be interpreted with care, as it could be a result of an improvement in the registration system.
The most common types of cancer among males were that of the haematopoietic system, that is, bone marrow, lymph nodes etc.

The proportion of that type of cancer increased from 6.0% in the 1989-1996 period to 9.4% in the 1997-1998 period.

During the same period, cancer of the stomach decreased slightly from 8.6% to 8.4%, that of the trachea, bronchus and lung from 12.1% to 8.4% while that of the prostate gland increased from 6.5% to 7.8%.
Among females, the most common types of cancer were that of the breast.

The percentage which was 25.0% in the 1989-1996 period decreased slightly to 24.7% in the 1997-1998 period.

During the same period, that of the cervix uteri decreased from 19.7% to 14.2%, that of the ovary from 5.6% to 5.0% while that of the haematopoietic system increased from 3.3% to 4.8%.
44 Census 2000 - Health and Quality of life, Morbidity and mortality Table 3.6 - Incidence of cancer in the Island of Mauritius, period 1989-1996 Site of tumour (I.C.D.
- Oncology 1975 Revision) Male Female B.Sexes No % No % No % Hypopharynx, oropharynx and nasopharynx Base of tongue Major salivary glands Floor of mouth Other & ill-defined sites of lip, oral cavity and pharynx Total lip, oral cavity and pharynx Stomach Recto-sigmoid junction and anus Oesophagus Colon Gall bladder Liver and intra-hepatic bile ducts Pancreas Other & ill-defined sites of digestive organs Total digestive organs Trachea, bronchus and lung Larynx Other & ill-defined sites of respiratory system Total respiratory system Total bones, joints and articular cartilage Total haematopoietic system Total skin Total connective, subcutaneous& soft tissues Total breast Cervix uteri Ovary Corpus uteri Vagina and vulva Other & ill-defined sites of female genital organs Total female genital organs Prostate gland Penis Testis Total male genital organs Bladder Kidney, pelvis and ureter Total urinary tract Brain Eye and adnexa Meninges, spinal cord and other sites of central nervous system Total eye, brain & other sites of central nervous system Thyroid gland Other endocrine glands Total endocrine glands Total lymph nodes All other sites - - - - - - - - - - - - - 1.5 - 1.2 - 9.1 - 5.9 1.3 7.2 3.1 0.6 0.8 4.5 0.3 0.7 1.0 69 26 95 95 6 29 130 48 22 70 3.2 10.1 81 310 - - - - Grand total 3,095 100.0 4,347 100.0 7,442 100.0 Census 2000 - Health and Quality of life, Morbidity and mortality 45 Table 3.7 - Incidence of cancer in the Island of Mauritius, period 1997-1998 Site of tumour (I.C.D.
- Oncology 1975 Revision) Male Female B.Sexes No % No % No % Hypopharynx, oropharynx and nasopharynx Base of tongue Major salivary glands Floor of mouth Other & ill-defined sites of lip, oral cavity and pharynx Total lip, oral cavity and pharynx Stomach Recto-sigmoid junction and anus Oesophagus Colon Gall bladder Liver and intra-hepatic bile ducts Pancreas Other & ill-defined sites of digestive organs Total digestive organs Trachea, bronchus and lung Larynx Other & ill-defined sites of respiratory system Total respiratory system Total bones, joints and articular cartilage Total haematopoietic system Total skin Total connective, subcutaneous& soft tissues Total breast Cervix uteri Ovary Corpus uteri Vagina and vulva Other & ill-defined sites of female genital organs Total female genital organs Prostate gland Penis Testis Total male genital organs Bladder Kidney, pelvis and ureter Total urinary tract Brain Eye and adnexa Meninges, spinal cord and other sites of central nervous system Total eye, brain & other sites of central nervous system Thyroid gland Other endocrine glands Total endocrine glands Total lymph nodes All other sites - - 9 0.8 - - - - - - - - - - - - - 0.9 - 0.6 - 9.3 - 3.8 1.7 5.5 3.0 0.2 - - - - - 1.3 1.1 2.5 2.2 - Grand total 1,148 100.0 1,336 100.0 2,484 100.0 46 Census 2000 - Health & Quality of life, Morbidity and Mortality 3.6 HIV / AIDS cases The first case of AIDS in the Republic of Mauritius was notified in 1987.
By the end of 2000, 287 cases of HIV/AIDS of whom 221 (145 males and 76 females) were Mauritians, were registered by the Ministry of Health & Quality of Life.

Out of the 221 Mauritians, 64 passed away leaving a presumable number of 157 living with the virus at the end of 2000.

Among the infected Mauritians, about 70% of the 221 infected Mauritians were heterosexuals; 17% were heterosexual/intravenous drug users and about 3% were babies born of infected mothers.

64 of them have passed away.


In 2000, a total of 54,601 HIV tests was carried out and 57 (50 Mauritians and seven foreigners) were found to be positive.

The number of new cases among Mauritians increased by 78.6% from 28 in 1999 to 50 in 2000.

These new cases of HIV were found mostly among persons of high-risk groups, including inmates of prisons.
Figure 3.1 - HIV/AIDS cases registered among Mauritians during period 1987-2000 r e b m u N Year Figure 3.2 - HIV/AIDS cases registered among Mauritians during period 1987-2000, by mode of transmission Othe r a nd unde te rm ine d M o the r to c hild tra ns m is s io n Ho m o s e xua l/bis e xu a l Intra ve no us drug us e r He te ro s e xua l / Intra ve no us drug us e r He te ro s e xua l Census 2000 - Health and Quality of life, Morbidity and mortality 47 Table 3.8 - Statistics relating to notification of HIV/AIDS cases and death during period 1987-2000 Period 1987-1994 1995 1996 1997 1998 1999 2000 Mauritian Both Male Female Sexes New cases of HIV/AIDS notified Non-Mauritian Total Deaths registered among HIV/AIDS cases (Mauritian) Male Female Both Sexes Both Male Female Sexes Both Male Female Sexes 43 13 9 19 13 16 32 17 7 7 5 10 12 18 60 20 16 24 23 28 50 24 7 5 3 5 5 3 6 - 2 1 1 - Total 145 76 221 52 14 66 197 90 287 48 16 64 Table 3.9 - Statistics relating to HIV tests carried out during period 1987-2000 1987 to 1997 No.
of tests 1998 1999 2000 No.

of tests Positive cases Rate per 100 No.

No.

of tests Positive cases Rate per 100 No.


Blood donors - Island of Mauritius 167,740 22,497 25,536 2 0.01 27,885 3 0.01 Blood donors - Island of Rodrigues 2,165 536 500 - - 500 - - Persons of high risk groups 21,787 3,325 3,737 23 0.62 4,218 28 0.66 Migrant workers (incoming foreigners) - Request for visa purposes (outgoing Mauritians) 4,129 - - - 31 Cardiac and renal patients undergoing surgery and their blood donors 5,696 1,647 2,024 - - - - 1,777 - 38 - 2,184 - - - - - - Screening on target groups (incl.
prison inmates) 24,746 4,426 4,485 6 0.13 3,319 20 0.60 Voluntary testing 520 170 195 - - 334 - - Antenatal cases screened ( Island of Mauritius) - 6,099 11,736 2 0.02 13,454 6 0.04 Antenatal cases screened ( Island of Rodrigues) - 1,000 1,243 - - 892 - - Total Tests 226,783 39,700 49,487 33 0.07 54,601 57 0.10 48 Census 2000 - Health & Quality of life, Morbidity and Mortality Chapter 4 - Mortality 4.1 Introduction Mortality plays an important role in demography being one of the three factors of population change.
In Mauritius, mortality statistics are usually obtained from the system of registration of vital events.

Indicators derived from mortality statistics are essential tools for monitoring the health status of the population.

This chapter analyses the evolution in the level and pattern of mortality over time as well as differentials that exist due to demographic factors.
4.2 Trends in mortality level Table 4.1 shows the evolution in the level of mortality as measured by the crude death rate (CDR) and the infant mortality rate (IMR).

The crude death rate is defined as the number of deaths in a year per 1000 mid-year population while the infant mortality rate is defined as the number of infant deaths (aged less than one year) in a year per 1,000 live births.
The figures indicate a fall in the crude death rate from around 15 in the 1950's to around 7 in the 1980's for both the Republic of Mauritius and the Island of Mauritius.

Thereafter, the rates oscillate at that level.

In the Island of Rodrigues, the crude death rate fell from around 11 in the 50's to around 5 in the late eighties and the level does not vary much since then.
It is to be noted that CDR does not take into account the age structure of the population and therefore it may not be appropriate to compare the rate for Mauritius with that of Rodrigues.

The infant mortality rate fell from around 80 in the early 50's to around 16 in 2000 in the Republic of Mauritius and the Island of Mauritius, and from around 110 to around 20 in the island of Rodrigues during the same period.
The general declining trend in mortality level over time is an indicator of improvement in the health status of the population.
Census 2000 - Health & Quality of life, Morbidity and Mortality 49 Table 4.1 - Crude death rate and infant mortality rate, 1951 - 2000 Year 1951-1955 1956-1960 1961-1965 1966- Republic of Mauritius CDR IMR Island of Mauritius CDR IMR Island of Rodrigues CDR IMR Differentials by age and sex Figure 4.1 shows that mortality varies with age, being relatively high during infancy, falls to a minimum at age 5-9 and thereafter increases with age.
As shown in table 4.2, the incidence of mortality is lower among females than among males at all ages.

As a result, females tend to live longer than males.
50 Census 2000 - Health and quality of life, Morbidity and mortality Figure 4.1 - Male and female death rates, Republic of Mauritius -2000 1000.0 100.0 ) 0 0 0 1 r e p ( e t a R 10.0 1.0 0.1 Male Female 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age (years) Census 2000 - Health & Quality of life, Morbidity and Mortality 51 Table 4.2 - Death rates(per 1000) by age group and sex, Republic of Mauritius and Island of Rodrigues - 1990 & 2000 Age Group 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ All Ages Republic of Mauritius 2000 1990 Island of Rodrigues 1990 2000 Male Female Male Female Male Female Male Female Comparison of the age and sex - specific death rates for 1990 with 2000 indicate significant improvements at almost all ages except for the age bracket 5-29 years among males, and age brackets 25-29 and 50-59 among females where either little improvement, no improvement or even deterioration in mortality was registered.
For the Island of Rodrigues, due to the small size of its population and the small number of deaths occurring in a year, the age-specific death rates tend to fluctuate with the various age groups.

Yet, the figures indicate an improvement in mortality at almost all ages except for the ages 25-34 among males and 20-34 among females where a deterioration is observed.

4.4 Deaths by cause Cause specific death rates by 100,000 mid-year population for the year 1990 and 2000 are given in table 4.3.
The causes of deaths have been categorised according to the " International Statistical Classification of Diseases, Injuries and Causes of death" (ICD-9) of the World Health Organisation.

"Diseases of the circulatory system" was the leading cause of death in the Republic in 2000 as in 1990, followed by "neoplasms" and "diseases of the respiratory system".
When analysed by sex, death due to "diseases of the respiratory system", "diseases of the digestive system" and "injury and poisoning" appear to be siginficantly higher among males with rates of 77.7, 56.8 and 65.6 respectively against 47.1, 16.2 and 19.4 among females.

Death rates by group cause in Rodrigues follow roughly the same pattern as in the Republic.
Table 4.3 - Cause specific death rates by sex, Republic of Mauritius and Island of Rodrigues - 1990 & 2000 Group Cause I II III Infectious and parasitic diseases Neoplasms Endocrine nutritional and metabolic diseases and immunity disorders IV Diseases of the blood and blood forming organs V Mental disorders VI Diseases of the nervous system and sense organs VII Diseases of the circulatory system VIII Diseases of the respiratory system IX Diseases of the digestive system X XI Diseases of the genito urinary system Complictaions of pregnancy, childbirth and the puerperium XII Diseases of the skin and subcutaneous tissue XIII Diseases of the musculoskeletal system and connective tissue XIV Congenital anomalies XV Certain conditions originating in the perinatal period XVI Symptoms, signs and illdefined conditions XVII Injury and poisoning Republic of Mauritius 1990 2000 Island of Rodrigues 1990 2000 Male Female Male Female Male Female Male Female All Causes 773.4 554.9 763.2 583.5 636.1 517.9 525.4 459.1 5 2 C e n s u s 2 0 0 0 - H e a l t h a n d q u a l i t y o f l i f e , M o r b i d i t y a n d m o r t a l i t y Census 2000 - Health & Quality of life, Morbidity and Mortality 53 An analysis of deaths at a lower level of disaggregation gives further insight about the specific diseases responsible for high death tolls.
Table 4.4 shows that the main cause of death is the heart disease.

This does not however imply that a high percentage of the population suffer from heart diseases.

In fact, the mortality pattern of a country does not necessarily reflect the morbid conditions of its people.

For instance, only 4.2% of all admissions in government general hospitals were due to heart diseases in 2000.

The percentage of deaths due to diabetes mellitus and hypertensive diseases decreased during the last decade.
This trend could be partly due to the aggressive campaigns made by the Ministry of Health & Quality of Life against these diseases.

Futhermore, with the implementation of the non-communicable disease (NCD) screening programme, the percentage of deaths due to such diseases is expected to further decrease during the coming years.
It is also observed that the percentage of deaths due to certain diseases of the respiratory system such as pneumonia and bronchitis (chronic and unspecified), emphysema and asthma has decreased from 1990 to 2000.
Table 4.4 - Selected principal causes of deaths1/ - Island of Mauritius - 1990 & 2000 Diseases 1990 2000 Heart diseases 2/ Cerebrovascular diseases Diabetes Mellitus Nephritis, nephrotic syndrome and nephrosis Pneumonia Cirrhosis of liver, liver abcess, chronic liver idseases and its sequelae Bronchitis (chronic & unspecified), emphysema and asthma Hypertensive diseases Senility without mention of psychosis Septicaemia 1/ expressed as percentage over total deaths 2/ excluding "Acute rheumatic fever", "Hypertensive diseases" and " Diseases of the pulmonary circulation" 23.4 13.1 5.1 3.2 3.5 2.3 3.4 3.9 3.0 1.0 29.8 16.2 4.6 3.1 2.9 2.9 2.7 2.5 1.8 1.1 4.5 Death rates due to diseases of the circulatory system by age and sex Diseases of the circulatory system are responsible for around 50% of all deaths in Mauritius.
It would thus be enlightening to study the age profile of those who have died from these diseases.

Table 4.5 gives the number of deaths as well as the death rates by age group due to these diseases.

One of the salient features observed is that the death rate increases rapidly with age for both males and females to attain a high level for the population aged 60 years and above.
54 Census 2000 - Health & Quality of life, Morbidity and Mortality Table 4.5 - Deaths and death rates by sex due to diseases of the circulatory system, Republic of Mauritius - 1990 & 2000 (a) Male Age group under 30 30-34 35-39 40-44 45-49 50-54 55-59 60+ (a) Female Age group under 30 30-34 35-39 40-44 45-49 50-54 55-59 60+ Deaths 1990 2000 Rates per 1,000 pop.


 Infant mortality Infant mortality rate (IMR) is defined as the number of deaths in a year of babies aged under one year per 1,000 live births registered in that year.
It is often used as an indicator of the level of development of a country.

There has been a 30% decline in the number of infant deaths from 462 in 1990 to 322 in 2000 with the IMR falling from 20.4 to 15.9.

This drastic fall in IMR can be attributed to the coming into operation of the Neonatal Intensive Care Service in May 1999.
This new service initially located at Victoria hospital and later extended to the Sir Seewoosagur Ramgoolam National Hospital, gives specialised treatment to newly born babies with complications after birth.
Census 2000 - Health & Quality of life, Morbidity and Mortality 55 Figure 4.2 - Infant mortality rates, selected years Republic of Mauritius 70 60 50 40 30 20 10 0 1970 1975 1980 1985 1990 1995 2000 Year NB: Rates per 1,000 live births In 2000, out of the 322 infant deaths registered in the Republic of Mauritius, 182(56.5%) and 73(22.7%) were early and late neonatal deaths respectively.

In other words, 79.2% of infant deaths actually occurred under the age of one month.
Since infant death is generally concentrated at the first days and weeks of life, an analysis of mortality rates at these ages would be useful.

Early neo-natal mortality rate (death rates for children aged 0-6 days) in fact fell from 13.8 in 1990 to 9.0 in 2000 while neonatal mortality rate (death rates for children aged 0-27 days) fell from 15.4 to 12.6 during the same period.

These are clear indications that there has been significant improvement in mortality especially at the early days of life.
In fact, figures from the Neonatal Intensive Care Service indicate that 307 newborns admitted for treatment in 2000, only 119 (38.8%) have died.

Most of the admissions were due to " disorders related to length of gestation and fetal growth" (41.4%) and " respiratory and cardiovascular disorders specific to the perinatal period" (34.2%).

(table 4.6).
(table 4.6).

56 Census 2000 - Health and quality of life, Morbidity and mortality Table 4.6 - Newborns treated (as in-patients) at the Neonatal Intensive Care Unit 1/ - Year 2000 (The figures given below are included in all tables pertaining to discharges from government general hospitals ) Number of cases of whom passed away Male Female B.Sexes Male Female B.Sexes Fetus and newborn affected by maternal factors and by complications of pregnancy, labour and delivery.
Disorders related to length of gestation and fetal growth.

Respiratory and cardiovasvular disorders specific to the perinatal period .

Infections specific to the perinatal period.

Haemorrhagic and haematological disorders of fetus and newborn.

Transitory endocrine and metabolic disorders specific to fetus and newborn.

Digestive system disorders of fetus and newborn.

6 76 61 19 1 1 7 Other disorders originating in the perinatal period.

- 3 4 - 1 1 3 - - Congenital malformations of the nervous system.
Congenital malformations of the circulatory system.

Congenital malformations of the respiratory system.

Congenital malformations of the digestive system.

Congenital malformations of the urinary system.

Congenital malformations and deformations of the musculoskeletal system.

Other congenital malformations .
Other causes Total of whom birthweight were less that 2.5 kg 1/ located in the complex of Victoria Hospital 2 51 44 7 - 1 3 1 - 5 1 2 1 2 2 2 127 105 26 1 2 10 1 3 9 1 3 2 5 2 2 8 2 - 31 21 10 19 11 4 2 50 32 14 2 2 2 2 1 119 87 - - - 1 1 - - 1 1 3 1 - 4 1 2 1 3 5 - - - 1 1 2 1 1 - 2 1 45 33 - - 183 133 124 93 307 226 74 54 Census 2000 - Health & Quality of life, Morbidity and Mortality 57 Table 4.7 - Principal causes of infant deaths, Republic of Mauritius - 1990 & 2000 Cause of infant deaths Number % Number % 1990 2000 Hypoxia, birth asphyxia and other respiratory conditions Slow foetal growth, foetal malnutrition and immaturity Congenital anomalies Septicaemia and infections specific to the perinatal period Ill-defined intestinal infections (colitis, enteritis, gastro-enteritis, diarrhoea) Pneumonia Meningitis Bronchitis and bronchiolitis Asthma Perinatal Jaundice All other causes Total 462 100.0 322 100.0 The principal causes of infant deaths are "slow foetal deaths, foetal malnutrition and immaturity" causing more than one third of all infant deaths followed by "hypoxia, birth asphyxia and other respiratory conditions of newborn" (22.1%) and "Congenital anomalies" (17.4%).
It is also observed that there has been significant reduction in infant deaths due to all causes listed in the table 4.7 except for congenital anomalies with an increasing death toll of 56 in 2000 from 50 in 1990.

4.7 Child mortality Table 4.8 shows the evolution of child mortality rate since the 50's.

Significant improvement has been achieved over time and the current rate is relatively low.
Table 4.8 - Child mortality rate1/, 1952-2000 Year 1952 1962 1972 1983 1990 2000 Republic of Mauritius Island of Mauritius Island of Rodrigues 13.6 6.8 6.8 1.5 0.8 0.6 13.7 6.6 6.4 1.4 0.7 0.6 21.9 19.8 12.8 5.3 1.5 1.5 1/ Defined as the number of deaths to children aged 1-4 years in a calendar year per 1,000 mid-year population of that age group 58 Census 2000 - Health & Quality of life, Morbidity and Mortality The table 4.9 shows that the leading cause of child death in 2000 is "injury and poisoning" responsible for 28.3% of child deaths followed by "congenital" anomalies (13.1%).
A compararison of 1990 with 2000 figures indicates an increase in the number of deaths due to "injury and poisoning" and a decrease in the number of deaths due to "ill-defined intestinal infections".
Table 4.9 - Principal causes of child deaths, Republic of Mauritius - 1990 & 2000 Causes of child deaths Number % Number % Congenital anomalies 11 18.6 6 13.1 1990 2000 Ill-defined intestinal infections (colitis, enteritis, gastro-enteritis, diarrhoea) Injury and poisoning Neoplasms Pneumonia Septicaemia All other causes 11 7 7 6 4 13 18.6 11.9 11.9 10.2 6.8 22.0 2 13 5 2 2 4.3 28.3 10.9 4.3 4.3 16 34.8 Total 59 100.0 46 100.0 4.8 Maternal mortality There has been significant fall in maternal mortality during the past decades.
The maternal mortality rate defined as the number of deaths due to "pregnancy, childbirth and the puerperium" per 10,000 live births during that year, fell from 17.7 in 1972 to 2.0 in 2000.

The rate is however still higher than those prevailing in developed countries (e.g.

around 0.7 in the United States of America).


Table 4.10 - Maternal mortality rate, Republic of Mauritius, 1972-2000 Year Rate 1972 1983 1990 2000 17.7 5.2 6.6 2.0 4.9 Old age mortality Around 60% of deaths in 2000 occurred to elderly people (aged 60 years and over).

Table 4.11 shows that around 60% of the deaths among the elderly in 2000 were due to "diseases of the circulatory system" compared to around 50% in 1990.
The second most common cause of deaths among the elderly was the "diseases of the respiratory system" responsible for around 11% of deaths followed by "neoplasms" (9%).

Analysis of the 2000 figures by sex indicate that deaths due to "diseases of the circulatory system" were higher among females (around 62%) compared to males (around 57%).

In contrast, deaths due to "diseases of the respiratory system" were higher among males (12%) compared to females (8%) and similarly with "neoplasms' ( 10% against 9%).
Table 4.11 - Deaths by cause among deceased aged 60 years and above, Republic of Mauritius - 1990 & 2000 Group Cause 1990 2000 I II III Infectious and parasitic diseases Neoplasms Endocrine nutritional and metabolic diseases and immunity disorders IV Diseases of the blood and blood forming organs V Mental disorders VI Diseases of the nervous system and sense organs VII Diseases of the circulatory system VIII Diseases of the respiratory system IX Diseases of the digestive system X XI Diseases of the genito urinary system Complictaions of pregnancy, childbirth and the puerperium XII Diseases of the skin and subcutaneous tissue XIII Diseases of the musculoskeletal system and connective tissue XIV Congenital anomalies XV Certain conditions originating in the perinatal period XVI Symptoms, signs and illdefined conditions XVII Injury and poisoning Male 48 197 Female 38 204 122 28 22 13 1,117 270 74 85 - - - - 149 20 3 8 997 212 50 55 - 2 1 1 Both Sexes 86 401 271 48 25 21 2,114 482 124 140 - 2 1 1 Male 26 248 Female 42 222 110 5 7 12 1,467 322 122 91 - 2 2 - 152 17 2 13 1,562 213 55 73 - 1 5 - - 141 25 Both Sexes 68 470 262 22 9 25 3,029 535 177 164 - 3 7 - - 273 67 - 226 53 - 253 32 - 479 85 - 132 42 All Causes 2,255 2,025 4,280 2,588 2,523 5,111 C e n s u s 2 0 0 0 - H e a l t h a n d q u a l i t y o f l i f e , M o r b i d i t y a n d m o r t a l i t y 5 9 60 Census 2000 - Health & Quality of life, Morbidity and Mortality 4.10 Life table mortality measures The mortality data obtained from vital statistics and the census data being of good quality permit the construction of reliable life tables.
Life tables for the Republic of Mauritius and the island of Rodrigues are given in tables 4.12 to 4.14.

A life table gives a summary of the current level and pattern of mortality of a country.

The life expectancy at birth is an important measure of the level of mortality obtained from the life table.

This measure, unlike the crude death rate, is comparable across countries as it is more robust against changing population age structure.
Table 4.12 - Abridged Life Table by sex - Republic of Mauritius, 1999 - 2001 Male 1/ Age m(x) q(x) l(x) d(x) L(x) T(x) e(x) Survival ratio Mortality 5/ 23 2 / 0 0.01969 0.01840 100,000 1,840 98,528 6,817,166 68.17 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 1/ Excluding Agalega and St Brandon 2/ Survival ratio from birth to age (0-4) 3/ Survival ratio from age (0-4) to age (5-9) 4/ Survival ratio from age 75+ to age 80+ 5/ From Coale and Guang," New Regional Model Life Tables at High Expectation of Life".
Note: In calculating the life table an average of the deaths registered for the years 1999 -2001 and the 2000 mid year population have been used.
3/ 0.99726 0.99833 0.99742 0.99545 0.99255 0.99077 0.98743 0.97975 0.96843 0.95099 0.92954 0.89511 0.84377 0.78297 0.70515 0.50695 4/ 23 23 23 23 22 21 21 20 20 19 19 19 19 20 22 24 C e n s u s 2 0 0 0 - H e a l t h a n d q u a l i t y o f l i f e , M o r b i d i t y a n d m o r t a l i t y 6 1 Table 4.12 - Abridged Life Table by sex - Republic of Mauritius 1/ ,1999 - 2001 (cont'd) Female Age m(x) L(x) T(x) q(x) d(x) l(x) e(x) Survival Mortality 5 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 0.01355 0.01274 100,000 1,274 98,980 7,530,154 0.00059 0.00231 98,726 228 394,310 7,431,174 2/ 75.30 0.98658 3/ 0.24327
71,978 12,162 329,488 956,993 0.05539 0.24327 59,817 14,552 262,704 627,505 13.30 0.79731 4/ C e n s u s 2 0 0 0 - H e a l t h a n d q u a l i t y o f l i f e , M o r b i d i t y a n d m o r t a l i t y 1/ Excluding Agalega and St Brandon 2/ Survival ratio from birth to age (0-4) 3/ Survival ratio from age (0-4) to age (5-9) 4/ Survival ratio from age 75+ to age 80+ 5/ From Coale and Guang, "New Regional Model Life Tables at High Expectation of Life".
Note: In calculating the life table an average of the deaths registered for the years 1999 -2001 and the 2000 mid year population have been used.
Table 4.13 - Abridged Life Table by sex - Island of Mauritius, 1999 - 2001 Male Age m(x) q(x) l(x) d(x) L(x) T(x) e(x) Survival ratio Mortality level 4/ 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 0.01960 0.01832 100,000 1,832 98,535 6,809,422 1/ 68.09 0.98127 0.00060 0.00234 98,168 229 392,098 6,710,888 68.36 0.99725 2/ 3/ 8.35 0.50603 6.50 5.01 23 23 23 23 23 22 21 21 20 20 19 19 19 19 20 22 24 C e n s u s 2 0 0 0 - H e a l t h a n d Q u a l i t y o f l i f e , M o r b i d i t y a n d M o r t a l i t y 6 3 1/ Survival ratio from birth to age (0-4).
2/ Survival ratio from age (0-4) to age (5-9).

3/ Survival ratio from age 75+ to age 80+.

4/ From Coale and Guang," New Regional Model Life Tables at High Expectation of Life".

Note: In calculating the life table an average of the deaths registered for the years 1999 -2001 and the 2000 mid year population have been used.
Table 4.13 - Abridged Life Table by sex - Island of Mauritius, 1999 - 2001 (cont'd) Female Age m(x) q(x) l(x) d(x) L(x) T(x) e(x) Survival ratio Mortality level 4/ 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ 0.01297 0.01221 100,000 1,221 99,024 7,527,257 75.27 0.00057 0.00224 98,779 222 394,543 7,428,234 75.20 1 / 0.98713 2 / / C e n s u s 2 0 0 0 - H e a l t h a n d Q u a l i t y o f l i f e , M o r b i d i t y a n d M o r t a l i t y 1/ Survival ratio from birth to age (0-4) 2/ Survival ratio from age (0-4) to age (5-9) 3/ Survival ratio from age 75+ to age 80+ 4/ From Coale and Guang," New Regional Model Life Tables at High Expectation of Life".
Note: In calculating the life table an average of the deaths registered for the years 1999 -2001 and the 2000 mid year population have been used.
Table 4.14 - Abridged Life Table by sex - Island of Rodrigues, 1998 - 2002 Male Age 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ m(x) q(x) l(x) d(x) L(x) T(x) e(x) Survival ratio Mortality level 4/ / 0.99560 2 0.99778 0.99790 0.99447 0.99251 0.99062 0.99122 0.99123 0.98332 0.96599 0.94390 0.91772 0.88361 0.82160 0.71044 3 / 0.48804 23 23 23 24 22 22 21 22 23 23 22 22 22 23 23 22 23 1/ Survival ratio from birth to age (0-4) 2/ Survival ratio from age (0-4) to age (5-9) 3/ Survival ratio from age 75+ to age 80+ 4/ From Coale and Guang," New Regional Model Life Tables at High Expectation of Life" Note: In calculating the life table an average of the deaths registered for the years 1998 -2002 and the 2000 mid year population have been used.
C e n u s u s 2 0 0 0 - H e a l t h a n d Q u a l i t y o f l i f e , M o r b i d i t y a n d M o r t a l i t y 6 5 Table 4.14 - Abridged Life Table by sex - Island of Rodrigues, 1998 - 2002 (cont'd) Female Age m(x) q(x) l(x) d(x) L(x) T(x) e(x) Survival ratio Mortality level 4/ 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ / 0.97823 0.99577 2 / 0.99954 0.99913 0.99718 0.99519 0.99513 0.99587 0.99262 0.98592 0.97871 0.97080 0.95002 0.92130 0.87329 0.79978 3 / 0.63027 22 22 24 24 23 22 22 23 23 22 22 23 23 23 23 24 25 1/ Survival ratio from birth to age (0-4) 2/ Survival ratio from age (0-4) to age (5-9) 3/ Survival ratio from age 75+ to age 80+ 4/ From Coale and Guang, "New Regional Model Life Tables at High Expectation of Life" Note: In calculating the life table an average of the deaths registered for the years 1998 -2002 and the 2000 mid year population have been used.
6 6 C e n u s u s 2 0 0 0 - H e a l t h a n d Q u a l i t y o f l i f e , M o r b i d i t y a n d M o r t a l i t y Census 2000 - Health & Quality of life, Morbidity and Mortality 67 4.11 Life expectancy at birth by sex Table 4.15 gives the male and female life expectancy at birth for the census years 1972 onwards.

It shows a continuous increase in life expectancy over time.

The average annual gain, however, has generally decreased over time except for males during the intercensal period 1990-2000.
In fact, the average annual gains for males were 0.31 year in period 1972-83, 0.17 in 1983-1990 and 0.26 in 1990-2000.

For females, the gains for the corresponding periods are 0.53, 0.24 and 0.19 respectively.

A fall over time is generally expected since the scope for improvement becomes less with increasing expectancy of life.

The increase among males during 1990-2000 could be due to the significant improvement in mortality among male adults as seen in figure 4.3.
Table 4.15 - Expectation of life at birth by sex, Republic of Mauritius, 1972-2000 Year 1972 1983 1990 2000 Expectation of life at birth (years) Male Female Difference 61.0 64.4 65.6 68.2 65.9 71.7 73.4 75.3 4.9 7.3 7.8 7.1 Also the gap between male and female life expectancy at birth which is in favour of females has been increasing over the years except for the intercensal period 1990- 2000 when it decreased from 7.8 to 7.1 years.
Figure 4.3 - Evolution of the pattern of mortality by sex between 1990 and 2000 Republic of Mauritius Male Female ) 0 0 0 1 r e p ( e t a r h t a e d 1000 100 10 1 0 0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Age group (years) 1990 2000 ) 0 0 0 1 r e p ( e t a r h t a e d 1000 100 10 1 0 0 1-4 5-9 10- 14 15- 19 20- 24 25- 29 30- 34 35- 39 40- 44 45- 49 50- 54 55- 59 60- 64 65- 69 70- 74 75- 79 80- 84 85+ Age group (years) 1990 2000 6 8 C e n s u s 2 0 0 0 - H e a l t h & Q u a l i t y o f l i f e , M o r b d i i t y a n d M o r t a l i t y Census 2000 - Health & Quality of life, Morbidity and Mortality 69 4.12 Life expectancy at selected ages by sex Table 4.16 gives the life expectancy at various ages for a series of census years starting 1972 while table 4.17 gives the percentage increase in life expectancy at each age during the intercensal years.
The tables show a general increase in life expectancy at all ages for both males and females especially during the last intercensal period.

Table 4.17 however shows that in the intercensal period 1990-2000, the increase in life expectancy has been higher among males than among females when compared age for age.
The figure 4.4 also shows that the gap between the 1990 and 2000 curve tend to widen in the age bracket 25-55 indicating relatively more improvement in mortality among males than among females at these ages.
70 Cenusus 2000 - Health and Quality of life, Morbidity and Mortality Table 4.16 - Life expectancy by age and sex at each census and sex differences in life expectancy Republic of Mauritius, 1972 - 2000 Exact age (years) 0 1 70 75 80 85+ Male Female Female - Male Table 4.17 - Percentage increase in expectation of life by age Republic of Mauritius, 1972-2000 Exact age (years) 0 1 70 75 80 85+ M a l e 1983- 1990 1990- 2000 1972- 1983 4.0 1.9 5.6 3.5 1.2 2.0 3.6 1.2 0.3 3.9 1.1 0.2 4.2 1.3 -0.2 4.7 1.2 -0.2 5.4 1.1 0.0 5.9 1.4 -0.3 6.6 1.7 -0.3 7.1 2.2 0.0 8.1 2.7 0.4 9.0 3.3 1.0 9.1 5.1 1.8 8.8 7.2 2.2 9.7 9.4 1.9 0.0 13.3 10.1 -2.9 14.1 11.6 -15.8 20.8 12.1 8.7 -28.6 31.4 F e m a l e 1983- 1990 1990- 2000 1972- 4.9
2.3 4.2 3.3 2.2 4.4 3.7 2.3 4.7 4.0 3.0 4.7 4.9 3.4 4.7 6.4 3.7 5.1 7.5 4.3 5.7 8.6 5.6 6.4 8.8 7.2 7.1 4.5 9.5 7.2 -3.8 12.0 10.7 Figure 4.4 - Difference between male and female life expectancy by age, Republic of Mauritius - census years 1972-2000 1972 1983 1990 2000 e c n e r e f f i D 9 8 7 6 5 4 3 2 1 0 0 1 Age 45 50 55 60 65 70 75 80 85+ 72 Census 2000 - Health & Quality of life, Morbidity and Mortality 4.13 Mortality differentials by sex As discussed in the previous chapters, there is evidence that mortality is more favourable to females than males resulting in a predominance of females in the population especially at the older ages.
4.14 Mortality differential by age The J-shaped mortality curve definitely shows that mortality is lowest in the age bracket 5-14 years.

Mortality is relatively higher at ages below five years especially among infants.

At ages 15 years and above mortality level increases exponentially with age.

4.15 Mortality differentials by region In order to study the mortality differentials among regions, a comparison of region- wise death rates should be made.
The death rates have been standardised in order to eliminate differences due to age structure.

In computing the adjusted death rates, the age distribution of the Republic has been used as standard.

Table 4.18 gives adjusted death rate by district and by island.

The figures indicate that mortality is lowest in Rodrigues and this is confirmed by the fact that the Island of Rodrigues has a higher life expectancy at birth than the Island of Mauritius.
The figures by district indicate that Plaines Wilhems has the lowest death rate (6.1) followed by Black River (6.4) while Port Louis has the highest rate (7.7).
Table 4.18 - Adjusted death rates by region, Republic of Mauritius - 2000 Region Adjusted death rate Port Louis Pamplemousses Riviere du Rempart Flacq Grand Port Savanne Plaines Wilhems Moka Black River Island of Mauritius Urban Rural Island of Rodrigues Republic of Mauritius 7.7 7.2 7.4 7.2 6.8 7.7 6.1 7.0 6.4 6.8 6.4 7.1 5.5 6.8 Urban/rural mortality differential is also present with the urban regions having lower mortality.