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2000

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									    ANNUAL REPORT OF
THE CHIEF MEDICAL OFFICER

         Year: 2000




       Ministry of Health
PREFACE

It is with great pride that we present to you the annual report of
The Chief Medical Officer, year 2000.
This report gives an overview of the Health infrastructure, information
concerning morbidity and mortality and some environmental issues.
The data was submitted to us by almost every institute, public and private,
working in the health field.

Although not perfect, there is a picture where we are at the beginning of
the 21st century.
In the future we will add more items to the report.
Every institute is improving their data gathering and the cooperation between
the health field and the Ministry of Health is also improving.

Thanks to every person or institute that have contributed to this report.
Special thanks to the motors behind this publication:
Mrs. Maltie Algoe, M.D., Coordinator National Health Information Systems,
Planning Division, Suriname Ministry of Health and
Miss Hope Johnson, the PAHO Technical Assistant.




Rinia Codfried-Kranenburg, M.D.
Director of Health




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The Chief Medical Officer Report 2000
                                                TABLE OF CONTENTS

1.  OVERVIEW ......................................................................................................................5
  1.1 Brief Physical Description.................................................................................................. 5
  1.2 Socio-Economic Profile ...................................................................................................... 5
  1.3 Demography........................................................................................................................ 9
    AGE AND GENDER POPULATION DISTRIBUTION ..............................................14
    BASIC DEMOGRAPHIC INFORMATION .................................................................15
2. HEALTH SITUATION ...................................................................................................17
  2.1 Wellness ............................................................................................................................ 17
  2.2 Morbidity........................................................................................................................... 17
  2.3 Population Sub-groups ..................................................................................................... 24
  2.4 Mortality ........................................................................................................................... 30
3. POLICIES, PLANS, PROGRAMMES ...........................................................................32
    NUMBER OF HEALTH PERSONNEL & POPULATION PER PROFESSIONAL.34
    FROM PUBLIC & PRIVATE SECTOR .......................................................................34
4. HEALTH INFRASTRUCTURE .....................................................................................35
  4.1 Organization of the Health System ................................................................................... 35
  4.2 Resources .......................................................................................................................... 35
  4.3 Legislation......................................................................................................................... 37
  4.4 Information Systems Development.................................................................................... 37
  4.5 Technology........................................................................................................................ 38
  4.6 Research............................................................................................................................ 38
    DISTRIBUTION OF NON-COMMUNICABLE DISEASE BY AGE AND SEX –
    Academic Hospital Discharges                     Year : 2000..............................................................40
    DISTRIBUTION OF NON-COMMUNICABLE DISEASE BY AGE AND SEX –
    Diakonessen Hospital Discharges Year : 2000.........................................................41
    COMMUNICABLE DISEASE REPORT......................................................................42
    SUMMARY OF CASES REPORTED 1998 – 2000 & RATES FOR SELECTED
    DISEASES per 100,0000 TOTAL POPULATION........................................................45
    DISCHARGE DIAGNOSES FROM ACADEMIC HOSPITAL BY AGE & SEX ......47
    DISCHARGE DIAGNOSES FROM DIAKONESSEN HOSPITAL BY AGE & SEX51
    TEN LEADING CAUSES OF HOSPITALIZATION WITH RATES PER 1000 OF
    THE POPULATION, YEAR 2000 .................................................................................56
    SELECTED CAUSES OF DEATH BY AGE & SEX ...................................................57
    TEN LEADING CAUSES OF DEATH WITH RATES PER 1000 OF THE TOTAL
    POPULATION, 1998 - 2000...........................................................................................70
     TEN LEADING CAUSES OF DEATH BY YEARS OF POTENTIAL LIFE
     LOST........................................................................................................................................ 72
    NUMBER OF DEATHS & PROPOTIONAL MORTALITY DUE TO SELECTED
    CAUSES BY AGE & SEX ..............................................................................................73
5. ENVIRONMENTAL HEALTH......................................................................................74
  5.1 Water Supply and Quality................................................................................................. 74
  5.2 Sewage Disposal ............................................................................................................... 74
  5.3 Solid and Liquid Waste Disposal...................................................................................... 74
  5.4 Pollution............................................................................................................................ 75



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The Chief Medical Officer Report 2000
   5.5 Occupational Health......................................................................................................... 75
   5.6 Veterinary Public Health .................................................................................................. 75
   5.7 Food Safety ....................................................................................................................... 76
   5.8 Quality Control of Drugs .................................................................................................. 76
   5.9 Pesticide Control .............................................................................................................. 77
   5.10 Disaster Management and Preparedness ......................................................................... 77
   5.11 Vector and Rodent Control ............................................................................................... 77
   5.12 Port Health........................................................................................................................ 77
   5.13 Building Development....................................................................................................... 77
6.ISSUES, CONCLUSIONS AND RECOMMENDATIONS FOR THE FUTURE..............78
APPENDIX A: Map of Suriname...........................................................................................79
APPENDIX B:LIVE BIRTHS & STILL BIRTHS BY BIRTHWEIGHTS.........................80
APPENDIX C: HEALTH INSTITUTION DATA.................................................................81
APPENDIX D: PERSONNEL DATA PER HEALTH INSTITUTION (as reported in April
2002) ........................................................................................................................................83
APPENDIX E: TOTAL LIVE BIRTHS BY AGE AND PARITY OF THE MOTHER .......85
APPENDIX F: TOTAL LIVE BIRTHS BY AGE AND DISTRICT OF THE MOTHER....86




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The Chief Medical Officer Report 2000
1.     OVERVIEW

1.1       Brief Physical Description
          A.     Geography
                 The Republic of Suriname, is located at the north-east coast of South-America
                 between 2o and 6o N latitude and 54o and 58o W longitude.
                 The neighboring countries are French Guyana in the east, Guyana in the west and
                 Brazil in the south. The Atlantic Ocean outlines the northern border.
                 (See Appendix A for map of country).

          B.         Physical Characteristics
                     The total land area of 163,820 sq. km (excluding disputed territories with French
                     Guyana and Guyana), and is divided into ten major civil “districts”. These ten
                     districts are subdivided into 62 “resorts”, or minor civil divisions. Suriname is
                     divided topographically into the northern coastal lowlands, central savanna area, and
                     southern highlands characterized by tropical rainforest referred to as the
                     “hinterland”. A mere 10% of this land, the coastal area, is well inhabited. Suriname
                     has a tropical climate with a mean annual temperature of 27o C. The relative
                     humidity averages between 80 and 82%. No natural disasters have ever occurred.
                     The capital Paramaribo and District Wanica, the urban districts, are inhabited by
                     approximately 68% of the total population, while it covers only 0.4% of the land
                     area. The population density of these 2 urban districts together is estimated as 470.1
                     per sq. km for the year 2000. The district Sipaliwini, created in 1984, occupies the
                     largest southern part of the country (130,566 sq. km), but the population density is
                     estimated at only 0.9 per sq. km for the year 2000. The overall year 2000 population
                     density for Suriname is 2.7 per sq. km.
                     Per January 1, 2000, Suriname is estimated to have 433,517 inhabitants. The last
                     census was held in 1980, and the next census is in preparation phase and scheduled
                     to commence in 2003.

          C.         Communications
                     Suriname can be reached:
                     • By air from the Netherlands Antilles, Trinidad & Tobago, the Netherlands,
                        French Guyana, Brazil, Guyana and the United States of America.
                     • By land from French Guyana and Guyana.
                     • By sea via regular shipping lines from Europe, USA, the Caribbean and Brazil.
                     Twenty-five radio stations and ten television stations are currently operating in the
                     country. Broadcasts from international television stations can be received through
                     cable subscription.
                     Two daily newspapers are distributed throughout the country.

1.2       Socio-Economic Profile

          A.         GDP per capita
                     Due to the constant fluctuation in the rate of inflation, the estimated GDP in US$ is
                     an estimate based on the average exchange rate. Some years this estimate is more
                     representative of the actual GDP than other years depending on the range of
                     inflation. During the years 1999 and 2000, the inflation rates were extremely
                     dynamic due to difficulties in the economy. The 2000 GDP data is from the
                     National Health Account Study in support of Health Sector Reform.


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The Chief Medical Officer Report 2000
                     Table 1. Gross Domestic Product, 1995 – 2000
                                              GDP                              GDP per capita
                        Year
                                      In Sur. Guilders                 In Sur.Guilders  In US$
                     1995             229,112 million                  560,360          1,136.63
                     1996             325,207 million                  786,611          1,889.17
                     1997             384,305 million                  917,369          2,111.90
                     1998             447,184 million                  1,053,214        1,896.38
                     1999             NA                               NA               NA
                     *2000            NA                               NA               1,914
                     Source: General Bureau of Statistics, November 2000
                             *National Health Accounts Study, 2001

          B.         Sector contribution to GDP
                     The 2000 data for the different sector contributions to the GDP growth are projected
                     figures from the National Planning Office. The economic hardship endured during
                     the years of 1999 and 2000 are reflected in the National GDP growth, which
                     decreased nearly two-times the value in 1998. The increase in sector contribution
                     from the Utilities, Water and Electricity, resulted from an overdue adjustment in the
                     selling price of water and electricity. The large decrease in sector contribution from
                     Mining in 2000 was due to labor strikes in the government owned Oil Company.

                     Table 2. Sector Contribution to Gross Domestic Product Growth, 1995 – 2000
                   Economic Sectors                                                  Growth of GDP per year
                                                                                1996 1997 1998 1999 20001
                   National GDP Growth                                          4.9  4.7    1.6    -1.3    -1.5
                   Agriculture                                                  1.4  -3.2   -5.5   -13.9 0.3
                   Mining                                                       7.6  12.1   0.1    1.6     -6.3
                   Industry                                                     2.2  1.7    18.4   -0.2    0.1
                   Water and Electricity                                        9.6  5.5    -2.6   -7.5    7.9
                   Construction                                                 10.0 NA     NA     NA      NA
                   Trade, Restaurants, and Hotels                               5.9  15.2   0.1    -5.2    -5.2
                   Transportation, Storage, and                                 21.4 4.6    2.9    4.5     1.0
                   Communication
                   Commercial Services (Banks and                               2.0       1.3         0.7         0.7          0.7
                   Insurance)
                   Public Services                                              -1.4      -1.0        0.0         1.0          2.0
                   Personal, social, and other                                  1.4       1.4         NA          NA           NA
                   community services (including bank
                   interest)
                     Source: National Planning Office, 2001
                     1
                       Projected Figures

          C.         Consumption per capita
                     The cost of healthcare per capita increased from US$ 43.58 in 1995 to US$ 101.71
                     in 1997, but the year thereafter, the cost seemed to decrease again. The 2000 data
                     was from the National Health Account Study in support of Health Sector Reform,
                     which studied health account data more extensively, and thus projected a very
                     different figure for healthcare cost than in previous years.


                     The percentage of GDP per capita spent on healthcare averaged around 4% for the
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The Chief Medical Officer Report 2000
                     years prior to the 2000 data from the National Health Account Study. The estimates
                     determined in the National Health Account Study gave a value over two-times the
                     average healthcare cost as a % of GDP for the previous 5 years.

                     Table 3. Healthcare cost as percentage of GDP, 1995 – 2000
                          Healthcare cost per capita, 1995 – 2000
                       Year      Cost in US$        % of GDP
                       1995                 43.58               3.83
                       1996                 75.24               3.98
                       1997                101.71               4.82
                       1998                 66.43               3.50
                       1999                   NA                 NA
                       *2000               180.33               9.42
                     Source: Collected financial healthcare information, MOH, Unpublished
                             *National Health Account Study, 2001

          D.         Employment data, dependency ratio, labor force, by gender and age group
                     Approximately 60% of the working force is employed by the Surinamese
                     government (Public Administration and Defense), which has remained steady over
                     the years. The 1999 data are provisional figures from the General Bureau of
                     Statistics, but adequately reflect the 3% increase in the unemployment rate from
                     1998. A steady increase can be observed in the commerce sector (Trade,
                     Restaurants and Hotels) until 1998, and decreases sharply in 1999 most likely due to
                     the economic difficulties that characterized the year.
                     Table 4. Average number of employees by type of activity, 1995 – 2000
                                      Sector                 1995     1996                    1997         1998        1999*)        2000
                  Mining activities                           3352     3509                    3368         3064         2736          NA
                  Manufacturing                               5617     6513                    6361         6473         5894          NA
                  Public utilities (gas, water, electra)      1255     1292                    1335         1308         1284          NA
                  Construction                                    -        -                       -            -            -         NA
                  Trade, restaurants and hotels               5658     6056                    6112         6622         6124          NA
                  Transport, storage and communication        2133     2365                    2290         2308         2059          NA
                  Financial institutions                      1578     1548                    1508         1605         1604          NA
                  Insurance                                    384      338                     324          309          311          NA
                  Community, social and personal              1880     1999                    2182         2333         2418          NA
                  services
                  Public Administration and Defense          37160    36663                   36757        37727      37889              NA
                  Total                                      59017    60283                   60236        61749      60319              NA
                    Note: In large enterprises, with 10 or more employees                                *) provisional
                    Source: General Bureau of Statistics, Nov. 2000

                     The male to female ratio of the labor force in 1998 and 1999 were 1.9:1 and 1.7:1
                     respectively. Nearly 10% of the available labor force was unemployed in 1998 and
                     increased to approximately 14% in 1999. Proportionately, women are over two times
                     more likely to be unemployed than men.




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The Chief Medical Officer Report 2000
         Table 5. Employment data for 1998-2000
       Economically              1998                                               1999*                                   2000
       Active
                      Male     Female     Total                      Male           Female       Total       Male       Female           Total
       Population
       Labor Force    64,886   34,465     99,351                     62,637         36,843       99,480      NA         NA               NA
       Employed        60,259     28,557       88,816      56,414                   29,299       85,713      NA         NA               NA
       Labor force
       Unemployed      4,627      5,908        10,535      6,223                    7,544        13,767      NA         NA               NA
       Labor force
         Source: General Bureau of Statistics, Nov. 2000
         Figures based on data from the 1st half of the year.

          E.         Poverty levels
                     Unfortunately no consistent data is available to provide detailed information on the
                     different poverty levels or the resulting social and health ramifications. The
                     Ministry of Social Affairs is the responsible institution for certifying the people
                     living in poverty and near poverty, and ensuring the economically disadvantaged
                     population has access to state subsidized healthcare. The Ministry of Social Affairs
                     provides access to state subsidized health care to approximately 42% of the
                     population (1996 estimate), of which most access care at the government hospitals
                     and clinics. From the data collected in the 1999/2000 Household Budget Survey, it
                     was estimated that between 50-75% of the population lives below the poverty line.
                     The National Planning Office estimated for the year 1999-2000 that on average
                     52.4% of the households is considered living in poverty, which equates to 59.2% of
                     the population. The 1999/2000 estimates are 30% greater than estimates thirty years
                     earlier. These estimates reflect pre- and post- Independence times.

          F.         Education indicators
                     Deficiencies in the Research and Planning Department of the Ministry of Education
                     have resulted in little educational data collection over the past years, but there are
                     plans for improvement. The General Bureau for Statistics collected the available
                     data for enrollment listed in Table 5 through direct contacts with the inspectorates
                     and schools.

Table 6. Students by sex, Number of Teachers, Classes formed, and Schools by education level, for the
         1998/1999 and 1999/2000 school years.
                                  1998/1999 School Year                                                  1999/2000 School Year
Education          Male       Female      Total      Teacher     Classes    Schools     Male        Female     Total       Teacher       Classes     Schools
                   Pupils     Pupils      Pupils                                        Pupils      Pupils     Pupils
Level
Pre-
          7,576  6,939 14,515                                      NA         265        6,150      6,136      12,286                      NA         263
Primary                        3,638                                                                                        3,579
Primary   32,741 31,112 63,853                                    2,433       272       31,526      29,892     61,418                     2,434       269
Lower
          13,540 15,182 29,022 1,861                              1,279       127       12,675      15,255     27,930       1,744         1,080       120
Secondary
Upper
          2,673  5,060   7,733  NA                                 NA          13        2,967      5,645       8,612        NA            NA          14
Secondary
Tertiary  NA     NA     NA     NA                                NA         NA          NA          NA         4,037       NA            NA          NA
Source: CIMS 2000, Sept. 2001




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The Chief Medical Officer Report 2000
          Although the enrollment of male pupils is slightly higher than that of females for pre-
          primary and primary education levels, the trend is quite different for secondary level of
          education. The male to female ratio for the 1998/1999 school year was 0.9:1 and decreased
          to 0.8:1 for the 1999/2000 school year for secondary education. Without current and
          accurate population data it is difficult to develop any inferences for the trends presented in
          the available education data.
          The Suriname Multiple Indicator Cluster Survey was a national survey conducted in the
          year 2000, in which 4,585 households were selected in the sample and 4,293 household
          questionnaires were successfully completed. Of the households interviewed, the overall
          primary school attendance was 86% for the children sampled. The geographic distribution
          of the households revealed different patterns in primary school attendance, although overall
          there was no significant difference in male and female attendance. Of the households
          interviewed in the urban, rural, and hinterland areas, the percent of children attending
          primary school was 95%, 91.5%, and 56% respectively. The percentage of children who
          enter grade 1 of primary school that eventually reach grade 5 for the urban, rural, and
          hinterland areas respectively were 85%, 67.5%, and 28.5%.

          The difference amongst education attainment by geographic distribution is further
          complicated, as the rural and hinterland areas have little access to education beyond primary
          school. There are no schools beyond primary level in the hinterland, and there are very few
          secondary schools in the rural areas. Only attending school in the capital can access most of
          the secondary and all of the tertiary levels of education.
          The deficiencies in available and accurate education data, have also made it difficult to
          estimate the literacy rates amongst the populations, a very important education indicator. In
          the CIMS Report 2000, the General Bureau of Statistics estimated the literacy rate for the
          Population aged 15 years and older for the two most populated districts (Paramaribo +
          Wanica = 68% of the population of Suriname) for the first half of the year 2000 as 93.5 for
          males, 90.9 for females, and 92.2 overall. The 2000 Suriname Multiple Indicator Cluster
          Survey estimated the overall literacy rate of the population sampled aged 15 years and older
          to be 86%, with a significant difference in the literacy rate of the hinterland population
          estimated at 51%. In general, the female literacy rate was lower than male across all
          geographic areas and the literacy rate declined steadily across age groups sampled.

1.3       Demography

          A.         Total Population by age and gender

          Table 7. Mid-year population estimates by age group and sex, 1995
             Age Group             Male             Female          Total
             0:4 years             22,422           21,864          44,286
             5:14 years            45,516           44,774          90,290
             15:24 years           40,573           38,642          79,215
             25:44 years           62,782           60,860          123,642
             45:64 years           24,755           26,808          51,563
             65+                   9,332            10,538          19,870
             Total                 205,380          203,486         408,866
          Source: General Bureau of Statistics, May 1999




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The Chief Medical Officer Report 2000
          B.         Population pyramid
                     Graph 1. Population pyramid 1985

                                                             80+
                                                            75-79
                                                            70-74
                                                            65-69
                                                            60-64
                                                            55-59
                                                                                              female
                                                            50-54
                                                                                              male
                        Agegroup
                                                            45-49
                                                            40-44
                                                            35-39
                                                            30-34
                                                            25-29
                                                            20-24
                                                            15-19
                                                            10-14
                                                              5-9
                                                              0-4



                                     20            10                   10                   20
                                                    Number of People (x1000)

                     Source: General Bureau of Statistics, May 1999

                     Graph 2. Population pyramid 1995

                                                             80+
                                                           75-79
                                                           70-74
                                                           65-69
                                                           60-64
                                                           55-59
                                                           50-54                       female
                                                                                       male
                        Agegroup




                                                           45-49
                                                           40-44
                                                           35-39
                                                           30-34
                                                           25-29
                                                           20-24
                                                           15-19
                                                           10-14
                                                              5-9
                                                              0-4



                                       20           10                 10               20
                                                    Number of People (x1000)

                     Source: General Bureau of Statistics, May 1999

          C.         Total Fertility rates
                     The steady decline in the Total Fertility Rate is most likely due to increased
                     education in family planning and contraceptive use. In the 2000 Suriname Multiple
                     Indicator Cluster Survey, 42.1% of the women married or in union reported current
                     use of contraception.




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The Chief Medical Officer Report 2000
                      Graph 3. Total Fertility rates in Suriname for the years 1980-1995.

                                      Total Fertility Rates for 1980-1995

                                       4            3,6            3,4
                                     3,5
                                       3                                          2,6           2,4
                                     2,5
                                       2
                                     1,5
                                       1
                                     0,5
                                       0
                                             1980            1985           1990           1995
                                                                     Year


                      Source: CIMS 2000, September 2001.

          D.          Population Growth Rate
                      During the 1980s, the average population growth rate was 1.3%. In the late 1980s,
                      the military controlled the country. During this time there was a large emigration of
                      Surinamese to other countries (mainly the Netherlands), and resulted in a significant
                      decrease in the population growth rate. Later in the 1990s the average population
                      growth rate was steady due to the decrease in the proportion of emigration amongst
                      the population, and increased immigration to Suriname.

                      Graph 4. Population Growth rates in Suriname for the years 1980-2000.

                              Population Growth Rates for years 1980-2000

                  3                   2.5
                                                     2.3
                2.5
                              1.7            1.8
                  2                                         1.5                                                                                  1.6           1.5 1.5
                1.5                                                 1.1           1.1 1.1                                          1.1 1.1              1.1
                                                                                                                            0.8
                  1                                                        0.6
                                                                                                              0.4
                0.5                                                                             0.1 0.1
                  0
               -0.5                                                                                                  -0.2
                 -1
               -1.5
                 -2
               -2.5
                 -3   -2.5
                       1980
                              1981
                                      1982
                                             1983
                                                     1984
                                                            1985
                                                                    1986
                                                                           1987
                                                                                  1988
                                                                                         1989
                                                                                                1990
                                                                                                       1991
                                                                                                              1992
                                                                                                                     1993
                                                                                                                            1994
                                                                                                                                   1995
                                                                                                                                          1996
                                                                                                                                                 1997
                                                                                                                                                        1998
                                                                                                                                                               1999
                                                                                                                                                                      2000




          Source: CIMS 2000, September 2001.

          E.          Transient Population
                      The total immigrants registered with the Civil Registry increased steadily since the
                      year 1995. Immigrants must be registered with the Civil Registry if their length of
                      stay will be longer than two months.




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The Chief Medical Officer Report 2000
                     In general, most immigrants arrive during the summer vacation months of July until
                     August, and a small influx around the time of Independence Day festivities in
                     November, of which most of these immigrants are tourists. The majority of
                     immigrants are between the ages of 20-49, and slightly more females than males.

                     The majority of immigrants in Suriname are of either Dutch or “Other Nationality”
                     (excludes Surinamese, American, Guyanese, French, Haitian, Antillean). In 1998
                     and 1999, the percentage of immigrants of “Other Nationality” greatly increased
                     from 32% to 60%, while the percentage of Guyanese immigrants decreased
                     significantly. Many of the immigrants of the “Other Nationality” include
                     immigrants from other countries in South America, predominantly Brazil,
                     throughout Caribbean region, and China. The gold mining industry attracts many
                     immigrants and affects travel patterns in this region, but particularly within the
                     country. The trend of increased immigration, particularly associated with the mining
                     industry, may affect the determinants and distribution of disease in the near future.

          F.         Indigenous Population
                     The General Bureau of Statistics population estimate was 433,517 as of January 1,
                     2000. Nearly 70% of the population resides in the urban districts, while these
                     districts cover only approximately 0.4% of the land area. The population of
                     Suriname is one of the most ethnically diverse per capita with many different ethno-
                     linguistic groups. The major ethnic groups are Hindostani (East-Indian descent)
                     who account for approximately 37% of the population, and Creole with 31%. The
                     third largest ethnic group consists of Javanese, descendants from Indonesia with
                     15%. Others include the Negro and indigenous populations who are the
                     predominant population groups in the hinterland of Suriname.




          G.         Life Expectancy by Gender
                     Due to the lack of available and accurate population data, the official national life
                     expectancy has not been calculated in several years, although various estimates have
                     been published. Upon completion of the census in 2003, the life expectancy will be
                     calculated. Some projections for the years 1990-1995 estimated the life expectancy
                     at birth in Suriname around 70 years of age, while there is a gender difference of
                     females living approximately 5 years longer than males.

          H.         Crude Birth Rate
                     The crude birth rate for Suriname declined steadily since 1992 to a low of 20.8 in
                     1994 then rose to 25.8 in 1997. Since 1997, the crude birth rate has again steadily
                     declined each year. The average crude birth rate for the 1990s was around 23 births
                     per 1000 population.




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The Chief Medical Officer Report 2000
                     Graph 5. Crude Birth Rates in Suriname for the years 1990-2000.

                                             Crude Birth Rates for years 1990-2000

                                23.8              24.4                                        25.8     24.1     23.6
                         30              22.6             23.3                       22.7                               22.5
                                                                   20.8     21.3
                         25
                         20
                         15
                         10
                          5
                          0
                                1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

                     Source: CIMS 2000, September 2001.

          I.         Crude Death Rate
                     The crude death rate has remained steady over the past decade with an average of
                     6.9 deaths per 1000 population.

                     Graph 6. Crude Death Rates in Suriname for the years 1990-2000.

                                      Crude Death Rates for years 1990-2000
                                                           7.4       7                 7                          7      7.1
                         8      6.9               6.7                        6.6               6.9      6.6
                                         6.4

                         6
                         4
                         2
                         0
                               1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

                     Source: CIMS 2000, September 2001.




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The Chief Medical Officer Report 2000
                        AGE AND GENDER POPULATION DISTRIBUTION
                                                                                                                             Year: 1980

                 AGE                        TOTAL                    (%)              MALE                  (%)           FEMALE                 (%)

            0 - 4 yrs                                 46,431           13.1                  23,487          13.4                 22,944         12.8

            5 - 9 yrs                                 49,432           13.9                  24,926          14.2                 24,506         13.7

         10 - 14 yrs                                  49,767           14.0                  25,043          14.2                 24,724         13.8

         15 - 19 yrs                                  47,211           13.3                  23,712          13.5                 23,499         13.1

         20 - 24 yrs                                  32,605            9.2                  15,990            9.1                16,615          9.3

         25 - 29 yrs                                  23,047            6.5                  11,160            6.3                11,887          6.6

         30 - 34 yrs                                  17,826            5.0                   8,556            4.9                  9,270         5.2

         35 - 39 yrs                                  15,859            4.5                   7,449            4.2                  8,410         4.7

         40 - 44 yrs                                  15,272            4.3                   7,265            4.1                  8,007         4.5

         45 - 49 yrs                                  14,269            4.0                   7,006            4.0                  7,263         4.1

         50 - 54 yrs                                  11,752            3.3                   5,857            3.3                  5,895         3.3

         55 - 59 yrs                                    9,310           2.6                   4,640            2.6                  4,670         2.6

         60 - 64 yrs                                    6,359           1.8                   3,128            1.8                  3,231         1.8

         65 - 69 yrs                                    5,242           1.5                   2,704            1.5                  2,538         1.4

         70 - 74 yrs                                    4,232           1.2                   2,000            1.1                  2,232         1.2

         75 & over                                      6,626           1.9                   2,896            1.7                  3,730         2.1

        TOTAL                                       355,240             100                175,818            100               179,422           100
      Source: General Bureau of Statistics, May 1999.




      Data is based on last census in 1980. Next census is scheduled to begin in 2003.




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The Chief Medical Officer Report 2000
                                  BASIC DEMOGRAPHIC INFORMATION

                                                                                                                   YEAR
                                    INDICATOR
                                                                                                   1998             1999             2000

Estimated mid-interval population                                                                 424,590          430,261          435, 797

Estimated # women in 15-44 age group at mid-interval                                                    NA               NA                NA

# fetal deaths of 22 weeks or more gestation                                                            228              223               260

Total births                                                                                        10,449           10,367              10,064


Live births                                                                                         10,221           10,144               9,804

Birth Rate (per 1,000 pop.)                                                                            24.1             23.6               22.5

Live births for females 15 - 44 yrs                                                                 10,148            9,794               9,279
                                                                                                       NA               NA                  NA
Fertility Rate (live births per 1,000 females 15- 44 yrs)

Deaths occurring during the year                                                                     2,814            3,060               3,090

Death Rate (per 1,000 pop.)                                                                              6.6              7.0               7.1
% Certified Deaths                                                                                     80%              85%               87%

Still Births                                                                                            228              223               260

Still Birth Rate (per 1,000 total births)                                                              22.3             22.0               25.8

Natural Increase                                                                                      7407             7152               6,714

Natural Increase Rate (per 1,000 pop.)                                                                 17.5             16.6               15.4

Infant Deaths                                                                                           163              227               175

Infant Death Rate (per 1,000 live births)                                                              15.9             22.4               17.8

Perinatal Deaths                                                                                        334              331               386

Perinatal Death Rate (per 1,000 total births)                                                          32.7             32.6               38.4

Neonatal Deaths                                                                                           92             109               146

Neonatal Death Rate (per 1,000 live births)                                                              9.0            10.8               14.9

Deaths in Children 1-4 yrs                                                                                79               50               73

Age Specific Death Rate in children 1- 4 yrs (per 1,000 pop.)                                           NA               NA                NA

Maternal Deaths                                                                                            9               11               15

Maternal Death Rate (per 1,000 live births)                                                            0.88             1.08               1.53



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The Chief Medical Officer Report 2000
Graph 7. Vital Statistic Rates in Suriname for the years 1995-2000.


                                                 Vital Statistics Rates for years 1995-2000
                                                 60

                                                 50
    Rates per 1,000 births




                                                 40

                                                 30

                                                 20

                                                 10

                                                  0
                                                         1995                   1996                   1997                   1998        1999     2000
                             Still Birth Rate            17.6                     21                   21.4                   22.3            22   25.8
                             Perinatal Death Rate        27.3                   31.5                   32.5                   32.7        32.6     38.4
                             Neonatal Death Rate           9                    10.7                    9.8                     9         10.8     14.9
                             Infant Death Rate           24.7                   52.5                     22                   15.9        22.4     17.8
                             Maternal Death Rate         0.46                   0.43                   0.74                   0.88        1.08     1.53
                             Estimated Birth Rate        21.3                   22.7                   25.8                   24.1        23.6     22.5
                             Estimated Death Rate         6.6                     7                     6.9                    6.6            7    7.1



All death rates remained steady between 1996 and 1998, then increased in 1999 and 2000. The increases in 1999 and 2000 can be contributed to better
reporting and case identification of deaths, and deaths due to causes exacerbated by the economic hardship during these years. The two-fold increase in infant
morality based on registered deaths in the year 1996 could not be explained, and was not supported by the data retrieved from death certificates. The increase
in 1996 in infant mortality is not perceived to be accurate and could possibly be due to a data collection or entry error.


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The Chief Medical Officer Report 2000
2.        HEALTH SITUATION

2.1       Wellness
          This section needs to be further developed pending the identification of the indicators to
          measure wellness in the population.

2.2       Morbidity
          A.   Non-Communicable Diseases
               Data on non-communicable diseases were available from the Medical Mission for
               1999, Regional Health Services for 1999 and 2000, and some hospital data from
               2000. There is currently no national system of monitoring non-communicable
               diseases.
               The Regional Health Service and Medical Mission clinics register consultations
               by total consults per the specified diseases, and thus only totals of consultations
               per specific disease can be analyzed. The Regional Health Services conducts
               many individual and community activities for their chronic patients. Some
               activities include special consultation days for the chronic disease patients,
               introduction of special diabetes care and healthcare informational activities with
               the community.
               Medical Mission has registered the occurrence of chronic disease in
               approximately 50% of villages with Medical Mission health centers in the
               hinterland, a population of approximately 28,000 people.
               • Hypertension
               The Regional Health Services had 28,850 and 23,352 consultations for
               hypertension for the years 1999 and 2000 respectively. The decrease in total
               consultations for hypertension in 2000 was most likely due to strikes amongst the
               physicians during this year. In 1999, hypertension composed 15% of all
               consultations at the Regional Health Services, and similarly 14% for the year
               2000. It is the leading disease-specific cause for consultation at the Regional
               Health Services. According to the data reported by the Regional Health Services,
               for all hypertension and diabetes consults, females are two times more likely to
               visit the clinics for diabetes consults than men, and three times as likely to visit
               the clinics for either hypertension or the combination of diabetes and
               hypertension.
               In 1999, the Medical Mission reported 600 hypertension patients in their chronic
               disease registry, with a prevalence rate of 21.4 per 1,000 populations in the
               hinterland. This Medical Mission data represents approximately 50% of villages
               with Medical Mission health centers.
               The available data on discharge diagnoses for the year 2000 from Academic
               Hospital reveal very different trends in hospitalizations for hypertension and
               diabetes amongst the different sexes. The discharge diagnoses reflect a more
               balanced distribution of hospitalizations for hypertension and diabetes amongst
               the sexes, while actually slightly more males than females hospitalized for these
               diseases.
               • Diabetes
               The Regional Health Services had 19,721 and 15,750 consultations for diabetes
               for the years 1999 and 2000 respectively. The decrease in total consultations for
               diabetes in 2000 was most likely due to strikes amongst the physicians during this
               year. In 1999, diabetes mellitus composed 10% of all consultations at the
               Regional Health Services, and approximately 9% for the year 2000.


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The Chief Medical Officer Report 2000
                     According to the diabetes data reported by the Regional Health Services, for all
                     the diabetes consults, females compose 66% of the consults for diabetes, and
                     nearly 75% of the visits for a combination of diabetes and hypertension.
                     In 1999, the Medical Mission registered 70 diabetes patients, with a prevalence
                     rate of 2.5 per 1000 population in the hinterland.
                     The Academic Hospital discharge diagnoses data depict the age group of 45-59
                     years with the largest amount of discharges for diabetes.
                     • Skin Disorders
                     The Regional Health Services reported 11,767 and 10,599 consultations for skin-
                     related disorders, approximately 6% of the total consultations.
                     No current data on skin disorders was available from the Dermatological
                     Services, the national institution for dermatological disorders, or the Medical
                     Mission.
                     • Accidents and Injuries
                     The emergency department of the Academic Hospital monitors the total visits for
                     external causes to the Emergency department. Some of the results from the year
                     2000 are in Table 8. Although the Emergency department visits for accidents and
                     injuries remains fairly constant over the years, there was a significant increase in
                     the amount of patients presenting to the Emergency Department for
                     symptomatic/disease medical help from 1998 through the year 2000. There is
                     currently no monitoring system for accidents and injuries at the national level.
                     The Medical Mission reported 1,726 health center consults for accidents in the
                     year 2000.

                     Table 8. Academic Hospital Emergency Department 2000 Reports.
                              Cause of visit to the ER Department                                     Total patients
                       A. Transport Accidents
                       Land Transport Accidents                                                      2,829
                       Other Transport Accidents                                                     234
                                             A. Total Transport accidents                                            3,063
                       B. Other Accidents and Injuries
                       Accidental falls                                                              2,390
                       Accident caused by fire and flames                                            50
                       Accident by drowning, asphyxiation                                            973
                       Suicide and self-inflicted injury                                             325
                       Homicide and injury purposely inflicted by other                              3,070
                       persons
                       Child abuse                                                                   75
                       Other external causes                                                         5,979
                                  B. Total Other Accidents and Injuries                                         12,862
                       C. Total Accidents and Injuries (A+B)                                                15,925
                       D. Total Visits for medical help other than                                          23,531
                       accidents and injuries
                              Total Emergency Department visits (C+D)                                       39,456
                       Other ER data:
                                     Total ER patients admitted to hospital                          6,276
                                                     Total ER patient deaths                         199
                                Total patients deceased upon arrival to ER                           163
                      Source: Academic Hospital Medical Registry, unpublished 2002.



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The Chief Medical Officer Report 2000
                     • Ill-defined causes
                     The Regional Health Services reported 34,043 and 29,172 consultations with ill-
                     defined causes in the years 1999 and 2000 respectively. Ill-defined causes are the
                     leading cause for consultation. Some reasons for the large number of consults
                     classified as ill-defined can be: inadequate communication between the physician
                     who makes the diagnosis and the personnel who report the consult, and the large
                     number of patients that present with general symptoms and lack of lab
                     confirmation of a specific disease at data reporting time (due to either patient not
                     tested, timeliness of lab results, or lab results do not confirm a specific
                     disease/illness).
                     • Mental disorders
                     There is currently no national monitoring of the magnitude of mental disorders in
                     Suriname, although some facilities such as the Psychiatric Centrum Suriname
                     collect limited data.
                     The PCS reported 570 admissions in the year 2000 for mental and behavioral
                     disorders . The males were twice as likely as females to be admitted.

                     The Academic Hospital reported 103 discharges in the year 2000, up from 90 in
                     1999, for mental and behavioral disorders. For both years, males were two times
                     as likely as females to be discharged for mental and behavioral disorders. The
                     age distribution for both sexes revealed those between the ages of 25-44 and 65
                     years of age or older were most likely to be discharged for mental and behavioral
                     disorders.

                     The impacts of mental disorders and public health are more recent areas of
                     discussion, which need to be further investigated in the near future.

                     • Neoplasm’s
                     There is one pathology laboratory in Suriname and very few other sources of data
                     on malignant neoplasms, yet there is no official national cancer registry in place
                     despite previous attempts. Efforts to develop a national cancer registry beginning
                     with the histological data available are currently under way, with the possible
                     introduction of the Canreg in Suriname.
                     In 1996 there were 55 cases of malignant neoplasm’s of the cervix identified at
                     the pathology laboratory, which increased to 65 in the year 2000. The
                     predominant ethnic groups affected by cervical cancer are women of Negro and
                     East Indian descent, between the ages of 35 and 64. The Stichting Lobi, a
                     national family planning foundation, started a National Pap Smear Project in
                     1998 in an attempt to identify cervical cancer cases in an earlier stage of the
                     malignancy.
                     The number of cases of malignant neoplasm’s of the female breast followed a
                     similar trend with 45 cases in 1996, and 75 in the year 2000. Again the
                     predominant ethnic groups were females of Negro and East Indian descent, but
                     between the ages of 40 and 64.
                     Malignancies of the lung have remained steady over the years 1996-2000. The
                     age groups most affected are those between 55 and 74 years of age. The male to
                     female ratio is 3.5, with the predominant ethnic groups affected are people of
                     Negro-descent, Javanese, followed by people of East Indian descent.


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The Chief Medical Officer Report 2000
                     In general, the malignancies reported by the Pathology Laboratory reveal several
                     distinct patterns:
                         Male to female ratio of 0.65
                         For males, the incidence of all cancers increases slightly beginning at age 30,
                         but then increases sharply between the ages of 50-90 years.
                         For females, the incidence of all cancers clearly increases between the ages of
                         30-80 years
                         The highest incidence of cancers are amongst the population of Negro-
                         descent with approximately 41%, followed by people of East Indian descent
                         with nearly 28%, and the Javanese population compose 16%.


                           Graph 8. Malignancies reported by the Pathology Lab (AZ) by age and sex, 2000.



                                             60
                                                                 Malignancies 2000
                                             50



                                             40
                                     Total




                                             30



                                             20



                                             10



                                              0
                                                  0-10

                                                         10-20

                                                                  20-30

                                                                            30-40

                                                                                    40-50

                                                                                            50-60

                                                                                                      60-70

                                                                                                              70-80

                                                                                                                      80-90

                                                                                                                              >=90

                                                                                                                                     Unknown
                                  Age group                                         Male            Female

                           Source: Pathology Laboratory-Academic Hospital, unpublished 2002.


                           Graph 9. Male malignancies by type, 2000.




                                                                 Urethra
                                                                   6%
                                             Other
                                             33%                               Prostate
                                                                                32%



                                         Unknown
                                         Location Skin                    Colon &
                                           6%                             Rectum
                                                  15%
                                                                            8%




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The Chief Medical Officer Report 2000
                          Graph 10 Female malignancies by type, 2000.
                          Source: Pathology Laboratory-Academic Hospital, unpublished 2002.
                                                                      Endome-
                                                                       trium
                                                                        6%




                                              Other
                                              31%
                                                                                        Breast
                                                                                         28%




                                                  Skin
                                                  11%
                                                                          Cervix
                                                                           24%




                     The National Pap Smear Project conducted by Stichting Lobi in cooperation with
                     the Leiden University began in 1998 and completed in 2001. Of the 59,000
                     women interviewed, this was the first pap smear for approximately 27% of the
                     women. From the pap smears collected, cytology was not established for 1226
                     patients, and 643 were pre-malignant. Of the 643 pre-malignant cases, this was
                     the first pap smear for 17% of the women. The results of the study revealed the
                     largest amount of pre-malignant cases were in women between the ages of 30-40
                     years. The highest prevalence rates were observed in the Bush Negro and
                     Creole/Mixed women.

          B.         Communicable Diseases
                     The Epidemiology/Biostatistics department of the Bureau of Public Health
                     compiles and analyzes communicable disease reports weekly, and submits reports
                     monthly to the Caribbean Epidemiology Center (CAREC), the PAHO, and the
                     Ministry of Health. Communicable diseases are identified regularly through
                     weekly hospital surveillance, sentinel surveillance (30 stations), and occasionally
                     through physician and outbreak reports.

                     • Epidemics: In 1998 there was a Dengue Type I epidemic from February
                     until June in the coastal areas of Suriname. During the 1998 epidemic there were
                     495 hospitalized cases, 149 laboratory confirmed, and 60 cases of DHF/DSS in
                     which 1 patient died. During the years 1999 and 2000, Suriname endured an
                     epidemic of Dengue Types I and II from October of 1999 until June 2000, when
                     it finally returned to endemic levels. The 1999-2000 epidemic was complicated
                     by the re-emergence of Dengue Type II, with 1582 cases hospitalized, 392
                     laboratory confirmed cases, and 144 cases of DHF/DSS. A Dengue Crash
                     Program was established and a Dengue Control Manual developed to aid in
                     managing the current epidemic and preventing future Dengue outbreaks.




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The Chief Medical Officer Report 2000
                     • STIs and HIV/AIDS
                     In accordance with the syndromic approach of sexually transmitted infections,
                     data is collected by the Dermatological Services, Stichting Lobi (Family
                     Planning), the Regional Health Services, and the Medical Mission. The Medical
                     Mission reported an incidence of sexually transmitted infections in the hinterland
                     of 0.5-6 cases per 1000 population older than 15 years of age in 1999.

                     Table 10. STIs, HIV/AIDS, in Suriname, 1998-2000.
                       Infection/Disease                           1998    1999  2000
                      AIDS                                         110     NA    NA
                      HIV                                          186     267   286
                      Chlamydia                                    NA      4     NA
                      Genital Discharge (Telefonade)               1460    1235  1511
                      Genital Discharge (Dermatology Services)     NA      947   NA
                      Genital Discharge (MZ)                       NA      NA    763
                      Genital Ulcers (Telefonade)                  83      43    55
                      Genital Ulcers (Dermatology Services)        NA      334   NA
                      Genital Ulcers (MZ)                          NA      NA    93
                      Gonococcal Conjunctivitis                    NA      11    NA
                      Gonococcal Infections                        327     629   NA
                      Syphilis                                     67      233   NA
                      Congenital Syphilis                          NA      8     NA
                     Source: Epidemiology Data 1995-1999, September 2000; CAREC Reports 2000

                     The National AIDS Program collects HIV/AIDS data. Due to inadequate
                     classification of AIDS amongst HIV positive patients, AIDS cases have not been
                     calculated consistently. Although the number of HIV positive cases is still
                     relatively low compared to other countries in the Caribbean region, the doubling
                     time of the number of reported HIV cases in Suriname is 2.5 years, in contrast to
                     the average of 4 years amongst the other Caribbean countries. The Academic
                     Hospital averaged about 65 discharges for HIV/AIDS from 1999-2000. The
                     predominant ethnic group infected by HIV and dying due to AIDS is the
                     population of Negro descent with high risk behaviors, mostly living areas of
                     lower socioeconomic levels and between ages of 15 and 44. The male to female
                     ratio for HIV infection was 1.7 in 1996 and dropped to nearly 1.0 in 2000.
                     • Endemic Diseases
                     The main endemic disease affecting Suriname is Malaria. The number of malaria
                     positives has increased sharply since 1997 from 5,077 to 9,014 in 1999, and
                     decreased slightly to 8,913 in 2000. Although there are three types of malaria in
                     Suriname, Pl. falciparum, malariae, and vivax, Pl. falciparum composes
                     approximately 89% of the malaria positives confirmed. With the majority of
                     malaria cases of the type Pl. falciparum, the resultant death rate due to malaria is
                     not surprising. The number of deaths each year has increased also from 15 to 19
                     to 24 in the years 1998, 1999, and 2000 respectively.
                     The deteriorating malaria situation is also affecting expectant mothers. The
                     number of indirect obstetric deaths due to malaria increased in the years 1998-
                     2000. Approximately 59% of the malaria positives confirmed by the Medical
                     Mission are from the Marowijne region of the hinterland of Suriname.




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The Chief Medical Officer Report 2000
                     The Medical Mission estimated the Annual Parasite Index as 152.6 and the
                     Annual Falciparum Index as 136.0 for the year 1999, and both are medium-high
                     risk levels in the hinterland region. Although there have been several initiatives
                     such as bed net projects and spraying, much more needs to be done to begin to
                     decrease the incidence of malaria, a major public health issue in Suriname for
                     many decades.

                     • Notification System
                     The years of economic hardship, 1999 and 2000, were plagued with strikes of
                     health personnel. The strikes affected the quality and consistency in disease
                     reporting, and affect the analysis of the health trends of these years. Lack of
                     reporting, inconsistent reporting, lack of uniformity in reported data, and late
                     reporting all were issues affecting the notification system during the years 1999
                     and 2000.

                     • EPI Diseases
                     Vaccine-preventable diseases are monitored and controlled by the Epidemiology
                     department and the EPI department of the Bureau of Public Health.

                     Table 11. EPI Disease occurrence in Suriname, 1998-2000.

                                        Disease                          1998        1999        2000
                     Congenital Rubella Syndrome            1      0         0
                     Diphteria                              0      0         0
                     Measles                                0      0         0
                     Mumps                                  256    61        94
                     Pertussis                              0      0         0
                     Poliomyelitis acuta                    0      0         0
                     Rubella                                88     6         0
                     Tetanus, excl. neonatal                3      0         3
                     Tetanus Neonatorum                     0      0         0
                     Source: Epidemiology Data, 1995-1999; CAREC Reports 2000.

          C.         Hospital-based Reports
                     There are four hospitals in the capital city and one in district Nickerie. These 5
                     hospitals have a total capacity of approximately 1,300 beds. In 1999 the average
                     occupancy of beds is estimated at 53% (range: 40% – 75%) which is a decline
                     compared to previous years (averaging at 60% since 1995).
                     Discharge diagnoses from all hospitals by age and sex are not available at the
                     time. Some problems have been mentioned by the medical registration officers
                     such as:
                           Lack of personnel to code diagnoses and to enter this data in the computer
                           and
                           Difficulties with timely coding of patient discharge diagnoses
                        Lack of adequate information systems that can tabulate the data by the
                        specified age groups and sex.
                     Discharge diagnoses data was available appropriately stratified from Academic
                     Hospital for this document.      The results are listed in the table titled
                     “DISCHARGE DIAGNOSES FROM ACADEMIC HOSPITAL BY AGE AND
                     SEX year 1999 /2000” and “DISCHARGE DIAGNOSES FROM
                     DIAKONESSEN HOSPITAL BY AGE AND GENDER year 1998/1999/2000”.
                     The leading causes for Hospitalization were not consistently grouped for all
                     hospitals.
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The Chief Medical Officer Report 2000
          D.            Other
                        The last survey on oral health was conducted in the period 1990 – 1992 by the
                        Dental care foundation for youth (Stichting Jeugdtandverzorging). Children in the
                        age of 6, 12 and 15 years were included in the survey. The DMF-T indicator
                        (Decayed, Missed and Filled Teeth) was measured for each age group.

                        The researchers concluded that overall, the DMF-T varies between 5.3 and 8.7,
                        which is considered to be high. Girls tend to have a lower DMF-T compared to
                        boys. It was recommended to conduct a similar survey every ten years.
                        The Youth Dental Care Foundation performed an average of 42, 448 dental
                        consults during the years 1998-2000, which increased annually with the largest
                        increase from 1998-1999. For 1998 and 1999, fillings composed approximately
                        46% of the visits, but dropped to 40% in the year 2000.

2.3       Population Sub-groups

          A.            Infants
                    •   EPI coverage:
                        Ever since MMR vaccine was introduced in 1994, the measles vaccination
                        coverage is at an average of 81.4% (Coverage in 1999 is 85.3%) Measles mass
                        immunization campaigns have been held in 1991 and 1997. With the last measles
                        campaign coverage of 98.4% was reached. No data was received from the
                        Bureau of Public Health EPI department due to computer problems resulting in
                        loss of data.

          Graph 11. EPI coverage <1 years of age, 1981-1999.

                            Percent of children immunized at age 1 year, 1981 - 1999
                                          for Measles, MMR, DPT, OPV

                    100
                     80
          percent




                     60
                     40
                     20
                      0
                            1981
                                   1982
                                          1983


                                                       1985
                                                              1986
                                                                     1987
                                                                            1988
                                                                                   1989
                                                                                          1990
                                                                                                 1991
                                                                                                        1992
                                                                                                               1993
                                                                                                                      1994
                                                                                                                             1995
                                                                                                                                    1996
                                                                                                                                           1997
                                                                                                                                                  1998
                                                                                                                                                         1999
                                                 198




                                                                                          year

                                                       Measles                      MMR                    DPT                  OPV
      Source: Epidemiology Data 1995-1999, September 2000.

                        •    Acute Respiratory Infections (ARIs):
                             The Regional Health Services reported 23,744 cases of acute respiratory
                             infections, and 19, 926 in the year 2000. In 1999, Medical Mission reported
                             that approximately 30-50% of the hinterland population visited the health
                             centers for acute respiratory infection annually.

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The Chief Medical Officer Report 2000
                                 In the year 2000, Medical Mission reported 23,429 consults for respiratory
                                 infections.
                                 The Academic Hospital discharges for acute respiratory infections greatly
                                 increased 212 to 276 from 1999 to 2000 respectively. Infants compose
                                 approximately 20% of these discharges due to ARIs.
                                 For the years 1997-1999 the mortality rate due to acute respiratory infections
                                 increased, then declined slightly in the year 2000. Acute respiratory
                                 infections are a leading cause of death in infants under the age of 1 year.


                     •           Low birth weight
                                 A recent study was conducted on birth weight during the period February 1,
                                 1999 and April 15, 1999, and revealed that 12.5% of babies are born with a
                                 weight below 2500 grams. The number of prenatal visits was negatively
                                 correlated to the birth weight. Pregnant women with less than 4 prenatal visits
                                 delivered significantly more LBW children compared to women with at least
                                 4 prenatal visits (source: Incidence of Low Birth Weight in Suriname, an
                                 inventory; thesis by C. P. Eersteling-Hammen).
                                 Low birth weight was the leading cause for admission in the Diakonessen
                                 Hospital pediatric unit in 1999. The number of infant deaths due to slow fetal
                                 growth, fetal nutrition, short gestation, and low birth weight has increased
                                 from 45 deaths in 1997 to 71 in the year 2000, and was significantly higher
                                 during the difficult economic years of 1999 and 2000.
                                 Live birth data including low birth weight data is available in Appendix B
                                 per institution. The 4 hospitals in Paramaribo are responsible for at least 75%
                                 of all deliveries in Suriname.

                     •           Perinatal problems: The perinatal mortality rate during the last 8 years
                                 averages approximately 30 per 1000 total births. The main causes of mortality
                                 in this group are short gestation, obstetric complications and asphyxia.
                         Graph 12. Perinatal mortality rates in Suriname, 1988-200.

                                                             Perinatal mortality rate, Suriname 1988 - 2000

                                                 50
                          Rate per 1000 births




                                                 40
                                                 30
                                                 20
                                                 10
                                                 0
                                                      1988

                                                              1989

                                                                     1990

                                                                            1991

                                                                                   1992

                                                                                          1993

                                                                                                 1994

                                                                                                        1995

                                                                                                               1996

                                                                                                                      1997

                                                                                                                             1998

                                                                                                                                    1999

                                                                                                                                           2000




                                                                                                 year


                         Source: Perinatal mortality 1995-1999, August 2000; Bureau of Public Health-
                           Epidemiology/Biostatistics, unpublished 2002.

                                 Before 1992 the Bureau of Public Health relied on data from death
                                 certificates to calculate perinatal mortality rates. In 1995, mortality data from
                                 1992 – 1994 were actively retrieved from the hospitals, resulting in higher
                                 perinatal mortality rates.


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The Chief Medical Officer Report 2000
                           In 1999-2000 a survey was conducted in the four major hospitals to retrieve
                           perinatal mortality data from 1995 – 1999. A major concern was the lack of
                           uniformity in data collection in the several hospitals.
                           The increase observed in the year 2000 could be in part due to the calculation
                           of the perinatal mortality rate based on data from the hospital surveillance and
                           death certificates received, as well as possible complications due to economic
                           hardship during this period.

                     •     Congenital Anomalies
                           Congenital anomalies are a consistent leading cause of infant death over the
                           years, which increased in the year 2000 with 27 deaths, up from 12 in 1999,
                           and 18 in the year 1998. There were approximately 55 discharges per year
                           for 1999-2000 from the Academic Hospital for congenital anomalies.

                           Graph 13. Infant deaths due to congenital anomalies by type, 2000.


                                                           remaining
                                                           conditions
                                                             20%         slow fetal
                                             maternal                     growth
                                            conditions                      36%
                                               7%
                                          respiratory                      bacterial
                                           disorders                        sepsis
                                              14%         obstetric          13%
                                                        complications
                                                            10%


                           Source: Bureau of Public Health-Epidemiology/Biostatistics, unpublished 2002.

          B.         Children (1 - 4 years)
                     • EPI Coverage
                     Due to computer problems resulting in loss of data in the EPI department of the
                     Bureau of Public health, no data is currently available.
                     • Service Utilization
                     In the year 2000, the Regional Health Services provided 36,818 consults in their
                     under age 5 care clinics. Of these total under age 5 consults, 4,809 consults were
                     new children in attendance of the under age 5 clinic. The Medical Mission
                     reported a total of 10,253 consults for children under age 5 for the year 2000.
                     • Gastroenteritis
                     The Regional Health Services had 2,377 consults for children under age 5 years
                     for gastroenteritis in the year 1999, while in the year 2000 there were 1,613
                     consults for children under 5 years of age for gastroenteritis. The decrease in the
                     year 2000 was most likely due to the labor strikes during this time in which the
                     health centers did not function full-time. Although not age specific, Medical
                     Mission reported 7,501 consults for gastroenteritis in the year 2000. The
                     Epidemiology Department of the Bureau of Public Health reported 2, 684 cases
                     of gastroenteritis in children under age 5 remain the leading cause of death for
                     children between 1-4 years. Due to the burden of this disease, the Epidemiology
                     Department of the Bureau of Public Health began hospital surveillance of
                     hospitalized cases of gastroenteritis in the year 2001.
                     Approximately 20% of the Academic Hospital discharges for intestinal infectious
                     diseases were children under age 5 years. The number of discharges due to
                     gastrointestinal diseases increased from 1999 to 2000.
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The Chief Medical Officer Report 2000
                     • Nutrition
                     The Suriname MICS 2000 survey found that 13.1% of children under age 5 are
                     underweight or too thin for their age, and 2.1% are severely underweight.
                     Approximately 10% of the children are stunted for their age while 6.5% are
                     wasted. MICS 2000 also revealed that children whose mothers have secondary or
                     higher education are the least likely to be underweight and stunted compared to
                     children of mothers with less education.



                     The Epidemiology Department of the Bureau of Public Health monitors the
                     hospitalizations for malnutrition. As seen in Graph 14, the number of
                     hospitalized cases slightly increased in the year 2000, and the number of
                     hospitalized malnutrition cases in the age group of 28 days to 11 months
                     increased significantly from 1999. Overall, according to the hospital surveillance
                     data, the age group with the largest amount of children hospitalized for
                     malnutrition are those children aged 28 days to 4 yrs. The children of Negro and
                     Creole ethnicity compose nearly 75% of all the hospitalized malnutrition cases,
                     and the male to female ratio averages about 1.3. The Epidemiology Department
                     of the Bureau of Public Health reported 79 cases of malnutrition for the year
                     2000 from the Telefonade Sentinel Surveillance.


                     Graph 14. Malnutrition hospitalizations by age group, 1995-2000.

                                         Hospitalized cases of malnutrition by agegroup
                                                          1995 - 2000
                                N=173
                       180
                                   3
                       160
                                            N=135       N=141
                       140                                         N=134                   N=131
                                                         2
                                  73          6                     2                        1               Age Unknown
                                                                              N=121         12
                       120                                                      6
                                                                                                             5+ years
                                              53         64
                       100                                           62                                      1 - 4 yrs
                                                                                            51
                        80                                                       69                          28 days - 11 months
                                                                                                             less than 28 days
                        60
                                  85
                        40                    72         70          67                     63
                        20                                                       45

                          0        7          3           3           2          1           4

                                1995        1996        1997       1998        1999       2000

                     Source: Epidemiology Data 1995-1999, September 2000; Bureau of Public Health-
                             Epidemiology/Biostatistics, unpublished 2000.

          C.         Adolescents (10 - 19 years)
                     • Adolescent Reproductive Health
                     A committee of the Ministry of Health: “Adolescent Reproductive Health
                     Planning Group” was installed in December 1998 as an advisory board of the
                     Government, acting as the Steering Committee for the Adolescent Sexual and
                     Reproductive Health project. This project is sponsored by the UNFPA.

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The Chief Medical Officer Report 2000
                     • Teen pregnancy
                     Teen births for 1998 and 1999 decreased in total from 1997, although the urban
                     teen mothers increased from 57% in 1997 to 63% in 1999, while simultaneously
                     the % rural teen mothers decreased from 43% in 1997 to 37% in 1999.
                     According to Appendix E and F teenage mothers are responsible for 15% of the
                     total live births.
                     * Sickle cell Anemia
                     The Medical Mission reported a prevalence of 16.1 per 1000 population in 1999
                     for sickle cell anemia, but unfortunately the data was not available stratified by
                     age group to ascertain the burden of the disease amongst adolescents. In general,
                     7-9% of the population has sickle cell anemia, but more research must be
                     completed to adequately measure the burden of this disease.
                     • STI's/HIV
                     Adolescents age 15-19 are amongst the high-risk age group for HIV as mentioned
                     previously in the HIV/AIDS section, but no age specific data is currently
                     available for 2000.
                     • Substance Abuse
                     According to data of substance abuse from the Bureau of Alcohol and Drugs,
                     drug use is predominant among Creole males aged 21-40, but in recent years the
                     age group has expanded to include adolescents aged 16-19. The male to female
                     ratio for the years 1998-2000 averaged 13.3. The number of adolescents
                     presenting to the Bureau of Alcohol and Drugs for alcohol has remained
                     relatively low. The choice of substance abused most frequently amongst
                     adolescents is a combination of drugs, followed by cocaine use only.
                     • Suicide
                     Suicide has greatly increased in the years of economic hardship of 1999 and
                     2000, up from 29 deaths in 1998 to 54 in the year 2000. In the year 2000, of the
                     54 suicides 10 were between the ages of 10-19, which is up from 5 of the 46
                     suicides in 1999. In 1999, it was 1:4 male to female suicides, and in the year
                     2000 it was 8:1 male to female suicides.
                     For the year 2000, the Emergency Department of the Academic Hospital reported
                     treating 325 patients for suicide and self-inflicted injuries. The Academic
                     Hospital discharged 124 patients, predominantly males, for suicide and self-
                     inflicted injuries in the year 2000, which was up from 102 in 1999

          D.         Females (Reproductive years)
                     • STDs/HIV
                     According to the National AIDS Program HIV 2000 data, although nearly 500
                     more women than men were tested, although nearly 20 more HIV positives were
                     confirmed amongst men than women. The increase in the numbers of women
                     tested for HIV was most likely due to the antenatal screening.
                     • Utilization of Family Planning Services
                     A study in 1992 reported the contraceptive prevalence rate as 49.3%. The
                     Suriname MICS 2000 estimated 42.1% of the women sampled that were either
                     married or living in union were currently using contraception.
                     Stichting LOBI reported an average of 12,540 consults for family planning
                     services from 1998-2000 in Paramaribo, Nickerie, and Moengo. There was a
                     slight increase in family planning consults in 1999 due to the lack of available
                     birth control pills in the country, in which more women visited Stichting LOBI to
                     obtain birth control pills.
                     The Medical Mission reported 2,645 family planning consults in the year 2000.
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The Chief Medical Officer Report 2000
                     • Utilization of Antenatal Services
                     Although no national data is available about antenatal services, the Suriname
                     MICS 2000 study estimated that nearly 91% of pregnant women have at least one
                     antenatal visit. According to data from the antenatal clinics of Academic and
                     s’Lands hospitals, each expecting women averaged 3 antenatal visits in 1999 that
                     increased to 4 in 2000. According to data from the Regional Health Services,
                     over half of the women were already between 16-27 weeks of gestation at time of
                     first antenatal consult, and nearly one-third were in 28-32 weeks of gestation.
                     Although the Medical Mission reported 936 births in the year 2000
                     (approximately 9.5% of the national live births), the number of consults for
                     antenatal care was 7, 989. Approximately 12% of the national live births are
                     registered to mothers in the Medical Mission region, and although Medical
                     Mission reported 9.5%, the other remaining live births may have been delivered
                     in the hospitals in Paramaribo.

                     • Birth order by age of the mother
                     The median age of the mother at birth of the child decreased for births 2-4, but
                     remained relatively unchanged for births 1 and 5.
                     Table 12. Birth order by median age of the mother, 1998-1999.
                        Year                      Birth order                         Total
                                1       2      3        4                   5
                      1998     22.5   26.1    27.4   31.1                  30.5        25.0
                      1999     22.6   24.7    26.9   28.6                  30.3        25.3
                     Source: CIMS 2000, September 2001.
                     • Maternal mortality.
                     As in most countries, maternal mortality is underreported in Suriname. The
                     Epidemiology unit of the Bureau of Public Health conducted a survey to identify
                     possible maternal deaths that have occurred in the 4 hospitals in Paramaribo
                     beginning with the year 1995. In this 6-year period, a total number of 44 maternal
                     deaths were identified, while only 22 maternal deaths were reported through the
                     death-certificates. With survey data, the Maternal Mortality Ratio (MMR) for
                     1995 – 2000 in Suriname went from 0.46 per 1,000 live births to 1.53 in the year
                     2000. The number of malaria-related maternal deaths is significant and increased
                     in the year 2000.

                     • Cancer of the cervix.
                     A project for cervical cancer screening was completed in 2001 nationwide. All
                     sexually active women, especially between the ages of 25-55 were encouraged to
                     have a pap smear test at the family-planning clinic of Stichting LOBI. The
                     results of this study are described in the section on Neoplasmata. The results of
                     the study revealed the largest amount of pre-malignant cases were in women
                     between the ages of 30-40 years. The highest prevalence rates were observed in
                     the Negro and Creole/Mixed women.

          E.         Males
                     • Accidents
                     Accidents and injuries are the leading cause of death amongst male’s aged 15-44.
                     Most of these deaths are due to an event of undetermined intent, followed by land
                     transport accidents, suicides, then homicides. Males aged 15-44 was three times
                     as likely to be discharged from the Academic Hospital in the year 2000 as
                     females due to land transport accidents.
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The Chief Medical Officer Report 2000
                     • STDs/HIV
                     The predominant ethnic group infected by HIV and dying due to AIDS is the
                     Bush Negroes, mostly living areas of lower socioeconomic levels and between
                     ages of 15 and 44. The male to female ratio was 1.7 in 1996 and dropped to
                     nearly 1.0 in 2000. For the year 2000, nearly 14% of the males tested for HIV
                     were found positive (1095 tested, 152 positive). Males aged 25-44 years were the
                     predominant group discharged from Academic Hospital for HIV/AIDS in the
                     years 1999-2000.

          F.         The Elderly
                     Very little data is collected and analyzed about the elderly. In the year 2001 more
                     attention was focused on the aging population. The leading causes of death in the
                     elderly are heart disease, cerebrovascular disease, and malignant neoplasmata.
                     Male patients aged 65 years and older were the leading age group to be
                     discharged from Academic Hospital for ill-defined causes in the 1999 and 2000.


                     Discharges for prostate cancer were highest amongst male patients age 65 years
                     and older. Hospitalizations for hypertensive disorders were also highest in the
                     age group of 65 years and older.

                     Nearly 30% of all Academic Hospital discharges for injuries due to falls were
                     amongst elderly women, of who were two times as likely as the elderly males to
                     be hospitalized for injuries due to a fall.


2.4       Mortality

                     Hypertension and diabetes remain the leading causes of death, and in the year
                     2000 Cerebrovascular diseases moved back to second place similar to 1998. The
                     death rate due to malignant neoplasmata has slightly increased each year and is
                     not far from third place. HIV/AIDS death rates are steadily increasing each year
                     and although it remains in 8th place since 1999. The main change in the leading
                     causes of death is the increased death rate due to certain conditions originating in
                     the perinatal period, which moved up to 5th place. The increase in deaths due to
                     certain conditions originating in the perinatal period are possibly due to two
                     reasons: increase in identification of perinatal deaths through efforts of the
                     Bureau of Public Health Epidemiology Department after the 1995-1999 perinatal
                     mortality study; and possibly due to the difficult economic hardships in 1999 and
                     especially in the year 2000.

                     One distinguishable and interesting trend in the mortality tables and graphs is the
                     large discrepancy between the rank orders of leading causes of death versus the
                     rank order by “Years of Potential Life Lost”. The certified deaths were used to
                     calculate the years of potential life lost, and the value of 65 years served as the
                     standard. Naturally, high death rates in the younger age groups yield higher
                     values for years of potential life lost. Due to the higher death rates from
                     conditions originating in the perinatal period, it is natural for the years of
                     potential life lost to be high, and thus it ranks 1st as the leading cause of death for
                     years of potential life lost.
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The Chief Medical Officer Report 2000
                     The number of years of potential life lost due to external causes and HIV/AIDS
                     are also alarming, as most of these deaths are preventable. The higher death rates
                     due to external causes and HIV/AIDS amongst the age groups that compose the
                     largest percentage of the economically active population could have long-term
                     repercussions further complicating the socioeconomic situation in Suriname.

                     The increase is percentage of death certificates received and improved data
                     collection and analysis of the mortality data are vital in understanding the health
                     and wellness of the population. The recent improvements have greatly
                     contributed to the analysis in this document and will remain vital in ascertaining
                     and monitoring the health and wellness of the population of Suriname.




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The Chief Medical Officer Report 2000
3.         POLICIES, PLANS, PROGRAMMES


     3.1             Major health programs.

                     In the past two decades Suriname went through a period of economic hardship,
                     which is currently improving. The political and economic problems were also
                     noticeable in the health sector. Shortness of finance, deterioration of health
                     facilities, and brain drain of trained personnel are the factors we are facing and
                     for which we are looking for solutions.
                     Everyone has a right for health. Good health care is the basis for a healthy
                     population, which can increase productivity and economic stability. This is the
                     objective of current efforts towards a health care system which must be easy
                     accessible, affordable, sustainable and which is based on equity.

     3.2           Major health events and developments in the past year.

                     Major health problems in the past period were dengue, dengue shock syndrome
                     and dengue hemorrhagic fever. Another problem is the increasing number of
                     leptospirosis infections, and in the hinterland malaria is still a problem. The
                     perinatal and maternal mortality are currently monitored more closely than in the
                     past. Suriname has eradicated most EPI diseases in the past few years. In
                     November 1999 mass vaccination campaign commenced against measles, rubella
                     and yellow fever. The yellow fever vaccination was introduced large scale due to
                     cases of yellow fever within the region (Brazil and French Guyana), and the
                     frequent migration between the countries, as well as the high Aedes Aegypti
                     Index.
                     Many data collection, surveillance, and health and management information
                     systems improvements have contributed to this document in the past year. The
                     increased communication and flow of information amongst all levels of the health
                     system will continue to aid these efforts. Although much has been achieved in
                     the health sector in the past year, much more needs to be done, especially in the
                     area of surveillance and information systems to be able to assess and monitor the
                     health situation, as a basis for action.
                     In support of health sector reform activities, the IDB is financing 8 studies
                     concerning the financing of health care. The results of these studies, as well as
                     the many other research activities recently and currently under way, will be used
                     to reorganize the sector and develop new policies, in support of the current health
                     system activities.
                     Overall, much more inter- and cross-sectoral activities in the form of education,
                     programs and projects, monitoring, planning, and implementation must take place
                     to help prevent and decrease the burden of these diseases and illnesses which
                     adversely affect the entire population. Preventable diseases must be controlled
                     now before they become generalized health problems that can further complicate
                     the already difficult socioeconomic situation in Suriname.




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The Chief Medical Officer Report 2000
  1. Planning & Policy Formulation:

                                  Director of Ministry of Health (Chief Medical Officer)

            Minister                                                Public Relations, Ministry of Health
                                                                    Legal Affairs, Ministry of Health
                                                                    Planning, Ministry of Health

                                                                    Medical Committee
2. Organization and
   Management                                                        External Relations

   General Affairs, Sub-director of
                                                                    Inspectorate:
   Ministry of Health:
                                                                           • Medical occupations
   • Personnel Affairs
                                                                           • Occupations in nursing and care
   • Financial Affairs
                                                                           • Pharmaceuticals and pharmaceutical
   • General Affairs
                                                                               occupations
   • Expedition
   • Maintenance
                                                                   Bureau of Public Health, Director:
                                                                          • Epidemiology/Biostatistics, Head of Department
                                                                          • Health Education, Head of Unit
                                                                          • Administrative Affairs, Sub-director
                                                                          • Social Healthcare, Sub-director:
                                                                              (Family Health, Medical Pedagogic Bureau,
                                                                              Tuberculosis Program, National Immunization
                                                                              Program, Maternal and Child Health, Nutrition,
                                                                              School Health)
                                                                          • Environmental Hygiene, Sub-director:
                                                                              (Environmental Inspection, Vector Control,
                                                                              Malaria Control, Central Lab, Food Inspection)




                                                                    National AIDS Program, Coordinator
                                                                    Dermatological Services
  3. Operational/Delivery                                           Foundations and Institutes
                                                                    Psychiatric Center Suriname



                                                                        Academic Hospital
                                                                        Government Hospital
                                                                        Diakonessen Hospital (Private)
                                                                        Nickerie Hospital
                                                                        St. Vincent Hospital (Private)
                                                                        State Health Insurance Fund
                                                                        Regional Health Services
                                                                        Medical Mission (Private)



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  The Chief Medical Officer Report 2000
         NUMBER OF HEALTH PERSONNEL & POPULATION PER PROFESSIONAL
                       FROM PUBLIC & PRIVATE SECTOR


                                                                                                              YEAR

                        CATEGORY                                              1998                              1999                             2000*

                                                                  Total        Population           Total         Population             Total    Population
                                                                                to each                            to each                         to each
                                                                      NA                                NA                                194           2,246
      Physicians
                                                                      NA                                NA
      Dentists                                                                                                                              35             1,245
                                                                      NA                                NA
      Hospital Administrators                                                                                                                5            87,159
                                                                      NA                                NA
      Sanitary Engineers                                                                                                                     0                0
                                                                      NA                                NA
      Social Workers                                                                                                                        10            43,580
                                                                      NA                                NA
      Nutritionist/Dietitians                                                                                                                5            87,159
                                                                      NA                                NA
      Registered Nurses                                                                                                                   698               624
                                                                      NA                                NA
      Nurse Practitioners                                                                                                                    0                0
                                                                      NA                                NA
      Enrolled Nurses                                                                                                                     234              1,862
                                                                      NA                                NA
      Nursing Assistants                                                                                                                  440               990
                                                                      NA                                NA
      Community Health Aides                                                                                                                80             5,447
                                                                      NA                                NA
      Radiographers                                                                                                                          4           108,949
                                                                      NA                                NA
      Laboratory Technologists/Technicians                                                                                                 NA               NA
                                                                      NA                                NA
      Pharmacists/Dispensers                                                                                                                24            18,158
                                                                      NA                                NA
      Physiotherapists                                                                                                                      34            12,818
                                                                      NA                                NA
      Occupational Therapists                                                                                                                0                0
                                                                      NA                                NA
      Dental Auxiliaries/Nurses                                                                                                             83             5,251
                                                                      NA                                NA
      Public/Environmental Health Inspectors                                                                                               NA               NA




* Data reported as of May 2000 : Personnel Data per institution in Appendix D is data reported in April 2002



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The Chief Medical Officer Report 2000
4.        HEALTH INFRASTRUCTURE

4.1       Organization of the Health System
          The Ministry of Health (MOH) is responsible for health system management, more specifically:
          the availability, accessibility and affordability of health care. The main responsibilities of the
          MOH are: planning, policy development, evaluation, coordination, and the setting of standards
          in the health system.
          The core institutions of the health care system are: Central Office of the Ministry of Health, the
          Bureau of Public Health and the Inspectorate. The Central Office and the inspectorate function
          at the level of national health planning and standard-setting, inspection, and monitoring while
          the Bureau of Public Health is responsible for the monitoring of programs and public health
          issues, as well as policy development.
          At the operational level, the health care providers include the government subsidized primary
          health care organizations, the Regional Health Service (RGD), which covers the coastal area and
          the Medical Mission who covers the population living in the hinterland. Also, the majorities of
          general practitioners are in private practice and serve people that are covered by the State Health
          Insurance (SZF), private companies, private insurance, or patients who pay out of pocket.
          Specialists provide inpatient and outpatient care in the local hospitals and health centers.
          Government target programs, such as special health programs and services for the entire
          population (Ex. STI’s, leprosy, youth dental care, malaria, tuberculosis, and immunization).
          Many non-governmental organizations are recognized by the government to provide specific
          health care services, e.g. the Foundation for Family Planning (Stichting LOBI), specialized in
          the field of reproductive health.
          Many non-governmental organizations are recognized by the government to provide specific
          services, including primary health care services, for target programs. Some examples include: the
          Foundation for Family Planning, specialized in the field of reproductive health, and other
          foundations working in the field of health information and education.

4.2       Resources
          • Manpower
          In the past 5 years of student enrollment (1994 – 1999), 64 physicians have graduated from the
          Anton de Kom University of Suriname, Faculty for Medical Sciences.
          An inventory of physicians revealed that by May 2000, 194 medical doctors are working in the
          private and public health sector. The male: female ratio is 2 : 1.
          At the same time, 101 medical specialists are present in the country. At least 11 are retired. The sex
          ratio in this group is 6 : 1 in favor of the male gender. Twenty physicians are currently enrolled in
          foreign medical specialty course. Physicians must obtain further education outside of Suriname for
          specialization. Due to lack of further specialized education in medicine as well as public health has
          resulted in a national shortage of qualified medical specialists, and senior level public health
          practitioners.
          The medical assistants of the Medical Mission follow a 3-year course, which is accredited by the
          Ministry of Health. These medical assistants (total of 60) serve at the health centers of the Medical
          Mission in the hinterland.
          The Youth Dental Services also offers a 3-year course for dental assistants. Not all graduates
          practice as dental assistants although some are employed in other types of work within the
          foundation. Only one dentist works with the Youth Dental Services, although there are many dental
          auxiliaries.


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The Chief Medical Officer Report 2000
          The Psychiatric Center of Suriname (PCS) currently has 6 practicing psychiatrists, one psychologist
          and other supportive staff, but no medical specialists. Patients in need of further medical attention
          receive care from the area specialists, and patients in medical care receive needed psychiatric care
          through the psychiatrists from PCS. The Psychiatric Centrum Suriname is a governmental hospital
          located in Paramaribo, and provides services for mental and behavioral disorders. None of the other
          hospitals have either in- or outpatient facilities for treatment of psychiatric patients.

          • Facilities
          There are 4 hospitals in Paramaribo of which two are private. Another hospital in the district of
          Nickerie has been strengthened through a project of the International Development Bank.
          The Regional Health Services and Medical Mission operate smaller ‘hospitals’ and health centers in
          the districts and the hinterland. The available beds in these health centers are mostly used for
          deliveries and observational purposes. The average length of hospital stay is approximately 7 days
          for all hospitals, except Academic Hospital, which is 9 days. For specialized and advanced care,
          patients are referred to one of the five hospitals.
          The Military Hospital delivers outpatient services for army personnel and their family.
          The psychiatric hospital in Paramaribo has a capacity of 280 beds. The duration of stay can vary
          from 2 days up to more than 2 months.
          The Medical Mission has 47 health centers in the hinterland. 8 medical doctors supervise the
          different regions, while 70 health assistants work at the health centers.
          The 48 Health centers of the RGD are located in all 8 districts in the coastal area. These physicians
          deliver primary health care.
          The Regional Health Services (RGD) employs fifty-two physicians.
          Emergency medical care is delivered by the Academic Hospital, the only unit with 24-hour service.
          The data in Appendix B indicates that approximately 40.000 visits occurred with miscellaneous
          causes. Approximately forty percent are accidents and injuries, while the other half consists of
          physical signs and symptoms requiring some type of medical help.
          See Appendix B for more detailed health system resources.

          • Finances
          In 1997, 4.8% of the GDP was spent on healthcare; this was a 25% increase since 1995. The costs
          per capita exceeded US$ 100.00 in 1997.


        Table 13. Financial; health expenditure as a percentage of the total government expenditure, as percentage of GDP,
                per capita

         Year          Healthcare           GDP                    Health- Popu-          Costs       Exchange                           Costs
                       costs                (x Sf 1000)            care      lation        per capita rate per                           per
                       (x Sf 1000)                                 costs in               (Sf)        US$                                capita
                                                                   % of                                                                  (US$)
                                                                   GDP
         1995            8,783,970            229,112,000               3.83      408,866   21,483.74     493.00                           43.58
         1996           12,952,257            325,207,000               3.98      413,428   31,328.93     416.38                           75.24
         1997           18,508,720            384,305,000               4.82      418,921   44,181.89     434.38                          101.71
         1998*          15,665,590            447,184,000               3.50      424,590   36,895.81     555.38                           66.43
         2000#         105,464,700                    NA                9.42      435,797 241,456.20         NA                           180.33
          * The figures of 1998 are not final                   # National Health Account Study, 2001


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The Chief Medical Officer Report 2000
          Financing of health services can be divided into:
                         Governmental
                         State Health Insurance Fund/MOH
                         Ministry of Social Affairs
                         And Other Ministries
                         Private (individual) and company (collective) Insurance Funds
                         Out of pocket
                         Foreign donations
          • External aid and technical cooperation
          Patients with certain diseases, who need more extensive treatment not available in Suriname, are sent
          to other countries (usually the Netherlands) for therapy. This is regulated through a project financed
          by the Dutch Development Fund.
          The main non-governmental organizations that provide support for the health system through
          technical cooperation are the PAHO/WHO and UNICEF, as well as other United Nation programs
          such as UNAIDS.

4.3       Legislation
          During the years 1998-2000, the only legislative document enacted was the Narcotics Act, which
          was developed to be in accordance with international guidelines. The National Assembly approved
          the Narcotics Act in 1998.
          Some other legislative documents prepared during 1998-2000 were aimed at updating and
          restructuring the legislation regarding Public Health in the following areas: quality assurance, mental
          health, sexually transmitted diseases, food legislation, plant and animal health.

4.4       Information Systems Development
          The Bureau for Public Health maintains 3 types of surveillance systems:
          1. The hospital surveillance system
          2. The sentinel surveillance by phone, the so-called Telefonade
          3. The Epidemiology surveillance system

          Ad. 1
          All 4 hospitals in Paramaribo are visited each week for the reporting of most communicable disease,
          perinatal and maternal mortality, and malnutrition cases. The Nickerie hospital is will be included in
          this surveillance system by 2003.
          Ad. 2
          Thirty sentinel stations (RGD and private clinics in the coastal area) are weekly contacted by phone
          to report a list of diseases such as gastro-enteritis, rash and fever, upper respiratory tract infections,
          STI syndromes etcetera.
          The main purpose is to identify trends in disease over time. Many epidemics can be anticipated
          through an increased reporting of cases by the sentinel stations.
          Ad. 3
          All reportable diseases must be reported to the Epidemiology department at the Bureau of Public
          Health. Nurses at the unit investigate each case and their controls if necessary.
          The Epidemiology department also coordinates reporting of diseases of the Expanded Program on
          Immunization.
          The Epidemiology department also requests data on most communicable diseases from institutions
          such as the Dermatology Services, the TB clinic, the National Blood Bank etc., in order to report
          these to CAREC in their quarterly Communicable Disease Reports.
          Note that there is no system for non-communicable disease surveillance in the country.

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The Chief Medical Officer Report 2000
          The many other institutions and services within the health system have their own information
          systems, but there is no consistent flow or type of information.
          Most of the health information reaches the MOH central planning unit through the reports of the
          Bureau of Public Health. Furthermore, the MOH relies on the year reports of each institution
          separately. As a consequence, year reports are submitted years too late or sometimes not at all.
          In the last 2 years the need for health information has increased tremendously. Policy makers
          recognize the shortcomings in the absence of an operational health information system. With
          assistance from the PAHO, efforts towards development of a National Health Information System for
          Suriname began in 2000. A national working group was established to clearly identify steps in a plan
          of action towards development of a National Health Information System.

4.5       Technology
          There were no new major technological developments in the year 2000.

4.6       Research
          The year 2000 was a productive year for research in Suriname as the health system aimed to improve
          collection of available data to begin to monitor many different indicators and assess the health
          system activities. The following are a few major research projects that began in the year 2000:

          • Health Sector Reform Studies
          In support of the Health Sector Reform, 9 studies were identified to assist the Government of
          Suriname to develop and initiate policy reforms to improve the efficiency, equity, quality and
          financial sustainability of the Health Care in Suriname.
          The studies will consist of five interrelated components:
          (a) Strengthening the policy making capacity of the Ministry of Health;
          (b) Improving the financial sustainability of the SZF;
          (c) Modifying reimbursement methods;
          (d) Improving the targeting of public subsidies by the MSA , and
          (e) Develop quality assurance mechanisms.
          The Household Study of Health Care Utilization and Expenditures started in may 1999 and was
          finished in February 2002. The study of the National Health Account and the study of Actuarial
          Model for the SZF started in January 2001 and completed in February 2002.
          The final reports of Primary Health Care Evaluation study and the Analysis of Payment Systems for
          Primary, Specialty Outpatients and Inpatients Care were presented in February 2002. The study of
          MSA Health Cards Awarding and the study of Quality Assurance Program already started in August
          2001 en will be finished in May 2002.
          Two other studies about Purchasing and Auditing at SZF and Integration of SZF and MSA started in
          March 2002 and will be finished in August 2002.

          • Suriname Multiple Indicator Cluster Survey 2000 (MICS)
          MICS 2000 survey was conducted to provide end of the decade information on a core set of
          indicators of specific aspects of the situation of children in coordination with other international
          organizations as established at the World Summit for Children in NY in 1990. The survey covered
          sample populations stratified into urban, rural, and hinterland geographic areas of Suriname and was
          to serve as a basis for action. The summary indicators covered areas such as Infant and Under-five
          Mortality, Education, Water and Sanitation, Child Malnutrition, Breastfeeding, Low Birth Weight,
          Immunization Coverage, Diarrhea, Acute Respiratory Infection, IMCI Initiative, Malaria,
          HIV/AIDS, Contraception, Prenatal Care, Assistance at Delivery, Birth Registration, Orphan hood
          and Living Arrangements of Children.

--------------------------------------------------------------------------------------------------------------------------------------   38
The Chief Medical Officer Report 2000
          •  Child Indicators Monitoring System (CIMS 2000)
           The CIMS 2000 research was conducted to begin to address issues as established in the 1993
          Convention on the Rights of the Child and the World Declaration on the Survival, Protection and
          Development of Children. CIMS is a compilation of data related to the welfare of families,
          specifically children, to serve as a monitoring system of these important indicators. The publication
          was a compilation of national data already collected properly and regularly regarding the child-
          specific indicators, which will serve as a system of continuous flow of national data.


          • Cervical Cancer in Suriname
          In 1998, the Stichting Lobi Foundation began a National Pap smear Project in cooperation with the
          Leiden University of the Netherlands, and was completed in the year 2001. Although the goal was to
          collect pap smears from 75% of the women in Suriname aged 25-55 years, approximately 60,000
          women, 66% was achieved. The objectives were to establish the prevalence of pre-malignant
          differences with respect to ethnicity, age, geographic location, and socio-cultural practices. Risk
          factors such as sexual behavior and smoking were also ascertained.


          • Cardiovascular Risk Factor Investigation (CVRFO)
          In the year 2000, the CVRFO set out to evaluate the prevalence of cardiovascular risk factors in the
          different ethnic groups in Suriname. It is known that cardiovascular diseases are an important cause
          of morbidity and mortality in Suriname, but the CVRFO studied the prevalence and distribution of
          risk factors such as smoking, hypertension, and diabetes in the different ethnic groups. The
          objectives of the CVRFO were to evaluate the cardiovascular risk factors to aid in identification and
          development of activities to prevent and reduce the incidence and prevalence of cardiovascular
          disease, and ultimately death.




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The Chief Medical Officer Report 2000
        DISTRIBUTION OF NON-COMMUNICABLE DISEASE BY AGE AND SEX –
                    Academic Hospital Discharges Year : 2000

                                                                                        AGE GROUPS IN YEARS
                                               TOTAL
                                                               <1      1-4       5 - 14      15 - 24      25 - 44      45 - 59      60 - 64   65 +
                 DISEASE

                                               M      NA       NA       NA         NA          NA           NA            NA             NA   NA
        TOTAL DISCHARGES                       F      NA       NA       NA         NA          NA           NA            NA             NA   NA

                                               M      376      26        21        12           31           73           78             20   114
    Ill-defined causes (R00-R99)
                                               F      300      13        34         8           16           77           60             22   70

                                               M      315       0        0          3            1           26          111             38   136
        Hypertension (I10-I15)                 F      333       1        0          0            2           26           80             49   175

       Cerebrovascular Diseases                M      291       1        0          0            1           40           78             42   129
              (I60-I69)                                                                                      18
                                               F      226       1        1          0            3                        44             26   133

                Neoplasms                      M      170       2        1          3            8           25           27             26   78
                (C00-D48)
                                               F      343       1        1          3           10          148           95             29   56

                                               M       75       0        0          0            2           12           32             10   19
                  Diabetes
                 (E10-E14)                     F       62       0        0          2            7            7           17             4    25

                                               M       78      15        29         3            5           10            7             0     9
        Nutritional Deficiencies
         (E40-E64,D50-D53)                     F       94       7        14         1           12           29           12             8    11

                                               M      NA       NA       NA         NA          NA           NA            NA             NA   NA
              Skin Problems                    F      NA       NA       NA         NA          NA           NA            NA             NA   NA

                                               M      710      10        17        63          176          267           80             14   65
                 Injuries
                (V01-Y89)                      F      315       6        26        32           39           88           37             15   82

                                               M       69       1        0          0            2           18           24             5    19
             Mental disorders
                 (F00-F99)                     F       34       0        1          1            1           11            3             4    13




--------------------------------------------------------------------------------------------------------------------------------------        40
The Chief Medical Officer Report 2000
        DISTRIBUTION OF NON-COMMUNICABLE DISEASE BY AGE AND SEX –
                   Diakonessen Hospital Discharges Year : 2000


                                                                                   AGE GROUPS IN YEARS
                                          TOTAL
            DISEASE                                       <1      1-4       5 - 14      15 - 24      25 - 44      45 - 59      60 - 64   65 +

                                          M      NA       NA       NA         NA          NA           NA            NA           NA     NA
   TOTAL DISCHARGES
                                          F      NA       NA       NA         NA          NA           NA            NA           NA     NA

                                          M       62       9        5          9            2            8            5            5     19
Ill-defined causes (R00-R99)                      97       7        2          4           11           40           17            8      8
                                          F

                                          M       13       0        0          0            0            4            6            2      1
   Hypertension (I10-I15)                         39       0        0          0            0           11           12            8      8
                                          F

  Cerebrovascular Diseases                M       49       0        0          0            0            1           17            8     23
         (I60-I69)                                26       0        0          0            0            0            5            5     16
                                          F

           Neoplasms                      M       53       0        0          3            1            1            8            5     35
           (C00-D48)                             213       3        1          4           10           85           79            9     18
                                          F

                                          M       14       9        2          0            0            1            1            0      1
             Diabetes
            (E10-E14)                     F       70       0        0          0            4           11           23            10    23

                                          M       4        0        0          1            1            1            1            0      0
   Nutritional Deficiencies
    (E40-E64,D50-D53)                     F       10       1        1          0            2            3            2            0      1

                                          M      NA       NA       NA         NA          NA           NA            NA           NA     NA
         Skin Problems                           NA       NA       NA         NA          NA           NA            NA           NA     NA
                                          F

                                          M       4        0        0          1            1            1            1            0      0
             Injuries
           (V01-Y89)                      F       1        1        0          0            0            0            0            0      0

                                          M       17       1        0          1            2            3            3            3      4
        Mental disorders
                                          F       7        1        0          0            0            4            2            0      0
          (F00-F99)



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The Chief Medical Officer Report 2000
                                         COMMUNICABLE DISEASE REPORT

                                 Disease and Category                                                      Cumulative Total for Year
                         International Classification of Diseases
                                                                                                     1998              1999              2000

      Diseases Subject to International Health Regulations
      Cholera                                                                        (A00)             0                 0                 0

      Plague                                                                         (A20)             0                 0                 0

      Yellow Fever                                                                                     0                 0                 0

                 sylvatic                                                          (A95.0)             0                 0                 0

                 urban                                                             (A95.1)             0                 0                 0

      Diseases under International Surveillance
      Human Immunodeficiency Virus - HIV                                         (B20-24)
                                                                                                     186                267               285

      Acquired Immunodeficiency Syndrome - AIDS                                  (B20-24)            NA                 NA                NA

      Malaria                                                                    (B50-54)          12,380             13,216             11,363

      Influenza                                                                   (J10-11)         23,091             19,266             21,363

      Diseases of the Expanded Program on Immunization

      Tuberculosis (Pulmonary)                                                   (A15-16)            NA                 NA                79

                 Acid Fast Bacilli smear positive                                                    NA                 NA                NA

                 Acid Fast Bacilli smear negative                                                    NA                 NA                NA

                 Acid Fast Bacilli not tested for                                                    NA                 NA                NA

      Tuberculosis (All Other Forms)                                           (A17-A19)             NA                 NA                10

      Tuberculosis (All Forms)                                                 (A15-A19)              44                101               89

      Diphtheria                                                                     (A36)             0                 0                 0

      Pertussis (Whooping Cough)                                                     (A37)             0                 0                 0

      Tetanus (excluding neonatal)                                               (A34-35)              3                 0                 3

      Tetanus neonatorum                                                             (A33)             0                 0                 0

      Poliomyelitis, acute                                                           (A80)             0                 0                 0

      Acute Flaccid Paralysis                                                                          0                 0                 0

      Measles                                                                        (B05)             0                 0                 0

      Mumps                                                                          (B26)           256                 61               94

      Rubella (German Measles)                                                       (B06)            88                 6                 0

      Congenital Rubella Syndrome                                                  (B35.0)
                                                                                                       1                 0                 0
--------------------------------------------------------------------------------------------------------------------------------------            42
The Chief Medical Officer Report 2000
                                Disease and Category                                                       Cumulative Total for Year
                        International Classification of Diseases
                                                                                                     1998              1999                 2000

                          Other Diseases of Regional Interest

      Leprosy (Hansen's Disease)                                                     (A30)            62                 50                  39

      Meningococcal Infection (due to Neisseria meningitidis)                        (A39)             0                 0                   0

      Dengue Fever                                                                   (A90)          495                691                  1093
                                                                                                (149 Lab C)        (145 Lab C)           (112 Lab C)

      Dengue Hemorrhagic Fever/Shock Syndrome                                        (A91)            60                 69                  85

                    Sexually Transmitted Diseases & Syndromes

                   Genital Ulcer Syndrome (not otherwise specified)                                  NA                 334                 NA

                 Syphilis                                                        (A51-53)             67                233                 NA

                Genital Discharge Syndrome (not otherwise specified)                                 NA                 947                 NA

                 Gonococcal Infection                                                (A54)           327                629                 NA

                 Chlamydial Infection                                            (A55-56)            NA                  4                  NA

                   Neonatal Conjunctivitis (not otherwise specified)                                 NA                  36                 NA

                 Due to Chlamydial trachomatis                                     (P39.1)           NA                  0                  NA

                 Due to Neisseria gonorrhea                                        (A54.3)           NA                  11                 NA

      Congenital Syphilis                                                            (A50)           NA                  8                  NA

                         Other Diseases of Caribbean Interest

      Typhoid and Paratyphoid Fevers                                                 (A01)            12                 2                   0

      Food borne Illness                                                         (A05-08)            198                 16                  0

      Gastroenteritis in < 5 years                                                   (A09)           2797              2630                 2668

      Gastroenteritis in >= 5 years                                                  (A09)           3875              3245                 3191

      Viral Hepatitis A (Lab. Confirmed)                                             (B15)             2                 7                   0

      Viral Hepatitis B (Lab. Confirmed)                                             (B16)           152                107                  54

      Viral Hepatitis Unspecified                                                (B17-19)              0                 0                   8

      Rabies (in humans)                                                             (A82)            13                 0                   0

      Leptospirosis                                                                  (A27)           218               253                  220
                                                                                                  (26 Lab C)        (23 Lab C)           (43 Lab C)

      Ciguatera Poisoning                                                          (T61.0)           NA                 NA                  NA

      Acute Respiratory Infection in < 5 years                            (J00-06, 12-22)
                                                                                                     NA                 NA                  NA


--------------------------------------------------------------------------------------------------------------------------------------             43
The Chief Medical Officer Report 2000
                                Disease and Category
                        International Classification of Diseases                                             Cumulative Total for Year

                                                                                                      1998                  1999         2000
      Other Diseases

      Salmonellosis                                                                  (A02)             57                    87          53

      Shigellosis                                                                    (A03)             136                  107          105

      Meningitis (due to Haemophilus influenza)                                    (G00.0)             NA                   NA            3

      Viral Meningitis                                                               (A87)              0                     0           0

      Viral Encephalitis                                                         (A83-86)               0                     0           0

      Scabies                                                                        (B86)             NA                   NA           1356




--------------------------------------------------------------------------------------------------------------------------------------    44
The Chief Medical Officer Report 2000
                    SUMMARY OF CASES REPORTED 1998 – 2000 &
            RATES FOR SELECTED DISEASES per 100,0000 TOTAL POPULATION

                                                              CASES REPORTED                                         RATES
                   DISEASES
                                                       1998             1999             2000            1998          1999          2000

                      Cholera                             0                0                0              0             0               0

                      Plague                              0                0                0              0             0               0

                    Diphtheria                            0                0                0              0             0               0

                     Pertussis                            0                0                0              0             0               0

                      Tetanus                             3                0                3             0.7            0               0.7

             Tetanus Neonatorum                           0                0                0              0             0               0

                     Measles                              0                0                0              0             0               0

                      Mumps                             256               61               94            60.3          14.2          21.6

                      Rubella                            88                6                0            20.7           1.4              0

                  Poliomyelitis                           0                0                0              0             0               0

                  Tuberculosis                           44              101               89            10.4          23.5          20.4

               Gastroenteritis < 5                     2797             2630             2668           658.8         611.3         612.2

               Viral Hepatitis A                          2                7                0             0.5           1.6              0

                Viral Hepatitis B                       152              107               54            35.8          24.9          12.4

         Viral Hepatitis Unspecified                      0                0                8              0             0           18.4

                 Typhoid Fever                           12                2                0             2.8           0.5              0

                    Ciguatera                           NA               NA               NA              NA            NA               NA

      Acute Respiratory Infection < 5                   NA               NA               NA              NA            NA               NA

               Other Food borne                         198               16                0            46.6           3.7              0

                      Malaria                         12,380           13,216           11,363         2,915.8       3,071.6       2,607.4

                                                        495              691             1093
                      Dengue                                                                            116.6         160.6         250.8
                                                    149 LabC         145 LabC         112 LabC

               Viral Encephalitis                         0                0                0              0             0               0

                  Leptospirosis                         218              253              220            51.3          58.8          50.5


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The Chief Medical Officer Report 2000
                                                              CASES REPORTED                                         RATES
                   DISEASES
                                                       1998             1999             2000            1998          1999          2000

                                                    26 Lab C         23 Lab C          43 Lab C

                     Influenza                        23,091           19,266           21,363         5,438.4       4,477.7       4,902.1

                    Meningitis                            0                0                0              0             0               0

                 Conjunctivitis                         NA              1814             2412             NA          421.6         553.5

               Hansen's Disease                          62               50               39            14.6          11.6              8.9

                     Syphilis                            67              233              NA             15.8          54.2              NA

             Gonococcal Infection                       327              629              NA             77.0         146.2              NA

                        HIV                             186              267              285            43.8          62.1          65.4




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The Chief Medical Officer Report 2000
                                                 DISCHARGE DIAGNOSES FROM ACADEMIC HOSPITAL BY AGE & SEX
                                                                                                                                                                                   Year: 1999/2000

Code       Descriptie                                     Year         Total          <1              1-4            5-14           15-24        25-44        45-59        60-64        65+          Age
                                                                                                                                                                                                     Unknown
                                                                       M       F      M       F       M      F       M       F      M       F    M       F    M       F    M       F    M     F      M    F
0.00       Ill-defined causes                             1999         306     257    25      16      24     12      15      3      18      16   63      58   43      53   20      30   98    69     0    0
                                                          2000         376     300    26      13      21     34      12      8      31      16   73      77   78      60   20      22   114   70     1    0
1.01       Intestinal infectious diseases                 1999         207     208    64      52      64     62      11      15     10      14   24      30   9       12   4       3    21    20     0    0
                                                          2000         269     223    58      42      68     60      15      10     14      15   41      39   20      22   17      4    36    31     0    0
1.02       Tuberculosis                                   1999         42      26     0       0       2      0       0       1      4       3    12      9    13      5    4       1    7     7      0    0
                                                          2000         36      14     0       0       0      0       0       0      7       4    14      6    6       1    1       1    8     2      0    0
1.03       Certain vector-borne diseases                  1999         161     89     3       2       0      5       11      5      49      22   75      46   19      8    4       1    0     0      0    0
                                                          2000         301     145    6       2       9      10      35      23     90      35   134     57   21      11   2       2    4     5      0    0
1.04       Certain diseases preventable by                1999         1       0      0       0       0      0       0       0      0       0    0       0    0       0    1       0    0     0      0    0
           immunization                                   2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0    0
1.05       Meningitis                                     1999         4       3      2       1       1      2       0       0      0       0    1       0    0       0    0       0    0     0      0    0
                                                          2000         10      4      1       2       6      1       1       1      0       0    2       0    0       0    0       0    0     0      0    0
1.06       Septicemia, except neonatal                    1999         2       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    2     0      0    0
                                                          2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0    0
1.07       HIV Disease (AIDS)                             1999         32      36     3       2       2      0       0       2      2       5    14      21   9       6    2       0    0     0      0    0
                                                          2000         32      29     0       1       0      2       0       3      1       4    27      17   4       2    0       0    0     0      0    0
1.08       Acute respiratory infection                    1999         112     100    26      16      11     13      5       4      7       6    12      14   17      16   7       5    27    26     0    0
                                                          2000         161     115    36      21      35     23      5       4      3       8    19      23   18      9    18      8    27    19     0    0
1.09       Other infectious and parasitic diseases        1999         112     88     3       2       9      9       5       5      24      20   42      34   12      8    8       3    9     7      0    0
                                                          2000         135     98     7       7       6      5       12      4      17      11   42      37   30      11   7       7    14    16     0    0
2.01       Malignant neoplasm of stomach                  1999         2       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    2     0      0    0
                                                          2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0    0
2.02       Malignant neoplasm of colon and                1999         3       0      0       0       0      0       0       0      2       0    1       0    0       0    0       0    0     0      0    0
           rectosigmoid junction                          2000         3       3      0       0       0      0       0       0      0       0    0       1    1       1    0       0    2     1      0    0
2.03       Malignant neoplasm of digestive organs &       1999         8       1      0       0       0      0       0       0      0       0    1       0    0       0    1       0    6     1      0    0
           peritoneum, except stomach & colon             2000         5       5      0       0       0      0       0       0      0       0    3       3    1       1    0       0    1     1      0    0
2.04       Malignant neoplasm of trachea, bronchus        1999         22      0      0       0       0      0       0       0      0       0    0       0    2       0    3       0    17    0      0    0
           and lung                                       2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0    0
2.05       Malignant neoplasm of respiratory &            1999         5       6      1       0       0      0       0       0      0       0    0       0    0       0    0       2    4     4      0    0
           intrathoracic organs, except trachea,          2000         2       1      0       0       0      0       0       0      0       0    2       0    0       0    0       0    0     1      0    0
           bronchus & lung
2.06       Malignant neoplasm of female breast            1999         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
                                                          2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
2.07       Malignant neoplasm of cervix uteri             1999         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
                                                          2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
2.08       Malignant neoplasm of corpus uteri             1999         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
                                                          2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
2.09       Malignant neoplasm of uterus, parts            1999         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
           unspecified                                    2000         0       0      0       0       0      0       0       0      0       0    0       0    0       0    0       0    0     0      0   0
2.10       Malignant neoplasm of prostate                 1999         20      2      0       0       0      0       0       0      1       0    10      0    1       0    1       0    7     2      0   0
                                                          2000         26      1      0       0       0      0       0       0      0       0    0       0    2       0    3       0    21    1      0   0
   --------------------------------------------------------------------------------------------------------------------------------------         47
   The Chief Medical Officer Report 2000
Code       Descriptie                                     Year         Total          <1              1-4            5-14           15-24        25-44         45-59         60-64        65+         Age
                                                                                                                                                                                                      Unknown
                                                                       M       F      M       F       M      F       M       F      M       F    M       F     M       F     M       F    M     F     M    F
2.11       Malignant neoplasm of other genitourinary      1999         3       7      0       0       0      0       0       0      0       0    0       2     2       1     0       1    1     3     0    0
           organs                                         2000         0       10     0       0       0      0       0       0      0       1    0       3     0       3     0       1    0     2     0    0
2.12       Leukemia                                       1999         8       5      0       0       0      0       0       0      0       1    0       0     0       1     2       0    6     3     0    0
                                                          2000         3       7      0       0       0      0       0       1      0       0    1       3     0       0     2       0    0     3     0    0
2.13       Malignant neoplasm of lymphoid, other          1999         7       7      0       0       0      0       0       0      0       0    3       1     1       4     0       0    3     2     0    0
           hematopoietic and related tissue               2000         8       2      0       0       0      0       0       0      1       0    5       1     2       1     0       0    0     0     0    0
2.14       Malignant neosplasm of other and               1999         42      42     1       2       2      0       0       0      1       0    7       8     7       13    7       6    17    13    0    0
           unspecified sites                              2000         51      50     0       0       0      0       2       0      2       0    7       14    7       9     10      12   23    15    0    0
2.15       Carcinoma in situ, benign neoplasms and        1999         46      174    2       8       1      0       1       1      4       5    9       76    9       72    5       4    15    8     0    0
           neoplasms of uncertain or unknown              2000         53      194    2       1       1      1       1       2      5       9    5       103   10      61    7       6    22    11    0    0
           behavior
3.01       Acute rheumatic fever & chronic rheumatic 1999              2       15     0       1       0      0       0       1      0       3    0       5     2       4     0       0    0     1     0   0
           heart disease                                2000           7       18     0       0       0      0       1       0      0       0    6       11    0       4     0       0    0     3     0   0
3.02       Hypertensive disease                         1999           238     333    9       8       0      0       1       1      2       2    30      26    70      105   26      48   100   143   0   0
                                                        2000           315     333    0       1       0      0       3       0      1       2    26      26    111     80    38      49   136   175   0   0
3.03       Ischemic heart disease                       1999           204     137    6       2       0      0       1       1      1       3    28      11    90      55    33      18   45    47    0   0
                                                        2000           262     154    0       0       0      0       0       0      0       1    39      17    131     63    42      26   50    47    0   0
3.04       Pulmonary heart disease, diseases of         1999           141     111    4       7       1      0       3       1      3       5    11      14    43      23    10      13   66    48    0   0
           pulmonary circulation & other forms of       2000           15      23     0       0       0      0       0       0      0       0    1       1     2       7     2       4    10    11    0   0
           heart disease
3.05       Cardiac arrest                               1999           0       0      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
                                                        2000           1       1      0       0       0      0       0       0      0       0    0       0     0       0     0       0    1     1     0   0
3.06       Heart failure                                1999           145     0      5       0       1      0       0       0      2       0    2       0     40      0     15      0    80    0     0   0
                                                        2000           142     129    0       2       0      0       2       0      0       0    12      11    38      27    15      16   75    73    0   0
3.07       Cerebrovascular diseases                     1999           181     172    10      4       2      1       0       0      0       1    14      16    50      43    30      23   75    84    0   0
                                                        2000           291     226    1       1       0      1       0       0      1       3    40      18    78      44    42      26   129   133   0   0
3.08       Atherosclerosis                              1999           0       0      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
                                                        2000           0       1      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     1     0   0
3.09       All other diseases of the circulatory system 1999           68      0      2       0       0      0       3       0      1       0    17      0     18      0     6       0    21    0     0   0
                                                        2000           0       0      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
4.01       Fetus and newborn affected by certain        1999           0       0      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
           maternal conditions                          2000           2       13     1       0       1      0       0       0      0       8    0       5     0       0     0       0    0     0     0   0
4.02       Fetus and newborn affected by obstetric      1999           1       1      1       1       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
           complications, birth trauma                  2000           3       7      3       0       0      0       0       0      0       4    0       3     0       0     0       0    0     0     0   0
4.03       Slow fetal growth, fetal malnutrition, short 1999           27      0      27      0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
           gestation, and low birth weight              2000           3       1      3       1       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
4.04       Respiratory disorders specific to the        1999           41      34     38      34      3      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
           prenatal period                              2000           45      32     44      32      1      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
4.05       Bacterial sepsis of newborn                  1999           1       0      1       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
                                                        2000           9       2      8       2       1      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0
4.06       Remainder of certain conditions originating 1999            126     79     123     77      3      0       0       0      0       1    0       1     0       0     0       0    0     0     0   0
           in the prenatal period                       2000           162     154    156     113     4      2       1       0      0       21   1       18    0       0     0       0    0     0     0   0
5.01       Land transport accidents                     1999           184     69     9       3       4      4       19      11     55      13   61      28    25      2     6       2    5     6     0   0
                                                        2000           184     61     6       3       3      4       26      9      60      7    59      27    14      7     4       1    12    3     0   0
5.02       Other and unspecified transport accidents 1999              2       1      0       0       0      0       0       0      1       0    0       1     1       0     0       0    0     0     0   0
                                                        2000           0       0      0       0       0      0       0       0      0       0    0       0     0       0     0       0    0     0     0   0

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   The Chief Medical Officer Report 2000
Code       Descriptie                                     Year         Total          <1              1-4            5-14           15-24        25-44         45-59        60-64        65+        Age
                                                                                                                                                                                                    Unknown
                                                                       M       F      M       F       M      F       M       F      M       F    M        F    M       F    M       F    M     F    M    F
5.03       Falls                                          1999         97      69     8       8       8      5       18      6      7       1    15       9    13      6    4       6    24    28   0    0
                                                          2000         77      72     0       0       9      5       13      4      4       2    17       7    10      7    2       5    22    42   0    0
5.04       Accidents caused by firearm discharge          1999         6       0      1       0       0      0       1       0      0       0    4        0    0       0    0       0    0     0    0    0
                                                          2000         1       0      0       0       0      0       1       0      0       0    0        0    0       0    0       0    0     0    0    0
5.05       Accidental drowning and submersion             1999         0       0      0       0       0      0       0       0      0       0    0        0    0       0    0       0    0     0    0    0
                                                          2000         4       3      0       0       1      2       1       0      1       1    0        0    1       0    0       0    0     0    0    0
5.06       Accidental threats to breathing                1999         2       1      0       0       0      0       0       0      0       1    0        0    1       0    1       0    0     0    0    0
                                                          2000         1       2      0       0       0      0       0       1      0       0    1        1    0       0    0       0    0     0    0    0
5.07       Exposure to electric current                   1999         2       0      0       0       0      0       0       0      2       0    0        0    0       0    0       0    0     0    0    0
                                                          2000         2       0      0       0       0      0       0       0      2       0    0        0    0       0    0       0    0     0    0    0
5.08       Exposure to smoke, fire, and flames            1999         5       2      0       0       0      2       1       0      2       0    1        0    1       0    0       0    0     0    0    0
                                                          2000         6       5      1       0       0      2       2       1      1       0    1        1    1       1    0       0    0     0    0    0
5.09       Accidental poisoning by and exposure to        1999         14      12     3       2       7      10      0       0      0       0    1        0    1       0    0       0    2     0    0    0
           noxious substances                             2000         0       0      0       0       0      0       0       0      0       0    0        0    0       0    0       0    0     0    0    0
5.10       All other accidents                            1999         167     80     5       6       7      12      28      4      35      10   50       18   24      13   6       2    12    15   0    0
                                                          2000         199     96     2       2       5      7       12      4      37      7    84       21   30      16   5       6    24    33   0    0
5.11       Intentional self-harm (suicide)                1999         50      52     3       3       1      1       1       4      6       19   28       20   8       3    0       1    3     1    0    0
                                                          2000         70      54     0       0       2      3       2       6      24      15   32       25   7       2    0       1    3     2    0    0
5.12       Assault (homicide)                             1999         88      16     5       1       0      0       2       1      30      3    44       8    6       3    0       0    1     0    0    0
                                                          2000         123     12     0       0       2      0       5       1      37      1    61       7    15      2    1       1    2     0    0    0
5.13       Event of undetermined intent                   1999         7       4      0       0       0      0       0       0      3       1    3        1    1       0    0       0    0     2    0    0
                                                          2000         18      6      1       1       1      0       3       1      6       2    6        0    0       1    1       1    0     0    0    0
5.14       All other external causes                      1999         12      2      1       1       0      0       0       0      4       0    5        1    1       0    0       0    1     0    0    0
                                                          2000         25      4      0       0       0      0       0       0      9       0    12       0    1       1    1       1    2     2    0    0
6.01       Diabetes mellitus                              1999         50      80     3       2       0      0       0       0      2       2    5        5    23      32   11      13   6     26   0    0
                                                          2000         75      62     0       0       0      0       0       2      2       7    12       7    32      17   10      4    19    25   0    0
6.02       Nutritional deficiencies & nutritional         1999         53      40     9       4       22     10      6       1      4       8    5        5    2       3    1       3    4     6    0    0
           anemia                                         2000         78      94     15      7       29     14      3       1      5       12   10       29   7       12   0       8    9     11   0    0
6.03       Mental and behavioral disorders                1999         44      26     2       1       0      1       2       0      2       1    10       9    15      7    4       2    9     5    0    0
                                                          2000         69      34     1       0       0      1       0       1      2       1    18       11   24      3    5       4    19    13   0    0
6.04       Diseases of nervous system, except             1999         149     88     16      4       9      4       9       3      6       9    41       18   33      12   12      14   23    24   0    0
           meningitis                                     2000         214     171    7       1       16     15      8       3      19      12   48       38   38      35   18      12   60    55   0    0
6.05       Chronic lower respiratory diseases             1999         67      69     10      15      13     12      1       4      2       1    4        9    7       9    5       8    25    11   0    0
                                                          2000         85      66     18      11      11     15      0       2      5       1    5        6    12      5    7       15   27    11   0    0
6.06       Remainder of diseases of the respiratory       1999         316     334    41      34      38     41      29      44     18      26   48       46   34      47   23      26   85    70   0    0
           system
6.06       Remainder of diseases of the respiratory       2000         423     338    63      33      57     45      21      35     25      21   63       63   60      34   35      43   99    64   0   0
           system
6.07       Appendicitis, hernia of abdominal cavity, &    1999         135     51     5       3       4      0       13      7      31      11   34       21   19      2    10      2    19    5    0   0
           intestinal obstruction
6.07       Appendicitis, hernia of abdominal cavity, &    2000         125     47     0       0       6      1       18      9      15      9    44       18   19      5    4       0    19    5    0   0
           intestinal obstruction
6.08       Cirrhosis and certain other chronic            1999         1       0      0       0       0      0       0       0      0       0    0        0    0       0    0       0    1     0    0   0
           diseases of the liver
6.08       Cirrhosis and certain other chronic            2000         0       0      0       0       0      0       0       0      0       0    0        0    0       0    0       0    0     0    0   0
           diseases of the liver

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Code       Descriptie                                     Year         Total          <1              1-4            5-14           15-24          25-44          45-59         60-64         65+         Age
                                                                                                                                                                                                          Unknown
                                                                       M       F      M       F       M      F       M       F      M       F      M       F      M       F     M       F     M     F     M    F
6.09       All other diseases of the digestive system     1999         510     328    19      18      12     5       27      15     56      30     160     104    117     55    26      35    93    66    0    0
                                                          2000         654     403    8       6       19     7       28      15     51      48     229     122    150     83    49      37    120   85    0    0
6.10       Diseases of the urinary system                 1999         250     157    6       8       0      2       8       3      8       10     56      41     69      46    38      16    65    31    0    0
                                                          2000         288     185    0       2       2      4       8       3      15      16     72      50     69      57    42      16    80    37    0    0
6.11       Hyperplasic of the prostate                    1999         121     4      3       0       0      0       0       0      0       0      0       1      9       0     27      1     82    2     0    0
                                                          2000         36      1      0       1       0      0       0       0      0       0      0       0      3       0     9       0     24    0     0    0
6.12       Pregnancy, childbirth, and the puerperium      1999         39      2249   7       45      0      2       0       17     10      1066   17      1112   0       2     5       2     0     3     0    0
                                                          2000         41      2541   0       10      0      0       1       26     22      1185   15      1314   3       6     0       0     0     0     0    0
6.13       Congenital malformations, deformations         1999         63      49     19      17      16     8       11      7      5       6      8       5      2       4     1       1     1     1     0    0
           and chromosomal abnormalities                  2000         55      53     15      8       14     11      9       7      7       8      4       11     3       6     1       2     2     0     0    0
6.14       Remainder of all other diseases                1999         0       0      0       0       0      0       0       0      0       0      0       0      0       0     0       0     0     0     0    0
                                                          2000         1582    1922   67      70      6      11      33      3      88      134    231     396    361     420   181     197   615   691   0    0




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                                              DISCHARGE DIAGNOSES FROM DIAKONESSEN HOSPITAL BY AGE & SEX
                                                                                                                                                                                                Year: 1998/1999/2000

Code       Descriptie                                       Year             Total           <1             1-4            5-14             15-24        25-44       45-59       60-64        65+       Age
                                                                                                                                                                                                      Unknown
                                                                        M       F      M       F      M       F       M      F       M         F    M       F    M      F    M      F    M      F    M    F
0.00       Ill-defined causes                               1998        51      58     11      2      4       4       3      4       6         6    5       23   7      11   1      0    14     8    0   0
                                                            1999        54      60     10      4      2       0       6      4       3         4    7       25   7      10   3      3    16     10   0   0
                                                            2000        62      97     9       7      5       2       9      4       2         11   8       40   5      17   5      8    19     8    0   0
1.01       Intestinal infectious diseases                   1998        35      43     14      7      3       5       1      1       2         4    4       12   5      9    2      0    4      5    0   0
                                                            1999        56      53     28      16     3       8       5      4       2         3    7       12   3      3    2      2    6      5    0   0
                                                            2000        84      79     22      14     8       4       10     2       4         9    9       16   6      16   4      2    21     16   0   0
1.02       Tuberculosis                                     1998        8       5      0       0      1       0       1      2       1         0    3       1    0      2    0      0    2      0    0   0
                                                            1999        12      3      2       0      1       0       1      0       2         1    1       2    1      0    1      0    3      0    0   0
                                                            2000        3       4      0       0      1       0       0      0       0         0    1       2    0      1    0      0    1      1    0   0
1.03       Certain vector-borne diseases                    1998        39      17     3       5      6       1       7      2       6         2    11      6    6      1    0      0    0      0    0   0
                                                            1999        56      47     10      3      4       11      8      1       15        9    18      17   1      3    0      1    0      2    0   0
                                                            2000        50      49     0       0      0       0       5      2       9         13   28      25   4      8    2      1    2      0    0   0
1.04       Certain diseases preventable by                  1998        2       4      0       0      0       0       0      1       0         0    1       1    1      1    0      1    0      0    0   0
           immunization                                     1999        3       0      0       0      1       0       0      0       0         0    0       0    1      0    1      0    0      0    0   0
                                                            2000        5       0      0       0      0       0       1      0       0         0    2       0    0      0    2      0    0      0    0   0
1.05       Meningitis                                       1998        4       3      3       3      1       0       0      0       0         0    0       0    0      0    0      0    0      0    0   0
                                                            1999        1       5      1       3      0       0       0      1       0         0    0       1    0      0    0      0    0      0    0   0
                                                            2000        2       0      1       0      0       0       0      0       0         0    0       0    0      0    0      0    1      0    0   0
1.06       Septicemia, except neonatal                      1998        4       1      1       1      0       0       0      0       0         0    0       0    0      0    1      0    2      0    0   0
                                                            1999        7       5      0       1      0       0       0      0       0         1    2       0    0      0    0      1    5      2    0   0
                                                            2000        13      6      0       2      0       0       1      0       0         0    1       1    1      1    2      0    8      2    0   0
1.07       HIV Disease (AIDS)                               1998        13      11     0       0      0       0       1      1       4         0    7       9    1      1    0      0    0      0    0   0
                                                            1999        12      13     1       0      0       0       0      1       1         2    8       8    1      1    0      0    1      1    0   0
                                                            2000        18      34     1       0      0       0       0      0       1         12   11      13   5      8    0      0    0      1    0   0
1.08       Acute respiratory infection                      1998        48      28     22      12     6       4       4      4       2         1    5       0    1      2    2      2    6      3    0   0
                                                            1999        46      23     25      9      2       1       2      2       1         3    4       2    3      2    1      0    8      4    0   0
                                                            2000        44      29     22      7      3       6       3      2       4         1    4       7    0      2    1      1    7      3    0   0
1.09       Other infectious and parasitic diseases          1998        27      48     3       2      0       2       2      2       3         5    10      16   4      10   0      4    5      7    0   0
                                                            1999        33      57     3       5      1       2       3      3       4         9    9       20   6      8    1      2    6      8    0   0
                                                            2000        65      72     12      7      1       1       5      3       7         8    7       21   5      9    7      4    21     19   0   0
2.01       Malignant neoplasm of stomach                    1998        2       2      0       0      0       0       0      0       0         0    0       0    2      0    0      2    0      0    0   0
                                                            1999        6       3      0       0      0       0       0      0       0         1    0       0    0      0    3      1    3      1    0   0
                                                            2000        1       1      0       0      0       0       0      0       0         0    0       0    0      0    0      1    1      0    0   0
2.02       Malignant neoplasm of colon and                  1998        3       1      0       0      0       0       0      0       0         0    0       0    2      1    1      0    0      0    0   0
           rectosigmoid junction                            1999        3       4      0       0      0       0       0      0       0         0    1       0    0      3    0      0    2      1    0   0
                                                            2000        5       3      0       0      0       0       0      0       0         0    1       2    2      0    0      0    2      1    0   0
2.03       Malignant neoplasm of digestive organs &         1998        2       4      0       0      0       0       0      0       0         0    0       0    0      2    1      1    1      1    0   0
           peritoneum, except stomach & colon               1999        3       4      0       0      0       0       0      0       0         0    0       0    2      2    0      1    1      1    0   0
                                                            2000        5       3      0       0      0       0       0      0       0         0    0       0    0      0    2      0    3      3    0   0
2.04       Malignant neoplasm of trachea, bronchus          1998        1       1      0       0      0       0       0      0       0         0    0       1    0      0    0      0    1      0    0   0
           and lung                                         1999        3       0      0       0      0       0       0      0       0         0    0       0    2      0    0      0    1      0    0   0

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Code       Descriptie                                       Year             Total           <1             1-4           5-14              15-24       25-44       45-59       60-64        65+       Age
                                                                                                                                                                                                     Unknown
                                                                        M       F      M       F      M       F       M      F       M         F    M      F    M      F    M      F    M      F    M    F
                                                            2000        2       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    2      0    0   0
2.05       Malignant neoplasm of respiratory &        1998              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
           intrathoracic organs, except trachea,      1999              0       1      0       0      0       0       0      0       0         0    0      0    0      0    0      1    0      0    0   0
           bronchus & lung                            2000              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
2.06       Malignant neoplasm of female breast        1998              0       23     0       0      0       0       0      0       0         0    0      7    0      6    0      5    0      5    0   0
                                                      1999              0       20     0       0      0       0       0      0       0         0    0      5    0      9    0      1    0      5    0   0
                                                      2000              0       17     0       0      0       0       0      0       0         0    0      3    0      5    0      2    0      7    0   0
2.07       Malignant neoplasm of cervix uteri         1998              0       19     0       0      0       0       0      0       0         0    0      2    0      8    0      2    0      7    0   0
                                                      1999              0       10     0       0      0       0       0      0       0         0    0      5    0      2    0      1    0      2    0   0
                                                      2000              0       18     0       0      0       0       0      0       0         0    0      6    0      7    0      1    0      4    0   0
2.08       Malignant neoplasm of corpus uteri         1998              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
                                                      1999              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
                                                      2000              0       2      0       0      0       0       0      0       0         0    0      1    0      0    0      0    0      1    0   0
2.09       Malignant neoplasm of uterus, parts        1998              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
           unspecified                                1999              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
                                                      2000              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
2.10       Malignant neoplasm of prostate             1998              17      0      0       0      0       0       0      0       0         0    0      0    1      0    3      0    13     0    0   0
                                                      1999              19      0      0       0      0       0       0      0       0         0    0      0    1      0    1      0    17     0    0   0
                                                      2000              15      0      0       0      0       0       0      0       0         0    0      0    1      0    2      0    12     0    0   0
2.11       Malignant neoplasm of other genitourinary  1998              0       1      0       0      0       0       0      0       0         0    0      0    0      1    0      0    0      0    0   0
           organs                                     1999              6       9      0       0      0       0       0      0       0         0    2      2    1      5    0      0    3      2    0   0
                                                      2000              0       3      0       0      0       0       0      0       0         0    0      1    0      1    0      1    0      0    0   0
2.12       Leukemia                                   1998              6       0      1       0      0       0       0      0       2         0    3      0    0      0    0      0    0      0    0   0
                                                      1999              1       2      0       0      0       0       0      0       1         0    0      2    0      0    0      0    0      0    0   0
                                                      2000              0       5      0       0      0       0       0      0       0         1    0      3    0      1    0      0    0      0    0   0
2.13       Malignant neoplasm of lymphoid, other      1998              12      1      0       0      0       0       0      0       0         0    4      0    4      0    0      0    4      1    0   0
           hematopoietic and related tissue           1999              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
                                                      2000              5       2      0       0      0       0       2      0       1         0    0      0    0      2    0      0    2      0    0   0
2.14       Malignant neosplasm of other and           1998              4       9      0       0      0       0       0      1       1         0    1      4    1      0    0      1    1      3    0   0
           unspecified sites                          1999              4       11     0       0      0       0       0      3       0         0    1      2    0      0    1      2    2      4    0   0
                                                      2000              4       14     0       0      0       0       0      1       0         0    0      2    3      7    0      1    1      3    0   0
2.15       Carcinoma in situ, benign neoplasms and    1998              21      169    1       5      2       2       4      6       3         5    3      84   3      60   0      3    5      4    0   0
           neoplasms of uncertain or unknown behavior 1999              8       81     0       1      0       0       1      2       0         5    2      38   2      25   3      2    0      8    0   0
                                                      2000              16      145    0       3      0       1       1      3       0         9    0      67   2      56   1      3    12     3    0   0
3.01       Acute rheumatic fever & chronic rheumatic  1998              2       1      0       0      0       0       1      1       0         0    0      0    1      0    0      0    0      0    0   0
           heart disease                              1999              0       1      0       0      0       0       0      0       0         0    0      0    0      1    0      0    0      0    0   0
                                                      2000              0       0      0       0      0       0       0      0       0         0    0      0    0      0    0      0    0      0    0   0
3.02       Hypertensive disease                       1998              7       30     0       0      0       0       0      1       0         1    3      6    3      11   0      2    1      9    0   0
                                                      1999              13      33     0       0      0       0       0      1       0         0    0      4    7      12   3      5    3      11   0   0
                                                      2000              13      39     0       0      0       0       0      0       0         0    4      11   6      12   2      8    1      8    0   0
3.03       Ischemic heart disease                     1998              19      20     0       0      0       0       0      0       0         0    3      2    3      12   1      2    12     4    0   0
                                                      1999              11      16     0       0      1       0       0      0       0         0    0      0    6      8    1      2    3      6    0   0
                                                      2000              11      19     0       0      0       0       0      0       0         0    1      0    6      9    0      2    4      8    0   0
3.04       Pulmonary heart disease, diseases of       1998              13      15     0       0      0       0       2      0       0         0    1      2    4      4    2      4    4      5    0   0

   --------------------------------------------------------------------------------------------------------------------------------------           52
   The Chief Medical Officer Report 2000
Code       Descriptie                                       Year            Total            <1             1-4           5-14              15-24        25-44        45-59       60-64        65+       Age
                                                                                                                                                                                                       Unknown
                                                                        M      F       M       F      M       F       M      F       M         F    M       F    M       F    M      F    M      F    M    F
                                                            1999        11     26      0       2      0       0       0      0       0         2    2       5    1       3    3      1    5      13   0   0
                                                            2000        31     18      2       0      0       0       1      1       1         0    2       2    8       4    4      2    13     9    0   0
3.05       Cardiac arrest                                   1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
3.06       Heart failure                                    1998        3      2       0       0      0       0       0      0       0         0    1       0    0       0    2      0    0      2    0   0
                                                            1999        3      1       0       0      0       0       0      0       0         1    0       0    0       0    1      0    2      0    0   0
                                                            2000        5      4       0       0      0       0       0      0       0         0    0       0    1       0    0      0    4      4    0   0
3.07       Cerebrovascular diseases                         1998        32     36      0       1      0       0       0      0       0         0    2       4    9       11   4      6    17     14   0   0
                                                            1999        28     38      0       0      0       0       0      0       0         0    4       6    8       8    4      6    12     18   0   0
                                                            2000        49     26      0       0      0       0       0      0       0         0    1       0    17      5    8      5    23     16   0   0
3.08       Atherosclerosis                                  1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      1       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      1    0   0
                                                            2000        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
3.09       All other diseases of the circulatory system     1998        22     35      1       0      0       0       0      0       0         3    8       21   8       10   1      1    4      0    0   0
                                                            1999        24     28      0       0      0       0       1      1       0         3    11      13   6       6    1      2    5      3    0   0
                                                            2000        17     30      0       0      0       0       0      0       0         2    7       16   2       7    3      2    5      3    0   0
4.01       Fetus and newborn affected by certain            1998        4      1       4       1      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
           maternal conditions                              1999        2      1       2       1      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        14     19      14      19     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
4.02       Fetus and newborn affected by obstetric          1998        16     10      16      10     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
           complications, birth trauma                      1999        7      10      7       10     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        12     11      12      11     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
4.03       Slow fetal growth, fetal malnutrition, short     1998        72     76      71      75     0       0       0      0       0         1    1       0    0       0    0      0    0      0    0   0
           gestation, and low birthweight                   1999        78     57      78      57     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        87     97      87      97     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
4.04       Respiratory disorders specific to the            1998        51     33      51      33     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
           perinatal period                                 1999        53     33      53      33     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        54     35      54      35     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
4.05       Bacterial sepsis of newborn                      1998        1      1       1       1      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      1       0       1      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        3      0       3       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
4.06       Remainder of certain conditions originating      1998        109    71      109     70     0       1       0      0       0         0    0       0    0       0    0      0    0      0    0   0
           in the perinatal period                          1999        88     58      88      58     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        124    70      124     70     0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
5.01       Land transport accidents                         1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
5.02       Other and unspecified transport accidents        1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
5.03       Falls                                            1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            1999        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
                                                            2000        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0
5.04       Accidents caused by firearm discharge            1998        0      0       0       0      0       0       0      0       0         0    0       0    0       0    0      0    0      0    0   0

   --------------------------------------------------------------------------------------------------------------------------------------           53
   The Chief Medical Officer Report 2000
Code       Descriptie                                       Year             Total           <1             1-4           5-14              15-24       25-44        45-59        60-64        65+       Age
                                                                                                                                                                                                       Unknown
                                                                        M       F      M       F      M       F       M      F       M         F    M      F    M       F    M       F    M      F    M    F
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.05       Accidental drowning and submersion               1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.06       Accidental threats to breathing                  1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.07       Exposure to electric current                     1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.08       Exposure to smoke, fire, and flames              1998        0       1      0       1      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.09       Accidental poisoning by and exposure to          1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
           noxious substances                               1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.10       All other accidents                              1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.11       Intentional self-harm (suicide)                  1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.12       Assault (homicide)                               1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.13       Event of undetermined intent                     1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
5.14       All other external causes                        1998        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            1999        0       0      0       0      0       0       0      0       0         0    0      0    0       0    0       0    0      0    0   0
                                                            2000        4       0      0       0      0       0       1      0       1         0    1      0    1       0    0       0    0      0    0   0
6.01       Diabetes mellitus                                1998        49      66     0       0      0       0       6      0       1         0    6      9    13      25   10      6    13     26   0   0
                                                            1999        56      63     0       1      0       0       6      2       5         2    8      7    10      16   9       12   18     23   0   0
                                                            2000        14      70     9       0      2       0       0      0       0         4    1      11   1       22   0       10   1      23   0   0
6.02       Nutritional deficiencies & nutritional anemia    1998        5       12     2       2      1       1       0      0       0         0    0      7    1       2    0       0    1      0    0   0
                                                            1999        6       5      4       2      0       0       0      0       0         1    1      1    1       1    0       0    0      0    0   0
                                                            2000        4       10     0       1      0       1       1      0       1         2    1      3    1       2    0       0    0      1    0   0
6.03       Mental and behavioral disorders                  1998        6       9      1       1      0       0       0      0       0         0    0      7    1       1    0       0    4      0    0   0
                                                            1999        6       15     0       1      1       0       1      0       0         3    2      7    2       2    0       2    0      0    0   0
                                                            2000        17      7      1       1      0       0       1      0       2         0    3      4    3       2    3       0    4      0    0   0
6.04       Diseases of nervous system, except               1998        22      20     1       2      2       0       3      0       2         3    3      12   7       1    1       0    3      2    0   0
           meningitis                                       1999        16      14     0       0      4       0       2      0       1         2    3      4    3       3    1       0    2      5    0   0
                                                            2000        9       26     0       0      1       1       0      0       0         3    0      6    3       5    1       2    4      9    0   0
6.05       Chronic lower respiratory diseases               1998        9       4      2       0      0       0       0      0       1         0    2      2    1       1    1       0    2      1    0   0

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   The Chief Medical Officer Report 2000
Code       Descriptie                                       Year            Total            <1             1-4            5-14             15-24        25-44          45-59         60-64        65+       Age
                                                                                                                                                                                                           Unknown
                                                                        M      F       M       F      M       F       M      F       M         F     M      F      M       F     M       F    M      F    M    F
                                                        1999            15     5       0       0      0       0       3      0       0         0     0      2      3       0     2       1    7      2    0   0
                                                        2000            10     10      0       1      1       0       0      0       0         0     1      3      2       2     0       1    6      3    0   0
6.06       Remainder of diseases of the respiratory     1998            11     14      1       1      0       3       0      0       0         3     3      5      4       2     1       0    2      0    0   0
           system                                       1999            12     3       2       0      0       0       3      0       3         0     3      2      0       0     0       1    1      0    0   0
                                                        2000            91     13      4       1      3       3       5      1       14        1     21     2      16      4     9       1    19     0    0   0
6.07       Appendicitis, hernia of abdominal cavity, &  1998            93     40      1       4      6       2       1      2       11        4     24     15     14      12    8       1    28     0    0   07
           intestinal obstruction                       1999            75     48      8       2      2       4       7      9       6         6     16     15     10      3     7       4    19     5    0   0
                                                        2000            7      64      0       5      0       7       0      4       0         2     0      19     2       16    2       3    3      8    0   0
6.08       Cirrhosis and certain other chronic diseases 1998            4      4       0       0      0       0       0      2       0         0     N/A    0      3       0     1       1    0      1    0   0
           of the liver                                 1999            1      3       0       1      0       0       0      0       0         0     0      0      0       1     0       1    1      0    0   0
                                                        2000            79     5       1       0      0       0       4      0       1         0     25     0      15      2     15      2    18     1    0   0
6.09       All other diseases of the digestive system   1998            101    121     2       2      1       0       1      4       12        10    30     58     19      20    14      14   22     13   0   0
                                                        1999            81     133     0       2      3       0       5      7       2         8     25     69     15      23    4       4    27     20   0   0
                                                        2000            64     86      3       4      0       2       2      3       4         7     16     23     16      19    2       8    21     20   0   0
6.10       Diseases of the urinary system               1998            64     48      4       0      1       0       4      4       4         3     27     19     5       16    6       1    13     5    0   0
                                                        1999            64     45      0       1      2       2       3      2       4         6     15     15     12      11    4       2    24     6    0   0
                                                        2000            35     40      0       0      0       2       0      4       0         2     2      9      6       12    3       4    24     7    0   0
6.11       Hyperplasia of the prostate                  1998            17     0       0       0      0       0       0      0       0         0     0      0      2       0     1       0    14     0    0   0
                                                        1999            24     0       0       0      0       0       0      0       0         0     0      0      2       0     7       0    15     0    0   0
                                                        2000            2      0       1       0      0       0       0      0       0         0     0      0      1       0     0       0    0      0    0   0
6.12       Pregnancy, childbirth, and the puerperium    1998            0      2023    0       16     0       0       0      11      0         619   0      1362   0       5     0       1    0      9    0   0
                                                        1999            0      1539    0       6      0       0       0      14      0         427   0      1084   0       6     0       0    0      2    0   0
                                                        2000            28     1976    22      0      3       1       2      12      0         598   1      1362   0       3     0       0    0      0    0   0
6.13       Congenital malformations, deformations and 1998              24     13      16      9      6       1       2      1       0         2     0      0      0       0     0       0    0      0    0   0
           chromosomal abnormalities                    1999            13     15      8       7      3       1       1      2       1         2     0      2      0       0     0       0    0      1    0   0
                                                        2000            113    12      7       7      7       0       16     3       12        1     22     1      22      0     5       0    22     0    0   0
6.14       Remainder of all other diseases              1998            133    425     11      11     10      3       23     12      11        42    19     209    23      101   11      20   25     27   0   0
                                                        1999            347    407     12      18     4       3       6      16      42        51    178    181    48      76    16      20   41     42   0   0
                                                        2000            17     122             23             10             13                11           23             17    17      6           19       0




   --------------------------------------------------------------------------------------------------------------------------------------            55
   The Chief Medical Officer Report 2000
        WITH RATES PER 1000 OF THE POPULATION, YEAR 2000


             CAUSES OF                        2000*
         HOSPITALIZATION                 RANK NO.   RATE
     Pregnancy, Childbirth and
                                            1       4,586
     Puerperium
     Gastrointestinal diseases              2       2,159
     Hypertension and
                                            3       1,986
     Cardiovascular diseases
     Diseases of the Respiratory
                                            4       1,533
     System
     External Causes                        5       1,048
     Certain Conditions
                                                     954
     originating in perinatal period        6
     Cerebrovascular diseases                        792
                                            7
     Malignant Neoplasmata                           779
                                            8
     Certain Vector-borne Diseases                   590
                                            9
     Urogenital disorders                            548
                                            10




*2000 hospitalization data was only available from St. Vincentius ,
     Academic hospitals and Diakonessen Hospital,
     and the grouping for the causes was not consistent, thus rates were not yet calculated
                                                                      SELECTED CAUSES OF DEATH BY AGE & SEX
Year: 2000


                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M      1539            20            189            21           68    247       243      128     623    27,243

                                                                                      F      1132            16            158            10           32    129       158      102     527    18,259.5
                 TOTAL DEATHS CERTIFIED (0.00-6.00)
                                                                                      U        6              0              1             0           1      0         1        1       2      124.5

                                                                                      M      1381            17            187            20           63    238       228      118     510    26,334.5

  1.00-6.00 Total Deaths from Defined Causes (A00-Y89,                                F      974             13            145            10           32    123       151       92     408    17,136.5
                          except R00-R99)
                                                                                      U        4              0              1             0           1      0         1        0       1      121.5

                                                                                      M      158              3              2             1           5      9         15       10     113     908.5

                                                                                      F      158              3             13             0           0      6         7        10     119     1123
     0.00        Ill-defined Causes (R00-R99) (SSI = 11.9%)
                                                                                      U        2              0              0             0           0      0         0        1       1        3

                                                                                      M      202              3             28             1           14     61        31       12     52      4,756
  1.00      Communicable diseases (A00-B99, G00-G03, J00-
                                                                                      F      128              2             26             6           9      30        18       6      31     3,547.5
                              J22)
                                                                                      U        1              0              1             0           0      0         0        0       0       63

                                                                                      M       25              0             10             1           1      1         1        2       9      780.5
                  1.01      Intestinal Infectious diseases
                                                                                      F       27              1             11             1           0      2         2        1       9      838.5
                                      (A00-A09)
                                                                                      U        0              0              0             0           0      0         0        0       0        0


--------------------------------------------------------------------------------------------------------------------------------------            57
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M        1              0              0             0           0      0         0        0       1      0

                      1.02 Tuberculosis (A15-A19)                                     F        3              0              1             0           0      0         0        0       2      63

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       25              0              2             0           5      8         4        1       5     652.5
   1. 03 Certain vector-borne diseases (A20, A44, A75-A79,
                                                                                      F       16              0              5             3           1      6         0        1       0     713
                A82-A84, A85.2, A90-A98, B50-B57)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        1              0              0             0           0      0         0        1       0      3
   1. 04 Certain diseases preventable by immunization (A33-
           A37, A80, B05, B06, B16, B17.0, B18.0-B18.1,                               F        0              0              0             0           0      0         0        0       0      0
                                 B26)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        9              0              5             0           1      0         1        1       1     376.5

                1. 05 Meningitis (A39, A87, G00-G03)                                  F        1              0              0             0           0      0         1        0       0      13

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       14              0              3             0           0      2         3        0       6     289

            1. 06 Septicemia, except neonatal (A40-A41)                               F       10              0              3             0           0      0         2        0       5     215

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       70              1              1             0           5      43        15       3       2     1806

                 1. 07 HIV disease (AIDS) (B20-B24)                                   F       40              1              2             0           7      21        9        0       0     1202

                                                                                      U        0              0              0             0           0      0         0        0       0      0


--------------------------------------------------------------------------------------------------------------------------------------            58
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M       47              0              7             0           1      3         6        4      26      668

              1. 08 Acute respiratory infection (J00-J22)                             F       25              0              4             2           0      1         2        1      15     422.5

                                                                                      U        1              0              1             0           0      0         0        0       0      63


    1.09 Other infectious and parasitic diseases (remainder of                        M       10              2              0             0           1      4         1        0       2     180.5
         A00-B99: A21-A32, A38, A42-A43, A46-A74, A81,
           A85.0-A85.1, A85.8, A86, A88-A89, A99-B04,
          B07-B15, B17.1-B17.8, B18.2-B19.9, B25, B27-                                F        6              0              0             0           1      0         2        3       0      80.5
                            B49, B58-B99)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M      1024             3              1             3           5      14        19       12     67     2575.5

                     2. 00      Neoplasms (C00-D48)                                   F      129              2              0             0           3      26        32       21     45     1408.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        6              0              0             0           0      0         1        1       4      16

            2. 01 Malignant neoplasm of stomach (C16)                                 F        3              0              0             0           0      1         0        2       0      36.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       11              0              0             0           0      1         2        1       7      59.5
      2. 02 Malignant neoplasm of colon and rectosigmoid
                                                                                      F        5              0              0             0           0      0         1        1       3      16
                        junction (C18-C19)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

 2. 03 Malignant neoplasm of digestive organs & peritoneum,                           M       19              0              0             1           0      1         2        3      12      121
        except stomach & colon (C15, C17, C20-C26, C48)
                                                                                      F       18              1              0             0           0      3         5        4       5     168.5


--------------------------------------------------------------------------------------------------------------------------------------            59
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       29              0              0             0           0      2         7        3      17     161
    2. 04 Malignant neoplasm of trachea, bronchus and lung
                                                                                      F        9              0              0             0           0      0         2        3       4      35
                            (C33-C34)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        0              0              0             0           0      0                  0       0      0
     2. 05 Malignant neoplasm of respiratory & intrathoracic
           organs, except trachea, bronchus & lung (C30-C32,                          F        0              0              0             0           0      0                  0       0      0
                                C37-C39)
                                                                                      U        0              0              0             0           0      0                  0       0      0

                                                                                      M        0              0              0             0           0      0         0        0       0      0

  2. 06 Malignant neoplasm of female breast (C50 in women)                            F       19              0              0             0           0      6         3        1       9     225

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        0              0              0             0           0      0         0        0       0      0

          2. 07 Malignant neoplasm of cervix uteri (C53)                              F       25              0              0             0           0      6         9        3       7     309

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        0              0              0             0           0      0                  0       0      0

          2. 08 Malignant neoplasm of corpus uteri (C54)                              F        0              0              0             0           0      0                  0       0      0

                                                                                      U        0              0              0             0           0      0                  0       0      0

                                                                                      M        0              0              0             0           0      0                  0       0      0
      2. 09 Malignant neoplasm of uterus, parts unspecified
                                                                                      F        1              0              0             0           0      0                  0       1      0
                               (C55)
                                                                                      U        0              0              0             0           0      0                  0       0      0
--------------------------------------------------------------------------------------------------------------------------------------            60
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M       20              3              0             0           0      0         1        3      16      3

             2.10 Malignant neoplasm of prostate (C61)                                F        0              0              0             0           0      0         0        0       0      0

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        4              0              0             0           0      0         1        0       3      13
    2. 11 Malignant neoplasm of other genitourinary organs
                                                                                      F       13              1              0             0           0      0         5        3       4      74
                (C51-C52, C56-C57, C60, C62-C68)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        6              0              0             1           3      1         0        1       0     225.5

                        2. 12 Leukemia (C91-C95)                                      F        8              0              0             0           1      3         1        1       2     153

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        6              0              1             0           1      1         2        0       1     165
  2. 13 Malignant neoplasm of lymphoid, other hematopoietic
                                                                                      F        5              0              0             0           0      2         1        0       2      74
                 and related tissue (C81-C90. C96)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       23              0              0             1           1      8         4        2       7     403
    2. 14 Malignant neoplasm of other and unspecified sites
          (remainder of C00-C97: C00-C14, C40-C47, C49,
                 C50 in men, C58, C69-C80, C97)                                       F       22              0              0             0           2      5         5        3       7     317.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        0              0              0             0           0      0         0        0       0      0
   2. 15 Carcinoma in situ, benign neoplasms and neoplasms
            of uncertain or unknown behavior (D00-D48)                                F        1              0              0             0           0      0         0        0       1      0

                                                                                      U        0              0              0             0           0      0         0        0       0      0

--------------------------------------------------------------------------------------------------------------------------------------            61
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M      438              5              1             0           4      46        94       48     240    3014

        3.00 Diseases of the circulatory system (I00-I99)                             F      333              6              0             0           3      16        53       40     215    1433.5

                                                                                      U        1              0              0             0           0      0         0        0       1       0

                                                                                      M        1              0              0             0           0      1         0        0       0      30.5
     3. 01 Acute rheumatic fever & chronic rheumatic heart
                                                                                      F        1              0              0             0           0      0         0        0       1       0
                          disease (I00-I09)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       47              1              0             0           0      3         11       5      27     249.5

                  3. 02 Hypertensive disease (I10-I15)                                F       40              3              0             0           1      1         4        6      25      146

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M      117              0              0             0           0      13        35       13     56     890.5

                 3. 03 Ischemic heart disease (I20-I25)                               F       78              0              0             0           0      4         20       9      45      409

                                                                                      U        0              0              0             0           0      0         8        4       0       0

                                                                                      M       41              0              1             0           2      7         6        6      19     483.5
      3. 04 Pulmonary heart disease, diseases of pulmonary
           circulation & other forms of heart disease (I26-I45,                       F       36              1              0             0           0      5         0        12     18     248.5
                              I47-I49, I51)
                                                                                      U        1              0              0             0           0      0         0        0       1       0

                                                                                      M        2              0              0             0           0      0         1        0       1      13

                         3. 05 Cardiac arrest (I46)                                   F        2              0              0             0           0      1         0        0       1      30.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                          3. 06 Heart failure (I50)                                   M       31              1              0             0           0      1         3        4      22      81.5

--------------------------------------------------------------------------------------------------------------------------------------            62
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      F       22              0              0             0           1      0         4        6      11     115.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M      182              3              0             0           1      16        32       22     108    1015.5
                     3. 07 Cerebrovascular diseases
                                                                                      F      144              2              0             0           1      5         16       13     107     445
                                  (I60-I69)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        6              0              0             0           0      0         1        0       5      13

                        3. 08 Atherosclerosis (I70)                                   F        7              0              0             0           0      0         0        0       7       0

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       11              0              0             0           1      5         3        0       2      237

   3. 09 All other diseases of the circulatory system (I71-I99)
                                                                                      F        3              0              0             0           0      0         3        0       0      39

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M      104              0            104             0           0      0         0        0       0     6552
     4. 00 Certain conditions originating in the perinatal
                                                                                      F       88              2             86             0           0      0         0        0       0     5418
                         period (P00-P96)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        8              0              8             0           0      0         0        0       0      504
      4. 01 Fetus and newborn affected by certain maternal
                                                                                      F        6              0              6             0           0      0         0        0       0      378
                        conditions (P00-P04)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

 4. 02 Fetus and newborn affected by obstetric complications,                         M       11              0             11             0           0      0         0        0       0      693
                  bi h       ( 01 03 10 1 )
--------------------------------------------------------------------------------------------------------------------------------------            63
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      F        8              0              8             0           0      0         0        0       0      504

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       37              0             37             0           0      0         0        0       0     2331
   4. 03 Slow fetal growth, fetal malnutrition, short gestation,
                                                                                      F       34              0             34             0           0      0         0        0       0     2142
                   and low birth weight (P05, P07)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       16              0             16             0           0      0         0        0       0     1008
   4. 04 Respiratory disorders specific to the perinatal period
                                                                                      F       10              1              9             0           0      0         0        0       0      567
                              (P20-P28)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       10              0             10             0           0      0         0        0       0      630

               4. 05 Bacterial sepsis of newborn (P36)                                F       14              0             14             0           0      0         0        0       0      882

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       22              0             22             0           0      0         0        0       0     1386
    4. 06 Remainder of certain conditions originating in the
        perinatal period (remainder of P00-P96: P08, P29, P35,                        F       16              1             15             0           0      0         0        0       0      945
                               P37-P96)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M      198              4             15            13           32     82        31       3      18     6035.5

                  5. 00      External causes (V01-Y89)                                F       64              0             11             4           10     17        6        5      11     1981.5

                                                                                      U        1              0              0             0           1      0         0        0       0      45.5

              5. 01 Land transport accidents (V01-V89)                                M       42              0              2             4           5      19        6        1       5     1236


--------------------------------------------------------------------------------------------------------------------------------------            64
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      F       11              0              1             1           1      3         2        0       3     281.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        1              0              0             0           1      0         0        0       0     45.5

   5. 02 Other and unspecified transport accidents (V90-V99)                          F        0              0              0             0           0      0         0        0       0      0

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        4              0              0             1           1      1         0        0       1     131.5

                          5. 03 Falls (W00-W19)                                       F        1              0              0             0           0      0         0        1       0      3

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        1              0              0             0           1      0         0        0       0     45.5

    5. 04 Accidents caused by firearm discharge (W32-W34)                             F        0              0              0             0           0      0         0        0       0      0

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       11              0              4             3           0      2         2        0       0     505.5

    5. 05 Accidental drowning and submersion (W65-W74)                                F        3              0              3             0           0      0         0        0       0     189

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        5              0              4             0           0      0         0        0       1     252

         5. 06 Accidental threats to breathing (W75-W84)                              F        1              0              1             0           0      0         0        0       0      63

                                                                                      U        0              0              0             0           0      0         0        0       0      0

           5. 07 Exposure to electric current (W85-W87)                               M        0              0              0             0           0      0         0        0       0      0

                                                                                      F        0              0              0             0           0      0         0        0       0      0
--------------------------------------------------------------------------------------------------------------------------------------            65
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        2              1              1             0           0      0         0        0       0      63

      5. 08 Exposure to smoke, fire, and flames (X00-X09)                             F        2              0              1             1           0      0         0        0       0     118.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        0              0              0             0           0      0         0        0       0       0
     5. 09 Accidental poisoning by and exposure to noxious
                        substances (X40-X49)                                          F        0              0              0             0           0      0         0        0       0       0

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M        7              0              1             0           1      1         3        0       1      178
     5. 10 All other accidents (W20-W31, W35-W64, W88-
                                                                                      F        3              0              1             0           0      1         1        0       0     106.5
                W99, X10-X39, X50-X59, Y40-Y84)
                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       39              1              0             1           9      21        5        0       2     1170.5

           5.11 Intentional self-harm (suicide) (X60-X84)                             F       14              0              0             0           3      8         0        2       1     386.5

                                                                                      U        1              0              0             0           1      0         0        0       0      45.5

                                                                                      M       13              0              0             0           2      8         0        0       3      335

                 5. 12 Assault (homicide) (X85-Y09)                                   F        6              0              1             0           2      1         0        1       1     187.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

                                                                                      M       71              1              3             4           12     29        15       2       5     2042.5

           5. 13 Event of undetermined intent (Y10-Y34)                               F       22              0              3             1           4      4         3        1       6     590.5

                                                                                      U        0              0              0             0           0      0         0        0       0       0

--------------------------------------------------------------------------------------------------------------------------------------            66
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      M        2              1              0             0           0      1         0        0       0     30.5

       5. 14 All other external causes (Y35-Y36, Y85-Y89)                             F        1              0              0             1           0      0         0        0       0     55.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M      315              2             38             3           8      35        53       43     133    4810
     6. 00 All other diseases (D50-D89, E00-E90, F00-F99,
           G04-G98, H00-H59, H60-H95, J30-J98, K00-K93,                               F      232              1             22             0           7      34        42       20     106    337.5
          L00-L99, M00-M99, N00-N99, O00-O99, Q00-Q99)
                                                                                      U        1              0              0             0           0      0         1        0       0      13

                                                                                      M       71              1              0             0           0      6         18       17     29     468

                   6. 01 Diabetes mellitus (E10-E14)                                  F       54              0              0             0           0      4         17       3      30      52

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        9              0              6             0           0      0         0        0       3     378
    6. 02 Nutritional deficiencies & nutritional anemia (E40-
                                                                                      F        4              0              1             0           0      0         0        0       3      63
                             E64, D50-D53)
                                                                                      U        1              0              0             0           0      0         0        1       0      13

                                                                                      M        5              0              0             0           1      0         1        0       3     58.5

         6. 03 Mental and behavioral disorders (F00-F99)                              F        4              1              0             0           0      1         1        0       1     43.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        7              0              2             0           1      2         0        0       2     232.5
   6. 04 Diseases of nervous system, except meningitis (G04-
                                                                                      F       15              0              1             0           0      5         3        1       5     257.5
                                 G99)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

        6. 05 Chronic lower respiratory diseases (J40-J47)                            M       23              0              1             0           0      1         2        2      17     125.5

--------------------------------------------------------------------------------------------------------------------------------------            67
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      F       14              0              4             0           0      1         0        2       7     288.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       11              0              3             0           1      0         1        1       5     250.5
      6. 06 Remainder of diseases of the respiratory system
                                                                                      F        9              0              1             0           0      1         2        1       4     122.5
               (remainder of J00-J99: J30-J39, J60-J98)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        7              0              0             0           1      1         2        0       3     102
  6. 07 Appendicitis, hernia of abdominal cavity, & intestinal
                                                                                      F        9              0              2             0           0      1         1        1       4     172.5
                    obstruction (K35-K46, K56)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       27              1              0             0           0      4         2        9      11     175
    6. 08 Cirrhosis and certain other chronic diseases of liver
                                                                                      F       14              0              1             0           0      2         4        3       4     185
                         (K70, K73, K74, K76)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       59              0              4             0           4      9         14       6      22     908.5
   6. 09 All other diseases of the digestive system (remainder
          of K00-K93: K00-K31, K50-K55, K57-K66, K71,                                 F       32              0              2             0           3      3         5        1      18     422
                         K72, K75, K80-K93)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       38              0              1             0           0      5         8        6      18     337.5

            6. 10 Diseases of urinary system (N00-N39)                                F       27              0              0             0           2      2         4        8      11     228

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                   6.11 Hyperplasia of prostate (N40)                                 M        1              0              0             0           0      0         0        0       1      0

                                                                                      F        0              0              0             0           0      0         0        0       0      0
--------------------------------------------------------------------------------------------------------------------------------------            68
The Chief Medical Officer Report 2000
                                                                                                                                                  AGE GROUPS IN YEARS
                    CAUSE GROUPS PER ICD-10
                                                                                       TOTAL            Unknown            0-4           5 - 14   15 - 24   25 - 44   45 - 59   60-64   65 +   YPLL

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M        0              0              0             0           0      0         0        0       0      0

  6. 12 Pregnancy, childbirth, and the puerperium (O00-O99)                           F        9              0              0             0           2      7         0        0       0     304.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       18              0             18             0           0      0         0        0       0     1134
        6. 13 Congenital malformations, deformations and
                                                                                      F        9              0              9             0           0      0         0        0       0     567
                chromosomal abnormalities (Q00-Q99)
                                                                                      U        0              0              0             0           0      0         0        0       0      0

                                                                                      M       39              0              3             3           0      7         5        2      19     640
    6.14 Remainder of all other diseases (remainder of A00-
         Q99: D55-D89, E00-E07, E15-E34, E65-E90, H00-
          H59, H60-H95, L00-L99, M00-M99, N41-N99)                                    F       32              0              1             0           0      7         5        0      19     341.5

                                                                                      U        0              0              0             0           0      0         0        0       0      0




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                                                                  TEN LEADING CAUSES OF DEATH
                                                    WITH RATES PER 1000 OF THE TOTAL POPULATION, 1998 - 2000

                                                                                       1998                                              1999                              2000
                    CAUSES OF DEATH
                                                                        Rank            No.            Rate           Rank               No.         Rate       Rank       No.        Rate
      Hypertension and Cardiovascular Diseases
                                                                                1           438           1.03                1            468           1.09          1     446       1.02
      (I00-I51) (I70-I99)

      Cerebrovascular Diseases                                                  2           266           0.63                3            229           0.53          2     326       0.75
      (I60-I99)

      External Causes                                                           3           228           0.54                2            239           0.56          3     263       0.60
      (V01-Y89)

      Malignant Neoplasms                                                       4           202           0.48                4            223           0.52          4     252       0.58
      ((C00-C97)

      Gastrointestinal Disorders                                                5           139           0.33                5            182           0.42          6     184       0.42
      (K00-K31) (K50-K93) (A00-A09)

      Certain conditions originating in the                                     6             96          0.23                6            128           0.30          5     192       0.44
      perinatal period
      (P00-P96)

      Diabetes Mellitus                                                         7             70          0.17                7                96        0.22          7     125       0.29
      (E10-E14)

      HIV/AIDS                                                                  9             69          0.16                8                85        0.20          8     110       0.25
      (B20-B24)

      Acute respiratory infections                                              8             70          0.17                9                83        0.19          9         73    0.17
      (J00-J22)


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The Chief Medical Officer Report 2000
      Diseases of the urinary system                                          10             65           0.15              10             81        0.19   10     65   0.15
      (N00-N39)

      Other causes                                                                          601           1.42                            671        1.56        641    1.47

      Total Certified Deaths                                                              2244            5.29                           2485        5.78        2677   6.14
                                                                                           80%                                                                   87%
      % Certified Deaths                                                                                                                 85%

      Total Registered Deaths                                                             2814            6.63                           2922        6.79        3090   7.09




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         TEN LEADING CAUSES OF DEATH BY YEARS OF POTENTIAL LIFE LOST
                                                                                            1998                    1999                      2000

                           CAUSES OF DEATH
                                                                                     Rank       YPLL         Rank        YPLL        *Rank       YPLL
                (Listed in order by leading cause of death)

           Certain conditions originating in the perinatal period
                                                                                      NA           NA         NA           NA            1       11,970
                                (P00-P96)

                                   External Causes
                                                                                      NA           NA         NA           NA            2       8,062.5
                                     (V01-Y89)

                               Malignant Neoplasms
                                                                                      NA           NA         NA           NA            3       3,984
                                    (C00-C97)

                          Gastrointestinal Disorders
                                                                                      NA           NA         NA           NA            4       3,309.5
                      (K00-K31) (K50-K93) (A00-A09)

                                       HIV/AIDS
                                                                                      NA           NA         NA           NA            5       3,008
                                       (B20-B24)

                  Hypertension and Cardiovascular Diseases
                                                                                      NA           NA         NA           NA            6       2,987
                             (I00-I51) (I70-I99)

                             Cerebrovascular Diseases
                                                                                      NA           NA         NA           NA            7       1,460.5
                                    (I60-I99)

                            Acute respiratory infections
                                                                                      NA           NA         NA           NA            8       1,153.5
                                     (J00-J22)

                          Diseases of the urinary system
                                                                                      NA           NA         NA           NA            9       565.5
                                   (N00-N39)

                                  Diabetes Mellitus
                                                                                      NA           NA         NA           NA            10          520
                                     (E10-E14)

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The Chief Medical Officer Report 2000
                       NUMBER OF DEATHS & PROPOTIONAL MORTALITY DUE TO SELECTED CAUSES BY AGE & SEX
                                                                                                                                                                          Year: 2000

                                                                                                                                             AGE GROUPS IN YEARS
                                                                                         TOTAL             Unknown              0-4      5 - 14      15 - 24   25 - 44    45 - 64          65+
                                             DISEASE
                                                                                             #       %      #       %       #      %     #     %     #   %     #    %     #    %       #         %

                                                                                     M      47      54      1       25      0       0    0     0     0    0    3    75    16   62    27          52
                                     Hypertension (I10-I15)                          F      40      46      3       75      0       0    0     0     1   100   1    25    10   38    25          48

                                                                                     M      71      57      1      100      0       0    0     0     0    0    6    60    35   64    29          49
                                       Diabetes (E10-E14)                            F      54      43      0       0       0       0    0     0     0    0    4    40    20   36    30          51

                                                                                     M     117      60      0       0       0       0    0     0     0    0    13   76    48   62    56          55
                             Ischaemic Heart Disease (I20-I25)                       F      78      40      0       0       0       0    0     0     0    0    4    24    29   38    45          45

                                                                                     M     182      56      3       60      0       0    0     0     1   50    16   76    54   65    108         50
                             Cerebrovascular Disease (I60-I69)                       F     144      44      2       40      0       0    0     0     1   50    5    24    29   35    107         50

                                                                                     M      39      72      1      100      0       0    1    100    9   69    21   72    5    71      2         66

                                                                                     F      14      26      0       0       0       0    0     0     3   23    8    28    2    29      1         34
                                       Suicides (X60-X84)
                                                                                     U       1       2      0       0       0       0    0     0     1    8    0    0     0     0      0         0

                                                                                     M      13      68      0       0       0       0    0     0     2   50    8    89    0     0      3         75
                                     Homicides (X85-Y09)                             F       6      32      0       0       1     100    0     0     2   50    1    11    1    100     1         25

                        Mental and behavioral disorders (F00-F99)                    M       5      60      0       0       0       0    0     0     1   100   0    0     1    50      3         75

                                                                                     F       4      40      1      100      0       0    0     0     0    0    1    100   1    50      1         25


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The Chief Medical Officer Report 2000
5.        ENVIRONMENTAL HEALTH

5.1       Water Supply and Quality
          It was estimated in 1998 that 93.7% of households in Paramaribo are connected to
          the piped water supply system. These households consume 72% of the water supply.
          The remaining 28% is for commercial use and institutions.
          The average water consumption in Paramaribo is estimated at about 120 l/c/d
           (liters per caput per day.)
          Few data exist about water consumption outside Paramaribo, because most systems are not metered,
          except for a part of the district Wanica, the city of Nieuw Nickerie, the city of Moengo/Wonoredjo
          and the city of Albina, which are operated by the Suriname Water Supply Company (SWM).
          According to the SWM data the use of piped water increased by 25% per household in Paramaribo in
          2000 and by 50% in the cities of Nieuw Nickerie and Albina because of the leakage caused by
          broken water mains and the use of water for agriculture purposes.

          The Water Supply Service of the Ministry of Natural Resources covers the rural population living in
          the coastal areas and in the hinterland. The average consumption in the rural areas is estimated at
          about 150 l/c/d, which is caused by the use of a relatively large proportion of water for agricultural
          purposes. Many villages in the hinterland have no access to piped water. Rainwater and surface
          water from the rivers and creeks are used for domestic purposes. The Suriname Multiple Indicator
          Cluster Survey in the year 2000 found that approximately 90% of the population sampled in urban
          areas, 64% for rural areas, and only 15% of populations in the hinterland had drinking water
          connected to a piped system or well. During the dry season the quality of the water from sources
          other than piped or well systems can be unsafe. The Suriname MICS 2000 study found that overall
          73% of the sampled populations had access to safe drinking water, while the situation in the
          hinterland was alarmingly worse with only 20% of the population sampled having access to safe
          drinking water.

5.2       Sewage Disposal
          The Ministry of Public Works is responsible for the collection and discharge of household and
          industrial waste in Paramaribo. Part of the domestic sewage is treated in septic tanks, while the
          effluent of septic tanks is collected in the street sewer. An estimated 86% of the houses have a septic
          tank. The remaining 14% have pit latrines. The other portion of domestic sewage, resulting from
          personal washing, laundry and from the kitchen enters the street sewers untreated.
          The building code for Paramaribo requires that all buildings should dispose of a septic tank and filter
          bed of crushed blocks to treat the flush toilet water. In general, the septic tanks treatment is
          satisfactory as solid matter and floating material are removed and organic waste, including
          pathogenic organisms, is stabilized.

5.3       Solid and Liquid Waste Disposal
          Domestic solid waste is collected with large trucks once or twice a week and dumped in designated
          landfills. There is no treatment for solid waste.
          Three kinds of wastewater are produced in the city of Paramaribo:
                  1.      Rain water run-off that is contaminated through contact with the surface
                  2.      Domestic waste water
                  3.      Industrial waste water
          The Suriname River with its auto-purification capacity is the receiving water. An assessment of the
          absorption capacity is necessary.




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The Chief Medical Officer Report 2000
          In rural Suriname, a community development project focusing on solid waste disposal has helped
          introduce composting technology and provide for safe disposal of waste generated by a nearby
          regional clinic.
          An other recycling project entails collecting plastic bottles, cutting them into pieces, and mixing them
          with cement to make concrete blocks.
          PAHO staff in Suriname joined national engineers, nurses, and educators in promoting sanitation and
          health education in upgrading water supply and sanitation facilities in the country’s schools.
          And, to dispose of voluminous infectious medical wastes – needles,syringes, and other materials –
          resulting from a mass vaccination campaign, PAHO worked with Surinamese vocational students to
          make incinerators out of drums donated by local Oil Companies.

5.4       Pollution
          With the gold rush in the Interior, thousands of gold miners use mercury in their procedures.
          Therefore, the risk of contamination of the environment increases, as well as the possibility of
          intoxication by mercury. Since the beginning of the new gold rush in 1993, an estimated 150 tons
          of mercury may have been emitted into the forest atmosphere and possibly in the urban areas as well.
          The environmental conditions are favorable for the mobilization of mercury, which is taken up by
          species in the aquatic environment. In 1995, six patients who suffered from a potential chronic
          mercury poisoning were treated in the Diakonessen Hospital.

          In the report, “Introducing Retorts for Abatement of Mercury Pollution in Suriname” prepared by
          Pollack et al. in august 1998, traces of mercury were found in the urine collector from miners and
          employees of gold shops and hair from the general population, as well as in fish, sediment and water
          from the rivers for analysis. The results indicated that water from Lawa and Suriname River and
          their tributaries have mercury levels that surpass the recommended levels for fresh water aquatic life
          and drinking water.

          In Suriname we do not have air quality surveillance programs or pollution control programs.
          Since the First Summit of the Americas (1994) Suriname have banned leaded gasoline because this is
          responsible for 90% of the lead in the atmosphere in most urban areas where leaded gasoline is still
          in use, representing an immediate health risk through inhalation, accumulation in the soil,
          contamination of drinking water, and entry in the food chain.

5.5       Occupational Health
          A symposium on occupational health in 1992 concluded that collection of data regarding occupation
          health is a necessity. The Ministry of Labor has a unit for occupational inspection services, which has
          the following tasks:
              • Maintenance of the judicial provisions concerning the working-conditions and the protection
                  of the worker
              • Supply information and technical advice to the employer
              • Report to authorities about shortages and imperfections in the structure.



5.6       Veterinary Public Health
          Measures for controlling the most common zoonoses, are collected by the Environmental Health
          department of the Bureau of Public Health, as there is no separate Veterinary Public Health unit
          within the Ministry of Health.
          All relevant matters are taken care of by the Veterinary Inspection of the Directorate of Animal
          Production and Health within the Ministry of Agriculture.


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The Chief Medical Officer Report 2000
          The measures for the control of all animal diseases and zoonoses is done through two federal laws:
                            1. The Meat Inspection Act and
                            2. The Animal Disease Prevention and Control Act.

          The most common zoonoses are controlled as follows:
          1. Exotic diseases are kept out of the country through a system of import permit for animals and
          animal products. Depending on the disease states of the country of origin, the permit is either not
          issued or yes with the necessary requirements attached.
          2. Within the country slaughterhouse surveys are done regularly to check for brucellosis and
          leptospirosis.
          The daily inspection of carcasses in slaughterhouse as well as random tests in the field shows no
          Tuberculosis. Vampire bat transmitted rabies is endemic in remote areas mainly in bovine herds in
          the interior of Suriname. Control of the vampire bat populations is carried out regularly by trapping
          bats and applying an anticoagulant gel (vampiricide) on their bodies.


5.7       Food Safety
          In 1997 a consultants’ report stated a strategy to reactivate the Inspectorate of food-products.
          Under the direction of the Bureau of Public Health, a cross-sectoral Food Safety Program was
          developed in the year 2000. There are several projects currently planned for the food safety program
          which include:
          • Strengthening the Food Control System of Suriname to improve the import and export of foods to
              ensure the quality and safety of the food supply in the country, scheduled to begin in 2002 with
              completion in 2003.
          • PAHO technical cooperation with Trinidad and Tobago, and Barbados to aid in the development
              of the legislative framework for the food safety program to assist in development of modernized
              food laws and to provide support for the development of the National Integrated Food Safety
              Program.
          • Awareness Food Safety Program 2002/2003 for Suriname, to increase awareness amongst the
              consumers and food handlers in food safety to decrease the incidence of food-borne illness.
          • Establishment of a National Food Safety Board as an advisory body for National Food Safety
              policy and program development.

5.8       Quality Control of Drugs
          All imported drugs must be registered with the Committee on Drug Registration, as well as the
          Medical Drug and Supply Company.
          The Pharmaceutical Inspection is the governmental institution for inspection of all pharmacies
          and other pharmaceutical-producing industries. The five top selling products are Atenolol (100
          mg); Amoxicilline (500 mg); Nifedipine (10 mg); Paracetamol (500 mg); Vitamin B complex
          /Multivitamins. There is a draft drug policy, to be submitted in the near future to the Minister of
          Health. The national drug list includes 458 items. All health care institutions use the list. The
          first edition was issued in 1988. The latest edition (the third edition) of 1997 has already
          undergone the third revision. In fact the entire population has access to all drugs on the list.
          However, due to discontinuation in supply the coverage is lower. The Medical Drug and Supply
          Company Suriname distributes all drugs on the national drug list to the private and public
          pharmacies, as well as to the hospitals. These institutes deliver the drugs to the patients,
          according to their membership in one of the Health Insurance Companies. A treatment protocol
          is included in a draft drug policy. There is a committee in place to formulate standardized
          therapies, up to now no therapy protocol has been released. In both private and hospital
          pharmacies the presence of the pharmacist is required.
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5.9       Pesticide Control
          No current information is available from the Ministry of Agriculture on pesticide control.

5.10      Disaster Management and Preparedness
          Although no activities were carried out in the year 2000 for disaster management and preparedness,
          plans were established to begin in 2001 and 2002 with the guidance of PAHO.
          Some of the future activities for disaster management and preparedness include:
                  1. National workshops with intersectoral representation to highlight the need for a national
                      disaster coordinator and health sector disaster coordinator. (Conducted in 2002)
                  2. Development of a contingency plan for the health sector for disaster management and
                      preparedness. (Pending)
                  3. Trainings for key people in first response and mass casualty management.
                      (Conducted in 2002)
          Fortunately, the country of Suriname is not as susceptible to natural disasters as many other countries
          and the only recent national disaster was an airplane crash in 1986. This perceived lack of
          susceptibility is the main obstacle hindering a more rigorous approach to planning and implementing
          disaster management and preparedness activities.

5.11      Vector and Rodent Control
          The Bureau of Public Health Vector Control department is responsible for vector control and
          monitoring. Environmental health inspectors go daily into the neighborhoods of Greater Paramaribo
          to establish monitor the environmental health situation, and calculate the Aedes Aegypti Index.
          They also work on some Malaria and Schistosomiasis investigations in the hinterland of Suriname.

5.12      Port Health
          The Environmental Health Department of the Bureau of Public Health controls all factors within
          the physical environment that can have adverse effects on Public Health.
          The Environmental Inspection Unit of this Department carries out inspections to identify problems
          that exist within the different communities and areas.
          The Environmental Health Officers of this Unit collect the following data:
          1. Water quality
          2. Mosquito premise Index (Breteau Index)
          3. Sanitation of premises and buildings (e.g. airport and harbors)
          Water supply, water storage containers, roof-gutters, drains, sewage and excreta disposal, and solid
          waste facilities of all premises and buildings are inspected.

          The Environmental Health Officers check each airplane landing at the International Airport,
          Johan Adolf Pengel, has followed the procedures to elimate insects that may carry contaminants for
          agricultural production in Suriname. In addition, water and sewage from the airplanes is tested and
          treated to ensure safe sewage disposal.
          The Environmental Health Officers, in collaboration with Kill It, an insect and pest control
          company; examine each ship coming into the harbors in Suriname. In order to dock and unload
          shipments, they must be granted clearance form the Bureau of Public Health.

5.13      Building Development
          In the year 2000, two large bridges were built. The first over the Suriname River,
          connecting Paramaribo with the district of Commewijne, and second over the Coppename River,
          connecting the district of Saramacca with the district of Coronie. These bridges have improved
          access to health services for villages and other districts surrounding Paramaribo.
          No action was taken in 2000 to provide low-income housing for citizens of Suriname.


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The Chief Medical Officer Report 2000
          6.ISSUES, CONCLUSIONS AND RECOMMENDATIONS FOR THE FUTURE

          The year 2000 was distinguished by many accomplishments that signify the true dedication of the
          health sector in improving the health situation in Suriname. The consistent improvements and
          evaluations must continue, but most importantly, there must be more active information-based
          planning and decision-making that results in action. With the great improvements in available data,
          information-based planning and policy development should become a priority, as the lack of
          available information was sited as a major obstacle in the previous years. The improvement in the
          quality of the information should be the next step, as well as planning actions based on the findings
          presented in the data. The integration of technology in the health system is an ongoing trend that will
          serve to facilitate further data collection and surveillance. Training and more advanced education in
          public health practices should remain a major focus for the upcoming years.




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APPENDIX A: Map of Suriname.

                                                                        ATLANTIC
                                                                        OCEAN

                                                  #
                                                  S
                                                                                                    #
                                                                    #
                                                                    S
                                                                                        #
                                                                                        S      #S
                                                                                               S
                                                                                               #
                                                                                               S
                                                                                                                  #
                                                                                                                  S
                                                                                               S#
                                                                                                                           #
                                                                                                                           S




                                                                                                        #
                                                                                                        S




                                                                                                                                         FRENCH
 GUYANA                                                                                                                                  GUYANA




                                                                    #
                                                                    S                       BRAZIL




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The Chief Medical Officer Report 2000
APPENDIX B:LIVE BIRTHS & STILL BIRTHS BY BIRTHWEIGHTS

Total
Births in
Suriname
               Live Births                                   Still Births

  Year         #       % of total births               #         % of total births Total Births
  1998       10221          97,8%                     228              2,2%          10449
  1999       10144          97,8%                     223              2,2%          10367
  2000        9804          97,4%                     260              2,6%          10064

                  Very Low Birth weight (VLBW)
                            <1500gr                                       Low Birth weight (LBW) <2500gr                                                 All Birth weights

                                                        Total
                 Live Births           Still Births     VLBW Live Births                 Still Births      Total LBW                Live Births                        Still Births           Total Births
                                                                                                                                                                         % of
                                                                                                                                    % of total   % of total              total % of total           % of total
                     % of total            % of total                      % of total        % of total         % of total          births at    births in             births at births in          births in
                 #    VLBW         #        VLBW             #        #      LBW         #     LBW          #    births        #    hospital     Suriname          #   hospital Suriname       #    Suriname
DZH     1998 10      26,3%        28      73,7%         38       156      79,2%         41   20,8% 197          13,4%        1429   96,9%        14,0%        46       3,1%    0,5%          1475   14,1%
        1999 11      44,0%        14      56,0%         25       127      84,7%         23   15,3% 150          13,2%        1100   96,7%        10,8%        37       3,3%    0,4%          1137   11,0%
        2000 28      50,9%        27      49,1%         55       160      82,5%         34   17,5% 194          13,8%        1364   96,9%        13,3%        43       3,1%    0,4%          1407   14,0%

AZP     1998 28      32,9%        57      67,1%         85       197      71,6%         78   28,4% 275          21,9%        1171   93,1%        11,5%        87       6,9%    0,9%          1258   12,0%
        1999 29      34,9%        54      65,1%         83       236      76,6%         72   23,4% 308          20,2%        1432   93,8%        14,0%        95       6,2%    0,9%          1527   14,7%
        2000 50      40,3%        74      59,7%         124      276      74,8%         93   25,2% 369          23,7%        1434   92,0%        14,0%        124      8,0%    1,3%          1558   15,5%

LH      1998 N/A     N/A          N/A N/A               N/A      N/A      N/A           N/A N/A           715   16,3%        4281   97,6%        41,9%        104      2,4%    1,0%          4385   42,0%
        1999 N/A     N/A          N/A N/A               N/A      N/A      N/A           N/A N/A           679   15,7%        4235   97,7%        41,4%        100      2,3%    1,0%          4335   41,8%
        2000 N/A     N/A          N/A N/A               N/A      N/A      N/A           N/A N/A           585   15,3%        3748   97,8%        36,7%        83       2,2%    0,8%          3831   38,1%

SVZ     2000 6       N/A          N/A N/A               N/A      48       N/A           N/A N/A           N/A   N/A          652    95,7%        6,4%         29       4,3%    0,3%          681    6,8%




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Chief Medical Officer Report
APPENDIX C: HEALTH INSTITUTION DATA

                                       SZN                AZP                  LH                 SVZ                      DZH        DD
                               1998 1999 2000 1998 1999 2000 1998 1999 2000                  1999     2000           1998 1999 2000 2000
Consults                       9.034 8.608 11.416 130.719125.309134.83249.67741.996 46.83525.006   43,149                48,75551,727
Hosp                           2.351 2.564 2.763 10.844 12.173 12.149 9.329 9.496 9.538 3.444      4.966
Births                         219 265 212        1.258 1.527 1.558 4.377 4.28 3.83 753            768               15211199 1482
Deaths                         110 85      101                                                                       174 163 150
Emergency Room Visits                             35,534 36,160 39,456                    125      136

<5 yr consults
Antenatal consults                                                      14.65912.101 12.555                             175   70
Family planning consults

Lab exams                      NA 97.452 131.762                                              229,640   218,237
X-rays performed               4.046 3.873 4.875                                                        20,611
E.C.G.                                                                                                                        710
ENDOSCOPIE                                                                                                              310   297

Accidents                                                      15.925
Traffic accidents                                              3.063
Other causes of accidents                                      12.862

Sexually Tran. Infections
Acute Resp. Infections                                                                        150 (adm.)160 (adm.)
Gastroenteritis                                                                                85 (adm.) 95 (adm.)



adm. = admissions




                                                                                                                                       81
Chief Medical Officer Report
APPENDIX C. HEALTH INSTITUTION DATA (CONTINUED)
                              MZ                RGD                                         JTV            Stg. Lobi              PCS
                         1999    2000     1999      2000                           1998 1999 2000 1998 1999 2000 1998 1999 2000
                                                                                36.985 43.590 46770
                               101,994                                          (16.795 (20.233 (18.848
                               +         102,743 +                              fillings fillings fillings
                               42,723    33,299                                 +        +        +
                               repeat    repeat                                 10.755 12.315 13.757
Consults                        visits   visits    249,669      281.225          extr.) extr.) extr.) 12.78 14,476 10,368 14.038 13.537 13.200
Hosp                                     386                                                                              539    670    570
Births                         850       936
Deaths                         109       175                                                                             10     8      13
Emergency Room Visits
<5 yr consults                           10,253     42,552     36,818
                                                    14,089 +   9,852 +
Antenatal consults                       7,989      4,996(new) 3,960(new)
Family planning consults                 2,645
                                         21.562 +
                                         33.313
                                         malaria
Lab exams                                tests      10,631      8,953                                                    3529   3043   3456
X-rays performed
E.C.G.
ENDOSCOPIE
Accidents                                1,726
Traffic accidents
Other causes of accidents
Sexually Tran. Infections 1407           878
Acute Resp. Infections    23.458         23,429     23,744       19.926
                                                    4,657        3,309
Gastroenteritis                7,836     7,501      (2,377< 5 y) (1,613< 5 y)



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Chief Medical Officer Report
   APPENDIX D: PERSONNEL DATA PER HEALTH INSTITUTION (as reported in April 2002)



                                                           2000
                              AZP DZH SVZ LH SZN RGDMZSt. JTV DDPCSBOGTOTALS
                                  MEDICAL STAFF
ANESTHESIOLOGIST                3          1 1 (PT)
BACTERIOLOGIST                  1
CARDIOLOGIST                    3       1 (PT) 1
CHEMIST (LABORATORY)            1          1    1          1
DENTIST                                                         1
DERMATOLOGIST                   2 1 (PT)1 (PT)         1          3
EAR,NOSE AND THROAT SPECIALIST 1           1    1
EYE-SPECIALIST/SURGEON          5                   1 (PT)
FYSIOTHERAPIST                  2               1      1
GENERAL INTERNIST               4          2    2      1
GENERAL PRACTITIONER           20          3    5          52 5   2   6
GENERAL SURGEON                 2          2    1      1
GYNAECOLOGIST/OBSTETRICIAN      2          1    3      1
MEDICAL BIOLOGIST                                                     1
MEDICAL PARASITOLOGIST                                                1
NEUROLOGIST                     2          1
ORAL SURGEON/ORTHODONTIST       1
ORTHOPEDIC SURGEON              3          2
PATHOLOGIST                     2
PEDIATRICIAN                    2          2    2      2
PHARMACIST                      1          1    1      1    1
PLASTIC SURGEON                 1
PSYCHIATRIST                                        1 (PT)          6
PULMUNOLOGIST                   1
RADIOLOGIST/RADIOGRAPHERS       1          1 1 (PT)
REHABILITATION SPECIALIST       2
UROLOGIST                       1




   PT = Part-time




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   Chief Medical Officer Report
APPENDIX D: PERSONNEL DATA PER HEALTH INSTITUTION (as reported in April 2002)
            Continued.


                                                  2000
                              AZ DZ SV      SZ RG M St.         D PC BO TOTAL
                                         LH
                               P H Z        N D Z JTV           D S G     S
                       NON-PHYSICIAN MEDICAL STAFF
AUXILIARY NURSE                58 89 52 94     65               8
DENTAL AUXILIARIES                                     80
FYSIOTHERAPIST ASSISTANTS                 3
                                         11
GENERAL NURSE                 217 127 77       63               7 66
                                          9
LABORATORY ASSISTANTS                 22 23    18
MEDICAL TECHNICIAN                    17 4
MIDWIFES                       10 12 5 16      11
NURSE ASSISTANT/HEALTH
                               78 63 179 35    19                   45
ASSISTANT
OTHER                                  8       23
PHARMACIST ASSISTANTS                    18    58
SOCIAL WORKERS                            2
                           NON-MEDICAL STAFF
ACCOUNTING                             3        2
ADMINISTRATION                        35       75
BILLING                                1
CASHIER                                9        1
DIETARY                                1 1
DRIVERS                                5       21
ENGINERING/MAINTENANCE                27 28    20
HOUSEKEEPING                         114 95    62
HUMAN RESOURCES                        4        1
LAUNDRY                               11
MEDICAL REGISTARY                      5 10
OTHER                                 57
SECURITY                              27 15    18
SUPPLY                                 3 12     7




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Chief Medical Officer Report
APPENDIX E: TOTAL LIVE BIRTHS BY AGE AND PARITY OF THE MOTHER

TOTAL LIVE BIRTHS (= Total LB) BY AGE AND PARITY(=P) OF THE MOTHER

Year 2000                         The Parity of the Mother
                                                                                                                                      Total LB
Age of the Mother                 P1          P2           P3           P4         P<5         P >4         P Kn.       P Unknown      by Age
< 15                              44          0            0            0          44          0            44          8             52
15                                96          4            0            0          100         0            100         14            114
16                                180         7            0            0          187         0            187         24            211
17                                239         44           5            2          290         0            290         45            335
18                                264         48           9            1          322         0            322         44            366
19                                277         107          33           3          420         0            420         49            469
Teenage Mothers < 20 yrs          1100        210          47           6          1363        0            1363        184           1547
% of the Total Live Births        11,2%       2,1%         0,5%         0,1%       13,9%       0%                       1,9%          15,8%
Mothers > 20 years                2365        1707         1237         658        5967        898          6865        937           7802
M. by Unknown age                 6           1            0            0          0           0            7           448           455
Total LB by Parity                3471        1918         1284         664        7337        898          8235        1569          9804
% of the Total Live Births        35,4%       19,6%        13,1%        6,8%       74,8%       9,2%                     16%           100%


TOTAL LIVE BIRTHS (= Total LB) BY AGE AND PARITY(=P) OF THE MOTHER
Year 1999                         The Parity of the Mother
                                                                                                                                      Total LB
Age of the Mother                 P1          P2           P3           P4         P<5         P >4         P Kn.       P Unknown      by Age
< 15                                     36            0            0          0          36           0           36             0            36
15                                       87            1            0          0          88           0           88             0            88
16                                      198           15            0          0         213           0          213             0           213
17                                      288           53            4          0         345           0          345             0           345
18                                      287           66            8          1         362           0          362             0           362
19                                      328           74           19          1         422           0          422             0           422
Teenage Mothers < 20 yrs               1224          209           31          2        1466           0         1466             0          1466
% of the Total Live Births            12,1%         2,1%        0,3%         0%        14,5%          0%                        0%          14,5%
Mothers > 20 years                     3743         1790         1268        668        7469          929                         0          8398
Age of the M Unknown                      0            0            0          0           0           0                        280           280
Total LB by Parity                     4967         1999         1299        670        8935          929        1466             0         10144
% of the Total Live Births            49,0%        19,7%        12,8%       6,6%       88,1%        9,2% 14,5%                 0,0%        100,0%


TOTAL LIVE BIRTHS (= Total LB) BY AGE AND PARITY(=P) OF THE MOTHER

Year 1998                         The Parity of the Mother
                                                                                                                                      Total LB
Age of the Mother                 P1          P2           P3           P4         P<5         P >4         P Kn.       P Unknown      by Age
< 15                                     52            2            0          0          54           0           54             0            54
15                                      109            4            0          0         113           0          113             0           113
16                                      184           12            0          0         196           0          196             0           196
17                                      277           34            6          0         317           0          317             0           317
18                                      294           60            6          0         360           0          360             0           360
19                                      358          118            7          1         484           0          484             2           486
Teenage Mothers < 20 yrs               1274          230           19          1        1524           0         1524             2          1526
% of the Total Live Births            12,5%         2,3%        0,2%         0%        14,9%          0%                        0%          14,9%
Mothers > 20 years                     3080         2122         1508        784        7494        1042         8536           159          8695
Totals LB by Parity                    4354         2352         1527        785        9018        1042        10060           161         10221
% of the Total Live Births            42,6%        23,0%        14,9%       7,7%       88,2%       10,2%                       1,6%         100%
SOURCE: Ministry of Internal Affairs: CBB, Department of Demographic Statistics
                                              Demographic Data Year 2000,1999 & 1998
NOTE: The numbers of the reported live births and still births by CBB are not accurate
                                  because those neonates dead at the time of registration at CBB
                                  were recorded as still births




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Chief Medical Officer Report
APPENDIX F: TOTAL LIVE BIRTHS BY AGE AND DISTRICT OF THE MOTHER

 Year 2000                                                              Residential District of the Mother
                                 Para-      Wani-    Nic-    Coro-   Sara-            Comme-       Maro-       Broko-   Sipali-                Total LB
      Age of the Mother                                                                                                               Abroad
                                 maribo      ca      kerie    nie    macca Para        wijne       wijne       pondo     wini                   by age
                          <15         27         4       3       0         1      3           1            4        5             3        1         52
                           15         49         9       6       3         3    12            5            7       10        10            0        114
                           16         96        21      11       0         4    15            7        21          19        14            3        211
                           17        161        50      22       1        12    19            9        15          19        20            7        335
                           18        171        55      28       2        10    15           19        19          22        20            5        366
                           19        209        83      26       5        14    24           28        27          25        19            9        469
 Teenage Mothers<20                  713      222       96      11        44    88           69        93         100        86           25       1547
 % of the Total LB                 7,3%      2,3%    1,0%     0,1%     0,4% 0,9%          0,7%       0,9%        1,0%     0,9%          0,3%      15,8%
 Mothers >20 years                  3765     1314      508      37       230   370          347       283         313       481          155       7802
 Age of the M Unknown                   3        1       1       0         1      5           0            7       21       415            1        455
 Total LB by District               4481     1537      605      48       275   463          416       383         434       982          180       9804
 % of Total Live Births           45,7%     15,7%    6,2%     0,5%     2,8% 4,7%          4,2%       3,9%        4,4%    10,0%          1,8%      100%


 TOTAL LIVE BIRTHS (= Total LB) BY AGE AND DISTRICT OF THE MOTHER
          Year 1999                                                     Residential District of the Mother
                                 Para-      Wani-    Nic-    Coro-   Sara-            Comme-       Maro-       Broko-   Sipali-                Total LB
      Age of the Mother                                                                                                               Abroad
                                 maribo      ca      kerie    nie    macca Para        wijne       wijne       pondo     wini                   by age
                          <15         19         2       1       0         0      2           3            0        3             6        0         36
                           15         48         4       5       1         1      4           1            3        8        13            0         88
                           16        120        13      12       0         6      9          10            7       18        18            0        213
                           17        218        30      22       0         5      9          12        14          17        18            0        345
                           18        196        31      17       4         3    17           27        15          16        36            0        362
                           19        211        56      44       5         6    16           15        31          15        23            0        422
 Teenage Mothers <20                 812      136      101      10        21    57           68        70          77       114            0       1466
 % of the Total LB                 8,0%      1,3%    1,0%     0,1%     0,2% 0,6%          0,7%       0,7%        0,8%     1,1%            0%      14,5%
 Mothers >20 years                  4967      960      549      45       149   274          290       265         310       589            0       8398
 Age of the M Unknown                   0        0       0       0         0      0           0            0        0       280            0        280
 Total LB by District               5779     1096      650      55       170   331          358       335         387       983            0      10144
 % of Total Live Births           57,0%     10,8%    6,4%     0,5%     1,7% 3,3%          3,5%       3,3%        3,8%     9,7%            0%      100%


 TOTAL LIVE BIRTHS (= Total LB) BY AGE AND DISTRICT OF THE MOTHER
          Year 1998                                                     Residential District of the Mother
                                 Para-      Wani-    Nic-    Coro-   Sara-            Comme-       Maro-       Broko-   Sipali-                Total LB
      Age of the Mother                                                                                                               Abroad
                                 maribo      ca      kerie    nie    macca Para        wijne       wijne       pondo     wini                   by age
                          <15         19         7       4       0         0      3           1            4        2        14            0         54
                           15         53        11       6       0         4    11            4            7        7        10            0        113
                           16         95        19      13       0         5    17            4        10           9        24            0        196
                           17        154        49      14       0         8      7          20        18          17        30            0        317
                           18        175        63      28       1         9    15           18        16          17        18            0        360
                           19        243        85      32       1        12    27           22        20          15        29            0        486
 Teenage Mothers <20                 739      234       97       2        38    80           69        75          67       125            0       1526
 % of the Total LB                 7,2%      2,3%    0,9%      0%      0,4% 0,8%          0,7%       0,7%        0,7%     1,2%            0%      14,9%
 Mothers >20 years                  4291     1584      507      29       245   369          386       311         197       776            0       8695
 Total LB by District               5030     1818      604      31       283   449          455       386         264       901            0      10221
 % of Total Live Births           49,2%     17,8%    5,9%     0,3%     2,8% 4,4%          4,5%       3,8%        2,6%     8,8%            0%      100%


 SOURCE: Ministry of Internal Affairs: CBB, Department of Demographic Statistics
                                Demographic Data Suriname Year 2000,1999 & 1998
 NOTE: The numbers of the reported live births and still births by CBB are not accurate because those neonatal dead
                                at the time of registration at CBB were recorded as still births




                                                                                                                                                          86
Chief Medical Officer Report
                               Annual Report of the Chief Medical Officer
                               Year 2000
                               An official document No. 01 / 2002
                               SURINAME MINISTRY OF HEALTH

                               A full-text electronic version of
                               this publication is available at
                               SURINAME Ministry of Health




                                                                            87
Chief Medical Officer Report

								
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