Geographical Locations - Barbados

• (Statistical) Number of Inhabitants per Doctor: 340
• CIA - World Factbook : Barbados

Organisations and Networks

UN and Multinational

• WHO
  -WHO country profile - Barbados
  - PAHO - Pan American Health organisation / Organización Panamericana de la Salud
  - Regional Office for the Americas / Pan American Health Organization (AMRO / PAHO) in Washington, D.C. (USA)
  - WHO - Tobacco Control: country profile - Barbados
  - WHO - Environmental Burden of Disease: Country Profile – Barbados
• UNDP - Barbados

Government

• Government of Barbados Information Network
• Central Emergency Relief Organization

Non-Government

National Policy and Related Documents

Reports, Guidelines, and Projects

• A study of child vulnerability in Barbados, St. Lucia and St. Vincent & the Grenadines
  "The Child Vulnerability Study was conducted during 2005 by the Governments of Barbados, St. Lucia and St. Vincent and the Grenadines with technical and financial assistance from UNICEF. Its aim was to enable the three countries to fulfil their obligations to children in terms of the United Nations General Assembly Special Session on HIV/AIDS, the Millennium Development Goals (MDGs) and other international and regional instruments. The Governments agreed that the study should be carried out concurrently in the three countries to allow valid comparisons… The study was designed to find out: (i) what constitutes child vulnerability in the participating countries? (ii) how many children fit this definition? (iii) what is their demographic profile? (iv) what are their physical and psychological needs? (v) what are the barriers to satisfying their needs and protecting their rights? and (vi) what measures are needed to overcome these barriers?... It is intended to serve as: (a) a planning tool to reassess national policy and develop national plans of action for vulnerable children; (b) • a communications tool to build awareness, advocate for action and mobilize human and financial resources; and (c) a baseline study against which the impact of any interventions can be assessed." [UNICEF Office for Barbados and the Eastern Caribbean, in association with the Governments of Barbados, St. Lucia and St. Vincent & the Grenadines, 2006]
• Antenatal voluntary counseling and testing for HIV in Barbados. Success and barriers to implementation
  Objective: To determine the success of voluntary counseling and testing (VCT) for HIV and to identify the barriers to implementation when VCT is offered as a package integrated with antenatal care. Methods: In this descriptive study we investigated antenatal VCT and HIV testing in all post-parturient women at the Queen Elizabeth Hospital, Bridgetown, Barbados, who gave birth between April and September 2002. Data were collected retrospectively from the antenatal care record and by recall during one-on-one interview. Results: Of 1 342 women surveyed, 954 (71.1%) received antenatal counseling and were offered an HIV test. Of the 954 women offered HIV test after counseling, 914 (95.8%) agreed to have the test. Among the women surveyed, 1 106 (82.4%) had a documented HIV test, 914 (85.7%) were tested after documented pretest counseling, and another 192 (14.3%) were tested without documented pretest counseling. Overall, 822 of the 1 342 women surveyed (61.2%) had a documented HIV test result in their antenatal case record at the time of delivery. Of the 1 106 women who had a documented HIV test, the test results were unavailable at the time of delivery in only 284 (21.2%). Among the reasons for unavailability of a documented HIV test result, the most common (45.0%) was that no test was done, followed by unclear documentation of the result. Conclusions: Twenty-nine percent of surveyed women failed to receive antenatal VCT and this is a cause of concern, for both the high coverage and good quality counseling are key to the overall success and cost effectiveness of the VCT program. Fourteen percent of the women surveyed who did not receive VCT were tested for HIV, a situation that is undesirable because some women may be tested without understanding the full implication of this policy, and as a result the overall impact of VCT may be reduced. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 15(4), 2004, pp.242-248]
• Characteristics of HIV-infected childbearing women in Barbados
  Objective: To describe the demographic profile, social and family characteristics, and lifestyle traits of HIV-infected childbearing women in the Caribbean nation of Barbados in comparison to a control group of HIV-negative women. Methods: Data for this report were drawn from the Pediatrics HIV Surveillance Program of the Queen Elizabeth Hospital in Barbados. The data covered all HIV-infected women in the country who delivered between 1986–2000, with similar data coming from a control group of HIV-negative childbearing women. Routine information recorded during antenatal care was obtained from the women’s case records. Additional data were collected from interviews with the women. Results: There were 182 HIV-infected women who delivered during the study period, and a group of 202 childbearing women served as controls. In comparison to the control group, the HIV-infected women were younger, more often multiparous, and more likely to have been unemployed at the time of their pregnancy. The HIV-infected women also had had an earlier onset of sexual activity, had had more sexual partners during their lifetime, and were more likely to be involved with an older sexual partner. At the time of giving birth most of the HIV-infected women were asymptomatic for AIDS and were living with either their parents (mother or father or both) or the baby’s father. In addition, at the time of their six-weeks-postnatal visit, the large majority of the HIV-infected women were involved in caring for their children. The proportion of HIV-infected women who were diagnosed prior to childbirth increased significantly over the study period, rising from 25% during 1986–1990 to 82% during 1996–2000. Slightly over one-fifth of the HIV-infected women had had one or more subsequent pregnancies after they had learned that they were infected. Conclusions: The early age of sexual activity as well as repeated pregnancies, especially from different and older partners, may have contributed significantly to both vertical and horizontal HIV transmission in Barbados. Future studies of HIV incidence and its trend among childbearing women could be important for monitoring the HIV epidemic in this country. Many of the HIV-infected childbearing women in our study were unemployed, sick, and had multiple children. Therefore, to help them to plan for and cope with the disease and also the care of their children beyond the perinatal period, there is a need to provide the women with repeated counseling with continued follow-up and, where necessary, additional economic, social, and medical support. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 13(1), 2003, pp.1-9]
• Detection of dengue infection in patients investigated for leptospirosis in Barbados
  The annual incidence of leptospirosis in Barbados is approximately 13 severe cases/100,000. The peak incidence occurs in October to December of each year, coinciding with the months of heaviest rainfall. During the second half of 1995, an epidemic of dengue type 1 infection produced almost 1,000 laboratory-confirmed cases. During the same period, leptospirosis mortality was twice the average, suggesting that some cases of leptospirosis were being misdiagnosed and treated inappropriately. Sera from patients investigated for dengue or leptospirosis were analyzed retrospectively to determine the extent of misdiagnosis. During 1995 and 1996, 31 of 139 and 29 of 93 patients, respectively, were confirmed as having leptospirosis. Sera from the remaining leptospirosis-negative patients were tested for IgM antibodies to dengue virus. During 1995 and 1996, 48 of 108 patients and 21 of 64 patients, respectively, were found to have dengue. In 1997, sera from all patients investigated for leptospirosis were also tested prospectively for IgM antibodies to dengue: 38 of 92 leptospirosis-negative patients (41%) were dengue IgM-positive, while 2 of 25 leptospirosis cases also had serologic evidence suggesting acute dengue infection. A second large outbreak of dengue caused by serotype 2 occurred in 1997. During the 1995 and 1997 dengue epidemics in Barbados, dengue cases outnumbered leptospirosis cases investigated in the leptospirosis diagnostic protocol. During 1997, patients investigated but negative for dengue were also tested for anti-leptospiral IgM: 7.3% (19 of 262) were IgMpositive. Substantial misdiagnosis of both dengue and leptospirosis can occur and greater public awareness and clinical suspicion of the similar presentations of these two diseases are necessary. [author abstract] [Am. J. Trop. Med. Hyg., 62(1), 2000, pp. 112–114]
• Dialysis in Barbados: the cost of hemodialysis provision at the Queen Elizabeth Hospital
  Objective: The purpose of this study was to assess the health service cost of hemodialysis delivered at the Queen Elizabeth Hospital in St. Michael, Barbados. Methods: A cost analysis was performed from the viewpoint of the tertiary hospital studied here, using treatment protocols based on current practice for establishing vascular access sites (surgical set-up) and dialysis maintenance. Cost and patient data were collected for the period from 1 April 1998 to 31 March 1999. Sixty-four patients were studied and a total of 7 488 hemodialysis sessions were performed in the study period. The costs analyzed were personnel, drug expenditure, supplies (dialysis and nondialysis), inpatient costs, laboratory and other ancillary services, and indirect or overhead costs such as engineering, housekeeping, laundry and administration. Results: The cost per hemodialysis treatment was calculated as US$ 156.64 in the first year and US$ 145.55 in subsequent years. The total cost per patient per year was US$ 18 327.22 in the first year of dialysis including surgical set-up, and US$ 17 029.54 thereafter. Direct costs (determined by patients’ utilization of resources and labor costs for physicians and nurses) contributed to 80.7% of the total cost. The main expenditures were dialysis-related supplies, labor and overheads. Conclusion: These findings are important in the light of limited economic resources available to health services in Caribbean countries coupled with the spiraling prevalence of kidney failure in these countries. Further analyses are recommended to review the provision of renal replacement therapy services in Barbados and to develop plans to expand and optimize services. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 16(5), 2004, pp.350-355]
• Estimation of the Risk of Stroke in Black Populations in Barbados and South London
  Background and Purpose: The incidence of stroke in black populations is a public health issue, but how risk varies between black communities is unclear. Methods: Population-based registers in South London (SLSR) and Barbados (Barbados Register of Strokes [BROS]). Stroke incidence estimated by age group, gender and stroke subtype from January 1995 to December 2002 (SLSR), and October 2001 to September 2003 (BROS). Incidence rate ratios [IRR] estimated adjusting for age and sex. Results: Two hundred and seventy-one cases registered in SLSR and 628 cases in BROS. Average age of stroke was 66.1 years (SD 13.7) in SLSR and 71.5 years (SD 14.9) in BROS (P<0.001). The incidence rate/1000 population in SLSR was 1.61 (European adjusted; 95% CI, 1.41 to 1.81) and 1.08 (world adjusted; 95% CI, 0.95 to 1.21). For Barbados incidence rates were 1.29 (European adjusted; 95% CI, 1.19 to1.39) and 0.85 (world adjusted; 95% CI, 0.78 to 0.92). Overall IRR for SLSR: BROS adjusted for age and sex was 1.26 (95% CI, 1.09 to 1.46). Statistically significant subtype differences included total anterior cerebral infarction (IRR, 1.82; 95% CI, 1.23 to 2.69), posterior cerebral infarction (IRR, 2.12; 95% CI, 1.28 to 3.53), primary intracerebral hemorrhage (IRR, 1.56; 95% CI, 1.03 to 2.35) and subarachnoid hemorrhage (IRR, 5.04; 95% CI, 2.54 to 9.97). Conclusions: The risk of stroke in black Caribbeans is higher in South London than Barbados, and particularly so for specific stroke subtypes. The risk in Barbados approaches that in the white population in South London and strokes occur at an older age. Whether environmental factors mediate these differences in migrant populations requires further study. [author abstract] [Stroke, August 2006, Volume 37(8): 1986-1990]
• Health in the Americas 2007: Barbados
  As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Barbados addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Barbados, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
• Human Campylobacter-associated enteritis on the Caribbean island of Barbados
  A longitudinal study of the incidence of Campylobacter enteritis in Barbados was undertaken from January 2000 to August 2003. Diarrheal stools received by the central public health laboratory were cultured for Campylobacter. The number of reported Campylobacter cases exceeded those of Shigella but were less than those of Salmonella, and increased steadily with each year. Isolates from stools were mainly C. jejuni (63.6%) and C. coli (31.8%). The highest isolation rate was found in children 1–4 years of age (40.8%), followed by infants less than 1 year of age (16.9%) and those 5–9 years of age (11.3%). The number of reported cases was higher in March, from June to August, and in November and December. There was no correlation between incidence and either rainfall, temperature, or humidity. Further epidemiologic investigation of this disease is needed to evaluate risk factors for Campylobacter infection and determine routes of transmission in Barbados. [author abstract] [Am. J. Trop. Med. Hyg., 74(4), 2006, pp. 623–627]
• Jamaican and Barbadian Health Care Providers’ Knowledge, Attitudes and Practices Regarding Emergency Contraceptive Pills
  Context: Little is known about health care providers’ knowledge of, attitudes toward and provision of emergency contraceptive pills in the English-speaking Caribbean, where sexual violence and unplanned pregnancies are persistent public health problems. Methods: We conducted interviewer-administered surveys of 200 Barbadian and 228 Jamaican pharmacists, general practitioners, obstetrician-gynecologists and nurses in 2005–2006. For each country, Pearson’s chi-square tests were used to assess differences in responses among the four provider groups. Results: Nearly all respondents had heard of emergency contraceptive pills, and large majorities of Barbadian and Jamaican providers had dispensed the method. However, about half had ever refused to dispense it; frequently cited reasons were medical contraindications to use, recent use, method unavailability, safety concerns and being uncomfortable prescribing it. Only one in five providers knew that the method could be safely used as often as needed, and few knew that it was effective if taken within 120 hours of unprotected sexual intercourse. About a quarter of Barbadian and half of Jamaican providers thought the method should be available without a prescription, and half of all providers believed that its use encourages sexual risk-taking and leads to increased STI transmission. Nonetheless, most respondents believed the method was necessary to reduce rates of unintended pregnancy and were willing to dispense it to rape victims, women who had experienced condom failure and women who had not used a contraceptive. Conclusions: Future educational efforts among Jamaican and Barbadian health care providers should emphasize the safety and proper use of emergency contraceptive pills, as well as the need to increase the availability of the method. [author abstract] [International Family Planning Perspectives, 2007, 33(4):160–167]
• Nutrition Country Profiles – Barbados
  "The micronutrient deficiency of importance in Barbados is iron. The prevalence in 1981 among children 6-59 months was 31.3%, with a greater proportion of boys (52.5%) compared with girls (38.2%) being anaemic. When a lower cut-off point (< 10.5 g/dL) was used to indicate the presence of anaemia, only 14.9% of the children 6-59 months were anaemic. This represented a decline in the prevalence of anaemia among this age group compared to survey findings in 1969 and 1975. Similarly when the prevalence of anaemia was determined by the criteria used by the 1969 survey (< 11.5 g/dL for males and < 11 g/dL for females), 25.4% of males and 29.1% of females (5-14 years) were found to be anaemic. These levels appear to represent an increase in the prevalence of Anaemia among school children compared to 1969, although a wider age group was examined in 1969. Again using the 1969 criteria, the prevalence of anaemia among the non-pregnant and non-lactating females was approximately the same for 1969 (19.0%) and 1981 (18.8%). The most recent national survey on food consumption carried out in Barbados was in 2000. Also, three surveys conducted between 1969 and 1981, along with more recent data, provide some information on the consumption pattern in the country. The proportion of protein derived from foods from animals increased from 38.8% in 1996 to 58.2% in 1996-98. This resulted in an increase in the amount of fat consumed. Along with the increase in per caput dietary energy supplies (DES) between 1965 (2636 kcal//day) and 2000 (3025 kcal//day) may also be factors contributing to the prevalence of overweight and obesity in the population. The proportion of average monthly income spent on food decreased from 51% in 1969 to 40% in 1981, possibly due to an improvement in the economic status of the population. Between 1993 and 1999 the World Bank reported that 8% of the population was living below the poverty line. This segment of the population is at risk for low nutrient intake, especially among children living in these households." [FAO, Rome, Italy, August 2003]
• Obesity, Diabetes, Hypertension, and Vegetarian Status among Seventh-Day Adventists in Barbados: Preliminary Results
  A population-based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status, body mass index (BMI), obesity, diabetes mellitus (DM), and hypertension, in order to gain a better understanding of factors influencing chronic diseases in Barbados. A systematic sampling from a random start technique was used to select participants for the study. A standard questionnaire was used to collect data on demographic and lifestyle characteristics, to record anthropometrics and blood pressure measurements, and to ascertain the hypertension and diabetes status of participants. The sample population consisted of 407 Barbadian Seventh-Day Adventists (SDAs), who ranged in age from 25 to 74 years. One hundred fifty-three (37.6%) participants were male, and 254 (62.4%) were female, and 43.5% were vegetarians. The prevalence rates of diabetes and hypertension were lower among long-term vegetarians, compared to non-vegetarians, and long-term vegetarians were, on average, leaner than non-vegetarians within the same cohort. A significant association was observed between a vegetarian diet and obesity (vegetarian by definition P=.04, self-reported vegetarian P=.009) in this population. Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity, diabetes, and hypertension. [author abstract] [Ethnicity & Disease, Volume 13, Winter 2003, pp.34-39]
• Stigma, discrimination, and HIV/AIDS knowledge among physicians in Barbados
  Objective: To determine the extent of clinical knowledge of HIV/AIDS that physicians in Barbados have and their attitudes towards persons living with HIV/AIDS. Methods: In 2000 the Barbados Association of Medical Practitioners conducted a survey in order to assess its members’ views on HIV/AIDS issues. Over a two-month period 203 physicians (76% of all those practicing in the country) were interviewed. The survey included physicians working in private practice and the public sector. They were surveyed individually concerning their attitudes towards counseling as well as their clinical knowledge, perception of safe practices, fear of occupational exposure, views on ethical issues, experience treating HIV/AIDS patients, and background with HIV/AIDS continuing education. Results: In comparison to physicians who had graduated in later years, physicians who had graduated in 1984 or earlier had seen fewer HIV/AIDS clients, had lower levels of knowledge about the disease, were more likely to test for HIV/AIDS without informed consent, and were less likely to have ever attended a continuing education training course on HIV/AIDS. Overall, knowledge of the clinical indications of HIV/AIDS was low, and 76% of the physicians did not think they had adequate counseling skills. Over 80% of the physicians were comfortable looking after HIV/AIDS patients. While 95% of the physicians would not release HIV test results without a patient’s consent, 33% would test, without consent, a seriously ill patient, and 15% would test without consent a patient upon whom they had to perform an invasive procedure if they perceived the patient to be from a high-risk population such as gay men or commercial sex workers. Only 53% of the physicians had attended an HIV/AIDS in-service training program between 1995 and 1999. Conclusions: Physician training in Barbados should focus on all aspects of HIV/AIDS care, including clinical and emotional factors. Attendance at such training should be mandatory for public sector physicians, and medical school curricula need to be examined to ensure their HIV/AIDS content is current and comprehensive. [author abstract] [Rev Panam Salud Publica, 2004; 16(6):395–401]

Educational Resources

• CDC Travellers' Advice- Temperate South America
• Library of Congress, Country Study: Caribbean Islands