KEY FACTS Joined Commonwealth: 1978 Population: 72,000 (2013) GDP p.c. growth: 1.8% p.a. 1990–2013 GNI p.c.: US$6,760 (2013) UN HDI 2014: World ranking 93 Life expectancy: 76 years (est. 2013) Under-five mortality rate (per 1,000 live births): 11 (2013) Largest contribution to mortality: Cardiovascular diseases Government health expenditure: 4% of GDP (2012) General information The Commonwealth of Dominica is one of the Windward Islands in the Eastern Caribbean, lying between Guadeloupe to the north and Martinique to the south. Climate: The climate is subtropical and hot, but cooled by sea breezes, with a rainy season in June–October, when hurricanes may occur. Rainfall is heavy, especially in mountain areas. Environment: The most significant environmental issues are shortage of drinking water; deforestation; soil erosion; and pollution of the coastal zone by chemicals used in farming and factories, and untreated sewage. 168 Commonwealth Health Partnerships 2015 Population: 72,000 (2013); 69 per cent of people live in urban areas. The population growth stood at 0.1 per cent between the years of 1990 and 2012, decreased over this time mainly to the emigration of young people. In 2012 the birth rate was 16 per 1,000 people (est 26 in 1970) and life expectancy was estimated at 76 years. The population is mostly of African and mixed African/European descent, with European, Syrian and Carib (2.9 per cent in 2001 census) minorities. There is a Carib reserve on part of the east of the island, referred to as the Carib Territory. Economy: Dominica is classified as an upper-middle-income economy by the World Bank. Health Child and maternal health: The rate of infant mortality in Dominica was ten deaths per 1,000 live births in 2013, with an under-five mortality rate of 12 deaths per 1,000 live births in 2013. Although there has been a consistent and encouraging decline in under-five mortality, which has decreased by a third since 1990, it is not yet in line with the country’s target of six deaths per 1,000 live births, as defined by Millennium Development Goal 4 (MDG 4). In 2010 the most prominent known causes of death for children below the age of five years were birth asphyxia (48 per cent), neonatal sepsis (14 per cent) and prematurity (ten per cent). Other contributory causes included neonatal pneumonia (three per cent) and congenital anomalies (seven per cent). Burden of disease: Non-communicable diseases (NCDs) in Dominica accounted for an estimated 85 per cent of all mortality in 2008. In 2008 the most prevalent NCDs were cardiovascular diseases (36 per cent). Cancer, non-communicable variants of respiratory diseases and diabetes contributed 21 per cent, five per cent and nine per cent to total mortality, respectively (2008). Communicable diseases along with maternal, perinatal and nutritional conditions in Dominica accounted for an estimated 11 per cent of all mortality in 2008. A government paper on HIV/AIDS reported a cumulative 410 HIV cases (150 of which resulted in death) in the period 1987–2013. Dominica is a non-endemic country for malaria. Estimated incidences of tuberculosis (TB) have halved in the period 1990–2012, while estimated mortality (when mortality data excludes cases comorbid with HIV) almost decreased slightly during this time. The most commonly diagnosed mental illnesses in Dominica are schizophrenia and depression. Health systems: In 2012 government expenditure on health was four per cent of GDP, equivalent to US$282 per capita. In the most recent survey, conducted between 1997 and 2009, there were 50 doctors, and 417 nurses and midwives per 100,000 people. Additionally, in the period 2007–12 all births were attended by qualified health staff and, in 2013, 93 per cent of one-year-olds Dominica
Commonwealth Health Partnerships 2015
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