Health Profile of São Tomé e Príncipe

This is a summary of the actual 1998/9 "Health Profile of São Tomé e Príncipe". For more information please do not hesitate to contact the relevant person at WHO in São Tomé e Príncipe. Please check the country profile page for details on other factors that influence health issues, such as on the economy, politics, education, geography and history of São Tomé e Príncipe. As in most African countries, the health situation in São Tomé e Príncipe has become worse in recent years due to the economic crisis facing the government. The sector has no political goals that have been elaborated, and lacks a health development plan.

Fatal illnesses

Children are the most severely effected by the three most important causes of death in the country: malaria, acute diarrhoearal diseases and acute respiratory diseases. Over the last few years all three have seen a slight increase in their prevalence. The most worrying of these trends is that of malaria. Financial pressures forced the government to stop its campaign of DTT spraying, that had almost eradicated the disease in the late 1980s. Since then the disease has re-established itself with a vengeance. In 1997 there were just over 39 thousand notified cases out of a total population of only 132,678.

Infant mortality

Available estimates show that between 1990-94 under-five mortality accounted for more than half of the total death toll. As such, it is one of the most important areas of concern in health. Again the visible trend is one of dramatic improvement up until the early eighties, and then a degree of deterioration. Although the figures remain better than the sub-Saharan African averages, they compare unfavourably with the goals of the National Programme of Action. Operators in this field again work without parameters.

Mental Health and Disability

Generally the situation is unsatisfactory and, as with other sectors, services have become worse in recent years. There is very little public and political visibility for these issues, and correspondingly little information. Mental health services operate exclusively in the Central Hospital with very basic work conditions. The gap between the provision of care for people with mental illnesses and the actual need is immense. About 4% of the population in São Tomé e Príncipe are registered as having a physical disability. The most common are those relating to eyes, speech and motor skills. No plan of action exists for these areas of health and hence the road to improvement has an obvious starting point.

Family Planning

In São Tomé e Príncipe the average number of children that a woman will have in her life time is 5.35 according to the 1991 census. Sexual activity starts early, especially for girls, the average age at which a woman will first give birth being 18-19. The use of contraceptives remains low, but has grown slightly - 12% in 1992 and 15.5 % in 1997. As of 1998, reproductive health services were available in 18 health facilities, covering all seven districts. WHO, UNICEF and UNFPA assisted in the rehabilitation of infrastructure, the training of staff and the provision of equipment and materials. Whilst the cover is by no means complete, improvements have been achieved since 1983 when only 35 women had effective family planning consultations.

The most common methods of contraception are the pill, injections and the coil. Since 1994 the use of condoms has also been increasing.

Substance abuse

In general there is very little information regarding drug, alcohol or tobacco abuse in São Tomé e Príncipe. It is clear that many road accidents are related to drink-driving, and some other accidents, such as fires, are also related to alcohol abuse.

Drugs are not really an issue of Sao Tomean life, and smoking fortunately remains uncommon. A survey conducted by WHO in 1996 in São Tomé e Príncipe found that 1.8% of men aged 14-20 and 0.6% of women described themselves as smokers. However, judging form the quantity of imports, it would seem that cigarette consumption is increasing.

Nutrition

As with many aspects of Sao Tomean life, the level of nutrition seems to have taken a turn for the worse in recent years. There are three main indicators of nutrition levels: birth weight, protein and calorie levels in diet, and the level of essential micro-nutrients.

The number of new born babies weighing under 2,500 grams in 1982-4 was on average less than 7.5% (FAO 1991). This figure was 12.3 % in 1993 and 12,4 % in 1994. According to a study carried out in 1996, there has been an increase in severe stunting over the last decade - the level in 1996 was found to be 32.6% of children, and the number of cases of severe wasting rose from 4.8% in 1986 to 7.8% in the more recent survey. These trends are worse in the southern-most district of Caué.

In terms of micro-nutrients there is a worrisome trend of iodine and iron deficiency. Iodine deficiency is a major preventable cause of mental retardation. In response to this problem the government has enacted legislation, prepared with the assistance of WHO and UNICEF, to require all salt sold in the country to be iodised. WHO and UNICEF have also been working together to establish the levels of anaemia and vitamin A deficiency in the country.

Health of the Environment

The state of the health of the population is of course inextricably linked to the level of sanitation. In São Tomé e Príncipe this is less than perfect, in terms both of general sanitation and also availability of drinking water. The percentage of people with access to drinking water in their house, or at a local waterstand is only 25%. The percentage of the population with an adequate sewage system is even lower at 19.1%. The links between this and the levels of acute diarrheoral diseases, dysentery and neo-natal typhoid cannot be emphasised enough. The importance of improving these conditions is heightened by the eminant possibility of cholera and dysentery outbreaks.

 

Health of particular groups

Women

Women in São Tomé e Príncipe must be a major focal point for any aspect of development work. Not only do women hold a key social position in teaching future generations basic awareness of health and sanitation issues, but also, given their low economic position, they comprise a vulnerable group in relation to health issues.

After malaria, one of the most pressing areas of health concern is maternal-infant mortality. Pre-natal services covered 71% of women in São Tomé e Príncipe in 1997 with the average number of visits standing at 4.5 - a marked improvement since the late 1980s. Anti-tetanus cover was at 73% in 1995. Figures are, of course, slightly better in the capital than in the more remote areas of the islands. However, at the same time as pre-natal visits are showing an increase, the number of women that give birth within a medical institution is dropping, and maternal mortality remains worrying, at 130 per 100,000 births between 1991 and 1993.

Sexually transmitted diseases, including AIDs, are also becoming an important feature of women’s health in São Tomé e Príncipe. According to the Ministry of Health, blood tests from small groups of pregnant women showed an HIV prevalence rate of 5.7% in 1994, 0.2 % in 1995, and 5.5 % in 1996. These figures are worryingly high for a small population. In addition, of the pregnant women examined in 1993, 18.8% had a vaginal infection of some sort.

Children

The provision of vaccines is a large area of concern in childhood health.

Assisted by both WHO and UNICEF the immunisation programmes have had some degree of success. The number of children aged 12-23 months who have been fully vaccinated against polio, diphtheria, whooping cough, tetanus, measles and tuberculosis has risen from 15% in 1983 to 80% in 1995.

Another important area is that of post-natal visits. These are governed by the new National Reproductive Health Programme. In 1995, 42,236 children under the age of five were covered. The number of consultants per child has also increased.

Elderly People

Because of a lack of strength in the family structure in São Tomé e Príncipe, that relates back to the social history under colonialism, the elderly are much more likely than in other countries to suffer from abandonment. In this situation there is a system of 80 old peoples homes. An external regime also subsidises the lives of about 2000 people. However, resources available for these schemes are minimal. In general the majority of elderly people remain in a highly vulnerable position with no real mechanism of protection.

Workers

Politically there are some basic rights of the worker that were put into the constitution as far back as 1958. However, these have not been put into practice, and as such, workers are vulnerable to any hazards at work with no rights regarding sick leave. They are forced to rely on the employers discretion.

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