To improve the health of citizens in Haiti, investigating factors that contribute to the major ongoing health crises in the island is a critical first step. Of primary concern is Haiti’s infant and maternal mortality rate, which is the highest in the Western Hemisphere.
The statistics reported by Jacobs et al. are chilling: 34% of children died within the neonatal period of life and 90% of neonatal deaths occurred within the first week of life. In 2013, the infant mortality rate was 55 per 1000 live births. Jacobs et al. explain that pneumonia is the leading cause of death for children under age 5 since Haiti cannot afford to supply its hospitals with enough antibiotics. Other factors contributing to high infant mortality include “asphyxia, injuries, low birth weight, malnutrition, infectious diseases such as diarrhea, and poor home sanitation.”1
From 2010 to 2013, the maternal mortality rate was 380 per 100,000 live births. Maternal death was driven by “heavy bleeding after birth, infections, obstructed labor, hypertension, and unsafe abortions.”1 At the onset of labor, women must navigate the failing infrastructure in Haiti’s hospitals and cope with a limited number of trained physicians and nurses. This increases a woman’s dependence on seeking treatment at nonqualified clinics which are not equipped for safe labor and delivery.1
Regretfully, almost a decade later, Haiti’s infant and maternal mortality rates remain high, and health crises continue. In 2021, Malhamé et al. write that maternal mortality is 359 per 100,000 live births and neonatal mortality is 28 per 1000 live births. This data was collected from a reputable hospital in the island: Saint-Nicolas Hospital, in Saint-Marc. Since Jacobs et al. published his 2013 findings in 2016, Malhamé et al. cite the same contributing factors to explain the high infant and maternal mortality rates on the island. 2 One example of an infectious disease contributing to maternal mortality is AIDS. However, Haiti’s struggle with AIDS is not restricted to the childbearing population; it is a nationwide health issue affecting people of all ages in Haiti.
Two major social factors contributing to the AIDS epidemic in Haiti are prostitution and poverty. Malow et al. explain that the likelihood of Haitian girls (13-24) acquiring the disease is very high. This reduces the likelihood of a safe pregnancy and healthy infant delivery when these women eventually enter their childbearing years. Malow et al. suggest that intervening in prostitution and encouraging safe sex is an important preventative step, since 90% of HIV transmission occurs within heterosexual relationships. However, the stigma around HIV reduces individuals’ seeking out intervention and support, thus diminishing the possibility of early diagnosis, and potential treatment. Describing the spread of HIV in Haiti is further complicated by what constitutes a vulnerable target. There are many co-infections associated with the disease, and tuberculosis (TB) is most concerning since it accelerates the progress of HIV into AIDS in the infected. Haiti began with a disadvantage since its population was struggling with TB well before HIV entered the picture and amplified the health crisis.
Malow et al. write that there are 500 cases of TB per 100,000 persons. Patients with HIV are more susceptible to infection from TB and transmit TB more readily. Thus, the presence of HIV alongside TB increases the prevalence and virulence of both diseases.3 Given the many challenges facing the country, improving health and healthcare in Haiti will most likely continue to require the intervention of W.H.O. and foreign aid.
References
- Jacobs LD, Judd TM, Bhutta ZA. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care. Perm J. 2016 Spring;20(2):59-70. doi: 10.7812/TPP/15-116. Epub 2016 Feb 25. PMID: 26934625; PMCID: PMC4867827.
- Malhamé I, Destiné R, Jacquecilien W, Coriolan BH, St-Loth W, Excellent MC, Scaide B, Wong R, Meltzer S, Jean-Baptiste E, Pilote L, von Oettingen JE, Israel K. Prevalence and perinatal outcomes of non-communicable diseases in pregnancy in a regional hospital in Haiti: A prospective cohort study. J Glob Health. 2021 Apr 17;11:04020. doi: 10.7189/jogh.11.04020. PMID: 33884191; PMCID: PMC8053393.
- Malow R, Rosenberg R, Lichtenstein B, Dévieux JG. The impact of disaster on HIV in Haiti and priority areas related to the Haitian crisis. J Assoc Nurses AIDS Care. 2010 May-Jun;21(3):283-8. doi: 10.1016/j.jana.2010.02.002. PMID: 20416497; PMCID: PMC2862993.
