Haiti’s Struggle With Morbidity And Mortality

Haiti is still rebuilding from the devastating events of the Earthquake that ravaged the country in 2010, causing lasting repercussions. While the country and various aid organizations have been working extremely hard to help the country recover, there is still a long way to go. Cardiovascular diseases, such as ischemic heart disease, and diarrheal diseases and lower respiratory infections make up the top two causes of both morbidity and mortality in Haiti. In 2016, the top cause of mortality in Haiti was due to cardiovascular diseases, at 30.01 percent of total deaths. This was followed closely by diarrheal diseases and lower respiratory infections, at 11.92 percent of total deaths. These two causes switch places when discussing morbidity - diarrheal diseases and lower respiratory infections are the top cause of morbidity - they account for 14.46 percent of total DALYs. Cardiovascular diseases follow, with 13.92 percent of total DALYs Mortality due to cardiovascular diseases in Haiti can be attributed to many factors. Individual determinants of cardiovascular disease include behavioral factors such as dietary risks (13.04 percent of total deaths due to cardiovascular disease) and malnutrition (2.38 percent).

In regard to all the cardiovascular diseases, similar determinants are present throughout. Environmentally, air pollution is a huge factor when taking into account cardiovascular diseases, with both household (2.73 percent of total deaths) and ambient air pollution (1.1 percent) being the biggest factors. When looking at social determinants, those 50 and older are most likely to die due to cardiovascular disease, with it being the cause of 41. 83 percent of total deaths for those aged 50-69. Diarrheal diseases and lower respiratory diseases, on the other hand tend to be highly communicable and spread quickly, which can devastate a population. In terms of individual determinants of health, malnutrition is the biggest factor in regard to mortality due to diarrheal diseases, at 1.96 percent of deaths due to malnutrition for lower respiratory infections and 2.22 percent of diarrheal diseases. Poor sanitation is the biggest environmental factor when looking at causes of diarrheal disease mortality. This accounts for 4.04 percent of total deaths. Air pollution causes 3.3 percent of total deaths due to lower respiratory infections..

For children under 5, unsafe water, sanitation, and handwashing is the biggest cause of mortality due to diarrheal diseases and LRIs, at 14.73 percent of total deaths. For those aged 15-49, the same cause is linked to 2.05 percent of total deaths.

The top causes of morbidity in Haiti are the same as the causes of mortality, with the biggest being diarrheal diseases and lower respiratory infections. These can be attributed to a variety of determinants: most are environmental, but individual determinants also play a role for both sexes. In terms of environmental determinants, unclean water, poor hygiene, and unsafe sanitation (WaSH) is the biggest determinant - unsanitary hygiene, water, and sanitation cause 5.28 percent of total DALYs due to diarrheal diseases and lower respiratory infections. Lower respiratory infections, on the other hand, are due mostly to air pollution, at 3.3 percent of total deaths. In regard to individual determinants, malnutrition is a major cause of both diarrheal diseases and lower respiratory infections, at 3.75 percent and 3.19 percent of total DALYs, respectively. With children under five, there is a much higher prevalence of DALYs due to unsafe water, sanitation, and hygiene (12.82 percent of total DALYs) than those aged 15-49, at 1.41 percent of total DALYs.

Women in Haiti are less likely to die from diarrheal diseases and lower respiratory infections, at 10.82 percent of total deaths, than men, at 13.16 percent of total deaths (GBD 2016). Cardiovascular diseases are the top causes of mortality for both men and women, but kill a higher percentage of women (34.6 of total deaths) as compared to men (24.93 percent) of total deaths. More women are killed by cardiovascular disease due to air pollution (10.28 percent) than men (7.23 percent), according to GBD Compare. These disparities can be exacerbated, however, each sex experiences different advantages and disadvantages A large determinant of health in Haiti is unclean water, poor sanitation, and bad hygiene. As a country, Haiti has the lowest rate of access to clean water in the Western hemisphere, at 69 percent, according to a study done in the American Journal of Tropical Medicine and Hygiene. Although the earthquake destroyed much of Haiti's infrastructure and was followed by a major outbreak of cholera, there are many international aid agencies, government programs, and interventions working to help reduce the burden of disease in Haiti, especially preventable diseases such as diarrheal diseases. Even before the earthquake, Haiti's government was focused on reforming the access to and spread of water and sanitation. The reform, beginning in 2009, created the National Directorate for Potable Water and Sanitation (DINEPA) and how the organization would be set up. After the earthquake, the United Nation Children's Fund, or UNICEF, along with DINEPA, organized to provide potable water to hundreds of internationally displaced persons settlements. These organizations have done much to help rebuild and develop Haiti's infrastructure and access to clean water and sanitation, as well as improve and manage hygiene services. For example, DINEPA created the Potable Water and Sanitation Technicians for the Communes, where 284 trained technicians were sent to rural communities outside of Port-au-Prince in order to monitor and manage the state of potable water, proper sanitation, and hygiene in these areas. Another successful related intervention was the World Bank, which partnered with DINEPA and the State and Peace Building Fund to increase the accessibility of clean water and improve sanitation facilities. In terms of water interventions, 15 drinking water systems were constructed or rehabilitated to serve over 50,000 people. Similarly, a new model for water and sanitation management was established in 9 communities, which serves nearly 50,000 people. 1,598 connections to water networks were established.at homes, and many water distribution kiosks were also upgrade. On the sanitation side, 25 latrines, 25 urinals, and 28 handwashing stations were established and 14 masons were trained from different communities in order to build more latrines. Similarly, 28 trainers and 28 community workers were trained in the Participatory Hygiene and Sanitation approach.

There were also sanitation campaigns established throughout the country. As these interventions are relatively recent, it is difficult to measure their success at the long term. There are some results coming through as a result of these interventions and many more - the rates of cholera has declined from 185,351 suspected cases in 2010 to only 26,198 cases. Haiti struggles with morbidity and mortality due to many types of diseases. These diseases, for the most part are most of the causes of both morbidity and mortality in the country, no matter the age or gender of its citizens. There are also similar determinants that increase the burden of these diseases, including lack of access to clean water, proper sanitation, and hygiene, and air pollution. Malnutrition is also a main contributor to disease. However, with the assistance of many interventions, access to clean water and sanitation has increased, which will assist in helping the rates of disease, diarrheal diseases especially, go down.