In this first article in a new series about children and their health in Trinidad & Tobago, the emphasis will be on diseases of children, especially the symptoms of illness and their responses to illness.
It seems appropriate to look at some statistics on diseases. The figures, the stats, are important. Without them, we cannot make informed decisions. We have an excellent Central Statistical Office.
Unfortunately, it has been starved of funds over the years and cannot do its job properly. Most of the statistics here come from a variety of sites, especially UNICEF. Many of the stats are unbelievably old.
Today we’ll look at population, births, mortality and morbidity in a general way. Population is where it all starts.
Births, which should continue population growth. Mortality that chips away at the population. Morbidity, or the illnesses themselves, that either end life or damage us or, usually, are minor blips in the life of children.
There are just over one and a half million of us in Trinidad & Tobago. Around 20 per cent are under the age of 14, about 281,000 children. That is fast changing. Ten years ago, about 18,000 babies were born annually. The last two years averaged just over 10,000 a year. Since slightly more than 14,000 Trinidadians and Tobagonians die annually, our population has started to decline.
For the period 2020 to 2023, an average of 336 children under the age of five years have died every year. There seem to be no reliable stats on deaths for the age group five to 15 after 2016. The average number of children dying per year for the five years before that was 53. Most children die before they get to five.
Half of these children die in the first year of life and half of those in the first month.
Those who die in the first month, the neonatal mortality, die because they are too premature or suffer oxygen deprivation before or during birth or have congenital anomalies or get infected. However, there has been a dramatic reduction in neonatal mortality since 2015 and we have already achieved the 2030 global neonatal mortality target of fewer than nine neonatal deaths per 1,000 live births. Ours was 6.7 in 2020.
Likewise, the number of children who died before their first birthday decreased from 21 per 1,000 births to 6.8, a really dramatic change.
After the first year of life, the major cause of children dying is injury, poisoning and accidents. This includes delightful things like being cuffed to death, shot during gang-related violence, burning to a crisp because you were left alone in bed whilst your caretaker went down the road for a “short while”, and being licked down on the road as you walk to school. In other words, violence, deliberate or not.
Now, what makes children sick? It’s not COVID nor dengue. It’s mostly coughs and colds and skin rashes. But these are minor illnesses. What serious illnesses do Trinidadian and Tobagonian children get? Our child morbidity is increasingly characterised by some form of disability, mental health issues, violence and chronic non-communicable diseases (NCDs).
Mental retardation, cerebral palsy and visual loss are the grossly apparent disabilities. Hearing loss is a problem but is difficult to discern, like the ones relating to social paediatrics, the neurodevelopmental entities: ADHD, autism spectrum disorder (ASD), learning disorders (dyslexia, dyscalculia), intellectual disabilities, motor disorders (dyspraxia), communication disorders. Then you have behavioural problems: oppositional defiant disorder, conduct disorder etc. And psychological issues: anxiety, bullying, increasing suicide rates. Link all this to social media addiction, high rates of child abuse, lack of parental control/advice/support, and poverty and you have a proper Trinbagonian callaloo.
All of these are associated with learning problems at school. If untreated, the children react with anger and violence.
The second major problem is the child with allergies. All children with “dry skin” and serious reactions to “mosquito bites”; children who snore and sneeze every morning; children whose parents have “sinus” and who “always have a cold”; children who “grind their teeth”; children with umpteen episodes of asthma—all of these children have allergies.
Allergy is increasing all over the world and the cause of this is pollution.
Pollution of the fetus in the mother’s womb by second-hand cigarette smoke and other toxins. Pollution of the baby’s stomach, intestine and immunological system by inappropriate feeding, including formula and sugar, leading to obesity. And pollution of our atmosphere by dust, Sahara dust from climate change, from burning down the hills to plant crops or build big houses, and by the fumes from car engines.
Birth, violence and pollution are the things to remember whenever we think of our children and their illnesses.
