The needs, models of care, interventions and outcomes of palliative care in the Caribbean: a systematic review of the evidence
Author(s): Sandhya Maharaj1 and Richard Harding2
Of the 58 million people who die yearly, 45 million die in low and middle income countries (LMIC) . In the last decade, 99 % of the population growth took place in the developing world . It is expected that by 2050, the population in developing countries will expand by 55 % . The Caribbean is defined as the Caribbean islands that are located in the Caribbean sea. These islands are Anguilla, Antigua and Barbuda, Aruba, Barbados, Bonaire, British Virgin Islands, Curaçao, Dominica, Grenada, Guadeloupe, Martinique, Montserrat, Saba, Saint Barthelemy, Saint Kitts and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Saint Eustatius, Trinidad and Tobago, US Virgin Islands, Cuba, Hispaniola (Haiti and the Dominican Republic), Jamaica, Puerto Rico, the Cayman Islands, the Bahamas and the Turks and Caicos Islands. These islands form an estimated population of 32 million persons [3, 4]. The Pan American Health Organization (PAHO) database states the leading causes of death in the Caribbean islands from 1995 to 2010 as Ischaemic Heart Disease, Cerebrovascular Disease, Diabetes Mellitus, Influenza and Pneumonia, Malignant neoplasm of the trachea, bronchus and the lung, Hypertensive diseases, Chronic diseases of the lower respiratory tract, Heart failure and ill-defined heart disease, Malignant neoplasm of the prostate and Dementia . The majority of these top ten causes of mortality require palliative care at some point during their illness trajectory .
In 2013, PAHO/WHO (World Health Organization) reported that 50 % of the cancer deaths in the Americas come from Latin America and the Caribbean . The highest cancer mortality rates in the region are found in Trinidad and Tobago and Cuba . Between 2012 and 2030 there will be an expected 67 % rise in cancer incidence in the Caribbean and Latin America . It is projected that by 2030, there would be 1.8 million people diagnosed yearly with cancer in the Caribbean and Latin America. In addition, nearly 80 % of deaths from non-communicable diseases (NCDs) occur in low income and middle income countries . In Latin America and the Caribbean specifically, chronic diseases are now the leading cause of premature mortality and account for two out of three deaths overall . The Caribbean is the region of the Americas affected the most by the epidemic of chronic diseases .
The Joint United Nations Programme on HIV and AIDS (UNAIDS), suggest that after Sub-Saharan Africa, the Caribbean is one of the most heavily affected regions with the Human Immunodeficiency Virus (HIV) epidemic . The adult HIV prevalence in 2011 was documented as 1 %, higher than any other region in the world apart from Sub- Saharan Africa .
The WHO projects greater life expectancy for the population of Latin America and Caribbean countries between 2004 and 2030 . This gain in life expectancy brings with it complex demands on the health care system . The health care needs of the elderly may be chronic, time consuming and costly [12, 13].
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