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At least 19 recordsLinked to original sources
PubMed1989

Health effects of the war in two rural communities in Nicaragua. Nicaragua Health Study Collaborative at Harvard, CIES, and UNAN.

We report on a pilot study to assess the effects of low intensity war in Nicaragua on the health of the civilian population. The study compared data from two regions in Nicaragua, one in an area of intense conflict, the other further removed from the war's violence. Information was obtained from a questionnaire administered to female heads of randomly selected households; structured interviews with community leaders and health workers; group discussions with community residents; and a review of regional and municipal death records. Height and mid-upper arm circumference of children were measured, and immunization records reviewed. The war has had a serious negative effect on the lives of the civilian population in both the war zone and the non-war zone, with the effects most severe in the war zone. In both communities, over half of the respondents reported the death of a friend or relative. In the war zone community, over one-fourth of respondents reported attacks on family members in non-combat situations around their homes. Death by firearms was the leading cause of death in persons over age 6 in the war zone. Vaccination coverage, nutritional indices, and familial disruption were worse in the war zone community. The findings suggest that continued funding of the Nicaraguan contra forces by the United States may be harming the ostensible beneficiaries of that policy, and that use of such low intensity conflict as a foreign policy tool should be questioned.

Cause of Death↗
PubMed2004

Occupational injuries identified by an emergency department based injury surveillance system in Nicaragua.

OBJECTIVES: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua. SETTING: Urban emergency department in Managua, Nicaragua serving 200-300 patients per day. METHODS: Secondary analysis from the surveillance system data. All cases indicating an injury while working and seen for treatment at the emergency department between 1 August 2001 and 31 July 2002 were included. There was no exclusion based on place of occurrence (home, work, school), age, or gender. RESULTS: There were 3801 work related injuries identified which accounted for 18.6% of the total 20 425 injures captured by the surveillance system. Twenty seven work related fatalities were recorded, compared with the 1998 International Labor Organization statistic of 25 occupational fatalities for all of Nicaragua. Injuries occurring outside of a formal work location accounted for more than 60% of the work related injuries. Almost half of these occurred at home, while 19% occurred on the street. The leading mechanisms for work related injuries were falls (30%), blunt objects (28%), and stabs/cuts (23%). Falls were by far the most severe mechanism in the study, causing 37% of the work related deaths and more than half of the fractures. CONCLUSIONS: Occupational injuries are grossly underreported in Nicaragua. This study demonstrated that an emergency department can be a data source for work related injuries in developing countries because it captures both the formal and informal workforce injuries. Fall prevention initiatives could significantly reduce the magnitude and severity of occupational injuries in Managua, Nicaragua.

Accidents, Home↗
PubMed1989

Foreign nations, international organizations, and their impact on health conditions in Nicaragua since 1979.

In July 1979, a coalition of social forces in Nicaragua, under the leadership of the Sandinistas, toppled the discredited 43-year Somoza dictatorship. In addition to revolutionary Nicaragua's own substantial efforts, since 1979 international forces and developments have had profound impacts on the nation's ambitious social programs. This article investigates the impact of foreign nations and international organizations on Nicaragua's health conditions since 1979. Given or pledged assistance, for health and other social needs, has been forthcoming, for example, from Latin America, Western Europe, socialist countries, the United Nations, the Organization of American States, and the European Economic Community. International forces, however, have also had a negative impact on Nicaragua's health conditions. Since 1981, counter-revolutionary guerilla forces, known as contras, have fought the Nicaraguan government troops in a disastrous conflict, involving substantial international assistance for each side. The United States and several other nations have provided some form of aid to the contras. The war in Nicaragua has resulted in enormous human and material losses, and, of course, has adversely affected health conditions.

Delivery of Health Care↗
PubMed1997

Initial screening for antituberculous drug resistance at an inpatient facility in Leon, Nicaragua.

Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.

Adult↗
PubMed1997

Critical care in Nicaragua.

Critical care nursing in Nicaragua is vastly different than critical care practiced in the United States. The current status of critical care nursing in Nicaragua is challenging at best. Medical personnel do not have access to arterial blood gases, blood cultures, and capillary blood glucose monitoring. The strengths and challenges present in Nicaraguan critical care has made the nursing staff rely on keen and astute nursing assessment of their patients. Due to the lack of technology in Nicaragua, creativity and improvising are a must in caring for a critically ill patient. However, the concerns and issues facing the nurses in Nicaragua are very similar to those experienced by critical care nurses in the United States. Critical care nursing in Nicaragua is indeed true nursing at its finest.

Critical Care↗
PubMed2004

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua.

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and pyuria >/=10 WBC/hpf were admitted to the study. Positive cultures from midstream urine specimens were defined as >/=10(5) cfu/ml of a single uropathogen. Susceptibility tests were performed with disc diffusion tests using the Kirby-Bauer method and broth microdilution using National Committee for Clinical Laboratory Standards criteria both in León and a reference laboratory in Utrecht. A positive culture was present in 62 of 208 study subjects (30%). Escherichia coli (56%), Klebsiella spp. (18%) and Enterobacter spp. (11%) were the most frequent pathogens isolated. Presence of cystocele, incontinence and increasing age were risk factors for bacterial UTI. E. coli was least resistant to ceftriaxone, amikacin and nitrofurantoin (>90% susceptible). We observed high resistance rates in E. coli to amoxicillin (82%, MIC(90) 128 mg/l), trimethoprim-sulphamethoxazole (TMP-SMX) (64%, MIC(90) 32 mg/l), cephalothin (58%, MIC(90), 32 mg/l), ciprofloxacin (30%; MIC(90), 32 mg/l), amoxicillin/clavulanate (21%, MIC(90) 8 mg/l) and gentamicin (12%, MIC(90) 2 mg/l). Our results suggests that community acquired uropathogens in Nicaragua are highly resistant to many antimicrobial agents. The use of amoxicillin, trimethoprim-sulphamethoxazole and cephalothin against uropathogens needs to be reconsidered. High quinolone resistance rates among E. coli in Nicaragua gives cause for great concern.

Adult↗
PubMed2006

Nutritional status and associated factors in children aged 0-23 months in Granada, Nicaragua.

OBJECTIVES: Nicaragua is one of two low-income countries in the Latin Americas. The objectives of this study were to clarify the nutritional status of children aged 0-23 months and to identify the associated factors in rural Nicaragua. STUDY DESIGN AND METHODS: This was a cross-sectional study; a questionnaire survey was performed and anthropometric measurements were taken in Granada province, Nicaragua. RESULTS: Seven hundred and fifty-six mothers with at least one child aged 0-23 months took part in this study. The proportion of underweight children [weight-for-age Z-score <-2 standard deviations (SD)] was 10.3%, while 30.1% of children exhibited stunted growth (height-for-age Z-score <-2 SD) and 5.0% were wasted (weight-for-height Z-score <-2 SD). Mothers' illiteracy or lack of formal education [odds ratio (OR)=3.476, P<0.01], a history of respiratory infection (OR=1.821, P<0.05) and a birth weight below the median (<3000 g; OR=1.704, P<0.05) were identified as risk factors for stunted growth. Breastfeeding for more than 12 months (OR=2.031, P<0.01), absence of participation in child growth monitoring (OR=1.956, P<0.05) and female gender of the child (OR=1.884, P<0.05) were identified as risk factors for underweight. DISCUSSION: Despite the steady economic development in Nicaragua since 1990, child nutritional status has not improved as much as might be expected. The present study revealed that a mother's favourable sociodemographic characteristics and her active participation in health activities, such as child growth monitoring, can protect against child malnutrition, particularly against underweight. More attractive health education or antenatal care programmes might lead to substantial improvements in maternal and child health in this small, poor community.

Adult↗
PubMed1987

Nicaragua: a health system developing under conditions of war.

Since its inception in 1979, the Nicaraguan National Health System has dramatically improved health care in Nicaragua through the provision of universal coverage, emphasis on preventive community-based primary care, and community participation in health activities. Of major importance in the development of the health system has been the decentralization of the administration, planning, and implementation of health programs. The war in Nicaragua has had a major impact on the development of the health system. Nicaraguan health personnel and facilities have been the objects of attack by the contras and scarce resources have been diverted from the development of social programs to military activities. A large refugee population has been created which further strains existing resources. Community-based preventive health programs have been adversely affected, particularly in rural areas where military activity is the most intense. Because of the war, efforts to optimize regionalization of the health system have been retarded. Economic pressures both within Nicaragua resulting from the war and within the entire Latin American area have further hampered efforts for development. Continued major improvements in health care in Nicaragua will depend on a settlement of the present military conflict which is draining resources in all sectors of development, including health.

Economics↗
PubMed2006

Suicidal expressions among young people in Nicaragua: a community-based study.

BACKGROUND: Suicidal behaviour is a major public health problem among adolescents. In Nicaragua as well as in most other countries, young people aged 15-24 have the highest rate of attempted suicide according to hospital records. The aims of this study were to investigate self-reported life-weariness, death wishes, suicidal ideation, suicidal plans and suicide attempts (i.e. suicidal expressions) among young men and women in the community and to identify factors associated with suicidal expressions. METHODS: The sample was derived from an established study base in the city of León, Nicaragua. From 352 randomly selected subjects aged 15-24 years, 278 individuals (145 males and 133 females) were interviewed using the Attitudes Towards Suicide (ATTS) questionnaire, including questions on suicidal expressions. RESULTS: The overall 1-year prevalence of any suicidal expression was 44.8% among males and 47.4% among females. A suicide attempt in the past year was reported by 2.1% of males and 1.5% of females. There was no significant gender difference in reporting of the separate types of suicidal expressions, except for death wishes, where females reported higher prevalence (33.8% vs. 20.7%). Exposure to suicidal expressions among significant others was significantly associated with own serious suicidal expressions. The study failed to identify any association between suicidal expressions and sociodemographic factors such as poverty or educational level. CONCLUSIONS: The present study highlights that suicidal behaviour is a significant public health problem among young people in Nicaragua. The finding that suicidal behaviour among significant others appears to have a contagious effect on adolescents, needs to be addressed in the prevention of suicidal behaviour.

Adolescent↗
PubMed1999

Malaria control in Nicaragua: social and political influences on disease transmission and control activities.

Throughout Central America, a traditional malaria control strategy (depending on heavy use of organic pesticides) became less effective during the 1970s. In Nicaragua, an alternative strategy, based on frequent local epidemiological assessments and community participation, was developed in the 1980s. Despite war-related social instability, and continuing vector resistance, this approach was highly successful. By the end of the contra war, there finally existed organisational and ecological conditions that favoured improved malaria control. Yet the expected improvements did not occur. In the 1990s, Nicaragua experienced its worst recorded malaria epidemics. This situation was partly caused by the country's macroeconomic structural adjustment programme. Volunteers now take fewer slides and provide less treatment, malaria control workers are less motivated by the spirit of public service, and some malaria control stations charge for diagnosis or treatment. To "roll back malaria", in Nicaragua at least, will require the roll-back of some erroneous aspects of structural adjustment.

Developing Countries↗
PubMed2004

Parasuicide in a low-income country: results from three-year hospital surveillance in Nicaragua.

AIMS: A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns. METHOD: All hospital-admitted parasuicide cases in the area of Leon, Nicaragua, were assessed over a three-year period using standardized instruments. RESULTS: Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15-19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May-June and September-October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide. CONCLUSIONS: Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

Adolescent↗
PubMed2000

Payment deferred: strychnine poisoning in Nicaragua 65 years ago.

BACKGROUND: In 1933 in Leon, Nicaragua, a 22-year-old woman died after an acute convulsive illness in which she experienced trismus, opisthotonos, and hyperpyrexia. Three years later her husband, Oliverio Castaneda, was convicted of her murder and that of 2 other people in the same city. METHODS: We went to Nicaragua to investigate documents involved with that case and evaluate whether the verdict of murder by strychnine was substantiated by the data. We present the results of the investigation and provide information about the practice of medicine, pharmacy, and toxicology early in this century. RESULTS: The clinical picture in all 3 cases suggests strychnine poisoning. The clinical, toxicological, and circumstantial evidence is strong and implicates Castaneda as a murderer and strychnine as the weapon. CONCLUSION: We conclude that Oliverio Castaneda was the probable perpetrator of three 1933 strychnine murders in Leon and that he may have previously used strychnine to kill others in Nicaragua and neighboring countries.

Adult↗
PubMed1990

Health for all in Nicaragua.

The state of health care in Nicaragua can be attributed in part to the interaction between 'revolutionary' and 'counter revolutionary' forces. Since 1979 development of primary health care has been rapid and ambitious. Nicaragua's early successes in the pursuit of 'Health for all by the year 2000' have been widely reported and rightly acclaimed. Since 1983, however, these advances have been difficult to maintain, leading to stasis and deterioration in the health system. The contribution of various factors to the current health status of Nicaragua is examined.

Education, Medical↗
PubMed1993

Childhood acute promyelocytic leukemia in Nicaragua.

BACKGROUND: The pediatric hematology-oncology service of the Managua 'La Mascota' Children's Hospital in Nicaragua began its activities in 1988. We report on unusual high incidence of acute promyelocytic leukemia (APL) observed in Nicaragua in the last three years. PATIENTS AND METHODS: From 1990 to 1992, 17 of 110 children with acute leukemia were diagnosed as having acute non-lymphoblastic leukemia (AnLL). The diagnosis was performed according to the FAB criteria. In two cases DNA was recovered for molecular analysis of the t(15; 17). RESULTS: Ten of 17 cases of AnLL were classified as APL. PML and RAR alpha gene rearrangements were observed in the two cases where molecular analysis was performed. Nine children received chemotherapy; one was treated with all-trans-retinoic acid (ATRA), achieving complete remission. Eight children who received chemotherapy died early of hemorrhage and/or sepsis. DISCUSSION: In Nicaragua, APL may be much more common than is generally observed elsewhere. In recent years initial treatment of APL with ATRA has proved to reduce the incidence of early hemorrhagic deaths, and complete remissions can be achieved without marrow aplasia and thus prevent infectious complications. From that perspective APL might become a curable disease, also in developing countries where the treatment of AnLL is not usually affordable.

Adolescent↗