------------------------------
PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Nicaragua has a surface area of 130,244 km2.
The country is divided into 15 departments and two autonomous regions. The Pacific
region, which covers 15.2% of its land area, has 58.2% of the population.
Demography:
The population was estimated at 5,710,670 inhabitants as of the year 2000 and
56.4% lived in urban areas. The indigenous population comprise approximately
5% of Nicaragua 's total population. Most indigenous groups live on the Caribbean
coast. For the period 1995-2000, life expectancy at birth was 68.4 years, the
birth rate was 35.3 per 1,000 population , and the fertility rate was 4.4 children
per woman, being greater in rural areas. However, the annual rate of population
growth slowed 2.7% over the period 1995 to 2000. Emigration and internal migration
have a strong impact on the country's economy. According to the National Quality
of Life Survey conducted in 1998 by the National Statistics and Census Bureau
(INEC), as of 1998, 47.9% of the population was living in poverty and 17.3%
was living in conditions of extreme poverty.
Literacy: The
survey also showed that the illiteracy rate was 23.4% in 1998. The three cornerstones
of the Government's social development strategy are the furtherance of economic
growth, particularly in rural areas; the promotion of spending on social programs
for the poor that are designed to reduce their vulnerability to economic, social,
and environmental risks; and the building of a stronger social safety net for
vulnerable groups in order to break the vicious cycle of intergenerational poverty.
Economy: The size of the economically active
population (EAP) as of 1998 was estimated at 1,728,900 individuals, 11% of whom
were unemployed. Unemployment more heavily affects women (in 1999, 14% of the
EAP in urban areas and 30% of the EAP in rural areas). In July 1999 the Ministry
of Labor reported that 56% of the urban gainfully employed EAP earned less than
US$ 9.20 per month, while the cost of the basic basket of goods was US$ 13.30.
Only 17% earned more than US$ 19.40 a month. A mere 12% of female workers had
monthly incomes of over US$ 19.40. Efforts to downsize the national government
are a pivotal part of the structural adjustment process. The assistance furnished
by the international community was crucial to reinforce coverage levels for
top-priority social services in the wake of Hurricane Mitch. Per capita GDP
stood at US$ 455.80 for the period from 1991 to 1998. It grew at an average
rate of 3.2%.
Mortality: The general mortality rate was
26.5 per 100,000 population in 2000. Infectious diseases fell from fourth to
fifth place among the leading causes of death in the last two years, with the
number of deaths attributable to this cause down by nearly 50% from 1996. The
number of deaths attributable to external causes rose in 1998 in the wake of
Hurricane Mitch.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): The
infant mortality rate for the period from 1997 to 2000 was 45.2 per 1,000 live
births. The leading causes of death among children under one year of age during
this period were respiratory and cardiac problems originating in the perinatal
period, pneumonia, diarrhea and gastroenteritis, bacterial sepsis of the newborn,
and congenital malformations. The leading causes of death among children 1-
4 years of age were pneumonia, diarrhea and gastroenteritis, and transport accidents.
Schoolchildren (5-9 years):
The leading causes of reported deaths in 1999 and 2000 were transport accidents,
pneumonia, accidental drowning and submersion, and accidental exposure to other
unknown factors.
Adolescents (10-14 years and 15-19 years):
The fertility rate for adolescents in 1999
was 152 births per 1,000 teenage girls of childbearing age (15-19 years of age).
Thus, 3 out of every 10 births involved teenage mothers in this age group. The
leading reported causes of deaths among adolescents in 1998 were: death associated
with natural disasters, pesticide poisoning, and accidents. Youths between 15
-19 years of age comprised 30% of cases of acute pesticide poisoning.
Adults (20-59 years): The
family planning service coverage level nationwide was 21% in 1999. According
to ENDESA-98, the rate of contraceptive use in Nicaragua was comparatively high:
68% of all women of childbearing age reported having used some form of birth
control at some point in their lives. In terms of maternal mortality, the nationwide
Maternal Mortality Surveillance System showed fluctuations, with rates of 102
per 100,000 in 1998, and 133 per 100,000 in 1999. Maternal deaths stemmed from
obstetrical problems, with the leading causes being hemorrhages caused by placenta
retention, pregnancy-induced hypertension, sepsis, rupture of the uterus, and
abortions.
The elderly (60 years and older): The
number of elderly was estimated at 4.7% of the population for the year 2000,
with males accounting for 45.4%. The age group 75 and over made up 1% of the
total population.
Workers' health: An
estimated 24,000 children 10-14 years of age were working at jobs in the informal
sector, with another 6,000 employed in the formal sector. Between 90% and 100%
of farmers and farmhands are exposed to some type of pesticide every year. Official
statistics for 1999 put the work-related pesticide poisoning rate at 5 cases
per 10,000 population . However, studies conducted in various parts of the country
estimate annual incidence rates for pesticide poisoning at from 3% to 9% of
exposed farm workers.
The disabled: The
National Rehabilitation Program operated by the Ministry of Health estimated
the percentage of the population with some type of disability at 12.1% in 2000.
The most common types of reported disabilities were visual impairments (63.9%)
and hearing impairments (9.2%). The leading causes of disabilities were problems
at birth (10%), disease (29%), war (3%), and accidents (12%).
Analysis by type of health problem Natural disasters: The
worst disaster during this period was Hurricane Mitch, which struck the country
in October of 1998. It caused 2,823 fatalities, with another 885 persons reported
missing, and damaged 49 municipalities. The most recent disaster was the earthquake
that struck the city of Masaya in July of 2000, with a death toll of nine.
Vector-borne diseases:The
largest number of malaria cases (76,269) was reported in 1996, with an annual
parasite index of 18.4 per 1,000 population . There was a downward trend in
malaria cases over the 1997-2000 period . The number of cases of P. falciparum
malaria nationwide fell 67.2% over the period. The risk of contracting dengue
quadrupled in 1998, with an incidence rate of 28.1 per 100,000 population .
Circulation of cases of dengue fever serotypes 3 and 2 were confirmed and 432
confirmed cases of dengue hemorrhagic fever were observed. A nationwide entomological
survey was conducted from 1998-1999 to establish the prevalence of triatomine
infestations in 14 departments (125 municipalities, 31,466 dwelling units),
finding prevalence rates of 1%-10%. A seroprevalence study of 11,375 blood samples
collected from schoolchildren between 7 and 14 years of age found 387 cases
of Chagas ' disease (3.4%).
Diseases preventable by immunization: Nicaragua
has successfully controlled the spread of diseases preventable through immunization
by achieving and maintaining high vaccination coverage levels over the past
few years and introducing new vaccines (the MMR vaccine in 1998 and the pentavalent
vaccine in 1999). Vaccination coverage for different biologicals ranged from
90% to 100% in 1999 and 2000. There were a total of 132 clinically diagnosed
cases of pertussis over the 1997-2000 period . The last registered case of neonatal
tetanus dates back to 1997. Vaccination coverage for women of childbearing age
is over 95% in most municipalities around the country. There were 37 cases of
non-neonatal tetanus reported over the period from 1997 to 2000, the majority
of which involved persons over 15 years of age whose occupations put them at
a higher risk of exposure. Haemophilus influenzae type b vaccination coverage
among children under 1 year of age was already greater than 90%. H. influenzae
type b comprised 56% of all cases of bacterial meningitis, which meant that
nearly 200 cases a year could have been prevented through immunization.
Intestinal infectious diseases: After
Hurricane Mitch, there were outbreaks of cholera, with 1,451 reported cases
(28.2 per 100,000 population) and 36 deaths (0.7 per 100,000 population), for
a fatality rate of 2.4%. Only 12 cases and 1 death were reported in 2000. Acute
diarrheal diseases are one of the main types of notifiable diseases. Children
under 5 years of age are hit hardest by these diseases, accounting for 73% of
the total reported. The morbidity rate was 484 cases per 100,000 population
in 1997 and 415 in 1998, with mortality rates around 7 per 100,000 in the same
years.
Chronic communicable diseases:Tuberculosis
is endemic in the country, the incidence rates fluctuated between 13 and 111
per 100,000 population . In 2000, there were 2,396 cases, 1,467 positive by
microscopic examination. The population 15-24 years were hardest-hit, accounting
for 26% of all cases of tuberculosis.
Acute respiratory infections : Acute
respiratory infections were the most common notifiable disease with an incidence
rate for the 1997-2000 period of 2,658 per 10,000 population. Children under
5 years of age were the hardest-hit, accounting for 57% of all treated cases
of the disease. The mortality rate was 6.47 per 100,000 population , with the
hardest-hit group that of children under 1 year of age, which accounted for
55% of all fatalities.
Zoonoses: Two
cases of human rabies were reported in the 1997-1999 period, both caused by
wounds inflicted by wild animals. Vaccination coverage for canine rabies improved
to over 85% countrywide. A leptospirosis epidemic was reported in 1998 in the
wake of the flooding caused by Hurricane Mitch, with 705 suspected cases reported.
HIV/AIDS:The
total cumulative number of cases of infection by HIV/AIDS over the period from
1987 to the year 2000 was 643 with 294 AIDS patients, of whom 164 have died.
The hardest-hit was the 20-44 age group, 81% of all cases, while 74% of all
cases were males. The leading mode of transmission was by sexual contact, (88%
of all cases, 64% by heterosexual contact), with 9 % attributable to intravenous
drug use, 2% to mother-to-child transmission, and 1% to blood transfusions.
Nutritional and metabolic diseases : ENDESA-98
found one out of every three children malnourished and 9% of all children severely
malnourished. The percentage of children in rural areas suffering from some
degree of malnutrition was 32%, compared with 19% in urban areas. The mortality
rate for all forms of malnutrition was 11 per 100,000 in 1998. Though iodine
deficiency is not a public health problem in Nicaragua , thanks to the fortification
of salt with iodine, there are high-risk groups in the South Pacific region
where the prevalence of goiter in certain communities is over 20%. The nationwide
prevalence rate for anemia in children between the ages of 12 and 59 months
was 28.4% with an average hemoglobin level of 10.6 mg/ dL .
Diseases of the circulatory system: Cerebrovascular
disease accounted for 31.7% of deaths due to diseases of the circulatory system
in 1992-1993. Hypertension was responsible for 12.6% of deaths attributable
to this group in 1998.
Accidents and violence:The
leading causes of death in the year 2000 were transport accidents (9.5 per 100,000
population), suicides (7.3), and homicides (6.6). According to ENDESA-98, 29%
of the married or in-union women surveyed had suffered sexual or physical abuse
at some time. There were 2,473 reported cases of attempted suicide by pesticide
poisoning over the period between 1997 and 2000, with a case fatality rate of
25.5%. Women accounted for 44% of these cases.
Oral health: In
1997, of the 233 communities covered by a study on fluoride content of drinking
water, only 12% had water supplies with optimal fluoride levels (0.5-1.0 mg/kg).
The total prevalence rate for dental caries in children between 6 and 15 years
of age was 85% with diagnosis of mild fluorosis in 2.6%, while only 0.8% of
the children studied had moderate to severe fluorosis .
RESPONSE OF THE HEALTH SYSTEM National health policies and plans: The
National Health Policy 1997-2002 is an extension of the commitment of social
policy to alleviate poverty and to improve service coverage, particularly for
the poorest and most vulnerable segments of society. There are five separate
health policies, aimed at modernizing the health sector, strengthening the Ministry
of Health, improving hospital care, formulating new public health strategies,
and modernizing the social security system. A number of initiatives designed
to strengthen the steering functions of the Health Ministry were initiated based
on technical instruments such as the health system profile, health analysis,
and the Ministry of Health's investment plan for 2000-2002.
The health system: Institutional organization:The health sector encompasses both the public and
private sectors. The public health sector consists of the Ministry of Health;
the Nicaraguan Social Security Institute; and the health services operated by
the Ministry of Government and by the Ministry of Defense. The divisions of
the Comprehensive Local Health System (SILAIS) represent the Ministry of Health
in technical and administrative matters at the departmental level. The private
sector includes hospitals, clinics run by health insurance management companies,
and nongovernmental organizations.
Developments in health legislation: The
National Health Policy 1997-2002 calls for revising and updating of the existing
legal framework through the passage of a number of laws and regulations, including
the General Health Act, the Unified Health System Act, the Social Security Act,
the Drug and Pharmacy Act, food monitoring regulations, regulations for the
control of pesticides and toxic and hazardous substances, regulations governing
ionizing radiation, regulations for professional health practice, and regulations
under the Health Administrators Law.
Organization of regulatory actions:At the primary care level, in 1997-2000, coverage
was provided by the different health delivery networks: public networks, 60%;
INSS networks, 10%; private networks, 20%; and other networks, 10%. The private
sector provides curative care to the insured population (15% of the EAP). The
Ministry of Health is the leading health service provider at both the primary
and the secondary care levels. At the primary care level, it operates health
centers (some with beds and some not) and health posts. Secondary care level
offers general and specialized medical care and outpatient and inpatient care
in basic areas. The private health sector consists of eight hospitals, private
medical and dental practices and clinics providing outpatient care, clinical
laboratories, and diagnostic imaging centers. Insurance management companies
provide insurance plan members with prescribed curative services outsourced
by the INSS. Insurance management companies have begun offering prepaid plans
to expand their service offerings. The Regulations Office also investigates
and responds to complaints with respect to the handling or treatment of patients
in public health care facilities and conducts audits to control the quality
of health care. The Office of Environmental Health monitors water quality through
sampling procedures conducted at specific points of the water supply network.
The Ministry of Environment and Natural Resources is also involved in regulatory
activities, exercising its powers under Law 290. However, the regulatory framework
for environmental protection is lacking, and the country has no systems in place
for the assessment of environmental risks. The Ministry of Environment and Natural
Resources and the Ministry of Agriculture and Forestry is putting into place
programs designed to protect natural ecosystems, with the emphasis on soil and
water conservation. The quality of food products is controlled through health
inspection and monitoring procedures and surveillance for foodborne disease.
The Ministry of Labor is in charge of formulating and coordinating occupational
safety and health regulations with relevant agencies and overseeing their enforcement
in the workplace.
Evaluation of health technology: The
equipment is insufficient and its use is limited by lack of resources for operation
and maintenance. In 2000, of all available equipment, 73% was used for diagnostic
and treatment purposes and in direct support of medical care; 82 % was in hospitals
but only 73% was in proper working order. The health centers and health posts
had 18% of equipment.
Organization of public health care services:
Health analysis, epidemiological surveillance,
and public health laboratory systems : The national register is maintained by
the National Vital Statistics System (SINEVI), which records official morbidity
(mainly hospital-data) and mortality statistics with a one-year delay. The national
and local epidemiological surveillance systems covers 25 specific health problems
subject to immediate notification requirements, such as outbreaks of disease
and disasters. Both SINEVI and the epidemiological surveillance system data
are used for strategic planning and health service management purposes at the
local and national levels.
Potable water and sewerage services: Potable
water supply was 89.4% in 1998, the urban coverage was 89.5% and the rural coverage
33.7%. Of the samples collected in 1999, 4% contained over 50 fecal coliform
bacteria per 100 mL . The percentage of the population without access to adequate
excreta disposal service dropped to 21.1% in 1998. Only 4.7% of the urban population
was still without service, compared with 31.7% of the rural population. Only
34% of collected wastewater received any type of treatment. The urban population
generated an estimated 1,396 metric tons of solid waste in 1999, 65% of which
were not subject to proper disposal methods. A great deal of progress has been
made in the area of environmental protection legislation, with the passage of
the General Environment and Natural Resources Act, environmental impact assessment
regulations, the Law Governing Pesticides and Toxic and Other Hazardous Substances,
regulations governing effluents, and the act creating the Environmental Protection
Agency.
Organization of individual health care services:The primary health care network offers virtually all
types of health promotion and risk and disease prevention services as well as
general curative care and preventive and restorative dental care. The physical
infrastructure administered by the Ministry of Health consists of 996 health
care facilities, 48.3% of which are concentrated in the Pacific coast area.
Managua has 11 hospitals, more than a third of all hospital facilities. The
INSS has no health delivery infrastructure of its own, outsourcing health care
services to public and private service providers.
Health supplies: Efforts
to develop a pharmaceutical industry are based on the country's National Medicinal
Drug Policy, whose strategies for the 1997-2001 period focus on institution-building,
promoting access to essential drugs, quality assurance, and rational drug use.
The essential drugs list for 2001 consists of 345 active ingredients, with their
generic names, and 509 drugs in their various pharmaceutical forms. The list
is used as a yardstick for the procurement, distribution, and use of drugs in
the public sector and the for-profit and not-for-profit private sector. According
to the Drug Regulations Office attached to the Ministry of Health, as of the
year 2000, there were 12,000 registered products, 255 drug importers/distributors,
12 domestically owned pharmaceutical laboratories whose output covered an estimated
20% of nationwide needs.
Human resources:In
1999, there were 23,285 health care workers, 32% of the government workforce,
of whom 47.4% were assigned to the primary care level and 52.6% to the secondary
care level. The wages of health care personnel consumed 60% of the Health Ministry
budget. In 2000 there were 5,656 registered general practitioners, 950 specialists,
323 professional nurses, 974 dentists, 1,042 pharmacists, 56 mid-level laboratory
technicians, and 21 radiologists. The number of nursing personnel in 1999 totaled
1,538, of whom 62% were assigned to the secondary care level, and 23% concentrated
in Managua . Of the auxiliary personnel, 52% worked at the primary care level.
In order to practice, health professionals must register their university degrees
with the Regulations and Accreditation Office attached to the Ministry of Health.
An estimated 90% of the nation's physicians are registered.
Health sector expenditure and financing:
Health resources are drawn from the public sector (41.5%), the private sector
(44.8%), and external cooperation (13.7%). Per capita health spending in 1998
reached US$ 45.1. The government allocation to the Ministry of Health for 1998
as a percentage of GDP was 3.2% in real terms, or the equivalent of 9.5% of
the general budget. International assistance to the Ministry of Health over
the period from 1991 to 1998 as a percentage of GDP was approximately 1.3%,
or the equivalent of 25.6% of its total budget. Household spending on health
as a percentage of GDP ranged from 2.5% to 2.8%.
