Nicaragua

Nicaragua is located in Central America, stretching 490 kilometers (300 miles) from the Caribbean to the Pacific Ocean. A chain of active volcanoes line the western borders, and rivers form most of the northern and southern borders. It is bounded by Costa Rica and Honduras. Since winning independence from the Spanish in 1821, Nicaragua has struggled to find its political and economic footing. It is the second poorest country in the Americas and has the most unequal distribution of wealth in the hemisphere. Almost 50 percent of the population lives below the poverty line.

The population is estimated at 5,675,000 and growing at a rate of 1.86 percent annually. The birth rate is 24.12 per 1,000 population, the death rate is 4.42 per 1,000 population, and the migration rate is in deficit at minus 1.15 per 1,000 population. The median age is 21.3 years. Life expectancy at birth is 68.82 years for males and 73.13 years for females. About 58 percent of the population lives in urban areas. Gross national income is estimated at $910 a year, with 45 percent of the population subsisting on $1 a day or less.

Poor sanitation and ample amounts of standing water create a hospitable climate for vector-borne and water-borne diseases. Malaria is common throughout the country, with little money or resources available to combat it. Dengue fever has been endemic since 1985. Cholera control programs have helped reduced the rate of infections dramatically since the 1990s. Acute respiratory infections impact 1 million people annually, leading to about 1,200 deaths.

The prevalence rate for HIV/AIDS is 0.2 percent, with more than half of the estimated 7,300 cases diagnosed within the last three years. While this seems like [Page 1240]a low-level epidemic, there are fears that it could become much more widespread. While the government has developed a strategic plan, there is little money to fund a comprehensive program of education and prevention, and it in a country where 88 percent of the population is either Roman Catholic or Evangelical, there are strong taboos regarding sex education and condom distribution.

Women and children are vulnerable populations with Nicaragua. UNICEF estimates that 1 in 3 children are chronically malnourished. Sexual activity begins early among Nicaraguan youths, with 25 percent of all pregnancies occurring in adolescents. For-ty-three percent of marry before the age of 17. About 69 percent of women use birth control, and 86 percent receive some form of prenatal care. Only 67 percent of births are assisted by a trained attendant. The maternal mortality rate is 150 deaths per 100,000 live births. Domestic violence is common, and women are the sole head of 1 in 4 Nicaraguan households.

An estimated 8.2 percent of the gross domestic product is devoted to health care. The government spends about $32 per capita on health services. There are around 2,000 doctors and 5,900 nurses at work in the country. Distribution of care is somewhat uneven outside the urban areas; 33 percent of the rural population is more than two hours walk from the nearest hospital. There is, however, a good system of health clinics to serve isolated communities. A private care system is emerging within the country, but most rely on public services.

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