Health in Nicaragua

Life expectancy in Nicaragua at birth was 72 years for men and 78 for women in 2016.[1] While communicable diseases such as dengue, chikungunya, and Zika continue to persist as national health concerns, there is a rising public health threat of non-communicable diseases such as diabetes, cardiovascular disease, and cancer, which were diseases previously thought to be more relevant and problematic for more developed nations.[2] Additionally, in the women's health sector, high rates of adolescent pregnancy and cervical cancer continue to persist as national concerns.[3]

Chronic diseases

There has been an observed increasing prevalence of chronic diseases such as type 2 diabetes, obesity, and hypertension. This increase in prevalence of chronic diseases has been attributed to lifestyle changes and increased urbanization.[4] Improved access to processed foods has led to higher consumption of highly processed snacks and sugar-containing drinks in rural areas of Nicaragua, and raw sugar cane is often freely available. Complementary feeding practices involving breastfeeding paired up with supplementation of artificial snacks were frequently observed amongst 6-to 8-month-olds. These early introduction to highly processed foods leads to increased risk of infections and impaired developmental growth.[5] In 2008, WHO reported that 55.5% of the population was overweight and 22.2% classified as obese,[6] and trends reveal that obesity rates are steadily rising.[7]

Hypertension and pre-hypertension are significant national medical concerns. Studies conducted in rural communities of Nicaragua that have revealed that 41.1% of their residents have hypertension. Beyond these patients who have met this traditional hypertensive minimum cut-off, there is also a large population of pre-hypertensive patients. Health promotional efforts that focus on preventative measures have been proposed to address this pre-hypertensive sub-population.[8]

Communicable diseases

Tuberculosis

In Nicaragua, 48% of tuberculosis (TB) patients have encountered issues with employment and 27% had reported social problems because of stigma associated with the disease.[9] In order to reduce false community beliefs and fears about tuberculosis that could be feeding into this social stigma, various solutions have been proposed and attempted in communities throughout the country.

In order to increase local awareness of this disease and improve TB control, volunteer-run TB clubs have been created in municipalities across Nicaragua to facilitate the creation of supportive community networks and lead educational workshops for citizens. These TB clubs have been reported to be a cost-effective strategy for controlling the spread of TB in Nicaragua; however, some have argued that they lack sustainability in funding.[10] Outside of the educational realm, a team of researchers found that they could reduce internalized social stigma of TB patients in rural Nicaragua by pursuing patient-centered care that allowed for medical professionals to see patients at their homes and gain a better understanding of the support given to them by their social networks.[11]

HIV/AIDS
Main article: HIV/AIDS in Nicaragua

Though the prevalence of HIV/AIDS amongst Nicaraguan adults was estimated to be 0.3% by UNAIDS in 2015,[12] in the past UNAIDS' numbers have been claimed to be grossly underreported due to data collection issues.[13] Nicaragua's high prevalence of sexually transmitted infections (STIs), high risk sexual behaviors associated with the culture of machismo, low prevalence of condom usage, and the early age of first sexual intercourse of its citizens all contribute to concerns about rising HIV/AIDS rates.[13]

In Latin America, stigma and discrimination against HIV/AIDS serve as barriers to effective responses and are linked to social inequalities associated with gender, living status, and sexuality.[14] One study found that while 90% of Nicaraguan adolescents would accept and care for a family member with HIV/AIDS, only 69% would tell anyone else if they got diagnosed as HIV-infected and only 46% would share food with someone who was infected.[13] Nine years following the detection of the first HIV case in Nicaragua, the Nicaraguan government instituted Law 238 to protect the rights of those infected with HIV/AIDS in regards to confidentiality, access to healthcare, and nondiscrimination,[15] setting the precedent for future intervention strategies focused on decreasing AIDs stigma amongst various professionals, including health care workers.

Mosquito-transmitted diseases

The chikungunya, dengue, and Zika viruses co-circulate in Nicaragua, and those infected with one or multiple of these viruses can present with similar clinical symptoms, making clinical treatment and diagnosis more difficult.[16] Co-infections are common in endemic areas in Nicaragua.[16]

Malaria has also been a historically major health issue in Nicaragua, and during the 1930s up to 60% of the population had malaria.[17] Usage of bed-nets protecting against mosquitos have been reported to be 25.3% amongst all Nicaraguan households. Within these households, it was found that children were more often protected than adults with 46% of bed-net coverage of infants under 1 year.[18]

Infant health

A study conducted in 2000 revealed that poverty of Nicaraguan families heightened the risk of infant mortality. Its findings also showed that social inequity, or the contrast in wealth between a household and its surrounding neighborhood, further increased this risk.[19] In addition to income levels, it has been shown that violence against mothers increases the risk of infant and child mortality.[20] Intimate partner abuse also contributes to low birth weight of infants.[21] Overall decreasing national infant mortality trends correspond with higher educational levels of mothers and lower fertility rates.[22]

Violence against women

Out of Nicaraguan women married or previously married women of childbearing age, 52% have identified having had experienced physical violence by an intimate partner at least once.[23] Additionally, 21% of these women report having experienced a full combination of physical, emotional, and sexual violence at one or more points in their lives.[24]

Domestic violence has immediate and lasting effects on its victims. An overwhelming majority of emotional distress cases amongst every-married Nicaraguan women is attributable to current or former experiences of domestic abuse.[23] Domestic abuse is also correlated with higher incidence of unintended pregnancies in Nicaragua.[25]

See also Healthcare in Nicaragua

References
  1. "Nicaragua". WHO. 2018. Retrieved 22 November 2018.
  2. Webber, Laura; Kilpi, Fanny; Marsh, Tim; Rtveladze, Ketevan; Brown, Martin; McPherson, Klim (2012-08-13). "High Rates of Obesity and Non-Communicable Diseases Predicted across Latin America". PLOS ONE. 7 (8): e39589. Bibcode:2012PLoSO...739589W. doi:10.1371/journal.pone.0039589. ISSN 1932-6203. PMC 3418261. PMID 22912663.
  3. Drain, Paul K.; Holmes, King K.; Hughes, James P.; Koutsky, Laura A. (2002-07-10). "Determinants of cervical cancer rates in developing countries". International Journal of Cancer. 100 (2): 199–205. doi:10.1002/ijc.10453. ISSN 1097-0215. PMID 12115570.
  4. Aschner, Pablo (September 2002). "Diabetes trends in Latin America". Diabetes/Metabolism Research and Reviews. 18 (S3): S27–S31. doi:10.1002/dmrr.280. PMID 12324982.
  5. Contreras, Mariela; Zelaya Blandón, Elmer; Persson, Lars-Åke; Ekström, Eva-Charlotte (2016-01-01). "Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua". Maternal & Child Nutrition. 12 (1): 164–176. doi:10.1111/mcn.12144. ISSN 1740-8709. PMC 6860125. PMID 25134722.
  6. World Health Organization. (2011). Noncommunicable diseases country profiles 2011: Nicaragua. WHO, 139.
  7. Laux, Timothy S.; Bert, Philip J.; González, Marvin; Unruh, Mark; Aragon, Aurora; Lacourt, Cecilia Torres (2016-12-12). "Prevalence of obesity, tobacco use, and alcohol consumption by socioeconomic status among six communities in Nicaragua". Revista Panamericana de Salud Pública. 32 (3): 217–225. doi:10.1590/s1020-49892012000900007. ISSN 1020-4989. PMC 4387569. PMID 23183562.
  8. Alicea-Planas, Jessica; Greiner, Lydia; Greiner, Philip A. (February 2016). "Hypertension and related lifestyle factors among persons living in rural Nicaragua". Applied Nursing Research. 29: 43–46. doi:10.1016/j.apnr.2015.05.010. PMID 26856487.
  9. Macq, Jean; Solis, Alejandro; Martinez, Guillermo; Martiny, Patrick; Dujardin, Bruno (2005). "An exploration of the social stigma of tuberculosis in five "municipios" of Nicaragua to reflect on local interventions". Health Policy. 74 (2): 205–217. doi:10.1016/j.healthpol.2005.01.003. PMID 16153480.
  10. Plamondon, Katrina M.; Hanson, Lori; Labonté, Ronald; Abonyi, Sylvia (2008-01-01). "The Global Fund and Tuberculosis in Nicaragua: Building Sustainable Capacity?". Canadian Journal of Public Health. 99 (4): 355–358. doi:10.1007/BF03403771. JSTOR 41995119. PMC 6975681.
  11. Macq, Jean; Solis, Alejandro; Martinez, Guillermo; Martiny, Patrick (2008-05-08). "Tackling tuberculosis patients' internalized social stigma through patient centred care: An intervention study in rural Nicaragua". BMC Public Health. 8 (1): 154. doi:10.1186/1471-2458-8-154. ISSN 1471-2458. PMC 2396624. PMID 18466604.
  12. UNAIDS (2015). Nicaragua Report. Available from: http://www.unaids.org/sites/default/files/country/documents/Nicaragua%20NCPI%202013.pdf
  13. Manji, A.; Peña, R.; Dubrow, R. (2007-09-01). "Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in León, Nicaragua: Implications for HIV prevention". AIDS Care. 19 (8): 989–995. doi:10.1080/09540120701244935. ISSN 0954-0121. PMID 17851995.
  14. Ugarte, W. (2013). "Measuring HIV- and AIDS-related stigma and discrimination in Nicaragua: Results from a Community-Based Study". AIDS Education and Prevention. 25 (2): 164–178. doi:10.1521/aeap.2013.25.2.164. PMID 23514083.
  15. National Assembly of Nicaragua. (1999). Ley 238: Promoción, Protección y Defensa de los Derechos Humanos ante el SIDA [Law 238: For the promotion, protection, and defense of human rights of people living with HIV/ AIDS].
  16. Waggoner, Jesse J.; Gresh, Lionel; Vargas, Maria Jose; Ballesteros, Gabriela; Tellez, Yolanda; Soda, K. James; Sahoo, Malaya K.; Nuñez, Andrea; Balmaseda, Angel (2016-12-15). "Viremia and Clinical Presentation in Nicaraguan Patients Infected With Zika Virus, Chikungunya Virus, and Dengue Virus". Clinical Infectious Diseases. 63 (12): 1584–1590. doi:10.1093/cid/ciw589. ISSN 1058-4838. PMC 5146717. PMID 27578819.
  17. Garfield, R. (1999-07-31). "Malaria control in Nicaragua: social and political influences on disease transmission and control activities". Lancet. 354 (9176): 414–418. doi:10.1016/S0140-6736(99)02226-6. ISSN 0140-6736. PMID 10437886.
  18. Kroeger, A.; et al. (1997). "Operational aspects of bednet impregnation for community-based malaria control in NIcaragua, Ecuador, Peru, and Colombia". Tropical Medicine and International Health. 2 (6): 589–602. doi:10.1046/j.1365-3156.1997.d01-319.x. PMID 9236827.
  19. Peña, R.; Wall, S.; Persson, L. A. (2016-12-12). "The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988–1993". American Journal of Public Health. 90 (1): 64–69. doi:10.2105/ajph.90.1.64. ISSN 0090-0036. PMC 1446115. PMID 10630139.
  20. Asling-Monemi, K.; Peña, R.; Ellsberg, M. C.; Persson, L. A. (2003). "Violence against women increases the risk of infant and child mortality: a case–referent study in Nicaragua". Bulletin of the World Health Organization. 81 (1): 10–16. PMC 2572309. PMID 12640470.
  21. Valladares, Eliette; Ellsberg, Mary; Peña, Rodolfo; Högberg, Ulf; Persson, Lars Ake (2002-10-01). "Physical partner abuse during pregnancy: a risk factor for low birth weight in Nicaragua". Obstetrics and Gynecology. 100 (4): 700–705. doi:10.1097/00006250-200210000-00015. ISSN 0029-7844. PMID 12383537.
  22. Peña, R.; Liljiestrand, J.; Zelaya, E. (1999). "Fertility and infant mortality trends in Nicaragua 1964–1993. The role of women's education". Journal of Epidemiological Community Health. 53 (3): 132–137. doi:10.1136/jech.53.3.132. PMC 1756845. PMID 10396488.
  23. Ellsberg, Mary; Caldera, Trinidad; Herrera, Andrés; Winkvist, Anna; Kullgren, Gunnar (1999). "Domestic violence and emotional distress among Nicaraguan women: Results from a population-based study". American Psychologist. 54 (1): 30–36. doi:10.1037/0003-066x.54.1.30.
  24. Ellsberg, M.; Peña, R.; Herrera, A.; Liljestrand, J.; Winkvist, A. (2000-12-01). "Candies in hell: women's experiences of violence in Nicaragua". Social Science & Medicine. 51 (11): 1595–1610. CiteSeerX 10.1.1.473.5453. doi:10.1016/s0277-9536(00)00056-3. ISSN 0277-9536. PMID 11072881.
  25. Salazar, Mariano; San Sebastian, Miguel (2014-01-01). "Violence against women and unintended pregnancies in Nicaragua: a population-based multilevel study". BMC Women's Health. 14: 26. doi:10.1186/1472-6874-14-26. ISSN 1472-6874. PMC 3925120. PMID 24521005.
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