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Objectives. To assess the oft-perceived protective relationship between women's asset ownership and experience of intimate partner violence (IPV) in the previous 12 months. Methods. We used international survey data from women aged 15 to 49 years from 28 Demographic and Health Surveys (2010-2014) to examine the association between owning assets and experience of recent IPV, matching on household wealth by using multivariate probit models. Matching methods helped to account for the higher probability that women in wealthier households also have a higher likelihood of owning assets. Results. Asset ownership of any type was negatively associated with IPV in 3 countries, positively associated in 5 countries, and had no significant relationship in 20 countries (P < .10). Disaggregation by asset type, sole or joint ownership, women's age, and community level of women's asset ownership similarly showed no conclusive patterns. Conclusions. Results suggest that the relationship between women's asset ownership and IPV is highly context specific. Additional methodologies and data are needed to identify causality, and to understand how asset ownership differs from other types of women's economic empowerment. [ABSTRACT FROM AUTHOR]

Gender inequity negatively affects health in Central America. In 2011, we conducted 60 semistructured interviews and 12 photovoice focus groups with young coupled men and women in León, Nicaragua, to explore the ways in which social norms around marriage and gender affect sexual health and gender-based violence. Participants' depictions of their experiences revealed gendered norms around infidelity that provided a narrative to justify male expressions of jealousy, which included limiting partner autonomy, sexual coercion, and physical violence against women, and resulted in increased women's risk of sexually transmitted infections, including HIV. By understanding and taking account of these different narratives and normalized beliefs in developing health- and gender-based violence interventions, such programs might be more effective in promoting gender-equitable attitudes and behaviors among young men and women in Nicaragua. [ABSTRACT FROM AUTHOR]

Objectives. This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education. Methods. A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10 867 women aged 15 to 49 years in Leon, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups. Results. IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households. Conclusions. Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality. (Am J Public Health. 2000;90: 64-69) [ABSTRACT FROM AUTHOR]

Objectives. This study measured the prevalence, frequency, and severity of physical wife abuse and its risk factors in León, Niearagua. Methods. A cross-sectional survey was conducted with a representative sample of 488 women 15 to 49 years of age. Results. The lifetime prevalence of spousal violence was 52% among ever-married women (n = 360). Spousal violence was significantly positively associated with poverty of violence in the husband's family. No significant associations were found between spousal violence and women's age, education, marital dependency, or occupation. Conclusions. Wife abuse constitutes a major public health problem in Nicaragua, requiring urgent measures for prevention and treatment for victims. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings. Methods. Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals. Results. During June and July 1987, an epidemic of 548 pesticide poisoning was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of age. Conclusions. Unsafe working conditions such as manual application of pesticides and the use of backpack sprayers, the introduction of a hazardous powdered formulation of carbofuran highly restricted in the developed world, and agricultural subsidies that encouraged the use of hazardous pesticides all contributed to the epidemic. [ABSTRACT FROM AUTHOR]

A comprehensive review of available sources of mortality data was undertaken to document the changes that have occurred in infant mortality in Nicaragua over the last three decades. It was found that a rapid fall in infant mortality commenced in the early 1970's and has continued steadily since. Trends in several different factors which might have led to this breakthrough were examined including: income, nutrition, breastfeeding practices, maternal education, immunizations, access to health services, provision of water supplies and sanitation, and anti-malarial programs. Of these, improved access to health services appears to have been the most important factor. At a time when the number of hospital beds per capita was dropping, increasing numbers of health care professionals, particularly nurses, were becoming available to staff primary health care facilities built in the 1960's. These were provided at least partly in response to the growing political turmoil enveloping the nation at that time. Certain Nicaraguan cultural attributes may have added to the impact of the reforms. Efforts in the field of public health made since the 1979 insurrection appear to have maintained the decline in child mortality. INSET: Sources of infant mortality statistics in Nicaragua.. [ABSTRACT FROM AUTHOR]

Improved health care in Nicaragua is a major priority of the Sandinista revolution; it has been pursued by major reforms of the national health care system, something few developing countries have attempted. In addition to its internationally recognized advances in public health, considerable progress has been made in health care delivery by expanding curative medical services through training more personnel and building more facilities to fulfill a commitment to free universal health coverage. The very uneven quality of medical care is the leading problem facing curative medicine now. Underlying factors include the difficulty of adequately training the greatly increased number of new physicians. Misdiagnosis and mismanagement continue to be major problems. The curative medical system is not well coordinated with the preventive sector. Recent innovations include initiation of a "medicina integral" residency, similar to family practice. Despite its inadequacies and the handicaps of war and poverty, the Nicaraguan curative medical system has made important progress. (Am J Public Health 1989; 79: 646-651.) INSET: New Journal Launched: AIDS Education and Prevention. [ABSTRACT FROM AUTHOR]

Abstract: 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 m 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. [ABSTRACT FROM AUTHOR]

Abstract: Millions of children in developing countries are dying from disease that could he prevented or treated by simple interventions. To examine ways to improve the delivery of these basic services, we evaluated well child clinics and mass vaccination campaigns under operational condition in a rural area of Nicaragua. We found that mass vaccination campaigns using volunteers reached 77.1 per ¢ of the population under age six. At stationary well child clinics in which villages were invited to a health center and a small food ration was used as an incentive, attendance improved to 94.1 per ¢. Similar attendance levels 99.2 per ¢ were attained by mobile well child clinics also using a food incentive. Attendance at stationary clinics decreased with the distance of the village from the health center. However, stationary clinics look up only hair is much health workers time as mobile clinics. Our results suggest that stationary clinics employing food as an incentive could be used for villages or neighborhoods close to a health center while mobile clinics offering food should be reserved for more isolated villages. Am J Public Health (1987: 77:1407-1411.) [ABSTRACT FROM AUTHOR]

Since 1983, war in Nicaragua has slowed improvements in health which had developed rapidly from 1979-82. The rate of war-related deaths among Nicaraguans now exceeds that of the United States citizens in either the Vietnam War or World War II, Forty-two of the 84 documented war-related casualties among Nicaraguan health workers have been deaths. This high case fatality rate reflects the targeting of health workers by contra troops. The number of staff and services of the public medical system decreased by approximately 10 per cent from 1983 to 1985. Population movements, the establishment of new settlements, and war-related destruction of the primary health infrastructure arc associated with recent epidemics of malaria, dengue, measles, and leishmaniasis. The estimated rate of infant mortality in Nicaragua, which had declined from 120 per 1,000 in 1978 to 76/1,000 live births in 1983, has since shown no further decline. Internationally mandated protections enjoyed by civilians and health workers during times of war do not appear to operate in this so-called "low intensity" conflict. Further declines in infant mortality, prevention of epidemics, and improvement in other health indicators will likely await the cessation of military hostilities. (Am J Public Health 1987: 77:615-618.) [ABSTRACT FROM AUTHOR]

Abstract: Before the Nicaraguan revolution of 1979, access to health services was largely limited to the affluent sectors of the urban population and the minority of workers with social security coverage. Repeated attempts at reform by organized medicine were ineffective. Since the revolution, a tremendous expansion in health services has occurred. The national health system receives approximately one third of its funds from the social security system Steadily increasing equity in access is a result of the promotion of primary care, health campaigns involving up to 10 per ¢ of the general population as volunteers, to use of paramedical aides, and foreign assistance. Private practice nevertheless remains strong. In the coming years, several complex issues must be examined, including; a balance in the number of nurses and doctors trained, the role of private practice, and the relationship of the Ministry of Health to the social security system, Further progress in health reforms may be delayed by the defensive war which Nicaragua is fighting on its northern and southern borders. Despite emergent health problems in the war zones, most of the innovative aspects of the health system remain intact as of this writing. [ABSTRACT FROM AUTHOR]

Abstract: In 1976 the Ministry of Health of Nicaragua began a low cost program to deliver simple health services in rural areas through trained traditional birth attendants or "parteras." After two years the program had prepared 768 parteras in a five-day training course. Parlera were equipped with a kit that included oral rehydration salts an antihelminthic multivitamins with iron, aspirin, contraceptives, and obstetrical equipment. The difficulties encountered in implementing this limited set of simple health services illustrate a number of potential obstacles to the achievement of universal, comprehensive primary health care in less developed countries. The most prominent difficulties involved elements of the health service delivery system itself, supervision, the collection and use of management information training partera selection and logistics. The experience also provided examples of issues in the design of delivery system that require specific applied research. [ABSTRACT FROM AUTHOR]

The Cooperative for Assistance and Relief Everywhere (CARE) and Centers for Disease Control and Prevention (CDC) Health Initiative in Nicaragua is distinctive in its focus on developing a cadre of in-country trainers whose aim is to equip frontline public health managers with widely applicable tools and techniques to assist them in identifying and solving implementation problems. Since 1999, 137 trainees--37% more than originally planned--have demonstrated competence by completing and presenting applied management projects. Nineteen professors from the preventive medicine faculty at the Autonomous University of Nicaragua also have been trained. The country office now has a cadre of seasoned trainers who can meet the ongoing management training needs of CARE staff and their counterparts in the Ministry of Health and in other nongovernmental organizations. [ABSTRACT FROM AUTHOR]

We analyzed the treatment schedule of a long-running HIV/AIDS prevention program in Managua, Nicaragua, that targets sex workers through mass and specific clinic based treatment of sexually transmitted infections and confirmed the role of frequency of treatment in generating a sustained reduction in measured prevalence of sexually transmitted infections. Unplanned variations in the time between treatments, a situation common to public health programs, provided the basis for attributing changes in measured levels of sexually transmitted infections to the program and for testing the statistical significance of the relationship. This information is critical to program design and funding and to resource allocation. (Am J Public Health. 2u06;96:1760-1761. doi:10. 2105/AJPH.2005.062596] [ABSTRACT FROM AUTHOR]

The author reflects on the success of the health system reform of the Sandinista regime in Nicaragua. He claims that the biggest factor of the said success lies in the government's commitment to primary care and equity of access to health services. Moreover, he proposes that the said success can become the basis of developing countries that want to reform their health services.

The article reports on the move of the American Public Health Association (APHA) in recognizing the deleterious effects of militarism on health care in Nicaragua. The association has gone on record criticizing specific federal budgetary issues involving health care and militarism. APHA stressed that the volume and scope of aid to the Contras represent an immense escalation of U.S. military intervention in Nicaragua. In addition, the association identifies the U.S. military aid to the Contras in Nicaragua represents a derogation of and impediment to the Contadora process which promises hope of peace in Central America.

Objectives: In response to requests by parents in Managua, Nicaragua, whose neighborhood borders a battery factory, 97 children were tested for blood lead, as were 30 children in a neighborhood without an obvious source of environmental lead., Methods: Venous blood was examined by atomic absorption spectrophotometry. Educational workshops were conducted., Results: Mean blood lead levels were 17.21 +/- 9.92 micrograms/dL in the index children and 7.40 +/- 5.37 micrograms/dL in the controls (P < .001)., Conclusions: Children living near the battery factory are at increased risk of lead poisoning. The parents were able to petition the government to control the factory emissions and to improve appropriate health services. The factory is now closed.

A cross-sectional medical survey was conducted among 63 Nicaraguan aviation mechanics exposed to organophosphate and other toxic pesticides. Thirty-one (49 percent) reported having been acutely poisoned on the job. Also, seven of 14 novice mechanics, with less than one year on the job, reported that they had been poisoned. Thirty-eight (61 percent) had cholinesterase levels below the lower limit of normal, including three workers with levels less than 20 percent of the lower limit of normal. Risk factors for low cholinesterase included recent hire and recent poisoning. Workers did not use protective equipment, nor were there facilities for bathing on site. As a result of this survey, the government has prohibited the mixing and loading of pesticides at this airport and requires the washing of planes prior to maintenance work; coveralls and thin, pesticide impermeable gloves are to be issued to mechanics handling pesticide-contaminated parts. Closed system mixing and loading systems have been installed at satellite airstrips.

Under the rubrics of preventive and social medicine, public health, and family and community medicine, medical educators in Latin America have developed programs to train physicians for community-oriented health care (COPC). The historical background for such programs in Latin America is reviewed. Three relevant examples of programs in Mexico, Nicaragua, and Costa Rica are highlighted, drawing on the author's direct experience with and in these faculties. The paper addresses the relation between these programs and national and regional trends in education and services.