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Nicaragua, a Country with High Mortality Rate

Introduction

As countries continue improving on the quality of health services, the mortality rate is drastically decreasing. Lack of access and/or poor health services are some of the factors that contribute to high mortality rates across the globe. Despite the improvement in healthcare services, the majority of the developing countries are yet to reduce mortality rates amongst the people. Most developing countries do not have stable health policies. Besides, their medical practitioners are poorly paid, which discourages them from offering quality services. Nicaragua is one of the Central American states with high mortality rates (Pena, Wall, & Persson, 2010). Child mortality rate, infant mortality rate, maternal mortality rate, and neonate mortality rate are still high relative to the same rates in developed countries. This paper aims at looking at the mortality rate in Nicaragua, the condition of health in the country, the country’s health priorities, and the use of traditional medicine. In addition, the paper will focus on health system and health delivery mechanisms used in Nicaragua. It will also look at how nurses may help in the realization of the set health priorities.

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Location/Geography

Nicaragua is the biggest but most sparingly populated state in Central America with Managua as its capital city. The nation is located at the center of the Central America cape. Nicaragua “covers a surface area of approximately 130,682 km2 and topographically, the state is split into three regions, viz. Atlantic, Pacific, and Central” (Lundquist & Massey, 2008, p. 45). To the north, Nicaragua shares a borderline of approximately 922 kilometers with Honduras and to the south; it shares a borderline of about 309 kilometers with Costa Rica. The western part of Nicaragua is highly mountainous and comprises fertile valleys.

Population

In 2011, the country’s population was approximately 5,727, 707 people. Over the past 50 years, the country has experienced steady population growth. Relative to its neighbor states, Nicaragua’s population index is higher. Despite the country experiencing increase in population, the population growth rate is continuously declining. Currently, the country’s population growth rate is at one percent. In the early 1990s, the country’s population growth rate was at 5.8 percent. Nevertheless, the high arrival of immigrants from other states contributed to this increase in the population growth rate. High birth rate is another factor that contributed to the high population growth rate in Nicaragua (Pena, et al., 2012). Today, the country’s birth rate is at two percent. Moreover, many people are moving out of the country compared to those migrating into the country. This disparity is leading to a decline in the population index. According to Pena et al. (2012), “69 per cent of the country’s population comprises of the Mestizo, 5 per cent comprises of the Amerindian, 17 per cent are whites, and 9 per cent comprises of the other races including the blacks” (p.322). Regular changes in migration patterns affect this demographic composition. Over 84 percent of the population in Nicaragua lives in urban areas.

Government

The government of Nicaragua is made up of four branches, which include the judiciary, the legislature, the executive, and the electoral body. The country’s president is the leader of the government and head of state. The government exercises the authority bestowed on the executive wing while the National Assembly exercises the powers of the legislative wing. The electoral body and the judiciary are autonomous. The legislature and the executive do not dictate what the judiciary and/or electoral branches do. The president, in consultation with the National Assembly, appoints magistrates to the Supreme Electoral Council and the Supreme Court.

Economy

Nicaragua has experienced a steady economic growth during President Daniel Ortega’s regime. The country’s economy is currently considered the most vibrant in the Central American region. Apart from growth in foreign direct investment and exports, Nicaragua’s economy is also waging stiff competition in the region. For decades, the country’s economy was considered one of the poorest. In 2011, the country recorded exports worth $4.3 billion. Besides, the country’s foreign direct investment increased to 91 percent from the previous year (Cuadra, & Bjorklund, 2012). Nicaragua recorded $967.8 million in foreign direct investment. One of the factors contributing to the current economic growth in Nicaragua is slow economic growth in most of the neighboring states like El Salvador and Honduras. Currently, Nicaragua is second in the region with respect to the number of dollars streaming into the country annually. Besides economic growth, Nicaragua is also diversifying its economy. The country is entering into trade agreements with varied trade partners. By 2007, the country had over 22 trade partners who invested in different economic sectors like telecom, energy, and free zones. In 2011, the country had over 41 states as its trade partners. The country’s foreign direct investment in the energy sector increased from $158.8 million to $217 million (Cuadra & Bjorklund, 2012). Other sectors that witnessed increase in foreign direct investment include telecom, free zones, commerce, industry, and mining.

The state of Health in Nicaragua

Key Determinants of Health

Nicaragua is a poor state with most of its population living in abject poverty. Hence, most the people are incapable of catering to their healthcare. In Nicaragua, most of the health problems encountered emanate from poor living standards. Poor living conditions in most parts of the country promote the growth and survival of parasites like amoebas and roundworms. Apart from poor living conditions, the level of hygiene in the country is wanting. People do not have access to clean water and thus most people use contaminated water. This contamination promotes the growth of parasites, which endanger the community’s health. In spite of healthcare providers working hard to offer healthcare services to the people of Nicaragua, it is hard to achieve the required health standards. Currently, the country does not require more heath facilities or increased health supplies. What the country requires is proper health education (Altherr, et al., 2008). Nicaraguans suffer from health challenges since they are not educated. Most of the people are uneducated; hence, they do not know how to observe and maintain sanitation and hygiene.

Apart from poor education, the country has poor health policies. Over the years, the government has been cutting down on health spending (Altherr, et al., 2008). Besides, the number of health consultations per patient has been declining. Poor government policies on health have forced most people to quit working as healthcare providers. According to a report by the World Health Organization, only 6.3 percent of the Nicaraguans have insured their health (Altherr, et al., 2008). The rest are incapable of ensuring their health. Hence, most of the people in the country have poor access to healthcare services, as they cannot pay for the services. The country has limited number of health facilities in rural areas. Consequently, majority of the people living in rural areas do not have access to health services.

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Key Health Status Indicators

To come up with proper healthcare policies, every country has data that estimates the life expectancy at birth of its people based on gender. In 2010, the life expectancy at birth of female Nicaraguans was 76.89 years. On the other hand, life expectancy at birth of male Nicaraguans was 70.72 years in same year. A report from the World Health Organization indicates that the infant mortality rate in Nicaragua is still high (Bearinger, et al., 2011). The rate is high especially in poorest areas. People living in these areas do not have money to cater to the health of their children. Besides, poor hygiene in the areas contributes to an increase in outbreaks of respiratory diseases and diarrhea. Most of the infants suffer from malnutrition and congenital malformations in these poor areas. Poverty augments the rate of infant mortality in the regions. However, improvement in healthcare services in Nicaragua is gradually leading to reduction in the infant mortality rate. By the year 2009, the country’s infant mortality rate was at 21.86 per a thousand infants born (Blau, 2009).

Despite improvements in health facilities and services, maternal mortality rate in Nicaragua is still high. Most of the less fortunate groups like the indigenous communities and people living in rural areas report high mortality rates. Furthermore, maternal mortality rate is high among the poorly educated women and adolescents in Nicaragua. Although the fertility rate has gone down in the country, over 55 percent of women do not visit health facilities when giving birth. They give birth at home with the help of midwives who in most cases are incompetent. Consequently, most of these women lose their life whenever they develop complications when giving birth. It is hard to account for the rate of maternal mortality in Nicaragua since most of the death cases go unreported. In 2010, the maternal mortality rate stood at approximately 95 for every 100,000 women that gave birth during the year (Pena, Wall, & Persson, 2010).

Poor feeding habits and hygiene in rural areas have contributed to the high rate of child mortality encountered in Nicaragua. Most of the families living in rural areas are incapable of acquiring a balanced diet. Hence, children suffer from malnutrition. Moreover, diarrhea is common in these areas leading to a high number of deaths in children. In 2010, the death rate for children below five years was 26.90 for every 1000 children while the death rate for neonates was 12.00 for every 1000 neonates (Pena, Wall, & Persson, 2010).

Burden of Disease

One of the many diseases that still haunt Nicaragua is communicable disease. Until today, Malaria is prevalent in most of the municipalities inhabited by indigenous people. These municipalities have poor drainage systems thus encouraging breeding of mosquitoes. Besides, most of the people living in inaccessible areas continue to suffer from tuberculosis. Female population in Nicaragua continues to suffer from HIV/AIDS. In addition to communicable diseases, Nicaraguans continue suffering from non-communicable diseases like cancer, diabetes, and cardiovascular diseases. Moreover, “the young generation continues to die from accidents, disabilities from external causes, drowning, and leukemia; moreover, domestic violence, neurosis, mental illness, and alcoholism are prevalent in urban areas” (Pena, Wall, & Persson, 2010, p.66). An increase in environmental degradation in Nicaragua is posing a major threat to the country’s health.

Traditional Medicine

Besides using modern medicine to cure diseases, Nicaraguans also use traditional medicines to cure different diseases. For instance, Chilga is used to treat muscle sores. On the other hand, Llanten treats allergies, cirrhosis of the liver and menstrual cramps. Lemongrass is used to treat swollen tonsils and colds. Traditional medicines take time to heal. Consequently, most of the people in the country prefer using the modern medicines. Nevertheless, a significant number of people continue using traditional medicines since they cannot access modern medicines (Coe, 2008). Nicaraguans believe that traditional medicines treat the cause of an illness, but modern doctors only treat the illness and not the cause of the illness. Since 2004, the Nicaraguan government has been using traditional doctors to treat people living in Ometepe Island. The traditional doctors work together with modern doctors in helping these people since they do not have access to modern medicines. In March 2011, the National Assembly passed a law that legalized the use of traditional medicines in Nicaragua (Coe, 2008). The law aims at improving the health services offered in the country by allowing traditional doctors to offer their services to the society. The government intends to enhance the quality of healthcare offered to citizens. Hence, integrating traditional medicines into the current healthcare system will go a long way in helping Nicaraguans gain access to quality healthcare services.

Healthcare System and Delivery

The Nicaraguan government offers health services to its people through the Ministry of Health. The current health system looks into the actual and perceived health needs of the citizens and comes up with measures to address them. Nicaragua’s health system promotes disease deterrence and health through a compassionate and incorporated approach. The government is currently working on modernizing its health facilities and enhancing efficiency as one of the ways of enhancing the quality of health services it offers. Numerous agencies are used in health service delivery in Nicaragua.

Currently, the Ministry of Health in collaboration with local authorities runs a project dubbed Barrio Limpio, which aims at ensuring that the community attains the required hygiene standards. The project comprises itinerant clinics that visit the marginalized communities and teach them how to keep their environment clean. In addition, the Ministry of Health organizes annual vaccination programs where elderly people, children, and pregnant women receive vaccinations containing vitamins. Moreover, the government comes up with health brigades to help the community in events of disease outbreaks (Jewell, 2009). For instance, during the dengue outbreak in 2008, the brigades comprising of teachers and health workers helped the community in treating contaminated water and draining stagnant water to avoid dengue infections.

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Health Priorities

Based on the healthcare system used by the Nicaraguan government, it is evident that the country gives first priority to treating and controlling the spread of communicable diseases. Most of the people in Nicaragua live in poorly drained suburbs. Besides, the level of hygiene in these suburbs is substandard. Hence, the government gives first priority to enlightening the public on how to improve hygiene levels. Communicable diseases are the major cause of infant and maternal mortality in the country (Thornton, et al., 2010). In collaboration with local authorities, the government educates the community on how to live in a healthy environment by showing them how to treat contaminated water.

Apart from enlightening the community on how to cope with communicable diseases, the government is also working on upgrading the standards of its health facilities. For decades, most the health facilities have not been having enough service providers. Besides, the facilities have not been having adequate supplies like medicines making it hard for them to cater to the needs of the target community. Currently, the government, through the Ministry of Health, is encouraging the establishment of private health institutions and improving the existing public health institutions as a way of enhancing the quality of health services in Nicaragua.

Nursing Implications

Nurses play a vital role in Nicaragua. Since the country has limited number of doctors, nurses are responsible for ensuring that citizens receive quality healthcare services. One of the challenges that Nicaraguan nurses face is poor remuneration. For a long time, the government embarked on reducing the amount of money spent in paying healthcare providers. Today, nurses in the country receive meager salaries discouraging many from pursuing the nursing career. To meet the above-described health priorities, the Nicaraguan government requires assistance from nurses. Nurses would help the government in teaching the public how to maintain hygiene. Nurses are capable of training youths on how to attain and maintain hygiene, who in return can educate the public. Besides, through the help of the nurses, the government can run its public campaigns aimed at treating and controlling communicable diseases. Nurses can work in collaboration with local authorities in administering vaccinations aimed at reducing child and maternal mortality in the country.

The Nicaraguan government is working on improving its health facilities. It cannot achieve this goal without the assistance of medical practitioners. It will require medical practitioners in every facility to offer healthcare services to the public. To achieve this priority, nurses can assist by working as medical practitioners in established health facilities. Besides, since the nurses have experience in the field of health, they can help the government agencies to identify the required health supplies and thus ensure that the government does not stock its health facilities with unnecessary supplies.

Conclusion

Nicaragua is one of the countries in Central America. Currently, the country’s population is estimated to stand at 5,727, 707 people. The country’s head is a president and it has four arms of government. Currently, Nicaragua’s economy is growing at a high rate relative to other Central American countries. Despite the current economic growth, the country still experiences immense health challenges. Most of the Nicaraguans are poor and cannot cater for their medical services. Besides, most of them are uneducated and have little knowledge on how to observe hygiene. The government does not have proper health policies, which leads to poor quality of healthcare services in the country. Currently, child, infant, maternal, and neonatal mortality rates are still high. The country is still far from coping with communicable and non-communicable diseases. As a way of improving healthcare delivery, the government is encouraging the use of traditional medicines together with modern medicines. Besides, controlling communicable diseases and improving healthcare facilities are some of the activities the government has given priority. Through the Ministry of Health, the government works with local authorities to enlighten the public on how to observe cleanliness. Nurses would help the government achieve its health priorities by offering their services and training the public on how to observe hygiene.

References

Altherr, A., Mosler, H., Tobias, R., & Butera, F. (2008). Attitudinal and relational factors predicting the use of solar disinfection: a field study in Nicaragua. Health, Education and Behavior, 35 (2), 207-220.

Bearinger, L. H., Sieving, R. E., Ferguson, J., & Sharma, V. (2011). Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. The Lacent, 369 (9568), 1220-1231.

Blau, D. M. (2009). Fertility, child nutrition, and child mortality in Nicaragua: an economic analysis of interrelationships. The Journal of Developing Areas, 20 (1), 185-202.

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Coe, F. G. (2008). Ethnomedicine of the Rama of Southeastern Nicaragua. Journal of Ethnobiology, 28 (1), 1-38.

Cuadra, M., & Bjorklund, J. (2012). Assessment of economic and ecological carrying capacity of agricultural crops in Nicaragua. Ecological Indicators, 7 (1), 133-149.

Jewell, G. (2009). Contextual empowerment: the impact of health brigade involvement on the women of Miraflor, Nicaragua. Journal of Transcultural Nursing, 18 (1), 49-56.

Lundquist, J. H., & Massey, D. S. (2008). Politics or economics? International migration during the Nicaraguan contra war. Journal of Latin American Studies, 37 (1), 29-53.

Pena, R., Perez, W., Melendez, M., Kallestal, C., Persson, L. (2012). The Nicaraguan health and demographic surveillance site, HDSS-Leon: a platform for public heath research. Scandinavian Journal of Public Health, 36 (3), 318-325.

Pena, R., Wall, S., & Persson, L. A. (2010). The effect of poverty, social inequality, and maternal education on infant mortality in Nicaragua. American Journal of Public Health, 90 (2), 64-69.

Thornton, R. L., Hatt, L. E., Field, E. M., Islam, M., Diaz, F. S., & Gonzalez, M. A. (2010). Social security health insurance for the informal sector in Nicaragua: a randomized evaluation. Health Economics, 19 (1), 181-206.

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