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Nicaragua is the largest country in the Central American isthmus. Its population in 2010 was 5,788,163. In terms of Human Development Index, Nicaragua is ranked number 129. It has an adult literacy rate of 78 percent and a Gini index of 52.3. Despite a decline in the poverty rate, the absolute figures have been rising, with poverty concentrated in rural and peri-urban areas. Nicaragua has one of the poorest macroeconomic indicators, import/export, and income/expenditure figures in the subregion. High levels of unemployment and migration (both internal and external, mainly to Costa Rica and the United States of America (USA)), have repercussions for family development, health, and access to services. The greatest contribution to the Gross Domestic Product (GDP) comes from agriculture; industrial development is still in its infancy.
Remittances from Costa Rica and the USA are a major source of income; in some areas, narcotrafficking is responsible for illegal inflows of foreign exchange. The Pan American Health Organization (PAHO)/WHO Strategic Plan 2003-2007 designates Nicaragua a priority country, which implies intensified technical cooperation to bridge the health gaps, both internally and with other countries in the Region of the Americas.
There are inequities in access to health services due to geography, socioeconomic status, gender, and ethnicity. Only 6.3% of the population is insured. Out-of-pocket expenditures constitute a serious barrier for the poor and ethnic minorities. Maternal mortality remains high in disadvantaged groups (rural areas, indigenous populations, the poor, adolescents, and women with low levels of schooling), even though the total fertility rate has fallen. Some 55% of women in rural areas give birth at home; 65% are illiterate. Maternal mortality remains high in these
populations, and adolescents account for approximately one-third of maternal deaths.
About 22% of children in the most disadvantaged quartile of the urban area suffer from malnutrition versus 0.4% in the richest quartile; 9% of births produce infants with low birth weight.
Communicable diseases continue to increase. Malaria (Plasmodium falciparum) is concentrated in municipalities with indigenous populations. Tuberculosis is prevalent in the poorest, most inaccessible areas. The incidence of HIV/AIDS is rising, especially among the female population; the ratio of males to females with HIV/AIDS has gone from 5:1 in 1999 to 3:1
Communities in Nicaragua
San Carlos (Río San Juan)