Abstract
BackgroundThe isolated northern region of Nicaragua has one of the highest rates of diarrheal disease in Central America. Political and environmental hardships faced by inhabitants of this region are contributing factors to this health inequity. The aim of this study was to assess the relationship between water and latrine infrastructure and the prevalence of diarrhea in this region.MethodsA population-based, cross-sectional survey of women of reproductive age was conducted in the Sahsa region of northern Nicaragua in July, 2009. Households were selected by two stage cluster sampling methodology. A questionnaire was administered in Spanish and Miskito with assessment of household and socioeconomic conditions, sanitation practices, and health care access. Diarrhea prevalence differences at the household level over a two week reporting period were estimated with a standardized instrument which included assessment of water treatment and latrine use and maintenance.ResultsThere were 189 women enrolled in the current study. The use of water purification methods, such as chlorine and filters, and latrine ownership were not associated with reduced prevalence of household diarrhea in the two week reporting period. Latrine overflow, however, was associated with an increased prevalence of diarrhea during the same two week period [adjusted prevalence difference and 95% CI: 0.19 (0.03, 0.36)].ConclusionsSimple, low cost interventions that improve water and latrine infrastructure may reduce the prevalence of diarrheal disease in the isolated regions of Nicaragua and Central America.
Highlights
The isolated northern region of Nicaragua has one of the highest rates of diarrheal disease in Central America
The analysis shows that latrine overflow was associated with a higher prevalence of diarrhea (PD = 0.19 95% confidence intervals (CI) = 0.02, 0.36)
The Prevalence differences (PD) comparing owning a latrine that did not overflow to not owning a latrine was -0.17 (-0.35, 0.01), while the PD comparing owning a latrine that did overflow to not owning a latrine was 0.02 (-0.18, 0.22) (Table 4). This population-based, cross-sectional study in the isolated Sahsa municipality of Nicaragua found a high prevalence of household diarrhea (41%), which is consistent with data from the Nicaragua Ministry of Health (MINSA)2
Summary
The isolated northern region of Nicaragua has one of the highest rates of diarrheal disease in Central America. Political and environmental hardships faced by inhabitants of this region are contributing factors to this health inequity. Diarrheal illness is common in Nicaragua, in the North Atlantic Autonomous Region (Región Autónoma del Atlántico Norte, RAAN) province, where household sanitation measures are not in. The RAAN is an extensive remote region in northern Caribbean Nicaragua, with a history of geographic and political isolation. While Nicaragua as a whole is primarily Hispanic Mestizo, the RAAN population is ethnically and culturally diverse, with multiple indigenous groups, including Miskito, Mayagna, and Creole. Due to the political reality, the geographic isolation of the region, and the distinct ethnic groups, the inhabitants of Sahsa have been marginalized, with significant health inequities
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