NICARAGUA
Figure 1. Malaria by Annual Parasite Index (API) at
municipality level (ADM2), Nicaragua, 2014
Malaria is endemic in the Moskitia area along the
Atlantic coast in the northwestern part of the country
that shares a border with Honduras (Figure 1). In 2014,
Nicaragua had reported 1,163 cases of malaria and no
deaths (Figure 2). The department of North Caribbean
Coast Autonomous Region (RACCN) has the highest
amount of cases and is home to some of the country’s
most affected municipalities such as Waspan (26.2%
of all 2014 malaria cases), Rosita (22.6%), Puerto
Cabezas (15.4%), and Prinzapolka (9.8%) (Figure 3).
However, malaria is also present in other parts of the
country including along the northern Pacific coast in
the department of Chinandega where sugar-cane
plantations are areas of mosquito proliferation. The
department of South Caribbean Coast Autonomous
Region (RACCS) has had an increase in the past few
years. Cases in Desembocadura de la Cruz de Rio Grande
Honduras
Nicaragua
API
per 1,000 people
No cases
≤ 0.1
0.11 - 1
1.01 - 5
Figure 2. Number of cases and deaths due to
malaria in Nicaragua, 2000-2014
5.01 - 10
10.01 - 50
25,000
10
20,000
10
6
20,000
2014
2013
2012
2011
2010
2008
2009
2007
2004
2006
0
5,000
P. falciparum & Mixed
Deaths
■ P. falciparum &0mixed
■ Confirmed cases ■ Deaths
Confirmed Cases
2014
2013
2012
2011
2010
2009
2008
2007
P. falciparum & Mixed
Deaths
Department
336 the highest398
305 cases in Nicaragua, 2012-2014
RACCN3.
** Municipalities with
Figure
number of malaria
Waspan
115
RACCN **
Puerto Cabezas
P rinzapol ka
Bonanza
Municipality
RACCN **
238
Department
253
Waspan
RACCN **
Rosita
RACCN **
Puerto
Cabezas
RACCS‡
86RACCN **
RACCN
135 **
32 RACCN **
RACCN **
2
Wiwili de Jinotega P rinzapol
Jinotegaka
Bonanza
RACCN
**
93
El Viejo
C hinandega
Desembocadura*
37 RACCS‡
Siuna
RACCN**
Desembocadura*
de Jinotega9
Laguna d e Perlas Wiwili
RACCS‡
El Viejo
0
Decrease
Siuna
Increase
Laguna d e Perlas
Decrease
Increase
171
35
115127
17
686
253
135
78
32 23
2 1
93
C hinandega
200
400 0
37
RACCN**
2012
9
RACCS‡
Jinotega
200
2013
263
179
114 398
336
51
50 171
35 40
32127
17 28
6 15
78
400 0
23
305
238
263
179
114
51
50
40
200
2014
32
400
28
1
15
*Desembocadura de Rio Grande
Caribbean
Coast
Region
0**North200
400
0 Autonomous
200
400
0
‡South2012
Caribbean Coast Autonomous
Region
2013
200
2014
400
*Desembocadura de Rio Grande
**North Caribbean Coast Autonomous Region
‡South Caribbean Coast Autonomous Region
86
86
- 84 -
2006
2005
2004
2003
2002
2001
2000
Confirmed Cases
Rosita
25
50
®
100
Kilometers
Longitude/Latitude
Datum WGS84
Source: PAHO/CHA/VT
municipality almost tripled in 2014 from the previous
8
year.
Together, RACCN and RACCS account for 90%
of all malaria cases in Nicaragua. During 2012-2014,
6
there
were 7 municipalities reporting more than 1 case
per 1,000 inhabitants in one or more years (stratum
4 (Figure 4). Main factors contributing to malaria in
3)
Nicaragua are migration, natural disasters (floods), and
2
drug
trafficking. Improved surveillance has also led to
the detection of more cases. Approximately 2% of cases
0
were
reported imported in 2014. On the contrary, Costa
Rica has reported five imported cases from Nicaragua
since 2011.
Deaths
2
10,000
2005
2001
2000
0
4
15,000
2003
10,000
Deaths
15,000
5,000
Municipality
0
8
25,000
2002 Number of cases
Number of cases
>50
Costa Rica
onon
thethe
Situation
of Malaria
in the
2000-2014
(DRAFT
V.3) V.3)
Situation
of Malaria
inAmericas,
the Americas,
2000-2014
(DRAFT
Figure 4. Number of municipalities (ADM2) by strata
in Nicaragua, 2012-2014
Figure 5. Malaria cases by age and sex in
Nicaragua, 2014
90
Stratum 2
56
Stratum 2
Stratum 3
Stratum 3
7
7
0
Age groups
50+
50+
45-49 years
20
80
45-49 years
Female
40-44 years
Male
40-44 years
100
35-39 years
Female
Male
80
100
35-39 years
30-34 years
Number of municipalities
on the
Situation
Malaria in the Americas,
2000-2014 (DRAFT V.3)
30-34 years
*Stratum 1: No autochthonous
malaria
case inof2012-2014;
25-29 years
Stratum1:2:No
<1 autochthonous
case per 1,000 inhabitants
in 2012-2014;
*Stratum
malaria case
in 2012-2014;
25-29
years
20-24 years
Stratum
3:2:
>1<1
case
perper
1,000
inhabitants
in 2012-2014.
Stratum
case
1,000
in 2012-2014;
on inhabitants
the Situation
of Malaria in the Americas,
2000-2014 (DRAFT V.3)
years years
Stratum 3: >1 case per 1,000 inhabitants in 2012-2014.15-19 20-24
Age groups
90
50+
Stratum 1
MenStratum
were45-49
more
affected than women in 2014 56
(Figure
5),
Female
2 years
6
Age groups
56
40
60
20 (DRAFT
40of municipalities
60
Number
2000-2014
V.3)
0
Situation of Malaria in the Americas,
90
90
10-14 15-19
years years
Age groups
5-9 10-14
years years
50+
Under
5 years
5-9
years
Age
groups
90 45-49
Unknown
Under 5
40-44 years 50+
Unknown
100
45-49 years
35-39 years
100
100
100
75
25
50
50
0
75
25
25
75
50
75
50
0
25
25
50
25
0
25
0
25
50
50
75
75
75
100
100
2014
2013
2012
2010
2011
2009
2008
2007
2006
2005
2004
2002
2003
2014
2012
2013
2011
2010
2009
2008
* First line treatment data is unavailable for 2001-2004.
2014
2013
2013
2014
2012
2011
2012
Others
2014
2013
2012
2011
2009
2007
Others
2008
2006
2005
2004
2003
0.0M
3.0M 4.0M
2014 2010
2011
2013
2009
2010
2009
2008
2007
2010
2011
2009
2006
2004
2005
2008
2003
2007
2002
2006
2005
2000
2001
0.0M
* First line treatment data is unavailable for 2001-2004.
0.0M 2.0M
2012
0.5M
2010
1.0M 3.0M
2008
0.5M 1.0M
2.0M 4.0M
0.0M
$ (in millions)
2014
2013
2012
2011
2009
3.0M
Confirmed Cases
1.0M 1.5M
3.0M
2.0M
*Funding
information
is not available for 2001-2005.
People protected by ITNs
People protected by IRS
Government
Global Fund
USAID
People protected by ITNs
1.0M 2.0M
2010
2008
2007
2006
1.0M
2005
0.0M
2004
1.0M
1.0M
Confirmed Cases
First-line treatments
1.5Mtreatment
2.0M data is unavailable for 2001-2004.
* First line
4.0M
*Funding 1.0M
information is not available for 2001-2005.
4.0M
Government
Global Fund
USAID
People protected by IRS
1.5M
2.5M
2002
SPR (%)
Cases per 100,000 people
100
75
100
0%
SPR (%)
Blood Slides Examined
1.5M
2.0M
0.0M
2012 2011 2013
2012 2014
2013
2013
2014
2014
2003
2002
2006
Blood Slides Examined
RDTs Examined
2001
3.0M
0.5M
2009 2007 2009
2008 2010
2010
2009 2011
2011 2010 2012
0
RDTs Examined
4.0M
0.0M
1.0M
2003 2005
2004 2006
2007 2005
2007
2008 2006 2008
2000 2002
2004 2001 2003
2005 2002 2004
2001
2000
* 1.5M
First line treatment
200,000data is unavailable for 2001-2004.
2%
People protected by
0
0%IRS
0.5M
People protected by ITNs
First-line treatments
2004
4%
0.0M
2.0M
2002
2013
2012
2010
2011
2009
2008
2007
2006
2005
2004
2003
People protected by ITNs
2%
0.5M
2003
2014
2013
2011
2009
2010
2008
2007
2006
2004
2005
2012
SPR (%)
People protected by IRS
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
Figure 8. Number of malaria cases and those treated
with first-line treatment in Nicaragua, 2000-2014
* First line treatment
2.5M data is unavailable for 2001-2004.
6%
4%
Unde
r5
2001
2014
2012
2013
2011
2009
2010
2008
2007
2006
2004
2005
2003
2002
6%
SPR (%)
Blood Slides Examined
2002
2001
200,000
2003
2002
2001
People examined
2000
2000
1.0M
2%
Confirmed
Cases
0%
2003
rotected by ITNs
400,000
0.5M
1.5M
RDTs Examined
0.0M
400,000
2002
rotected by IRS
Blood Slides Examined
600,000
2001
PR (%)
0
1.0M
2000
0%
600,000
1.5M
RDTs Examined
2000
n millions)
2%
Slide Positivity Rate (SPR)
4%
2001
2.0M
200,000
6%
2000
Figure 7. Blood slides examined, RDTs examined,
2.5M
First-line
and SPR
in Nicaragua, 2000-2014
0
0% treatments
0.0M 1.0M
Number of people (in millions)
2000
2000
2001
2001
2002
2002
2003
2003
2004
2004
2005
2005
2006
2006
2007
2007
2% 4%
2001
200,000
400,000
Cases per 100,000 people
Unde 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
4%
400,000 r 5
600,000
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs 6%yrs
yrs
2000
Slide Positivity Rate (SPR)
0
2001
9
8
6%
2000
11
10
600,000
5
8
Confirmed cases
9
Diagnosis
and Treatment 11
0
10
35Microscopy
8
Unde
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50+
is
the
primary
method
of
diagnosis
in
the
30
5
Female
r 530 yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
though
RDTsyrswere
introduced
inyrs2006
for
use in
0 country,
Male
35
that
are
difficult
to
access
(Figure
7).
Nicaragua’s
30
Female
25places
Unde 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
30
26 is
r5
yrs treatment
yrs
yrs
yrschloroquine
yrs
yrs and
yrs primaquine
yrs
yrs
yrs
first-line
for
Male
20
21
both25P. falciparum and P. vivax
infections. An observed
2.5M
and primaquine
(30 mg/kg/day)
15dosage of chloroquine 26
First-line treatments
13 20
21
2.0M
is
given
over
the
course
of
7
days
for
treatment
of P. vivax
10
11 Confirmed Cases
9
15
10
in
Nicaragua
as
compared
to
a
15
mg/kg/day
dosage
13
8
1.5M 2.5M5
First-line
treatments
for 14
days
that
is
given
in
Honduras.
The
difference
in
10
11
9
2.0M0dosage10
may cause confusion along the
borderCases
for those 8
Confirmed
1.0M
5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
Unde
with P. vivax infections due to the varying treatment
1.5M
r 50 yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
0.5M
schemes.
US$ (in millions)
13
10
2014
Slide Positivity Rate (SPR)
Slide
Positivity
Number of people (in millions)
US$ (in
millions)Rate (SPR)
21
13
10
2000
26
20
5
Number of people (in millions)
US$ (in Slide
millions)
Positivity Rate (SPR)
Number of people (in millions)
Cases per 100,000 people
Female
Male
25
People protectedPeople
(in millions)
People examined
protected (in millions)
People examined
Number of people (in millions)
US$ (in millions)
cted (in millions)
People examined
100
Cases per 100,000 people
75
50
25
0
25
50
30
30
15
75
100
Cases per 100,000 people
35
2014
2013
80
50
40-44
years
Stratum
1to7 have incidence rates of 17.7 andMale
and were
found
14.9
Female
Stratum
3
100
years
cases
per35-39
100,000
people, respectively. Analysis by56age
Stratum
2
Male
20
40
30-34 0
years men
groups shows
incidence60at most 80
Female
Stratumthat
3
7 have higher
Number of municipalities
s malaria case in 2012-2014;
Confirmed cases
40-44 years
30-34 years
25-29 6).
years
ages
(Figure
Children
(10-14)
and
adolescents
(15Male
000 inhabitants in 2012-2014;
0
201: No autochthonous
40
60 case in 2012-2014;
80
100
*Stratum
malaria
35-39 years
20-24highest
years
Confirmed cases
000 inhabitants in 2012-2014.
19) had the
incidence
of2:malaria.
There
were
an in 2012-2014; 25-29 years
Number
of1,000
municipalities
Stratum
<1 case
per
inhabitants
30-34 years
15-19
20-24 years
Stratum
>1 case perpregnancies
1,000 inhabitants in 2012-2014.
estimated
17years
malaria cases
per3:100,000
*Stratum 1: No autochthonous malaria case in 2012-2014;
25-29 years
10-14
years
15-19
years
35 in 2012-2014;
in 2014, which was similar to
the 2:
incidence
in1,000
nonStratum
<1 case per
inhabitants
30 years
Female
20-24
Priority
Groups
5-9 years
10-14
years
Stratum
3:
>1
case
per
1,000
inhabitants
in
2012-2014.
30
pregnant women of child-bearing age, implying that
Male
35 The Miskito
15-19
years of Nicaragua are disproportionally
people
Under 5
5-9 years
30
Female
pregnant women were not at a higher risk of having
25 30
10-14
Unknown
Under
5 years due to poverty, underdevelopment,
affected
by
malaria
26
malaria.
Male
5-9
years to healthcare compared to the rest
Unknown
20
and limited
access
21
25
UnderThe
5
of the country.
area they inhabit traverses the
26
Confirmed
Figure 6. Malaria incidence by age
and cases
sex in
15
Unknown which poses a problem for disease
1320 Honduran border,
21 Confirmed cases
Nicaragua, 2014
10
11
9
10
15 tracking.
60
alities
100
Stratum 1
Stratum 1
- 85 -
5
US$ (in millions)
Number of people (in millions)
1.5M
Funding
2.5M
1.0M
Governmental
2.0M
2014
2013
2013
2014
2012
2013
*Funding information is not available for 2001-2005.
2014
2013
2012
2011
2010
2008
2009
2007
2006
2004
2005
2003
2002
0.0M
2001
2014
2012
2013
2012
2011
2011
2010
Government
Global Fund
USAID
Others
2014
2008
2012
2011
2010
2009
Others
2008
2007
2006
USAID
2005
2004
2003
2002
2001
2000
Global Fund
2009
2007
2006
2005
2004
2002
0.0M2.0M
0.0M
Government
2014
2013
2012
2011
2009
2010
2008
2007
2006
2005
2004
2003
2002
2001
2000
2011
2010
2009
3.0M
1.0M
1.0M
*Funding information is not available for 2001-2005.
0.0M
0.5M
2010
2008
2009
2008
2007
2005
2007
2006
2004
2006
2004
2005
2003
2002
2003
2002
2001
2000
2001
2000
2.0M4.0M
2003
People protected by ITNs
Figure 10. Funding for malaria control in
2000-2014
3.0M
Nicaragua,
2000
People protected by IRS
0.5M
1.0M
Confirmed Cases
2001
2014
2012
2013
2011
2009
2010
2008
2007
2006
2004
2005
2002
2003
Blood Slides Examined
SPR (%)
People protected by IRS
1.5M
First-line treatments
*4.0M
First line treatment data is unavailable for 2001-2004.
People protected by ITNs
2000
- 86 -
2001
2000
RDTs Examined
5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50+
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
yrs
treatments
funding for malaria at the First-line
national
level
Confirmed Cases
has varied from one year to the other. In 2014, it was
0.5M
1.5M
less
than that in 2013, but higher than any year during
0.0M
2010-2012. The Global Fund has been the main
1.0M
contributor
of external resources since 2006 through
national
grants as well as providing resources through
0.5M
* First line treatment data is unavailable for 2001-2004.
the EMMIE initiative (Figure 10). Other external funders
0.0M
include
USAID via the AMI/RAVREDA project and PAHO/
WHO.
0%
1.0M
People protected (in millions)
People protected (in millions)
RDTs
Blood Slides
Examined
SPR (%)
Figure
9.Examined
People protected
by IRS
and by ITNs
in
0
Nicaragua, 2000-2014
1.5M
Slide Positivity Rate (SPR)
2%
2.5M
Unde
r5
2.0M
US$ (in millions)
2014
2013
2011
2012
2009
2010
2007
2008
2006
2004
2005
2003
2002
200,000
2001
2000
People examined
People examined
Vector Control
4%by
Nearly
95,000 people are estimated to be protected
400,000
6%
600,000
IRS in Nicaragua,
which has decreased steadily since
2007 (Figure 9). Tests conducted in 2012-2014 found
both200,000
An. albimanus and An. pseudopunctipennis to2%be
4%
400,000
susceptible
to pyrethroids. More people are estimated
to be protected
by ITNs that IRS in 2014, with ITNs
0
0%
protecting 173,000 people.
Slide Positivity Rate (SPR)
6%
600,000
Number of people (in millions)
0