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May 19, 1993

Health Care in Nicaragua: Primary Care Under Changing Regimes

Author Affiliations

University of Wisconsin Madison

JAMA. 1993;269(19):2562. doi:10.1001/jama.1993.03500190106053

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A number of books have been written about health services in developing countries, but none have attempted to introduce a modern preventive-curative health service in its economic, political, and social context as does this one on Nicaragua from 1980 through 1990. The authors describe the social, economic, and health services and the condition of the country at the beginning of the 1980s following the dictatorship of the Somoza family, the subsequent Cuban-type revolution by the Sandinistas, and an election in 1990 in which they were replaced by a more moderate, pluralistic type of western capitalist democracy. In addition to the political upheavals and guerilla tactics of the contras against the Sandinistas and a devastating earthquake and ferocious hurricane, Nicaraguan society emerged a somewhat better society than it had been previous to the Somozas. In addition, the population increased from an 1.7 million in 1964 to 4.1 million in 1990. From