With a population of 5.6 million, Nicaragua is among the poorest urban nations in Central American. The capital, Managua is its largest city, having an estimated population of 1.4 million, or 25% of the country's population. It has been destroyed by earthquakes in 1931 and 1972. Managua is the nost accessible city for its people as well as visitors to Nicaragua.

Nearly 50% of Nicaragua's people live in poverty with the average gross income only $488.50/person (2006). Because of poverty and unemployment there are widespread housing shortages, malnutrition and poor health care. There are extensive urban slums with many houses made of cardbaord  with dirt floors. Many people have no access to clean drinking water and plumbing.

The birth rate in Nicaragua is 28/1000. With a population of 5.6 million, that results in some 156,000 births each year. With 1 percent of the children being born world wide with congentital heart defects, this translates into almost 1,570 Nicaraguan children born with heart defects each year.  Without corrective surgery in the first year, almost 550 of these children (35%) will die.