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The purpose of this study was to demonstrate the usefulness of the Northwestern Nicaraguan Ministry of Health surveillance system for detecting pesticide poisonings. Cases were reported to the regional department of epidemiology through daily telephone reports and through monthly consolidated reports from each of the 18 health centers of the National Health Service. Reporting forms were also distributed to the four area hospitals. During June and July 1987, an epidemic of 548 pesticide poisoning was detected in northwestern Nicaragua. Seventy-seven percent of the poisonings were caused by carbofuran or methamidophos. Of the work-related cases (91% of reported poisonings), more than 80% occurred among maize farmers and on small to medium land holdings (fewer than 140 hectares). Nineteen percent of the work-related cases involved children under 16 years of …