We established methods for monitoring pesticide use and associated health hazards in Central America. With import data from Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama for 2000-2004, we constructed quantitative indicators (kg active ingredient) for general pesticide use, associated health hazards, and compliance with international regulations. Central America imported 33 million kg active ingredient per year. Imports increased 33% during 2000-2004. Of 403 pesticides, 13 comprised 77% of the total pesticides imported. High volumes of hazardous pesticides are used; 22% highly/extremely acutely toxic, 33% moderately/severely irritant or sensitizing, and 30% had multiple chronic toxicities. Of the 41 pesticides included in the Stockholm Convention on Persistent Organic Pollutants (POPs), the Rotterdam Convention on Prior Informed Consent (PIC), the Montreal Protocol on Substances that Deplete the Ozone Layer, the Pesticide Action Network (PAN) Dirty Dozen, and the Central American Dirty Dozen, 16 (17% total volume) were imported, four being among the 13 most imported pesticides. Costa Rica is by far the biggest consumer. Pesticide import data are good indicators of use trends and an informative source to monitor hazards and, potentially, the effectiveness of interventions.