A six-year-old girl in the Honduran beach town of Morazan was killed when one of the walls of her house fell on her.
Another man in the nearby town of Tela suffered a heart attack when the quake struck and was taken for treatment.
Scenes of fear
Local residents told of scenes of fear as people struggled to find safety and some were trapped under buildings.
"I felt the car rock and I started to hear little bits of debris from the building next door hitting the roof," Pedro Ramirez, a security guard who was in his lorry outside an office building in Tegucigalpa when the tremor hit, said.
"It was frightening because it was shaking a lot. I've never felt anything like it."
Alfredo Cedeno, at the Gran Hotel Paris in the beach town of La Ceiba, said: "People were running for the door.
"You could really feel it and you could see the water come out of the pool."
Democracy Bridge, which crosses the Ulua, the country's largest river, collapsed in the town of El Progreso.
"It was an earthquake of great proportions,'' Ana Maria Rivera, a spokeswoman for the Honduran emergency commission, said.