REPORT ON COMMUNITY HEALTH DIAGNOSIS

BONCH V.D.C. DOLAKHA

SUBMITTED BY: GROUP A VALLEY COLLEGE OF TECHNICAL SCIENCES BPH II YEAR, I BATCH (2066/2067)

SUBMITTED TO: Department of Public Health VALLEY COLLEGE OF TECHNICAL SCIENCES MID BANESHWOR, KATHMANDU 2010

Group Members Name

Roll No.

1. Anu Gomanju................... 09 2. Narayan Bhatta................. 15 3. Prakash Kumar Yadav.....................................................................07 4. Rabina Kumari Rajak.......................................................................04 5. Rajesh Giri..........16 6. Rubita Pulami.............14 7. Sangam Thapa.............22 8. Sanjiv Bhujel......... 27 9. Sizerin Dhungel........ 08 10. Shreetina Kesari Tuladhar........... 12 11. Sundeep Magar..............20 12. Susma Joshi........ 18

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APPROVAL SHEET

A Report on Community Health Diagnosis, done in Bonch V.D.C. of Dolakha from 2066/12/27 to 2067/01/28 Submitted by member of Group A of B.P.H. second year, Valley College of Technical Sciences, Affiliated to P.U. has been approved.

Approval Committee Members

1. Campus Chief Prof.Hari Bhakta Pradhan

2. Field Coordinator Lecturer Dilli Pd.Poudel

3. External Examiner Prof.Chitra Kumar Gurung Department of Public Health, IOM

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Acknowledgement
This is our immense delectation to present the report of Bonch VDC; unlike each student group we also extended a lot of pragmatic knowledge while devising this task .We enjoyed each and every spasm of time while preparing this report. We would like to explicit our gratitude to all of them who provided us very informative and precious as well as proper information on penmanship of this report. First of all, we would like to thank Valley College of technical sciences for providing us chance and allowing us for this study. We are heartily indebted to all the teacher and staffs of Valley College of technical sciences. We personally obliged and highly grateful to our BPH coordinator Mr. Dilli Prasad Poudel , campus chief Hari Bhakta Pradhan, M.D Ubin Pokhrel , Manager Mr. Om Sharma , last but not the least our teacher Mr. Subash Adhikari for their valuable ideas, guidelines and direction during orientation class. We humbly thank all people for giving their valuable time, encouragement, suggestion during our community diagnosis. Our special thank go to Mr. Shyam Krishna Thapa, secretary, Bonch VDC and Mr. Jeevan Thapa Magar, In charge of Bonch Health post. They heartily helped us by their all possible effort .We also express our gratitude to all the community people of Bonch VDC, formal and informal leaders, principal , teacher and supporting staffs of Shree Devi Higher secondary school and Shree Prithivi Narayan lower secondary school as well as female community health volunteer(FCHV's) for their cooperative and coordination for creating a sound environment to perform our activities. Lastly, we cannot stop ourselves for expressing our gratitude to the people of Bonch for their cooperation and active participation in spite of being busy engaged in daily work. We will always cherish the sweet memory of villager's love, help and coordination.

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TABLE OF CONTENT Content Page No.

GROUP MEMBERS.i APPROVAL SHEET.ii ACKNOWLEDGEMENTiii TABLE OF CONTENTiv-v ABBREVIATIONvi-vii SUMMARY.viii-ix

CHAPTER I: INTRODUCTION 1.1 Background1-2 1.2 Objectives of our study2 1.3 Village profile .3 1.4 Social map of Bonch VDC .4 1.5 Work Plan5 CHAPTER II: METHODOLOGY 2.1 Methodology6 2.2 Tools and Techniques of Data Collection6 2.3 Data Source..7 2.4 Validity and Reliability7 2.5 Limitation of the Study7 2.6 Ethical Consideration8 2.7 Organization of Field Work..8

CHAPTER III: FINDINGS 3.1 Socio Demography and Cultural Characteristics9-12 3.2 Socio Economic Status13-16 3.3 Environmental Sanitation.....16-21 3.4 Knowledge Attitude and Practice 22-33 3.5 Immunization33-34 3.6 Family Planning35-38 3.7 Nutrition38-40 3.8 Maternal and Child Health Care...41-49 54

CHAPTER IV: FOCUS GROUP DISCUSSION, COMMUNITY PRESENTATION AND MICRO HEALTH PROJECT 4.1 Focus Group Discussion50-51 4.2 Community Presentation52-53 4.3 Micro health Project...54-58 4.4 School health Program..59-61

CHAPTER V: CONCLUSION, RECOMMENDATIONS AND LEARNING REFLECTIONS 5.1 Conclusion62-63 5.2 Recommendations. 63 5.3 Learning Reflections..64.

BIBLIOGRAPHY..65 ANNEX
Annex1: Questionnaire.66-90 Annex 2: Observation Checklist..91-92 Annex 3: photo gallery93-104 Annex 4: Required Document.105-109

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ABBREVIATION

AIDS ANC ASFR CBR CD CHD CDR DHO DOTS DPT EPI FCHV FGD FP GFR GRR HHs HIV HS IMCI

= = = = = = = = = = = = = = = = = = = =

Acquired Immune Deficiency Syndrome Ante Natal Care Age-Specific Fertility Rate Crude Birth Rate Community Diagnosis Community Health Diagnosis Crude Death Rate District Heath Office Directly Observed treatment Short Course Diphtheria Pertusis Tetanus Expanded Program on Immunization Female Community Health Volunteer Focus Group Discussion Family Planning General Fertility Rate General Reproductive Rate Households Human Immunodeficiency Virus Higher Secondary Integrated Management of Childhood Illness

IMR KAP

= =

Infant Mortality Rate Knowledge, Attitude and Practice

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MCH MHP VCTS ORS PEM PLSS PU SDK SHP STD TB TBA TTBA TFR TT U5MR VDC WHO

= = = = = = = = = = = = = = = = = =

Maternal and Child Health Micro Health Project Valley College of Technical Sciences Oral Rehydration Solution Protein Energy Malnutrition Prithivi Lower Secondary School Purbanchal University Safe Delivery Kit Sub Health post Sexually Transmitted Disease Tuberculosis Traditional Birth Attendance Trained Traditional Birth Attendance Total Fertility Rate Tetanus Toxoid Under Five Mortality Rate Village Development Committee World Health Organization

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SUMMARY
This community diagnosis, field study survey mainly for learning purpose so that how we conduct any programme in future. The primary purpose of this diagnosis was to identify the real health status and for getting the detailed information about demographic situation, socio-economic status ,environmental status , health seeking behavior, MH, Family planning and child health situation. This report of community diagnosis is submitted to the public health department. This report id the output of community diagnosis field study conducted in Bonch VDC of Dolakha district by an effort of term students of BPH 2nd year of Valley College of technical sciences, Mid-Baneshwor within one month. The objective of the program was learn from community people to be with them in the process of acquiring knowledge and skills to identify the health related problems and their causes and the resources available in the community. The aim was also to know about the community in real sense practically. This report includes the findings and their analysis from household surveys, PRA and information obtained from secondary data. From the record of health post among the 803 household we selected 256 households using the systematic random sampling method. According to our study, total population of our sample was 1388 among them Male were 704(51%) and Female were 685(49%). The male female ratio was 103:100.The average family size was 5.42. The total dependency ratio of the VDC was 47.33%.The crude birth rate (CBR) was 18.08 per thousand, crude death rate(CDR) was 6.29 per thousand,U-5 Mortality was found 39.29 per thousand. Maternal mortality rate were not found. Morbidity was found 4%. The main occupation of people of VDC was student (50%). The main source of income of people was agriculture (59%). Only 7% of the population had enough food for the whole year. The main crops cultivated were paddy, millet and maize respectively

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Literacy rate was 73%. Tobacco consumption habit was found 14% and the alcohol drinking habit was 13%. Drinking habit was most common in Tamang ethnicity and smoking habit was 20%. Most of the household 90% used to bring the drinking water from tap or pipe. 10% of the household used to cover drinking water. Only 81% of house hold had safe disposal of solid waste.66% of household used to dispose waste water on kitchen garden.84% of household used to defecate in toilet. 67% of household used soap water to wash hand after defecation, among the people who used to wash hand after defecation. 95% 0f household used to daily brushing, among them only 5% used to brush twice a day.98% of house hold had heard about diarrhea.99% had heard about oral rehydrated solution(jeevan jal), among them only 51% were known the right method of ORS preparation. 46% had heard about ARI/Pneumonia. 46% had heard about TB among them only 66% were known about correct mode of transmission of TB.93% respondent hadn't heard about DOTS.34% had heard about STI and HIV/AIDS, among them 50% were known that it is transmitted through sexual contract.84% of household members used to contact at health institution when get ill. Majority 59% of respondent had got married before the age of 20 years.54% had given birth before the age of 20 years. 82% of the respondent had heard about Antenatal check up (ANC), among them only 72% had done it. Among those who had done ANC, 39% had done it for four or more times. 77% about total respondents had taken TT vaccine and 66% had taken iron tablet during pregnancy.31%respondent used to smoke and drink during pregnancy.

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CHAPTER I INTRODUCTION
1.1 Background Sweeping changes are taking place in the field of health. In most of the developing country like Nepal, people are living unhealthy life cultivating many health problems within them and their surroundings. No matter how advanced, intensive and extensive the medical services are, yet it has not been able to cope successfully with community health problems. Owing to this perspective, community health diagnosis proves its essence.

Community health diagnosis is defined as "a comprehensive assessment of the state of an entire community in relation to its social (includes cultural, political factors) physical and biological environment. The purpose of this diagnosis is to define existing problems, mine available resources and set priorities for the planning, organizing and implementing health actions or programs of health care by and for, or with the community." CHD, a course of second year including a month field work, is not only problem based learning but importantly is community oriented learning, directed toi) To find out health and disease status of a community by examining and analyzing the pattern of factors influencing the health and disease condition of a community. ii) To modify/change knowledge, attitude and practice of people through appropriate health programs.

In this competent age of globalization, with the aim of providing extensive courses in public health and health science through systematic management in producing technically socially responsible human manpower in health lead to the establishment of Valley college of Technical Sciences 2065, in the affiliation with P.U.

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This reports paints the vivid portrait of one month long community Health Diagnosis of Bonch VDC, Dolakha which was composed a team of BPH students of second year from Valley College of Technical Sciences, Mid Baneshwor.

Through the application of different means and mediums of health education, our team diligently collected the health information of Bonch VDC from primary and secondary sources. To this regard, we do hope that a report presented in this document will help the community and nation visualize the real health status of its people and encourage for uplifting health situation of the people.

1.2 Objectives of our study General objective To identify and the health problems and the factors for their causation and help community people to solve the prioritized health problems/needs by conducting the Micro Health Project (MHP) by the maximum exploration and utilization of local resources. Specific objectives To assess the present health status of Bonch VDC. To find out the health seeking behavior. To find out the hidden health problems. To identify the underlying causes of the prevailing health problems. To explore the available resources. To prioritize the health needs and launch MHP. To handover the MHP to the community for its sustainability. To develop working skill at community

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1.3 Village Profile VDC District : : Bonch Dolakha 13 km west from the district headquarter Charikot, 125 km east Boundary : from the capital city Kathmandu.

Distance :

Lakure dada in the West, Sindhupalchowk district Chokati VDC in the North and Bhimsen Nagarpalika in East gives the shape to the VDC. Charnawati River divides VDC from Bhimsen Nagarpalika. And in South Magapauwa VDC.

VDC is shoe shaped pointed or marginalized slowly towards ward no. 6. Located on the mountainous region the VDC is full of natural beauty with temperate climatic condition. Most of the people are engaged in agriculture. However some of people are attracted towards foreign job. The major productions are wheat, rice, oats etc. Total wards in VDC Total no. of household Total population: Religion Major ethnic group Brahmin, Kshetri and : : : : : 9 803 4065 Hindu, Buddha and Christian Tamang, Dalit (kami,damai,sarki),

Newar

The most important characteristic of the VDC was the presence of Small scale Nepali paper Industry where use of local resources is made at maximum level. Beside this there is Agriculture form Krishi which works under the Government in the field of Horticulture, Production of major crops, and Animal Husbandry as well.

There are few number of Developmental partners working in VDC, working in welfare of marginalize people. 62

Talking about the geographical accessibility of Health Care Service Providers, we found the people of ward no 4 and 6 much deprived from the facility. It simply takes 2 hours of walking to reach the HP. There is black pebbled road extending towards the district headquarter Charikot touching ward number 8,9,7,5,3,2,1. It would be more clarified via the social map we present here.

1.4 Social Map of Bonch VDC

Figure 1: social map

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1.5 Work Plan S. no 1 27/12/2066 2 3 28/12/2066 29/12/2066- 30/12/2066 4 5 6 7 31/12/2066- 08/01/2067 09/01/2067- 12/01/2067 13/01/2067 14/01/2067- 23/01/2067 Departure from college Arrival at Bonch Rapport building Social mapping Secondary data collection Primary data collection Data processing and analysis Focus Group Discussion Preparation presentation 8 9 10 11 12 13 24/01/2067 24/01/2067 25/01/2067 26/01/2067- 27/01/2067 28/01/2067 30/01/2067- 08/02/2067 14 15 09/02/2067 11/02/2067 Community presentation Needs and problem prioritization Preparation of MHP Implementation of MHP Departure to college Report writing Preparation for college presentation `College presentation Report submission of community Date Activities

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CHAPTER II: METHODOLOGY

2.1 Methodology Study Area: Study Population: Study type: Unit of analysis: Bonch VDC of Dolakha district Total households of Bonch VDC Descriptive type, cross-sectional study Household Individuals Sampling frame: Sampling frame was the total number of households of Bonch VDC recognized primarily by the name of head of the family, if not present, then by a recognizable member of the family. Sample size: 256 households random sampling method for

Sampling technique: Systematic

household data collection

2.2 Tools and techniques of data collection Tools Structured questionnaire Interview guidelines Observation checklist FGD guidelines Anthropometric instruments (Salter balance, measuring tapes, Shakirs tape) Secondary data review formats Techniques Structured interview Observation Focus group discussion Anthropometric assessment Records review Social mapping

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2.3 Data sources Primary data Household head or family members Local leaders Health staffs and FCHVs Married women of the community Aama samuhas leaders Secondary data Health post records VDC of Bonch

2.4 Validity and Reliability Pre-testing of questionnaires and checklists. To reduce selection bias, the study strictly followed the sampleframe Discussion over questionnaire before data collection and everyday discussion on the collection. Self checking and cross checking (consistency checking and completeness checking). Supervision and guidance from the faculties. procedure was followed during the data

2.5 Limitations of the study Selection of mixed household of sampling frame due to absence of members of sampling house. Inability to meet some mothers of under-5 children due to unfavorable topography and time selected for community diagnosis. Some of the respondents were the household head: it may lead to biased answers on KAP of diseases and service utility and also in gender related matters.

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2.6 Ethical consideration Permission was taken from VDC office Purpose and objectives of the study were explained and verbal consent was taken from each respondent Assurance of confidentiality of the information Freedom was given to the respondent to skip any question during interview process Dignity of the individuals was highly considered Low profile was maintained so as not to let them put high expectations 2.7 Organization of field work Financial support and transportation Campus had provided Rs4500 per person.Two way transportation was also provided by the campus. Lodging and Fooding The group stayed at Bonch VDC from Chaitra 27th to Baisakh 28th for one month. We stayed in a house in ward no.7. The house owner managed kitchen for us. Health education materials The health education materials were brought from Health post (Bonch VDC). Stationeries and first aid The campus provided some of the stationeries and the group managed rest. Set of questionnaire, first aid box were also provided by the campus. Pattern of group working Each and every members of the group was fully committed to his/her work. Decisions were made after consultation in the group. Though group work was the dominant feature, some special work assigned to each individual for whom he/she had authority to take decisions lying within the group norms.

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CHAPTER III: DEMOGRAPHY 3.1Findings from our study

3.1.1 Demography "There is simply nothing so important to a people and its government as how many of them there are, whether their number is growing or declining, how they are distributed as between different ages, sexes and different social classes and social and ethnic groups, and again which way these number are moving.." By: Daniel Patrick Demography, a scientific study of population is especially concerned with following facts: structure (size and composition) events that brings changes in the size of population (due to): Fertility Migration, and Mortality

Characteristics and distribution. we first collected data regarding above facts and then using various demographic tools and techniques analyzed and shaped the data into manageable form as raw number, rates, ratios and other types of statistic and observed parameters were compared with the national and district figure.

The main components that we have included in this chapter are:

1) Size, Composition and Distribution:

Population Size Age-sex composition

Ethnic wise sex distribution

2) Components that brings changes in size (vital statistics):

Fertility Mortality

3) Disability

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4) Characteristics of population a) Socio- economic status i.Family composition ii.Occupation iii. Literacy iv.Educational status v. Food sufficiency b) Socio-cultural status i. Religious ii. Language iii. Smoking habit iv. Alcoholism v. Tobacco

Population growth is the primary source of environmental damage

Table 1: List of demographic indicators

Demographic Indicators of Bonch VDC

Numerical Value

No of households No of sample households Total Population of sample Female Male Sex ratio

803 256 1388 684 704 103 males per 100 females

Literacy rate: Total dependency ratio Child dependency ratio CBR

73% 69.18% 59.89% 12.96 births per 1000 population

CDR Morbidity rate

17.29 per 1000 39.29 per 1000

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3.1.2 Population pyramid

Population pyramid of bonch V.D.C

80+ 75-79 yrs 70-74 yrs 65-69 yrs 60-64 yrs 55-59 yrs 50-54 yrs 45-49 yrs 40-44 yrs 35-39 yrs 30-34 yrs 25-29 yrs 20-24 yrs 15-19 yrs 10-14 yrs 5-9 yrs 0-4 yrs

Male

0% 0.29% 0.93% 0.93% 2.44% 1.58% 3.03% 1.65% 2.16% 3.24% 3.03%

0.43% 0.64% 0.86% 1.51% 1.87% 1.87% 2.23% 2.23% 2.08%

Female

2.98% 2.16% 4.39% 6.63% 6.27% 5.40% 4.68%

4.69% 5.69% 6.48% 5.90% 4.90% 3.24%

3.03%

Figure 2: Population pyramid of Bonch VDC

A population pyramid graphically displays a populations age and sex composition, by showing numbers or proportions of males and females in each age group, the pyramid gives a vivid picture of a population characteristics. The sum of the age-groups in the pyramid equals 100 percent population. Population pyramid of Bonch VDC shows that the population of age group 0-4 and 5-9 years is less than of age group 10-14 and 15-19 years. This may be the consequences of decreasing no. of fertility and shows the effective use of contraceptives to prevent the birth.

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 The population of age group of 0-9 and 10-19 years is higher with
comparison to other age group which shows the high rate of fertility 10-19 years back.

The female population of age group of 30-34 is less with comparison to

other age group. This may be due to various complications to mother during child bearing.

Likewise, male population tends to be little bit higher than female in the
age above 80 years. It indicates survival rate of male is slightly higher than that of female

This pyramid resembles with the pyramid of developing countries (more

people in younger age group

3.1.3 Fertility
Fertility shows the rate of population increase. It means the number of live birth the women have .One of the important measure of fertility is CBR. Crude birth rate is the total number of live birth per thousand midyear population. In Bonch the CBR was found to be 12.96 per1000.

3.1.4 Morbidity
From our study top 5 diseases prevalent in last 1 year were found to be as follow: Table 2: Top 5 diseases Rank 1 2 3 4 5 Disease of Bonch VDC Lower respiratory tract diseases Skin disease Pyrexia of Unknown Origin Diarrhea disorders Gastritis National 2007 Annual report Skin diseases Acute respiratory infections Ear Infections Sore eye and complaints Urinary tract infection

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3.2 Socio-economic status

The V.D.C. was BrahminChhetri dominated with having Dalits community in ward no.9. Regarding the major source of occupation, it was agriculture. The flow of human resources to foreign countries was also found considerable. Apparently, the V.D.C. seemed to be surviving by agriculture but our survey showed more than half of population didnt harvest food sufficient for whole year. They seek alternatives for living .i.e. 59.4%, followed by service ,16.4%,business 8.5%, labor 8.2%,Remittance 3.2%, and others 4.3%

3.2.1 Family Type

Table 4: Types of family

Nuclear 6%

Joint 38%

3-generation 56%

3.2.2 Source of Income

In Bonch V.D.C., more number of people was involved in agriculture and less number of people was involved in remittance. So, their economic condition is not good 59.40% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

16.40%

8.20%

8.50%

3.20%

4.30%

Figure 3: Main source of income

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3.2.3 Food sufficiency from agriculture production

As we already discussed that agriculture is the main source of income. Most of the family has their own land; it is seldom sufficient for survival and may have to supplement their income with low wage labor. In Bonch V.D.C., we found about 41.4% had food sufficient for 6 months, likewise 6.6% for more than 1 year
6.60%

41.40%

52%

0-6month 52% 6-12month 41.40% 12 and above 6.60%

Figure 4: Food sufficiency from agricultural production 3.3.4 Religion Religion is defined as the set of beliefs that guide the people. According to our data, 62% were Hindu, 32% were Buddhist, 4% were Christian, and 2% were others

2% 4%

32% 62%

Hindu 62% Buddhist 32% Christian 4% Others 2%

Figure 5: Religion distribution

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3.3.5 Educational status Among the data collected in 256 households the literacy rate was 73%. Most of the population was educated up to primary level which occupies 28% among literates
Table 5: Educational status

Distribution among literate and illiterate illiterate Informal education Primary education Lower secondary Secondary Higher secondary Bachelors Masters

Percentage

27% 3% 25% 18% 20% 3% 2% 2%

3.3.5 Schooling practice In Bonch V.D.C., as a whole education status is upgrade. We did not find gender discrimination in the field of education .i.e., 15% girl student study in private school/institution and rest 85% study in government school.

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Similarly, 13% boy student studied in private school/institution and remaining 87% study in government institution.
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 87%

85%

13%

15%

Son Private

Daughter

Son

Daughter Government

Figure 6 Schooling practice

3.3 Environmental Sanitation Environmental sanitation determines the health status of a community to a great extent Imbalance in the relation between man and his environment leads to illhealth 1) Supply of drinking water and purification method 2) Waste disposal (solid, liquid) 3) Human excreta disposal system

3.3.1 Supply of water

Water supply is a major part of the environmental sanitation .water supply at Bonch V.D.C. was studied in terms of distance of the source from the homes and water treatment pattern .The following table shows the different water sources used.

In the Bonch V.D.C., around 89.8% household use tap water and around 0.78% household uses. River water and may be others.Except few household there is available of tap water but, it is not adequate to fulfill their requirements.

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Thus they are obliged to fetch water from the river which is quite muddy during monsoon and of course unhygienic owing to open defecation .If only safe and wholesome water can be supplied to the community ,the incidence of diseases will go down dramatically

3.3.2 Liquid waste management Kitchen garden was one of the most used methods of draining waste water in Bonch VDC and feeding cattle is the least one used.

5.50%

13.30%

15.60% 65.60%

kitchen garden 65.60% thrown haphazardly 15.60% cattle feeding 13.30% others 5.50%

Figure 7 Liquid waste management

3.3.3 Solid waste management The term solid waste includes garbage and food waste, rubbish (plastic, wood, metal, throw away, and containers, glassed), Demolition products (bricks, masonry, pipes), dead animals and other discarded animals. It is solid that there is correlation between improper disposal of solid waste and incidence of vector born diseases. Solid waste, it allow to accumulate it create health hazards because it attracts flies, rodents and vermin and causes water and soil pollution

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In Bonch VDC majority of household, about 35.2% used burning, about 32.4% used composting, 16.8% was thrown waste haphazardly, around 13.3% buried the waste and remaining 2.3% used other methods of disposing the solid waste like reusing or recycling for other works.
2.30% 13.30% 35.20% 16.80%

Burning 35.20% composting 32.40% Thrown haphazardly 16.80% Buried 13.30% others method 2.30%

32.40%

Figure 8 Solid waste management 3.3.4 Latrine Latrine means where human excreta is thrown out .Since Bonch VDC is rural, most of the had latrine around 84% household have latrine and rest 16% use of open toilet. We can see on the following charts: From above data we can conclude, most of the people used toilet and least number of household had no toilet in Bonch VDC.

Due to different problems there is lack of toilets in some households of Bonch. Though they know about the necessity of the toilet there are many problems.

In Bonch V.D.C., 48% of 214 household did not build latrine due to lack of money and 10% did not build latrine because they did not feel that latrine is necessary.

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10% 28% 14%

Not necessary Unknown Lack of money Lack of Place

10% 14% 48% 28%

48%

Figure 15: Latrine

3.3.5 Personal Hygiene The Word Hygiene is Derived from the Greek word hygiene i.e. goddess of health in Greek mythology. She is a beautiful woman holding her hand a bowel from which serpent is drinking (art of healing). Thus, science of health and embraces all factors which contribute to healthful living practices; nail cutting, bathing and hand washing.

3.3.6 Habit of brushing teeth Brushing Tooth properly helps to prevent plaque, carries and other gingival diseases. An ideal time of tooth brushing is around two minutes twice daily after meal Fluoride tooth paste should be used for tooth brushing .as whole brushing tooth condition is good around 95% household has tooth brushing habit. 95% of sample population used to brush and 5% does not used to brush.

3.3.7 Material used to brush teeth Many people in country side used twigs of neem trees as a tooth brush; some used ashes and some charcoal. Educated and those who have come is contact with urban life used toothbrush. since it is the rural V.D.C., about 90% of 78

villagers use tooth paste 6% uses coal, 3% uses teeth stick (datiwan ) and 1% others.
3% 1% 6%

paste Datiwan Charcoal others

90% 3% 6% 1%

90%

Figure 16: Material used to brush teeth 3.3.8 Practice of hand washing before meal Hand washing practice is one of the major personal health hygiene behaviors. It helps to protect from different kind of communicable diseases. From the data collected in Bonch V.D.C. we found that, 51% of 256 respondent uses soap-water to wash hand before meal, similarly 46.6% uses water only, 1% ashes, 1% sand and soil and 0.4% did not use any of the above. They said they did not wash their hand before their meal.
60% 50% 40% 30% 20% 10% 0% soap water water only Ashes Sand -Soil Do not Wash 1% 1% 0.40% 51% 46.60%

Figure 17: Practice of hand washing before meal

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3.3.9 Practice of hand washing after using toilet Hand washing practice is the most important component in personal hygiene. This practice also prevents from different communicable diseases

In Bonch V.D.C., we found that, 66.8% of 256 respondents use soap-water to wash hand after the use of toilet. Whereas, 13.3% uses ashes, 5.1% uses water only, 2.3% uses sand-soil and 2.7% uses other measures. Also, 9.8% of the villagers did not practice any of the above, which is a very poor result.

100.0% 50.0%

66.8% 5.1% 13.3% Ashes 2.3% sand Soil 9.8% Donot Wash 2.7% others

0.0% soap Water water only

Figure 18: Practice of hand washing after using toilet 3.4) Attitude and Practices on health and diseases Knowledge is the understanding or familiarity gained by experience, it is a range of information acquire. Attitude is the way of thinking, or a settled opinion and the Practice means the way of doing something that is common, habitual or done regularly. Knowledge, attitude and practice are the triad of health education.

In Bonch VDC, knowledge level in people is found good but the practice are lacking. Most of the people are found unknown about many diseases when they become sick, they seek traditional healers .and at a time they feel the essence of health post and Medicine, it has already become late and no option to throw unhealthy body to purgatory. This withdraws the real scenario of community people.Diseases is a condition of pathological change inside the body which make or people illness man 80

3.4.1 Information on causation of communicable disease Majority i.e. 67% of the people said lacks of environmental sanitation, then 13% Said due to contaminated water and food, 10% Have no idea about how it cause and 5% said due to microorganism ,2% said due to curseof god and 3% said other cause. Causes Lack of environmental sanitation Micro Organism Contaminated Water and Food God Curse No Idea Other Total 6 25 7 256 2 10 3 100 13 34 5 13 No. of Households 171 Percentage 67

Table 6 Knowledge on causation of communicable disease

3.4.2 Place for treatment of disease According to our study most of the people are aware about the disease.84% people went to health post . We have found very less people going to dhami jhakri i.e. 7%.4% believe in home treatment ,3% go to FCHVs whereas 2% went for others.

4% 3% 7%

2%

health Post 84% Dhami jhakri 7% Self treatment 4% FCHV 3% Others 2%

84%

Figure 19: place for treatment of disease

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3.4.3 Means of health Information Majority i.e. 34% knew from Health personnels, 28% by FCHV's.15% by media i.e. radio, tv.13% people not able to get any information, 7% by teacher and only 3% from other source.
3% 13% 28% 7% 15% 34% Health Worker 34% Teachers 7% Media 15% FCHV's 28% No idea 13% Others 3%

Figure 20 Means of health information 3.4.4 Measures for preventing diseases Majority i.e. 75% view is proper environment sanitation protect from diseases, 9% said eating nutritious food,4% said protect by immunizing children,5% said by worship god and 7% said other reason.
5% 9% Environmental Sanitation Taking nutritious food Praying to god Immunization Others 75% 9% 5% 4% 7%

4%

75%

Figure 21 Measures for preventing diseases

3.4.5 Diarrhea Passing of loose stool three or more than three times in 24 hours is called diarrhea. It is the most important public health problem in Nepal mostly in children below 5 years of age.

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Information on causation of diarrhea In the case of diarrheal diseases, 36% said due to poor environment 26% said unsafe food.14% said poor drinking water.10% have no idea.8% said due to microorganism.6% said other reason.

6% 8% 36% 26% Polluted Environment Micro Organisms Polluted Water Unhygienic food unknown Others 36% 8% 14% 26% 8% 6%

14%

8%

Figure 22 Knowledge on causation of diarrhea

3.4.6 Treatment of diarrhea According to our study 180(70%) take health centers, 55(21%) treatment by jeevanjal 15(6%) homemade ORS, 4(2%) go to dhami jhakkri, 2(1%) go to ther places.for the treatment of diarrhoea

2% 1% 21% ORS feeding 6% home solution health post Dhami jhakri other 21% 6% 70% 2% 1%

70%

Figure 23: Treatment of diarrhea

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3.4.7 Pneumonia
Pneumonia is one of the major public health problems in Nepal. Among fewer than five years children it is the main cause of child mortality and morbidity. Knowledge about Pneumonia
56% 54% 52% 50% 48% 46% 44% 42% yes No 46% 54%

Figure 26: Knowledge about Pneumonia

3.4.8 Means of communicability

Majority i.e. 69(58%) said non communicable diseases, 30(25%) said communicable diseases and 19(17%) have no idea.

17%

25%

Communicable 25% Non Communicable 58% no idea 17%

58%

Figure 24: Means of communicability

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3.4.9 Sign and Symptoms of Pneumonia

4% 8%

12%

22%

19%

Coughing 12% Fever 19% difficult in breathing 16% Chest Pain 22% chest indrowning 8% unknown 4%

16%

Figure 25: sign and symptoms of Pneumonia

3.4.10 Place for Treatment of Pneumonia

1% 7% Dhami Jhakri 4% health Post 84% Treatment at home 1% unknown 7% Others 4% 4% 4%

84%

Figure 26: Place for treatment of Pneumonia

3.4.11 Tuberculosis (T.B.) TB is a specific infectious disease caused by Mycobacterium Tuberculosis. The disease primarily affects lungs and causes pulmonary tuberculosis. It can also affects intestine, meninges, bones and joints, lymph glands, skin and other tissues of the body and cause secondary tuberculosis. It stills remain the worldwide public health problem despite the fact that the causative organisms was discovered more than 100 years ago and highly

85

effective drugs& vaccines are available making TB a preventable and curable disease. Every year about eight million people develop TB worldwide. During the year 2000 about 1.66 million people die of this disease with 25% of the worlds population SEAR carries a disproportionate 38% of the world burden of TB. In Nepal it is estimated that there are about 80000 cases of TB and yearly there are about 40000 new cases of TB. It is also estimated that 5000-7000 people die yearly due to TB.In Bonch VDC, 46% of people were known about TB and remaining 54% of people are unknown about TB. 3.4.12 Information about Tuberculosis
56% 54% 52% 50% 48% 46% 44% 42% known Unknown 46% 54%

Figure 27: Information about T.B. 3.4.13 Knowledge on treatment of TB The knowledge of people on the treatment of TB was found good. Many people reported TB as the communicable disease.86% of people was found to have a clear knowledge on the treatment of TB and they said that the treatment of TB is possible. Even some literate respondents listed the name of some drugs for its treatment where as 8% said that the treatment is not possible and 6% of the respondents do not know whether the treatment is possible or not.

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100% 80% 60% 40% 20% 0%

86%

8% possible Impossible

6% Unknown

Figure: 28 Treatment of T.B.

3.4.14 Symptoms of Tuberculosis

35% 30% 25% 20% 15% 10% 5% 0% Blood In Sputum Evening Fever Chest pain Cough for more than 2 weeks Others 8% 13% 19% 33% 27%

Figure 29: Symptoms of T.B.

3.4.15 Treatment Place Many people were found visiting health institutions for the treatment of TB. Very few cases were reported of visiting dhami-jhakri. They were found going to hospitals for prompt treatment as soon as the symptoms of TB was realized. 79% of people go to healthpost for treatment, 7% go for dhami jhakri, 6% replied isolation and remaning 8% to other place like private clinic, pharmacy etc.

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90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

79%

7% Health institution Dhami jhakri

6% Isolation

8%

Others

Figure 30: Treatment Place 3.4.16 HIV/AIDS Knowledge on HIV/AIDS It is the most fatal disease ever known. The no. of people dying with HIV/AIDS is on increasing trend. Yet no treatment has been found except supportive treatment.

Heard on HIV/AIDS Very few people have heard about HIV/AIDS Through different Medias like TV, radio, health workers etc. It is found that 34% people have heard on this disease. Whereas remaining 66% havent heard about HIV/AIDS.

34%

Heard 34% Not Heard 66%

66%

Figure 31: Heard on HIV/AIDS

From the above data we can conclude that most of the people have not heard about HIV/AIDS 88

3.4.17 Mode of Transmission of HIV/AIDS Among the questions asked on HIV/AIDS, many respondents hesitated to reply the answer. However, only many of people were found to have good information on MOT of HIV/AIDS. And many more people were found having no real information about MOT of HIV/AIDS.

50% of people answered that the disease is transmitted by unsafe sexual contact, 23% by infected syringes, in the same way 15% said by blood transfusion, 5% from infected mother to her unborn child and 7% of people dont know about the mode of transmission of HIV/AIDS.
50% 50% 40% 30% 20% 10% 0% unsafe Sex Infected Syringe Blood transfusion infected mothers Don't know 23% 15% 5% 7%

Figure 32: Mode of transmission 3.4.18 Information on prevention of HIV/AIDS Almost 87% of the people are well known about the prevention of this disease. 13% of the people dont know about its prevention, and among the known people 57% said safe sexual contact, in the same way 25% use of family planning methods and 5% said others like avoided multiple sexual partners etc.

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5% 13%

25%

57%

Safe Sexual Contact use of F.P.methods Don't know Others

57% 25% 13% 5%

Figure 33: Information on prevention of HIV/AIDS 3.4.19 Behavior with HIV/AIDS Patient It is our immense pleasure that most of the people replied that HIV patient should be treated with lovable behavior i.e. 57%. In the same way 30 % the normal behavior and only 13% said that the HIV patient should be hated and isolated.
57% 60% 50% 40% 30% 20% 10% 0% Love Normal Hate 13% 30%

Figure 34: Behavior with HIV/AIDS patient

3.4.20 Polio Information about Polio As per the data that we collected, most of the respondents in Bonch VDC are known about the Polio i.e. 52% of the respondents has already heard about the polio and remaining 48% has not heard or they are unknown about Polio.

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48% 52%

Known 52% unknown 48%

Figure 35: Information about Polio

3.4.21 Information on MOT of Polio Although most of the people of this VDC have heard about polio, about 66.41% of the people dont know about the MOT of this disease. 14% of the respondents replied that the disease is non communicable, 3.73% by polluted water, 2.23 by stool, & 2.23% said that the disease is transmitted by curse of god and goddess and 10.44% said by others like through blood, respiration etc.

4% 2% 2% 10% 15% Polluted water Curse of god Stool & Urine Non Communicable Don't Know Others 4% 2% 2% 15% 67% 10%

67%

Figure 36: Knowledge on MOT of Polio

3.5 Immunization Nepal started Expanded Program on Immunization (EPI) in 1979, in three districts as a pilots program. This was extended to all 75 districts by 1988 with all 7 recommended antigens.

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Nepal joined the global polio eradication initiative in 1996, with Implementation of supplementary immunization activities in a form of National Immunization Days (NID), and intensified polio surveillance activities.

The overall goal of the national immunization Program of Nepal i.e. to reduce child mortality and morbidity occurring due to vaccine preventable disease.

Immunization is one of the most cost effective health interventions to prevent serious infectious disease. Immunization describes the process of inducing immunity artificially by administrating antigenic agents. Universal

immunization of children less than 1 year of age against the 7 vaccine preventable disease in reducing infant and child morbidity and mortality.

The practice of immunization on Bonch V.D.C. was found as following Yes 68% No 32% Total 100%

Table 7: Practice of immunization

According to above table, 68% of total respondent had immunized their children, 30% of them hadnt immunized because of lack of immunization facility and 70% of lack of information about immunization
120% 100% 80% 60% 40% 20% 0% B.C.G. D.P.T./HEP.B Polio measles 96% 96% 96% 88%

Figure 37: Coverage of Immunization

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Among the total under 5 children, 96%were immunized with B.C.G. 96% were immunized D.P.T. /H.E.P. B, 96% were immunized with polio. Similiarly, 885 were immunized with measles; among them some were on process.

3.6 Family planning

Family planning is a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decisions by individual and couples, in order to promote the health and welfare of family group and thus contribute effectively to the social development of a country. -WHO expert committee 1971AD Family planning, in fact refers to practices that help individuals or couple to attain certain objectives like avoid unwanted birth, bring about wanted birth, regulate the interval between pregnancies, control the time at which birth occur in relation to the ages of parent and determine the number of children in the family. Various knowledge and practice of family planning were asked to the married women of reproductive age (15-49 years), the finding of which are presented below:

3.6.1 Family Planning device users

Among the interviewed mothers, 51% of couples were using family planning Contraceptives and remaining 49% of couples were not using family planning contraceptives.

49% 51%

Heard 51% Not Heard 49%

Figure 38: Family planning device Users 93

3.6.2 Family Planning Method

Among the Family Planning methods, Permanent method of family planning users were 37% and temporary were 63%About 70% of couple used Depo, 61% of them used vasectomy,39.3% of them used minilap, 18% of them used 5.3% of them used condom 5.3% of them used copper-T and remaining 1%of them used Norplant
44% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 22% 15% 11% 3.30% 3.30% 1%

Figure 39: Family planning method

3.6.3 The Advantages of family planning method

8%

15%

2%

30% 45%

Birth Spacing 15% prevent from STI's 2% prevent pregnancy 45% Unknown 30% Others 8%

Figure 40: Advantages of Family Planning

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3.6.4 Reasons for not using Family planning Devices

27%

30% Lack of trust Religious Belief negative belief others 30% 16% 27% 27%

27%

16%

Figure 41: Reason for not using family planning method

3.6.5 Sources of Information about family planning

5%

3% 3%

Health Post Private Clinics F.C.H.V's Others

89%

89% 5% 3% 3%

Figure 42: Information about family planning

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3.6.6 Knowledge in age gap regarding two consecutive children

3% 34% 15% 25% 23% 2 years and below 3% 2years 15% 3years 25% 4years 23% 5years and above 34%

Figure 43: knowledge in age gap

3.7 Nutrition
Nutrition is the science of foods, the nutrients and other substances therein, their action, interaction and balance in relationship to health and disease, the process by which the organism ingests, digests ,absorbs, transports and utilizes nutrients and disposes of their end products. In short, nutrition signs are the area of knowledge regarding the role of food in the maintenance of health. Nutritional status is the state of our body as a result of foods consumed and their use by the body. Nutrition status can be good, fair or poor. During the period of one month field work at Bonch VDC, we assessed different nutritional status of the community. 3.7.1 Information about Sarbottam Pitho
80% 60% 40% 20% 0% Heard Not heard

Figure 44: knowledge about sarbottam pitho

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3.7.2 Salt used while preparing food Salt, they suffer from itching and allergy. So they refuse to use iodized salt. Out of 256 respondents of Bonch VDC, 100 i.e. 39% used dhike noon and only 156 i.e. 61% used iodized salt.

80% 60% 40% 20% 0% Dhike salt Iodized salt

Figure 45: salt used while preparing food

3.7.3 Vitamin A consumption Vitamin a deficiency still remains to be a public health problem amongst school aged children. Rates of night blindness increase with age in children. Out of 201 respondents of Bonch VDC, 183 i.e. 91% provided vitamin A to their children. But 18 i.e. 9% didnt provide vitamin A to their children

8% Consumption 91% Non consumption 8%

91%

Figure 46: Vitamin A consumption

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3.7.4 Cause of worm infestation

45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Sweets food unhygienic food Raw food Others

Figure 47: cause of worm infestation

3.7.5 Nutritional Status of under-5 Children

70% 60% 50% 40% 30% 20% 10% 0% Normal Moderate Severe

61% 37% 2%

Figure 48: Nutritional status of under -5 children

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3.8 Maternal and child health (MCH):

Definition: The term maternal and child health refers to the promotive, preventive, curative and rehabilitative health care for mothers and children.

Mother and child must be considered as an important unit of public health. Mothers and children not only constitute a large group but they are vulnerable or risk group. The risk is connected with child bearing in the case of women and growth, development and survival in the case of infants and children

3.8.1 Age at marriage It has been known to us that the appropriate age of marriage for an individual should be after the reproductive organs of the individual is properly developed, i.e. enough to conceive a baby. Normally, the age of marriage for a boy should be above 22 and in the same way a girl should get married after she is 20 from the point of view of health.

During the data collection, we found that people in Bonch VDC are not aware enough to judge the appropriate age to get married and also we found that the people who got married before the age of 20 are about 59% and who got married after the age of 20 are about 41% .

40% 60% Less than twenty Years 60% more than twenty years 40%

Figure 49: Age at marriage

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3.8.2 Age at the time of Pregnancy

Though the reproductive age in females begin from the age of 15, the suitable time for child bearing, according to the family health department is from 20-25 years of age. But, in our study, we found that the females in Bonch VDC mostly give birth to their first child at the age below 20.it was found that about 54% women firstly conceived at the age below 20, 46 % at age above 20

45% 55%

Age less than twenty Years 55% Age more than twenty years 45%

Figure 50: Age at the time of Pregnancy

3.8.3 Antenatal checkup:

According to our study, among total only 72% had gone for ANC check up and 28% had not. Among the women who had gone for ANC visit, it was found that 25% women had ante-natal checkup just once, 40% women had 2-3 times ANC visit, 27% had 4 times and 8% women had ANC visit more than 4 times

8% 27%

25% once 25% 2-3 times 40% 4 times 27% more than 4 times 8% 40%

Figure 51: Antenatal checkup

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3.8.4 Place of antenatal checkup: According to our study we found 82% of women had visited health post, 6% visited private clinics and similarly 12% visited others places.
100% 80% 60% 40% 20% 0% Health Institution Private clinic F.C.H.Vs

Figure 52: Place of antenatal check up

3.8.5 Food consumption during pregnancy

Additional food intake is essential during pregnancy to meet the demand of mother and her fetus. In the study, it was found that 64% of women had taken food as usual; about 29% had taken additional food during their pregnancy while 7% of women had taken food less than usual
7.03% As usual More nutritious than before food less nutritious than before 64.32% 64.32% 28.65% 7.03%

28.65%

Figure 53: Food Consumption during pregnancy

3.8.6 Work done during pregnancy It is well known to everyone that it is not good to perform heavy works during pregnancy. Even then the pregnant women in the villages have to do all the household works by themselves.

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From our data collection we got to know that 62.8% women in Bonch VDC used to do as usual work during their pregnancy, 25.40% of women used to do heavy works whereas 12.3% used to do nothing

80% 60% 40% 20% 0% As usual Heavy works nothing

Figure 54: work done during Pregnancy 3.8.7 Complications during pregnancy: In absence of adequate care and nutrition, certain complications may arise during pregnancy. Out of total respondent 40% women had faced problems during pregnancy while 60% had not.

21% 8% 6% 30%

35%

Dizziness 35% Oedema 30% Headache 6% Vaginal Bleeding 8% Others 21%

Figure 55: Complication during pregnancy

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3.8.8 Tetanus Toxoid (TT) immunization during pregnancy: TT immunization of pregnant women is essential for prevention of maternal and neonatal tetanus. The study showed that 77% of total mothers of Bonch VDC had taken TT vaccine and 23% had not taken any vaccine.

23% Immunized 77% Non Immunized 23% 77%

Figure 56:T.T. Immunization among pregnant women 3.8.9 Frequency of TT immunization According to our study 27.7% women had take one time,36.3% had two times,30% had 3 times and 5.59% get more than three times.
40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% one time two time three time more than three time

Figure 57: Frequency of T.T. immunization 3.8.10 Place of delivery of first child Environment and the place of delivery should be appropriate for mother and new born baby. Clean and safe place of delivery ensures good health of the mothers and their children In Bonch VDC, our study showed that the majority of the deliveries ,i.e. out of total respondent 72% were conducted at home; 21% at Government health centers,6% at Private health center and the remaining 1% others.

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1% 6% 21% Home 72% Health Post 21% Private Hospital 6% Others 1%

72%

Figure 58: Place of delivery of first child

3.8.11 Cord-cutting practices:

From the perspective of availability in the study community, use of new blade was considered as sterilized practice. About 35% people used new blade for cutting the cord, 29% used sickle/knife, 18% used Scissor, 13% used bamboo knife and remaining 7% used others.
40% 35% 30% 25% 20% 15% 10% 5% 0% Knife new Blade Bamboo Scissor others

Figure 59: Cord Cutting Practices

3.8.12 Knowledge about safe delivery kit:

Among 134 mothers who delivered baby at home only 71(53%) mothers were known about the safe delivery kit and 63(47%) were unknown about it.

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29% yes 53% No 47%

71%

Figure 60 Knowledge about safe delivery kit

3.8.13 Frequency of breast feeding:

Among 185 mothers in Bonch VDC 22% used to feed their babies less than 6 times a day, 13% used to feed 6-8 times a day, 28% used to feed more than 8 times a day, 21% did not notice the frequency
5% 12%

14% 69%

less than 6 month 6-8 month more than 8 times Others

22% 12% 38% 28%

Figure 61: Frequency of breast feeding

3.8.14 Duration of breastfeeding:

Exclusive breastfeeding till the child reaches six month of age its very important because the breast milk is an ideal food for their growth and development and prevention against many diseases. From the study it was found that only about 12% of the respondent had exclusively breast fed their baby. About 5%did it for less than six months, 14% did it for 6-12 months and remaining 69% did it for more than one year

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5% 12% less than 6 month upto 6 month 6-12month more than 1 year 6% 12% 14% 69%

14%

69%

Figure 62: duration of breast feed

3.8.15 Weaning food practices:

Starting time of weaning food: As per the data, 16% of mothers started weaning foods from the age less than 6 months, 44% of mothers started from 6 months, 40% of mothers started when their babies became more than 6 months of age

16% 40% Less than 6 months 16% 6months 44% more than 6 months

44%

\ Figure 63: Weaning food practices

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3.8.16 Food included in weaning food practices

Weaning food means all those different nutritious foods given to children after they become able to digest the solid foods. These foods are provided to the children along with the mothers milk. From our findings we explored that 47.56% mothers gave litto as extra food to their children, 18.91% gave cows milk, 18.37% gave porridge whereas 15.14% gave similar food as they used to consume

15.14% 47.56% 18.37% 18.91% Litto 47.56% Cow's milk 18.91% Porridge 18.37% Others 15.14

Figure 64: food including in weaning food practices 3.8.17 Consumption of iron tablet The study showed that about 34% women didnt take iron tablet at all during their prenatal period, 27% took it for some period, 28% took just during pregnancy 3% took just at post-partum period and 8% took the complete dose.
3% 8% 34% 28% not taken 34% for some period 27% Only during pregnancy 28 at post partum period 8% complete dose 3%

27%

Figure 65: Consumption of iron tablet

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CHAPTER IV FOCUS GROUP DISCUSSION 4.1 Focus group discussion

Date: 2067-01-13 No. of Participant: 11(FCHVs & others) Site: Health Post Building, Bonch Time: 11am Topic: Diarrhea

Student involve in Focus Group Discussion

Moderator : Prakash Kumar Yadav Note keeper : Sizerin Dhungel Recorder : Sangam Thapa

4.1.1 Process of FGD

1. Introduction Introduction of self and organization Inform participants on the objectives of the study Introduction of the participants to the group Inform the participants on general rules Request them to speak one at ones Request them to speak loudly and clearly There is no right or wrong answer. Warm up Main Discussion Closing the discussion Feedback

4.1.2 Questionnaire FGD

What is diarrhea? Is it communicable or not? Cause of diarrhea? Mode of transmission 108

General features of Diarrhea Treatments First treatment place for diarrhea Knowledge about preparation of ORS solution Importance of ORS solution Personal hygiene

4.1.3 Discussion on Diarrhea

It is a communicable disease which can be defined as loose motion for three or more than three times per day. There are different factors responsible for the causation of diarrhea for example poor sanitation, polluted water, poor personnel hygiene.

We also discussed about the different features of diarrhea like abdominal pain, sunken eyes, skin turgidity, weakness, loss of appetite etc. For the treatment we discussed about ORS i.e. Oral Rehydration Solution, food hygiene, personal hygiene, ORS preparation techniques etc and its importance.

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COMMUNITY PRESENTATION 4.2 Community Presentation

After we had completed our data collection process, we analyzed and processed it in numerical value to illustrate the comprehensive magnitude of needs i.e. rate, ratio, percentage, proportion, etc. Thus, from obtained data we were able to identify the real health situation of the VDC regarding introduction, demography, nutrition, FP/MCH, environmental health etc and we decided to present these findings to the community people and accordingly, we prepared and presented it on presentation.

4.2.1 Objectives:
To disseminate all the findings of survey to community people and to generate the possible solution. To give the health scenario of the Bonch VDC. To prioritize the real needs with the help (feedback) of the community people. To interact our team and community people for further programme. To participate the community people for planning, implementation and evaluation for MHP.

4.2.2 Schedule of the Program:

We made all preparation needed for presentation. We prepared relevant graphs, charts, pictograms, tables in the simpler form which could be easier to understand by the community people. We informed the VDC chairman to call the community people for presentation. On the 24th of Baisakh 2067, the preparation program was held. Date of program Site of the program No. of participants : 24th of Baisakh 2067 : Shreedevi Higher Secondary School. : Nearly 85 Materials used Graphs, charts, tables and pictures and findings

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4.2.3 Steps of Program

Chairperson: VDC Secretary Chief Guest: Health post in charge Guest : VDC members, Teachers, Political Leaders, Local Leaders, Social and Health workers, Community people.

4.2.4 Content of Our Presentation

Introduction of our team members Overview about VDC Aims and purpose of community diagnosis Demography Socio-economic status Environmental sanitation Personal Hygiene Knowledge Attitude and Practice on Health and Diseases Nutrition and Immunization Family Planning Maternal and Child Health Observation Checklist

4.2.5 Feedback
We collected oral feedback from presented leaders (political and local), Social and Health Workers, VDC members, Community people

4.2.5 Closing of Section

Chairperson of the ceremony thanked everyone and appreciated us for organizing the program and conveyed the message to Valley College of technical Sciences to make further arrangement for such work in the future to be in the Bonch VDC.

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MICRO HEALTH PROJECT 4.3 Micro health project

As the name says micro we can conceptualize micro health project as the short term health project which is launched at the community after the systematic prioritization of the real need which we get by unifying observed need from outsiders and felt needs from the community itself. There is maximum utilization of the local resources which include human resources, materials, money, time, information etc. with the combined and effective participation with the local people. Micro health project doesnt seek much help from the government side. Its just the miniature form or a kind of small scale project for the people, by the people and to the people of the community. MHP is concerned with the implementation of the health action or activity. In another words we can generally term MHP as intervention. The soul reason behind launching the MHP, or conducting health intervention or action is to solve the real health need or the real health problem of the community. So weve got the following:

4.3.1 Importance of MHP

Helps to neutralise or solve the problem as soon as possible It helps for the maximum utilization of the local resources. It provides the sense of unity to the local people for the solving their problem themselves with the spirit of self reliance and the self determination. It tries to develop and conceptualize to build the positive attitude towards health and healthy leaving. Final or the ultimate goal of MHP is to control the disease prevalence.

4.3.2 Goal of MHP

To raise awareness of community people by providing health education on real health needs as below a) MCH/FP b) HIV/AIDS c) Diarrhoea

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4.3.3 Objectives of MHP

To encourage pregnant womens for antenatal visits To raise awareness about institutional delivery To demonstrate the preparation of sarbottam pitho( super flour) To encourage target couple to use family planning methods and devices. To aware people on early diagnosis of T.B. Group A, about a one month stay at the community at the Bonch VDC, found various health needs which we call it observed needs. After the collection of the data we analysed thus data and listed the observed needs of the community. And then we called local people along with the key persons of the community for listening their need and we thus found their felt need as well. Then we submerged the observed and the felt need and prepared a list of the real health need of the community and finally we prioritized such real health needs with the community people and we ranked the real needs. Finally we launched the MHP on the heading of the awareness program about MCH/FP , awareness about HIV/AIDS and STIs", "adolescent health, awareness about malnutrition" "awareness about Diarrhoea" which was ranked on the top most position after the prioritization of the real needs. We launched the MHP for two consecutive days at two different places. Observed needs, felt needs and real needs are listed as below

4.3.4 Observed needs

These are the needs observed by outsiders. Observed needs are determined by us after the process of data analysis. We conceived the following needs to be the health needs of Bonch VDC. 1. Promotion of maternal and child health awareness. 2. KAP on HIV/AIDS 3. KAP on ORS and sarbottom pitho Preparation

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4. KAP on Family planning measure 5. Lack of consumption of Iodised salt 6. Home Delivery 7. KAP on environment sanitation 8. Extension of health service. 9. KAP on TB, 10. KAP on malnutrition. 11. Lack of waste management 12. KAP on HIV/AIDS 13. Health institution delivery. 14. Use of iodised salt.

4.3.5 Felt needs

Those needs which are felt by the community people are known as felt needs. Felt needs of the community were determined by the sound discussion with community key leader, FCHVs, HWs and local people. After discussion local people concreted the following felt needs. 1. Awareness about Safe motherhood and MCH and F/P 2. KAP on HIV/AIDS 3. KAP on TB 4. KAP on Nutritious 5. KAP on ARI and diarrhoea. 6. Uterus Prolapsed 7. Distribution of essential drugs from health post 8. Regular free health check up camps

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4.3.6 Real needs

Real needs are those needs which are believed to be actual needs. In other words validity of the real needs is sent percent. Real health needs are listed by submerging or unifying both of the felt and observed needs. We finalised following set of real health needs of Bonch VDC under which the prioritised real health need will be launched as MHP. 1. Awareness about Safe motherhood and MCH and F/P 2. KAP on HIV/AIDS 3. KAP on TB, Pneumonia &Polio 4. Use of iodised salt 5. KAP on diarrhoea 6. KAP on super flour and ORS preparation.

4.3.7 Prioritization of Real Need

Prioritization programme was carried out in presence of community key leaders HWs, FCHVs and local people. And major things that were considered during prioritization were magnitude of the problem, availability of the resources, cost benefit and cost analysis, acceptability in local cultural setting, budget, infrastructure, time limits etc

4.3.8 Implementation of MHP

To meet our objective which was set we launched the MHP for two consecutive days dated 2067 Baisakh 26 and 27. We invited all the community people along with the strict presence of HWs, FCHVs and key leaders at the corresponding place and time. At the first day, our MHP was launched under the heading of awareness about the malnutrition since we found there was maximum ignorance about malnutrition and the misconception regarding the treatment of malnutrition as well. It was launched to the FCHVs because they were the key or the measure to disseminate the light of knowledge about the very real health need. There was 12 FCHV's present. MHP was conducted for about 1 hour at the health post in 26th of Baisakh.

115

At the second day of our MHP i.e. on 27th Baisakh 2067, MHP site was at Shree Devi Higher Secondary school ward no.9 Bonch VDC, where we invited all the members of the community. Topics of MHP were: a) Awareness about Safe motherhood and MCH and F/P b) Awareness about HIV/AIDS c) Awareness about Diarrhoea We used the resources or materials available at the health post. MHP was successfully ended. There was huge presence of the community people. Under the MHP not only the topics about the ANC visits, essential drugs, nutrition, etc were elaborated also the birth preparedness, INC and PNC were stated. Methods and devices of F/P were also discussed with community people. After that, awareness about HIV/AIDS was kept forward. DOTS, S/S, prevention were promptly described to the community people. Each topic was divided among the 10 group members who gave health education about related topics. We tried our best to elaborate the subject matters more practically.

116

SCHOOL HEALTH PROGRAM 4.4 Introduction

School heath is an important part of community health as well as education subject, which takes place in school or through the efforts for school personal provides knowledge, attitude and conduct relating personal and community health. The school family should conduct such an important program regularly and properly so that this program will be helpful to improve the health status of the student, teachers and staffs of school as well. School health program means the prepared course of action taken by the school in the interest of the school children and personal and also according to the real need of community. The essential activities of school health program are: -school health service -health instruction or education -healthful school environment -School-community joint activities

4.4.1 Committee of USA defines SHP as

School Health Program is a school process that comprises of health services, health instruction and healthful school environment which contributes in the health promotion and protection of the students and the whole staff of the school.

4.4.2 Objectives of School health programme:

Helpful to improve the health status of school family by conducting all areas of school health programme. Helpful to encourage desirable health KAP in each child. Helpful to control communicable diseases and other epidemic diseases. Helpful to establish good habits and health awareness in the student that he/she will protect their own health. Helpful to assist their parents in building up and maintaining the high possible level of health in each child and in developing the necessary competence in child deal with the health problems of life. 117

 Development of high level of self-esteem in each youngster. Establishment and maintenance of sanitary practice and surroundings. To prepare a person to do what is necessary for the protection and preservation of his own health. Helpful to produce healthy manpowers that can contribute to build the nation in the future.

4.4.3 Conduction of School Health Program

We, the group A, conducted the school health program as session of MHP for a day at Shree Devi Higher Secondary School of Bonch VDC, ward no.9 and Shree Prithvi Narayan Lower Secondary School of Bonch VDC, ward no.1. After the completion of analysis of the collected data, the problem of the village was prioritized. And so as, on the required subject matter we conducted the school health program. The topics that we took on school health program are as follows: I. Nutrition and its deficiencies -Marasmus -Kwashiorkor -Iodized salt -Preparation of Super flour (Sarbottam Pitho) II. Safe motherhood and maternal health ANC, INC and PNC. III. Child health, breast feeding, immunization IV. Common childhood illness and their prevention V. Family planning6. Communicable diseases - Tuberculosis -Diarrhea -Measles -HIV/AIDS

VI. Non-communicable diseases: -Typhoid 118

-Heart Disease VI. Environmental sanitation VII. Personal hygiene

4.4.4 Methods Of health Education

Lecture Demonstration Group counseling Group discussion

4.4.5 Media of health Education Posters Pamphlets Funnel graphs Flash charts Flip cards For the feedbacks of our school health program, we conducted a small health quiz program in the very schools. In this way we conducted school health program as extra activity in CHD.

119

CHAPTER V Conclusion, learning reflection and recommendation 5.1 Conclusion

a) Demography The total population of the VDC was 4065 with total no of households 803 and average family size of 6.36 per household. The crude birth rate was 18.08%.whereas crude death rate was 6.29%.per 1000. Sex ratio was 102 males per 100 females with Highest number of people in age group 15-19 female occupying 16% among female and 7.8% among total population. The morbidity rate was 39.31 per 1000 population and Disability rate was 2%.Total dependency ratio was about 43

b) Socio-economic status The major occupation of people was agriculture (21%).Overall the literacy rate was 73%.Prevalence of smoking, alcohol consumption and chewing tobacco were found to be 19%, 13% and 14% respectively among 657 people with bad habits out of 1388 of total population. Around 86% of houses were semi strong (kachha pakka).

c) Maternal and child health:

ANC visit at least once was 25% whereas more than 4 times was 8%. Only about 29% of mothers having children less than 5 years admitted taking extra food during pregnancy. Similarly, smoking and drinking during pregnancy was not common among the respondent women. Home delivery was found to be very high (72%). Among the total home delivery cases, most of the deliveries were conducted by health workers. Use of safe delivery kit during home delivery among 134 cases, was only 31 i.e.44%. About 8% of the total respondents had taken complete doze of iron tablet. 40% of the 185 respondents had heard of "sarbottam pitho" out of which only 44% were found to know the correct method of preparation of sarbottam pitho. About 77% of the total respondents (n=185) had taken TT vaccine during pregnancy.

d) Family planning:
Majority (68%) have heard about family planning. More than fifty percent (51%) of total eligible couples are found to use family planning. Among the total users of temporary methods of family planning (63%), Depo-Provera was found to be common (59%). Male sterilization (87%) was quite common than female sterilization (20%). More of the respondents (33%) admitted that the space between two children should be more than 5 years.

e) KAP on health and Diseases

Only 34% have heard about HIV and AIDS (n=256). 93% of people have good knowledge about transmission of HIV and AIDS (n=147). Only 68% of people have known about causation of TB. About 85% of people have known the causation of the Diarrhea

f) Environment/housing/sanitation
Majority of household (89.8 %) used tap as the source of drinking water. Majority of total household (84%) had latrine in their home. Nearly 22% of the total household had separate kitchen whereas 18.3% of the total households had "sudhariko ko chulho" (smokeless kitchen). Almost 39% of the total households had proper ventilation at their home. The percentage of people using soap-water for hand washing after toilet was found satisfactory i.e. 68.8%.

5.2 Recommendation to the community

Continuation of the awareness raising programmes should be carried out Institutional delivery should be increased and use of SDK in home delivery should be encouraged There should be co-ordination between several NGOs, INGOs, stake holders and service providers for fruitful health care. People should utilize properly the free health service provided by government Environmental sanitation programme should be carried out in regular interval of time 2

5.3 Learning Reflections

Our study group has learnt to adopt in real field situation. Rapport building is difficult task. Tackling with the difficulties is the key to solve the problem in the community. Intersectoral Co-ordination is important to identify resources and to evaluate achievements. Developing competencies to conduct different forms and informal programs (meetings, mass awareness program) requires confidence and exposure. Application of theory into practice requires different types of modifications in it. Changing the behavior and attitude of people is not an easy task

BIBLIOGRAPHY
1. Hale Cynthiya, Shrestha I.B., Bhattacharya Archana, Community Diagnosis Manual, first edition. Kathmandu: HLMC, 1996 2. Joshi Anand Ballabh, Banjara Megh Raj Research Methodology and Thesis writing, First edition, Kathmandu :Dr Annanda Ballav Joshi, Mr. Megh Raj Banjara,2004 3. Park K, Text book of Preventive and Social Medicine, 18th Edition. Delhi: M/S Banarasidas Bhanot, 2005 4. Devkota Bhimsen, Community Health Diagnosis, first edition. Kathmandu: Ratna Pustak Bhandar, 2002. 5. Mahajan B.K. , Methods in Biostatistics, 6th edition Delhi: Jaypee Brothers Medical Publishers(p)Ltd, 1997 6. Previous community diagnosis report 7. Lecturer notes provided by Mr. Dilli Prasad Poudel 8. G.Tyler Miller Jr, Environmental Science 10th edition,Thompson Books/Cole 2004 9. www.who.in search date : 13 May 2010 10. DoHS, Annual Report, 2007

ANNEX 1 Questionnaire Eofln sn]h ckm 6]SgLsn ;fO{G; dWo afg]Zj/, sf7df8f}+ hg:jf:Yo :gfts tx -bf]>f] jif{_ ;d"bfo :jf:Yo lg?k0f cGt/jftf{, k|ZgfjnL @)^^

ldltM kmf/d g+=M

!= ;fdfGo hfgsf/L lhNnf M================== uf=lj=;= M ufpF 6f]n M

=========================== j8f g+= M================== 3/d'nLsf] -pQ/ bftf_ gfd M =====================================pd]/M ============== ln =============== wd{ M kl/jf/sf] ;+VofM

@= kfl/jfl/s hfgsf/L (Demography) qm =;+ Gffd pd] ln 3/d'nL k]zf j}jflx / ;+usf] s lzIff dW okf Wfd| ;"tL{ kfg ;]jg
5

s}lk mot

= != @= #= $= %=

gftf

l:ylt

@=!+ kl/jf/sf] lsl;dM -s_ Psn -v_ ;+oQm -u_ a[xt

#= dxTjk'0f{ tYof\s (Vital Statistics)

#=! ljut Ps jif{df tkfO{sf] kl/jf/df s;}sf] hGd ePsf] lyof] < s_ lyof] v_ lyPg

olb lyof] eg], qm=;+= aRrf hGdfpg] cfdfsf] pd]/ cfdfsf] cjZyf -hLljt . d[t_ aRrfsf] cjZyf -hLljt . d[t_ != @= #= $=

#=@ tkfOsf] aRrfsf] hGdbtf{ u/fpg ePsf] 5 ? -s_ 5 - v_ 5}g

6

# # ut Ps dlxgf leq tkfO{sf] kl/jf/sf] s'g} ;b:o lj/fdL kg'{ ePsf] lyof] < s_ lyof] v_ lyPg

#=#=! olb lyof] eg], s] ePsf] lyof] < qm= /f]u ;+= != @= #=$= ut Ps jif{ leq tkfO{sf] kl/jf/sf] sf]lx ;b:osf] d[To' ePsf] lyof] < s_ lyof] v_ lyPg sf/0f k|yd pkrf/ :yfg

lyof] eg], qm ; != @= #= d[tssf] pd]/ ln sf/0f s}lkmot

# % ut Ps jif{ leq tkfO{sf] kl/jf/sf] sf]lx ;b:osf] ljjfx ePsf] lyof] < s_ lyof] v_ lyPg

lyof] eg] qm ;
7

ln

pd]/

s}lkmot

!= @= #=

# ^= tkfO{sf] 3/df sf]lx ckf 5/5}g s_ 5 v_ 5}g

5 eg] s:tf] vfnsf] ckftf qm= k|sf/ ;+= != @= #= $ cfly{s ;fdflhs cjZyf (Socio-Economic) sf/0f s}lkmot

$=! cfly{s $=! ! tkfO{sf] cfDbfgLsf] d'n ;|f]t s] xf] < s_ s[lif _ j}b]lzs /f]huf/ v_ gf]s/L u_ dhb'/L 3_ Jofkf/

r_ cGo======================

-olb s[lif d'n ;|f]t xf] eg] k|Zg g+ $=!=@ df hfg]_

$=! @= tkfO{sf] s[lifjf6 x'g] jflif{s pTkfbgn] slt ;do ;Dd u'hf/f ug{ k'U5 <

s_ )^ dlxgf dfly

v_ ^!@ dlxgf

u_ !@ dlxgf eGbf

gf]6M )^ dlxgf = cltu/Lj dfly ;DkGg

^ !@ dlxgf ;Dd u/Lj

!@ eGbf

$=!=# tkfO{sf] 3/sf] cGo cfo;|f]t s]lx 5g\ < s_ 5 v_ 5}g

$=!=#=! 5g\ eg], s] s] 5g\ < s_ ===================== ==================== v_

u_ ==================

$=!=$= tkfO{sf] dfl;s cfDbfgL slt hlt x'G5 xf]nf < s_ @,@)) eGbf sd v_ @,@)) b]lv dfly

$=@ ;fdflhs $=@=!= tkfO{n] cfkm\gf] 5f]/f5f]/L b'j}nfO{ ljBfno k7fpg'x'G5 < s_ k7fp5' u_ 5f]/fnfO{ dfq v_ k7fplbg 3_ 5f]/LnfO{ dfq

$=@=@= tkfO{sf] 5f]/f / 5f]/L s:tf] ljBfnodf hfG5g\ < lghL 5f]/f -;+Vof_ 5f]/L -;+Vof_
9

;/sf/L

% jftfj/0fLo ;/;kmfO{ ( Environmental Sanitation) %= != tkfO{n] lkpg] kfgL sxfFjf6 Nofpg'x'G5 < s_ 9'Fu]wf/f 3_ vf]nfjf6 cGo========= v_ wf/fjf6 _ 3/df g} 5 u_ s'jfjf6 r_

%=@= 3/af6 kfgLsf] ;|f]t;Dd k'Ug slt ;do nfU5 < s_ kfFrldg]6 jf ;f] eGbf sd u_ kGw| b]lv lt; ldg]6 v_ kfFr b]lv kGw| ldg]6 3_ lt; ldg]6 jf ;f] eGbf a9L

%=#= lkpg] kfgLnfO{ s'g} tl/sfn] z'4 ug]{ ug'{ ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= %= $ df hfg]_

%=#=!= obL 5 eg] s'g tl/sfn] z'4 ug'{x'G5 < s_ pdfn]/ v_ cf}iflw xfn]/ u_ 5fg]/ 3_ lkmN6/ u/]/

_ cGo========

%=$= 3/sf] sfdsfhaf6 lgSn]sf] kmf]x/ kfgLnfO{ s] ug]{ ug'{ ePsf] 5 < -Liquid Waste) s_ s/];faf/L xfNg] kmfNg] 3_ cGo v_ ufO{ j:t'nfO{ v'jfpg] u_ htfkfof] Tot}

%=%= 3/af6 lg:s]sf] kmf]xf]/nfO{ s] ug'{x'G5 < -Solid Waste) s_ hnfpg] v_ k'g]{ u_ hyfefjL kmfNg]

3_ dn agfpg]

_ cGo

%=^ tkfO{ lb;flkzfj sxfF ug'{x'G5 <

10

s_ rkL{df

v_ h+undf

u_ vf]nfdf _

3_ hyfefjL -v'Nnf d}bfg /jf/Lsf] kf6f]df_ cGo=============

%=&= -obL rkL{ 5}g_ eg] lsg gagfpg' ePsf] < s_ cfjZos geP/ v_ yfxf geP/ u_ k};f geP/ 3_ 7fpF

geP/ _ cGo===========

^= JolQmut ;/;kmfO{ (Personal hygiene) ^=!= tkfO{ bfFt dfem\g'x'G5 < s_ dfem\5' hfg'xf];\_ v_ dfem\lbg -k|Zg g+= ^=@ df

^=!=! tkfO{ bfFt s] n] dfem\g'x'G5 < s_ d+hg v_ bltjg u_ uf]n/c+uf/ 3_

cGo==================

^=!=@ lbgdf slt k6s bfFt dfem\g'x'G5 < s_ Psk6s ======== ^=@= tkfO{ vfgfvfg' cl3 s] n] xft w'g'x'G5 < s_ kfgL dfq v/fgL 3_ afn'jfdf6f] _ w'Flbg r_ cGo v_ ;fj'g kfgL u_ v_ b'O{k6s u_ slxn]sfFxL 3_ cGo

^=#= tkfO{ lb;f lkzfj ul/;s]k5L xft s] n] w'g'x'G5 <

11

s_ kfgL dfq v/fgL 3_ afn'jfdf6f] cGo==========

v_ ;fj'g kfgL

u_

_ w'Flbg

r_

&= /f]u ;DalGw hfgsf/L &= != /f]u ;DaGwL 1fg, wf/0ff / cEof;M (Knowledge, Attitude & Practice ) &= != != tkfO{sf] ljrf/df /f]u nfUg'sf] d'Vo sf/0f s] xf]nf< s_ ;/;kmfO{sf] sdL kfgL/vfgfsf] sf/0fn] 3_ b]jL b]ptfsf] >fk ============== _ yfxf 5}g . r_ cGo v_ sL6f0f'sf] sf/0fn] u_ b'lift

&= != @= tkfO{ lj/fdL kbf{ sxfF hfg'x'G5 < s_ :jf:Yo rf}sL pkrf/ ug{] 3_ dlxnf :jf:Yo :j+o ;]ljsf _ cGo=============== v_ wfdL emfFqmL u_ 3/d}

&= != #= -olb :jf:Yo rf}sL hfg'x'Gg eg]_, lsg hfg' x'Gg < s_ :jf:Yo rf}sL 6f9f eP/ -k|Zg g+= &=!=#=! df hfg'xf];\_ ljZjf; geP/ u_ ;dosf] cefjn] cGo=============== 3_ k};f geP/ v_ _

&= != #=!= tkfO{sf] 3/af6 :jf:Yo rf}sL sltsf] 6f9f 5 < s_ $% dLg]6 eGbf sd 306f@ 306f;Dd v_ $%! 306f 3_ @ 306f a9L
12

u_ !

&= != $= tkfO{n] :jf:Yo ;DalGw gofF hfgsf/L s;/L kfpg] ug'{ePsf] 5< s_ :jf:Yo sdL{jf6 3_ dlxnf :jfYo=:jo+ ;]ljsf cGo=============== v_ lzIfsaf6 _ kfplbg u_ ;+rf/ dfWodaf6 r_

&= != %= tkfO{sf] ljrf/df /f]u nfUg glbg s] ug'{knf{ < s_ eujfgnfO{ k'sfg'{ k5{ u_ jRrfnfO{ vf]k nufpg'k5{ cGo=================== v_ ;/;kmfO{ ug'{k5{ 3_ kf]if0fo'Qm vfgf v'jfpg'k5{ _

&=@ emf8f kvfnfM &=@=! tkfO{sf] ljrf/df emf8fkvfnf s;/L ;5{ < s_ kmf]xf]/ jftfj/0f v_ lb;fdf ePsf k/hLjLjf6 3_ b'lift kfgL lkPdf _ yfxf

u_ c:j:Yos/ vfg]s'/f vfPdf 5}g r_ cGo==========

&=@=@=emf8fkvfnfsf] pkrf/ s;/L ug'{x'G5 < s_ hLjg hn v'jfpg] v_ 3/d} tof/ kfl/Psf] g"g lrgL kfgL v'jfpg]

u_ :jf:Yo rf}sL n}hfg] r_ cGo =======

3_ emf/km's ug]{ _ s]xL gug]{

&=@=@=! -obL hLjg hn gv'jfPdf_ s] tkfO{n] hLjg hnjf6 x'g] pkrf/sf] jf/]df ;'Gg'ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+ &=# df hfg]_
13

&=@=@=@ s] tkfO{sf] hLjghn jgfpg] t/Lsf yfxf 5 < s_ 5 v_ 5}g

&=@=@=# obL yfxf 5 eg] s;/L tof/ kfg'{x'G5 < -ljwL_ s_ 7Ls v_ j]7Ls

gf]6M ljlw =========================== ^ lrof uLnf; ;kmf kfgL jf ! ln= kfgLdf ! k'/Lof hLjg hn ldnfpg] / @$ 306f leq lkpg]

&=# Zjf; k|Zjf; ;DjGwL M &=#=!= s] tkfO{n] lgdf]lgof /f]uaf/] ;'Gg'ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+ &=$ df hfg]_

&=#=@= 5 eg] s:tf] lsl;dsf] /f]u xf] < s_ ;g]{ v_ g;g]{ u_ yfxf 5}g

&=#=#= tkfO{sf] ljrf/df lgdf]lgofsf] nIo0fx? s] s] xf] < -ax'pQ/_ s_ gfs jGb x'g'/l;+ufg cfpg' u_ Hj/f] cfpg' _ sf]vf xfGg' r_ 5ftL of/ of/ ug'{ cGo ========== 5_ yfxf 5}g h_ v_ vf]sL nfUg' 3_ ;f; km]g{ ufxf] x'g'

&=#=$= aRrfnfO{ lgdf]lgof ePdf sxfF nfg'x'G5 < s_ wfdL emfs|L sxfF hfg] v_ :jf:Yo ;+:yf hfg] 3_ yfxf 5}g _

u_ 3/}df pkrf/ ug]{ -k|Zg g+= &=#=% df hfg]_ cGo=================

14

&=#=%= 3/]n' pkrf/ u/]df s] ug'{ x'G5 < s_ Gofgf] kf/]/ /fV5' lr;f]af6 arfp5'' v_ pDn]sf] tftf]kfgL v'jfpF5' _ emf]lnnf] u_

3_ vf]k nufp5'

kbfy{ VfjfpF5' r_ cGo ==============

&=$ Ifo /f]u &=$=! s] tkfO{n] Ifo/f]usf] af/]df ;'Gg' ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= &=% df hfg]_

&=$=@= tkfO{sf] ljrf/df Ifo/f]u s;/L ;5{ xf]nf < s_ vf]Sbf/xfR5\o' ubf{ v_ vfgfsf] dfWodaf6 _ yfxf 5}g u_ lb;f lk;fjaf6 r_ cGo

3_ /f]uLnfO{ 5f]P/ ==============

&=$=#= Ifo/f]u nfu]df pkrf/ ug{ ;lsG5 ls ;lsb}g < s_ ;lsG5 v_ ;lsb}g u_ yfxf 5}g

&=$=$ of] /f]usf] nIf0fx? s] s] x'g< -ax'pQ/_ s_ vsf/df /ut b]lvg] cfpg] u_ 5flt b'Vg] v_ b'Anfpb} hfg] / ;fFemkv Hj/f] 3_ b'O{ xKtf eGbf a9L nuftf/

vf]sL nfUg]

_ cGo===============

&=$=%=Ifo/f]u, (T.B) nfu]sf] a]nfdf pkrf/sf] nflu sxfF hfg'x'G5 < s_ :jf:Yo ;+:yf cnUu} /fVg] v_ wfdL emfs|L 3_ cGo u_ lj/fdLnfO{

&=% HIV/AIDS
15

&=%=!= tkfO{n] P8\; /f]usf] af/]df ;'Gg' ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= *=! df hfg]_

&=%=@=of] s:tf lsl;dsf] /f]u xf] < s_ ;g]{ 5}g v_ g;g]{ u_ yfxf

&=%=#= -;5{ eg]_ of] /f]u s;/L ;5{ < -ax'pQ/_ s_ c;'/lIft of}g ;Dks{ v_ ;+qmldt ;'O{ ;f6f;f6 ugf{n]

u_ ;+qmldt JolQmsf] /ut ln+bf 3_ ;+qmldt cfdfaf6 hlGdg] aRrfnfO{ _ cGo r_ yfxf 5}g

&=%=$= tkfO{sf] larf/df pkrf/ ubf{ of] /f]u lgsf] x'G5 < s_ x'G5 v x'b}g u_ yfxf 5}g

&=%=%= P8\; /f]uaf6 aRg s] ug{ ;lsG5 <-ax'pQ/_ s_ yfxf 5}g (Condom) u_ w]/} hgf ;+u of}g ;Dks{ gugf{n] 3_ cGo v_ kl/jf/ lgof]hgsf] ;fwg pkof]u u/]/

&=%=^= tkfO{ P8\; /f]u nfu]sf] JolQm;Fu s:tf Jofjxf/ ug'{x'G5 < -jx'pQ/ cfpg] k|Zg_ s_ 3[0ff v_ dfof/;b\efj u_ ;fdfGo

*= kf]lnof] ;DaGwdf: *= != s] tkfOFn] kf]lnof] /f]usf] af/] ;'Gg'ePsf] 5 < s= 5 v= 5}g -k|Zg g+= (=! df hfg]_
16

*= @= -obL 5 eg]_ of] /f]u s;/L ;5{ < s= kmf]xf]/ kfgL lkP/ lk;faaf6 cGo========== 3=;b{}g v= b]jLb]jtfsf] >fkn] _ yfxf 5}g u_ lb;f r_

(= vf]k (Immunization) kfFr jif{d'lgsf] aRrf ePdf (=! tkfO{n] aRrfnfO{ vf]k nufpg' ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= (=@ df hfg]_

olb aRrfnfO{ vf]k nufpg' ePsf] 5 eg], sf8 x]/]/ eg]{ . qm=;+= Vf]fksf] lsl;d k'/f ePsf] ! BCG @ DPT/HEP.B # Polio $ Measles Gff]6M nufPsf] vf]ksf] ljj/0fM lj=l;=lh, l8=lk=l6, kf]lnof], bfb'/f % jif{ d'gLsf] jRrfsf] nflu k'/f gePsf] s}lkmot

(=@= olb nufpg'ePsf] lyPg eg], lsg < s_ vf]ksf] ;'ljwf geP/ eP/ u_ hl6ntf -vf]ksf] g/fd|f] c;/ b]lvP/_ cGo========== 3_ hfgsf/L geP/ _ v_ :jf:Yo ;+:yf 6f9f

17

!)= kl/jf/ lgof]hg ;DjlGw -!% b]vL $( aif{ ;Ddsf ljjflxt bDktLnfO{ ;f]Wg]_

!)=!= tkfO{n] kl/jf/ lgof]hgsf] s'g} ;fwg k|of]u ug'{ ePsf] 5 . s_ 5 !)=!=!= 5g eg] s'g < c:yfoL Dflxnf s}lkmot k'?if s}lk mot lkN; l8kf] -;+lugL # dlxg] ;'O{_ g/KnfG6 sk/- 6L s08 d :yfoL Dflxn s}lkm k'?if f ldgL Nofk ot Eof;]S6 f]dL s}lk mot v_ 5}g

!)=!=@= -5}g eg]_ lsg k|of]u ug'{ ePg < s_ ljZjf; gnfu]/ u_ gsf/fTds c;/n] ubf{ v_ wfld{s sf/0fn] ubf{ 3_ cGo -v'nfpg'xf];\_

!)=@+= k/Ljf/lgof]hgsf] kmfObfx? s] s] x'g< s_ hGdfGt/sf nflu v_ of]g /f]ujf6 jRg u_ ue{ /xg lbb}g To;}n] 3_ yfxf 5}g _ cGo==========

!)=#= -obL k|of]u u/]sf] eP_ tkfOn] kl/jf/ lgof]hgsf] ;]jf sxfFaf6 k|fKt ug'{ePsf] 5 <

18

s_ :jf:Yo ;+:yf u_ :jo+ ;]ljsf

v_ k|fOe]6 lSnlgs 3_

cGo==================

!)=$= tkfO{sf] ljrf/df b'O{ aRrfsf] hGdfGt/ stL x'g'k5{ < s_ @ jif{ eGbf sd v_ @ jif{ u_ # jif{

3_ $ aif{

_ % aif{ jf ;f] eGbf dfly

!)=%= tkfO{sf] ljrf/df ljjfxsf] nflu s]6f s]6Lsf] pko'Qm pd]/ slt jif{ x'g'k5{ < s]6f ===========================================s]6L ===========================================

19

!!= kf]if0f (Nutrition) !!=! -% aif{ d'lgsf aRrf ePsf dlxnfnfO{ ;f]Wg]_ s] tkfO{nfO{ ;jf]{Qd kL7f] /ln6f] agfpg] ljwL sf] af/]df yfxf 5 < s_ 5 v_ 5}g -k|Zg g+= !!=@ df hfg]_

!!=!=! olb yfxf 5 eg] ;jf]{Qd kL7f] agfpg] t/Lsf atfpg'xf];\ . s_ l7s v_ j]l7s

-@ efu cGg, ! - ! efu @ lsl;dsf_ / @ efu u]8fu'8L_

!!=@= tkfO{n] vfgf ksfpg s:tf g"g k|of]u ug'{x'G5 < s_ l9s] g"g u_ jL/] g"g v_ Kofs]6sf] cfof]l8g o'Qm g"g 3_ cGo

!!=#=s] tkfO{n] aRrfnfO{ le6fldg 'P' SofK;'n v'jfpg' eof] < s_ v'jfPF v_ v'jfOg

!!=#=!=olb v'jfpg' ePg eg] lsg < s_ yfxf geP/ 6f9f eP/ 3_ sf]lx v'jfpg cfPgg\ _ v_ cfjZos g7fg]/ u_ :jf:Yo ;+:yf

cGo=======================

!!=$= tkfO{sf] ljrf/df k]6df h'sf kg'{sf] sf/0f s] xf]nf h:tf] nfU5 < -jx'pQ/ cfpg] k|Zg_ s_ u'lnof] vfg] s'/f vfgfn] vfg]s'/f vfgfn]
20

v_ kmf]xf]/

u_ sfFrf] vfg]s'/f vfgfn] cGo==================

3_

!!=%=s] tkfO{n] cfkm\gf] aRrfnfO{ h'sfsf] cf}iflw v'jfpg' eof] < s_ v'jfP v_ v'jfOg

!!=%=!=olb v'jfpg' ePg eg] lsg < s_ yfxf geP/ eP/ 3_ sf]lx v'jfpg cfPgg\ _ v_ cfjZos g7fg]/ u_ :jf:Yo ;+:yf 6f9f

cGo=======================

!!=^= ;fukft / t/sf/L tkfO{ s'ga]nf kvfNg' x'G5 < s_ sf6\g' cl3 kvflNbg v_ sfl6;s]k5L u_ b'j} k6s 3_

!!=&= tkfO{sf] ljrf/df s'kf]if0f -;'s]gfz / km's]gfz_ /f]u s] sf/0fn] nfU5 < s_ kmf]xf]/ vfgf vfgfn] u_ kf]lifnf] vfg]s'/f gvfP/ v_ k/ ;/]sf] dlxnfn] 5f]P/ 3_yfxf 5}g _ cGo

!!=*= tkfO{sf] ljrf/df s'kf]if0f /f]u lgsf] kfg{ s] ug'{knf{ < s_ wfdL emfFs|L jf]nfpg' v'jfpg' u_ :jf:Yo ;+:yfdf n}hfg' _ yfxf 5}g 3_ cfkm} lgsf] x'G5 r_ cGo
21

v_ kf}li6s cfxf/

!!=(= kfFr jif{ d'lgsf jRrfx?sf] kf]if0f l:yltM

jRrfsf] kf]if0f ;DjlGw ljj/0fM kfv'/fsf] gfk l;= g+= aRrfsf] gfd pd] / ln tf}n prfO { xl/of] /fd|f] _ ! @ # $ kx]+nf ] /ftf] vt/f_

xf]l;of/ _

!@= dft[ lzz' :jf:Yo(Maternal & Child Health): -kfFrjif{d'lg aRrfx?sf] cfdfnfO{_

!@= != ljjfx x'Fbf tkfOF slt jif{sf] x'g'x'GYof] < jif{

!@= @= klxnf] k6s ue{jtL x'Fbf tkfOF slt jif{sf] x'g'x'GYof] < jif{

!@= #= ue{jtL x'Fbf hfFr u/fpg'ePsf] lyof] < s= lyof] v= lyPg

!@= #=!= -olb lyof_] eg] slt k6s hfFr u/fpg'ePsf] lyof] < s= ! k6s v= @ - # k6s u= $ k6s 3= $ eGbf al9
22

!@= #=@= -olb lyof]_ eg] sxfF hfFr u/fpg' ePsf] lyof]< s_ :jf:Yo ;+:yf u_ :jo+ ;]ljsf cGo================== v_ k|fOe]6 lSnlgs 3_

!@= #=#= -olb lyPg_ eg] lsg < s= yfxf geP/ u= ;do geP/ cfjZostf g7fg]/ v= :jf:Yo;++:yf 6f9f eP/ 3= d=:jf:YosdL{ geP/ r= cGo

!@=$= uef{j:yfdf s:tf] vfgf vfg'x'GYof] < s= ;fljs h:t} v= ;fljs eGbf kf]lifnf vfgf u= ;fljs eGbf sd

!@=%= uef{j:yfdf s:tf] lsl;dsf] sfd ug'{x'GYof] < s= ;fdfGo sfd u= s]lx klg ul/gF v= ufxf] ;fdfg p7fpg] sfd 3= cGo

!@=^= s] tkfOFnfO{ uef{j:yfdf s'g} lsl;dsf :jf:Yo ;d:ofx? b]vf k/]sf] lyof] < s= lyof] v= lyPg

!@=^=!= -olb lyof] eg]_ s:tf k|sf/sf ;d:ofx? b]vf k/]sf lyP < s= xftv'f ;'lGgg] u= 6fpsf] b'Vg] / j]xf];x'g] v= l/6f nfUg] 3= /ut hfg] cGo
23

!@=&= tkfOFn] uef{j:yfdf 6L= 6L vf]k nufpg'ePsf] lyof] < s= lyof] v= lyPg

!@=&=!= olb lyof] eg] slt k6s nufpg'ePsf] lyof] < s= ! k6s u= # k6s v= @ k6s 3= ;f] eGbf a9L

!@=*= tkfOFn] uef{j:yfdf h'sfsf] cf}ifwL vfg'ePsf] lyof] < s= lyPF v= lyOFg

!@=(= tkfOFsf] klxnf] jRrf sxfF hlGdPsf] lyof] < s= 3/d} v= uf]7df 3= lghL :jf:Yo ;+:yf _

u=;/sf/L :jf:Yo ;+:yfdf

cGo===================================

-obL 3/df g} hlGdPsf] eP dfq k|Zg g+ !@=!) b]vL !@=!# ;Dd ;f]Wg]_

!@=!)= jRrfsf] gfnsf6\bf s] k|of]u ug'{ePsf] lyof] < s= xFl;of /r'n];L / rSs" 3= jFf; /rf]of v= s}+rL u= gofF An]8 = cGo

!@=!!= tkfOFnfO{ ;'Ts]/L ;fdfu|Ljf/] yfxf 5 < s= 5 v= 5}g

!@=!@= -olb yfxf 5 eg]_ jRrf hGdfpFbf ;'Ts]/L ;fdfu|Lsf] k|of]u ePsf] lyof] <
24

s= lyof]

v= lyPg

!@=!#= gfn sf6]sf] 3fpdf s] nufpg' ePsf] lyof] < s=a];f/ / t]n v= uf]j/ u= cf}ifwL 3_

cGo=========================

!@=!$= jRrfnfO{ lauf}tL b"w v'jfpg'ePsf] lyof] < s= lyof] v= lyPg

!@=!$=!= olb lyPg eg] lsg < s= rng geP/ u= xfgL x'G5 eg]/ v= kmf]xf]/ x'G5 eg]/ 3= cGo

!@=!$=@= tkfOFn] jRrfnfO{ sltk6s b'w v'jfpg' x'G5 < s= ^ k6s eGbf sd v= ^ * k6s u= * k6s eGbf al93= cGo

!@=!$=#= jRrfnfO{ cfdfsf] b"w dfq slt ;do;Dd v'jfpg'ePsf] lyof] < s= ^ dlxgfeGbf sd ! jif{eGbf dfyL v= ^ dlxgf k"/f u= ^ - !@ dlxgf 3=

!@=!% != slt dlxgfsf] pd]/ b]lv jRrfnfO{ 7f]; cfxf/f v'jfpg ;'? ug'{eof] < s= 5 dlxgf eGbf sd v= ^ dlxgf u= ^ dlxgfeGbf a9L

!@=!%=@= 7f]; cfxf/df s] v'jfpg'ePsf] lyof] < s= ln6f] v= ufOsf] b"w

25

u= hfpnf]

3= cGo

!@=!%=#= tkfOFn] k"0f{ cjwL;Dd Iron rSsL vfg'ePsf] lyof] < s= vfFb} gvfPsf] u= ue{jtL cj:yfdf dfq} vfPsf] 3= ;'Ts]/L cj:yfdf dfq = k"0f{ cawL vfPsf] v= s]xL cjwLdfq

Gff]6 M k"0f{ cjwL eGgfn] ue{ cj:yf b]lv ;'Ts]/L ePsf] $@ lbg kl5 ;Dddf @@% rSsL vfPsf]

cGt/jftf{ lng]sf] gfd ============================= x:tfIf/ =============================

EofnL sn]h ckm 6]SgLsn ;fOG; dWo jfg]Zj/, sf7df8f}+ ;d"bflos :jf:Yo lg?k0f b[io cjnf]sg kmf/d -Observation Check-List) ldtL: kmf/d g=: !_ 3/sf] k|sf/ s= sRrf gf]6 : sRrf : kSsf : sRrf kSsf: h:tf cflbn] ag]sf] @_ 5fgfsf] k|sf/
26

v= kSsf

u= sRrf kSsf

df6f]n] ag]sf]/ sfFrf] O{f/v/n] 5fPsf] ;Ld]G6n] ag]sf] 9'f df6f/] h:tfn] 5fPsf] /6fonlem+u6L sf7

s= v/sf] v= h:tf u= 9'f,6fO{n 3= k/fnsf] =l;d]G6 #_ sf]7f leq pHofnf] s= kof{Kt -;j} ;fdfg :ki6 b]lvg]_ :ki6 glb]lvg]_ $_ e]G6Ln];g - /f];gbfg _ s= 5 v= 5}g v= ckof{Kt -;j} ;fdfg

%_ efG5f 3/ s= 5'\6} ePsf] ^_ r'Nnf]sf] k|sf/ s= w'jfF cfpg] v= UoFf; r'Nnf] u= :6f]e/dlt]n ;'wf/LPsf] r'Nnf] &_ kfgLsf] ;|f]t s= ;kmf v= kmf]xf]/ 3= v= Ps} 7fpdf ePsf]

*_ 3/af6 lg:s]sf] kmf]xf]/ kflgsf] Aoj:yfkg s= s/];faf/Ldf (_ kfgL hd]sf] 7fpF s= 5 v= 5}g v= gfnL/9ndf u= cJjl:yt

!)_ kmf]xf]/ d}nfsf] Aoj:yfkg

27

s= hnfP/ !!_ 3/ j/k/sf] jftfj/0f

v= sDkf]i6 dn agfP/ u= k"/]/ 3= hyfefjL

s= ;kmf v= kmf]xf]/ !@_ rkL{ s= 5 !#_ 5 eg] s:tf] < s_ kSsf v_ sRrf v= 5}g

u= l7s}

!$_ olb 5 eg] rk{Ldf kfgLsf] Joj:yf s= 5 v= 5}g

!%_ rlk{sf] cj:yf s= ;kmf v= kmf]xf]/

!^_ s/];faf/L s= 5 v= 5}g

!&_ uf]7 s= 3/ leq} v= 3/ ;Fu hf]l8Psf] u= 3/ eGbf 5'6}

3= !% ld6/ 6f9f

= 5}g
28

S.N 1

ANNEX 2 Observation Check List Characteristics Frequency Types of house(N=256)

Kachaa Pakka 27 10 219

percentage
10% 4% 86%

Kachaa-Pakka 2 Roof Type

Khaar Tin Tile Straw Cemented

18 172 60 0 6

7% 67% 24% 0% 2%

Light(N=256)
Sufficient Insufficient 90 166 35% 65%

Ventilation (N=256)
Yes No 100 156 39% 61%

Kitchen (N=256)
Separate Attached with house 56 200 22% 78%

29

Type of Chulo (N=256)

Smokey gas Stove Smoke less chulo 205 4 0 47% 80% 2% 0% 18%

Water Sources (N=256) Pure/ Impure

229 27 89% 11%

Liquid Waste Management(N=256)

Kitchen Garden Drainage 202 20 34 70% 8% 13%

haphazardly 9 Waste Management(N=256)

Burn Composting Buried haphazardly

82 65 41 68

32% 25% 16% 27%

10

Sorrounding Environment(N=256)
Good Satisfactory Unsatisfactory 35 25 196 14% 10% 76%

11

Toilet(N=256)
Yes No 214 42 63% 37%

12

Toilet Conditioin(N=256) Clean 58 23% 30

Unclean Adequate No Kitchen Garden

156 243 13

77% 95% 5%

13

Kitchen Gardening

14

Animal Shed(N=256)
Inside Home Attach with home Separate from home 15minute far No 5 136 63 33 19 2% 53% 25% 13% 7%

ANNEX 3

31

Photo gallery

A glance of Bonch V.D.C

First Day on Bonch with field coordinator. 2066/12/28

32

Rapport Build-up with community people 2066/12/2

Rapport Build up

33

Primary Data Collection 2067/01/01

34

35

Collecting Secondary Data from Health Post 2067/01/04

36

Focus Group Discussion

FGD program on Diarrhea 2067/01/13

37

College Representatives at F.G.D.

Group Photo after focus group discussion

38

Community Presentation

Participant on community Presentation 2067/01/24

39

Community Presentation

40

Group photo after community presentation

School health program on HIV/AIDS 2067/01/28 41

School Health Program

Health Education program 2067/01/28

42

College presentation

43

ANNEX 4

44

45

46

47

48