CHAPTER ONE INTRODUCTION

1.1Back ground Fast changes are taking place in the field of health. In Cameroon people are living unhealthy life bringing many health problems within them and their surroundings. In this age of globalization, with the aim of providing extensive courses in public health, the level 400 students of the FHS in the university of Buea were sent to the Kumba health district( KMHA more specifically) to conduct a community health survey. To this regard we hope that a report like this will help the community and the country to see the real health status of its people and encourage for uplifting health situations of the people. 1.2 Objectives of our Study 1. Describe the administrative, socio-cultural and demographic structure of their community. 2. Participate in preventive health activities at the level of the health facility including: IWC, Antenatal clinics, Nutrition education, HIV/AIDS prevention etc. 3. Describe the health facilities in their health area, their functioning, management and the role of the community in the functioning of the health facility. 4. Conduct a community health diagnosis, and describe the top ten major health concerns in the community. 5. Identify any occupational health risks in the community. 6. Assess the MDGs achievements in their respective health areas. 7. Assess the situation of water borne diseases in their health areas, identify risks factors specific to their community, recommend treatment and propose preventive methods. 8. Participate in health education activities in the health facility/heath area.

CHAPTER TWO METHODOLOGY

2.1 Methodology -Study Area: Kumba Mbeng Health Area. -Study Type: Descriptive type, Cross-sectional study. -Unit of Analysis: Households, Individuals. -Sample size: 485 Households, 2626 People. -Sampling technique: Convenient Sampling (ease of access) for household data collection. 2.2 Tools and Techniques of data collection -Structured questionnaire for both health facility and community. -Anthropometric instruments (weighing scale, measuring tapes) and assessment. -Group Discussions. -Observation. -Records review. -Chalk to indicate houses visited. -Camera: To take photographs. -Languages: English, French and Pidgin where necessary. -Internet: For references. 2.3 Data Sources. -Household heads or family members. -Chief of Centre (Bukemue Health Centre). -Heads of all health facilities visited in the health area. -Quarter Heads. -Schools.

2.4 Validity and Reliability -Discussion over questionnaire before data collection and everyday discussion on the procedure followed during data collection, adjustments to questionnaire, challenges faced during the data collection and suggestions to getting better information. -The houses were marked with chalk to avoid collecting information from a house twice. 2.5 Ethical Consideration. -Letters were given to quarter heads to obtain their permission to enter their quarters and also for them to inform the inhabitants of their quarters through the town criers. -Purpose and objectives of the study were explained and verbal consent was taken from each respondent. -Freedom was given to the respondent to skip any question during interview process. -Dignity of the individuals was highly considered. 2.6 Limitations of Study - The time for the survey was limitation. -Some of the people were very aggressive and unreceptive towards us. -Some of the people gave us fake information and some did not even give us answers to all the questions. -Inability to meet some people at home because they go to their farms or business places. -The rural areas were distant from our place of lodging and we had to move long distances or pay taxis to get there. -Inability to get give talks to some schools because of the time selected and the hierarchy to follow -Values gotten from health facility did not reflect the population of the KMHA and it caused some values to be exaggerated. - The weather and temperature was very unfavourable to us.

CHAPTER THREE FINDINGS

3.1 DESCRIPTION OF HEALTH AREA. The KMHA is found in Kumba (kumbaIII precisely), the capital of Meme division in the South West Region. This health area is bounded to the north by the fiango health area, to the south by Banga Bakundu health area, to the west by Kumba Town health area and to the east by Ntam health area. This health area has a total population of 24003 people and is made up of eight quarters listed below and their population; Makata 2 Nshie Menye Ekemue 1 Barombi Native Long Street Mapembe Mabonji Ekemue 2 2977 5677 3181 939 2461 1735 1310 5723

Of the eight quarters listed above, three are rural ( Long Street, Mapembe and Mabonji) while the remaining five ( Makata 2, Nshie Menye, Ekemue1, Barombi Native and Ekemue2) are urban. Most of the land in the urban quarters were inhabited (70%), but in the rural areas(30%) the people were settled mostly by the road side and the rest of the land used as farmlands.

3.1.1 ADMINISTRATIVE STRUCTURE. Kumba at the divisional level is headed by a Senior Divisional Officer who is followed by the Divisional Officer then the Government Delegate who heads the Kumba city council. The mayor heads the Kumba3 council and he reports to the Government Delegate. At the level of the community is the following hierarchy;

Paramount Chief Chiefs Quarter Head Councilors PTA Chairman The paramount chief (first class chief), the chiefs (third class chiefs) and the quarter heads are part of a traditional council. The quarter heads, their assistants and the Councilors form part of the quarter council which is also made up of a council chairman, his vice and a secretary who are still Councilors. The councilors are the blockheads (each quarter is divided into blocks).The PTA chairpersons represent their various schools. 3.1.2 SOCIOCULTURAL

Physical Environment
The KMHA consists of thousands of people of all age groups. The air is dusty during the dry season .In some quarters the land is leveled but in Mabonji and Mapembe the land is sloppy. The climate is hot and humid especially during the dry season. The drainages in Makata II were poor .

Health and Social Services.

The KMHA has a number of clinics and hospitals apart from the Bukemue health centre. Also present in this community are traditional healers (8) to whom some of the inhabitants go to in time of illness.

Economy

There is no main market in this area

The soil in this area is very fertile, and a good number of the inhabitants are farmers. They cultivate food crops like; Vegetables, Plantains, Cocoyams, Beans, Corn, Cassava(which some of the people use to make garri) and cash crops like; Cocoa, Palms, Rubber, (in quarters like Nshie Menye, Mabonji, Mapembe, Long Street and Barombi Native) for home consumption and also for commercial purposes. In addition animal farming is also practiced; animals reared include fowls, goats and pigs. In Barombi Native some people nursed seedlings of cocoa for commercial purposes as a means of survival. Places like hotels, schools, banks, petrol stations, health facilities, beer parlours, restaurants and small enterprises offers employment to most of the inhabitants.

Transportation and Safety.

The main road in the Kumba Mbeng community is tarred while the roads in the quarters are untarred and dusty during the dry season. Available in this community is a park and a railway station which provides transportation to its inhabitants. There are taxis and bikes which transport people around town. The community is safe but for a few cases of theft which occur sometimes. There is a police station in Ekemue1 which ensures safety to the inhabitants.

Politics and Government.

As seen under the administrative structure.

Communication.
Formal means Informal means Newspapers, radio, TV, phones ,internet Njangi meetings, town criers, councils, churches

Education.
Schools Nursery Primary Secondary Tertiary Government 3 3 5 0 Schools Mission Schools 3 4 2 0 Private 12 12 4 3 The highest educational attainment of the people were FSLC, O/L, A/L, MD, HND, Bachelors degree, secondary school. The languages spoken are English, French, Pidgin and their dialects. Most of the people could read and write (99.1).

Recreation.
The people of this community go to bars, matango clubs and football fields for relaxation.

Religion.
There are a good number of churches of different denominations. Also present are Muslims and those who believe in tradition.

Ethnicity.
The KMHA is a cosmopolitan area, made up of a diverse group of people.

Foreigners (Egyptians and Nigeria) are also present. Indicative of the different ethnicities are the many cultural meetings (Njangi groups) and the different traditional meals the people eat (mostly their preferences). Intermarriages are common. 3.1.3 DEMOGRAPHIC A. Demographic Indicators and their Numerical Values. Males Females Sex ratio Crude Birth Rate Crude Death Rate Dependency ratio % of pregnant women 1140 1486 77/100 Health Facility:50.83 per 1000 Community:31.99 per 1000 6.25 per1000 72.3% 3.2%

B. Population Pyramid.

Population pyramid : Kumba Mbeng Health area

Males 75+ yrs 70-74yrs 65-69yrs 60-64yrs 55-59yrs 50-54yrs 45-49yrs 40-44yrs 35-39yrs 30-34yrs 25-29yrs 20-24yrs 15-19yrs 10-14yrs 5-9yrs 0-4yrs 0.04% 0.19% 0.23% 0.84% 0.46% 1.52% 0.88% 2.40% 3.27% 3.27% -2.86% -4.61% -5.06% -4.38% -6.59% -6.28% 0.23% 0.84% 0.65% 1.48% 0.85% 1.71% 1.90% 2.55% 3.39% 3.80% 5.71% 4.45% 7.01% 6.59% 5.29% 10.13% Females

The population of age group 0-4 and 5-9 years is higher than the population 10-14 and 15-19 years which shows increase fertility. The population of age group 0-9 and 10-19 years is higher compared to the other age groups showing high fertility rate in the past 10-19 years. Female population is a little higher than the male population in the age above 70 years indicating a slightly higher survival rate of females than males The pyramid is typical of developing countries with more people in younger age groups.

3.2

Description of the Health Facilities

BUKEMUE HEALTH CENTRE Bukemue Health centre is the leading health unit in the KMHA. This health centre is found in Ekemue II precisely inside the Kumba Health District Service building. It popularly known as preventive and it is a pilot health centre in the district. The health centre was created in 1997 primarily to offer preventive services, but now it offers curative services. The following health units are in the KMHA; Presbyterian General Hospital Ejed Medical Foundation St Francis Polyclinic St Ricardo Pampuri clinic Bambini Medical Foundation Apostolic Health Centre

I.

STRUCTURE OF BUKEMUE HEALTH CENTRE

The health centre since its creation in 1997 has no permanent structure of its own. It has been patching in the District Health Service building where it uses 5 rooms. Below is a direction chart of the Bukemue Health centre offices in the DHS building. Direction Chart: Appendix II. FUNCTIONING

The Bukemue Health centre operates Monday to Saturday with working hours from 07am-3pm from Monday to Friday and 07am-12pm on Saturday. Personnel 1 SRN, 1Brevete nurse, 4 Assistant nurses, 2 Laboratory Assistants, 1 Microscopist, 1Microbiologist, 1Propharmacy Attendant,1 yardman,1 night watchman, 2 voluntary workers, 1Auxilliary giving a total of 16 workers. Minimum Activities Package (MAP)

Bukemue health centre offers the complete MAP required at First Line of Health Services (FLHS) which are; Curative care in the form of consultation, diagnosing and prescription of drugs. Antenatal care which is done every working day either on a one on one basis or in a group depending on the number of pregnant women who turn out for ANC on that day. Under-fives clinic. Follow up of chronic patients Family Planning. This too is done either on a one on one basis or as group. Nutrition Rehabilitation Participations to identify additional interventions and activities. The health centre does not carry out any deliveries, admissions and they do not have specific days for ANCs, family planning because they have no space and so cannot accommodate many people. Stations

Reception This station has no office; it occupies the open space at the entrance into the DHS building .This is where vital signs are taken. Consultation Room Clerking and Examination is done by nurses. This room is divided by a curtain into two stations so that two nurses can carry out consultations at a time. Also ANC, family planning, HIV counseling is done here. Dressing and Injection Room. 1 compartmentalized room used for; IWC, vaccinations, injections, wound dressing. This room has 2 beds where patients can lie to rest or take emergency drips. Laboratory Samples are gotten from patient and viewed under the microscope or tests are carried to detect cause of illness. The results are the issued to the patient. Pro-pharmacy This station has an attendant who acts as the cashier and the drug dispenser. It is called a propharmacy because it supplies drugs to other drug stores. Equipment

Beds Weighing Scales Microscope Centrifuge Refrigerators Autoclave Sphygmomanometer Stethoscope Participation in Primary Health Care

3 1 1 1 2 1 1 1

Bukemue health centre compared to the other health facilities in the area who participate very little or not at all, is the most involved in primary health care. This health centre is involved in primary prevention, secondary prevention and tertiary prevention III. MANAGEMENT

Administrative Structure: Chief of Centre Management Committee

Assistant Nurse

Pro-pharmacy Attendant

Reception

Consultation

IWC/Cold chain

Lab Department

Dressing/Inj ection room

Non-medical Staff

The health centre has a functioning management committee with the following members; a chairman who is elected from community representatives, a secretary who is the chief of health unit, a treasurer elected from community representatives and two other members who are elected from community representatives and who represent the area at the district level. The committee has the following roles; Participates in management of material, personnel and finances of the health unit. Identifies health problems and draws up a programme of activities for appraisal and approval by the general assembly of the health area committee.

 Employs the pharmacy attendant, night watchman and any other community staff if needed and also ensures the regular payment of the pharmacy attendant. Supervises the pharmacy to ensure its smooth daily functioning. Draws up the budget and submits for approval to the health area committee. Supervises collection of fees for services in the health centre and keeps financial records.

OTHER HEALTH FACILITIES The description of the other health facilities which are listed above is in the appendix Table 3.

3.3

COMMUNITY HEALTH DIAGNOSIS IN KMHA

Community Health Diagnosis is the comprehensive assessment of health status of an entire community in relation to social, physical and biological environment. The people of KMHA have so many health concerns but the top ten major health concerns are given below. These health concerns were ranked according to the number of people affected. Top Ten Major Health Concerns 1. Poor Quality and Sustainability of Drinking Water Good water is very essential to health. The people of KMHA lack safe pipe borne water. The tap water in this area is colored, has taste and is full of dirt particles. This has been a serious issue since July last year. As a result of this problem a majority of the population have to travel long distances to get safe water for drinking. These sources include boreholes which were built by benevolent people in the community and springs. Some people even travel to Mile 29 to get water from the supermont spring. Most of the springs had unclean surroundings which increased the risk of contamination.

83.3% of the population had unsustainable drinking water (had to travel long distances to get water) while 14.43% of the population had no access to safe drinking water (drank from

untreated wells and springs ). Consequences: High prevalence of malaria which is the reason for most consultations, admissions and deaths in the area , typhoid and other waterborne diseases . Appendix Table 4. 2. Improper Garbage Disposal methods The people of KMHA dump their garbage mostly in the open. More commonly in Ekemue I and II and Nshie Menye the people dump their garbage in Kumba water which runs in that area. Some of the people put their garbage in bags before throwing either into the city council truck which comes once in a week or mostly once in a month or like in the rural areas they took their garbage to their farms to use as manure. It is worth noting that these bags were uncovered which attract vectors and favour their growth. Some hospital wastes like syringes were poorly disposed of in kumba water. Risks and consequences: The growth of disease vectors like flies, rats, cockroaches and mosquitoes in open dump grounds. These vectors transmit diseases to the people. Also the syringes could be a source of infection as the water washes its content and some of the people use the water for their different purposes. 3. Inadequate Housing Conditions Overcrowding was a problem in this community as evident by the number of people living per room.

In quarters like Mabonji,Mapembe,Long Street and CCAS quarters , most of the houses were built close to each other (shared the same wall). Most the houses of Mabonji and Long Street had uncemented floors. Most of the houses especially those made of wood (29.9%) were unsafe due to poor maintenance. Risks and Consequences: Increased risk of transmission of URTIs as evident by its prevalence (see appendix Table 4) The uncemented floors also pose a problem since they cannot be cleaned properly thus easily habour pathogens and vectors. 4. Reluctance to Use Mosquito Nets and Poor Vector control In the course of our survey a number of people complained of not haven received mosquito

nets(especially in Mapembe). Reasons for not using: Heat, fear of death (from past stories), inadequate knowledge of proper use, and poor education on benefits of usage. Also the vectors in this area are hardly controlled since the garbage is still dumped in the open and poor toilet sanitation which favour growth of the vectors. Food is poorly preserved (29%of households) which attracts the vectors. Also the people are negligent towards the vector control. Consequences: High prevalence of malaria and other diseases transmitted by the vectors. 5. Pollution

Water pollution: This was a problem in our community because in some of our quarters (Ekemue I and II and Nshie Menye) a majority of the population dumped their garbage into kumba water, others washed their clothes in this water and fertilizer washed off from farms around the water pollutes the water. Hospital wastes thrown into the water pollutes the water.

Risks and Consequences: some people did fishing in the kumba water exposing them to: Skin infections and parasitic infections since the fish is an intermediate host for some of these parasites. This is evident from the prevalence of helminthic infections and skin infections (Appendix Table 4) Air Pollution: This is due to burning of garbage where 27.2% of the households burn their garbage (nondegradable). The KMHA also has many untarred especially within the quarters which are very dusty during the dry season. This is worsened by cars and bikes that pass on these roads raising dust and emitting toxic gases. 28.2% of the households lived by these dusty untarred roads. Also 51.8% of the households use solid fuels to cook their food. The smoke from these can be hazardous to the lungs. Risks and Consequences; There is an increase risks of transmission of RTIs and irritation of mucosal membranes (conjunctivitis) as seen by the high prevalence of RTIs. 6. Poor Latrine Sanitation and Safety

Most of the households in the rural areas used poorly constructed toilets. Most of the toilets had just two planks for support and the walls were made of old clothes, rust zinc and grass. Appendix pic In CCAS quarter which is a student residential area, an average of 9 people used a single pit toilet .A similar case was seen in Makata II with an average of 7 people per toilet and certain parts of Mabonji with 10 people per toilet. To remedy this use of toilet with several people some people used pails (4.12%) and emptied into the toilet. Risks and Consequences: Transmission of STIs like Trichomoniasis especially in females, negligence to maintain proper sanitation due to lack of organization since many people use the toilet, pails used could be a means of transmission of parasites. 7. Distance to Health Facility

Certain quarters (especially the rural areas) in the KMHA could not access the health facility even after a 30minutes walk. The table below gives the various distances and time to reach health facility (BH). Quarter Makata II Nshie Menye Ekemue I Ekemue II Barombi Native Long Street Mapembe Mabonji Distance 3.5km 2.5km 2km 4km 4km 4km 4km 8km Time 1hour 1hour 30minutes 1hour 30minutes 1hour 30minutes 1hour 30minutes 1hour 30minutes 3 hours

Consequences: Reluctance to go to health facility due lack of transport fare, emergencies could be brought late to the health facility; people would prefer to go to chemists (28%) for consultation. 8. Low Health Personnel to Population Ratio From our findings we had 91 health personnel, 9 doctors, 68 nurses and 14 lab technicians Health personnel to population ratio Doctor to population ratio Nurse to population ratio Lab Technician to population ratio 1:264 1:2667 1:353 1:1715

Consequences: Low quality of health services rendered to population due to work overload since some of the health facilities are underused. 9. Poor Transport Safety

The majority of the population use motor bikes as a means of transportation around the community. These motor bikes carry overload either with passengers or goods especially with the issue of water scarcity where bike drivers are paid to transport many liters of water to some households. The majority of the RTAs are bike related. The bike drivers barely put on helmets and most of them drive in slippers. Some of the bridges were not maintained and were very unsafe (support figure: Appendix pic 3) Consequences: Accidents 10. Alcohol Abuse and Cigarette Smoking From our study we found that 1.22% of the population was smokers and 20.35% consumed alcohol. This alcohol could be beer or palm wine (especially in the rural areas). 0.72% of the total population abuse alcohol consumption by consuming an average of 20 bottles of beer a week. Consequences: lung diseases for smokers, increase risks of cancers, arteriosclerosis and hypertension, liver problems and decreased years of living.

3.4 OCCUPATIONAL HEALTH RISKS IN THE KMHA

OCCUPATION

HEALTH HAZARDS

OUTCOME

RISK EVALUATION

CONTROL

Farmers

-Exposure to toxic chemicals and farm soil dust.

-Cancers -Poisoning. -Respiratory tract infections. -Loss of sense of smell.

-Low to moderate -moderate -moderate -low

-No smelling of chemicals. -Better handling of chemicals and use of protective equipments(gloves) -Wash hands with solvents after work. -Use of protective equipments like gloves and boots. -Enough rest. -Aid in the form of better farming materials and methods from small cooperatives. -Use of protective wears. -Careful use of farming equipments. -Avoid climbing wet trees. -Palm wine tappers should fasten their ropes. -Care should be taken as the farmer moves around the farmlands.

-Exposure to diseasecausing microorganisms.

-Schistosomiasis, athletes foot,

-Low

-Physical and psychological stress.

-Poor yield. -Exhaustion

--Moderate -High

-Trauma Cuts Falls

-Wounds -Infections(e.g tetanus) -Fractures -Wounds -Musculoskeletal pain -Moderate -Moderate-High -Moderate

-Exam/Study related stress

-Headache(Migraine) -Poor performance -Depression -Pregnancy -STIs

-Low -Moderate

-Enough Rest -Early preparation

-Sexual harassment.

-High especially in females. -

Students -Starvation -Epigastric pain. -Body weakness and deceased efficiency. -High

-Decent dressing. -Legitimate punishment on defaulters. -Sensitization against sexual harassment. -Appropriate management of food and finance. -Regular intake of food.

-Noise

-Headache

-Low to moderate

-Better classroom management. -Better planning.

-Work related stress

-Absenteeism from work. -Headache -Respiratory tract infections

-Moderate

Teachers

-Blackboard chalk.

-Moderate to high

-No better control method.

-Prolonged standing -Varicoses -Joint pain -Thrombosis -Infection -Absenteeism from work -Low -Advice teachers to sit when not lecturing -Appropriate safety measures wearing of gloves and air mask and proper hand washing. -More educative forums like seminars to teach quality control measures. -Adequate rest -Patients visiting hours should be strictly followed. -Ensure that hospital shoes are worn.

-Biologic hazards. For example; Cholera, Tuberculosis, HIV/AIDS. Health workers -Psychosocial hazards like stress.

-Moderate to high -Low

-High -Decreased efficiency.

-Physical hazards; Noise -Headache Slips trips -Sprains, fractures

-Low -Low

-Inhalation of wood dust. Carpenters -Physical trauma

-Upper respiratory tract infectionsCancers.

-Moderate -Low

-Air masks should be worn. -Use of gloves to protect hands.

-Fractures -Blisters -Fractures -Wounds. -Disability. -Death

-High -Adequate usage of equipments. -Moderate -Moderate -Moderate -Low to moderate -No alcohol consumption before and during driving. -Follow high way codes. -Adequate usage of safety measures like seatbelts, helmets. -Enough rest. -Avoid overload.

-Road Traffic Accidents

Drivers

Business people.

-Noise. -Work related stress. -Stress from taxation, theft.

-Headache -Restlessness. -Suicide, stroke, hypertension

-Moderate -High -Low to moderate

-Adequate rest -Insurance

OCCUPATION

HAZARDS

OUTCOME

RISK EVALUATION

CONTROL

3.5 ASSESSMENT OF MDGs ACHIEVEMENTS IN THE KMHA. The MDGs are a summary of the development goals agreed on at various international conferences. The goals are 8 in number, with 18 targets and 48 indicators. These values are assessed against the MDG values obtained for Cameroon updated as of 2012(UN MDG Progress Report). Considering KMHA to be a subset of Cameroon, comparism is done against these values Goal 1: Eradicate extreme poverty and hunger Target 1: Halve, between 1990 and 2015 the proportion of people whose income/consumption is less than 1$ a day. Indicators Findings(2013) 1990 value Other values 1.Proportion of population living below 1$ per day 26.4% 2001: 10.8% Goal may not be achieved. People are still living in poverty due to the economic crises and they are struggling to make ends meet. Some people are farmers who cultivate most of the food they eat and will barely spend 1$ a day Target 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger. 4.Prevalence of moderately underweight children(U5 of age) 1.4% 1991: 18.0% 2004:15.1% 10% Goal achieved .The children have low weight because of poverty and they lack a balanced diet to keep them 1996: 24.9% Expected value in 2015 Commen t

healthy. Goal 2: Achieve universal primary education Target 3: Ensure that by 2015, children everywhere, boys and girls alike will be able to complete a full course of primary schooling. Adult literacy rate Proxy indicator: proportion of 1524 years population who have completed primary education 99.1% 100% By 2015 this goal may not still be achieved since those who have not completed primary education and who are not in school now would not have finished primary education. Goal 3: Promote gender equality and empower women Target 4: Eliminate gender disparity in primary and secondary education, preferably by 2005, and to all level of education no later than 2015 Ratio of girls to boys in primary, secondary and tertiary education. Primary:128% Secondary:99.9% 100% Goal achieved indicating that girls and boys have equal and even more opportunities to participate in education at all levels 44.4% 1990: 14.4% 2005:8.9% 50% Goal is on track. Women are now

empowered to higher posts of responsibilities and since there are more women we expect more women in high posts to eliminate the disparity. Goal 4: Reduce child mortality Target 5: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate Under-five mortality rate 54.1 per 1000 live births 1990:145.2 2000:139.5 48.4 per 1000 Goal achieved. This show the improvement in child health over the past 2 decades. Infant mortality rate 71.4 per1000 live births 1990:56 2000:86.3 18.7 per 1000 Far from being achieved. Social, economic and environmental factors still impinge on childrens health. Some mothers are illiterate. Malaria too constitutes a big problem. Proportion of 1year old children 99.7% 0.3% was not 1990:56 18.7% Goal is on track. Measles will no

immunized against measles

immunized against measles.

2006:73

longer be a threat to childrens health.

Goal 5: Improve maternal health Target 6: Reduce by three quarters, between 1990 and 2015 the maternal mortality ratio Target 7: Achieve by 2015, universal access to reproductive health Maternal Mortality Ratio 163.9 per 100000 1990: 670 2000:730 167.5 Goal achieved. The ratio keeps changing which may be due to unsafe abortions, Malaria during pregnancy or infections. Proportion of births attended by skilled health personnel 96.4% 1991:63.8 2000:60.0 17 Goal achieved. This shows that most of the pregnant women use the health facilities. Target 7 Contraceptive prevalence rate 33.3% 1991: 16.1 2000:25.6 100% The goal still has a long way to be achieved .Many people have not had access to reproductive health services and some of

those who have do not use it because of fear of the side effects or it is against their tradition or religion. ANC coverage 91.67% 1991:78.8 2000:75.3 2006:82.0 Goal 6: Combat HIV/AIDS, malaria and other diseases Target 8: Have halted and begun to reverse the incidence of malaria and other major diseases. Prevalence and death rate associated with malaria. Prevalence: 53680 per 100000. Death rate: 150 per 100000 Prevalence 2008:27818 Death rate: 2008:103 0 This goal is beyond achievement. The mosquito nets shared are not used by everybody, the level of sanitation is still low and many deaths are caused mainly by malaria. Prevalence of Tuberculosis 512 per 100000 1990: 123 2000:224 0 By 2015 goal would not be achieved. The disease is airborne and overcrowding homes favour the 100% Goal is on track given that access is increasing slowly but surely.

transmission. Goal 7: Ensure environmental sustainability Target 9: Integrate the principles of sustainable development into country and programs and reverse the loss of environmental resources. Proportion of population using solid fuels 51.8% 2001:83 2007:81 0 Goal may not be achieved by 2015. With the changing times people are adapting to less stressful means of living. Target10: Halve by 2015 the proportion of people without sustainable access to safe drinking water. Proportion of population with sustainable access to an improved water source. 86.4% 1990:49 2000:64 74.5% Goal is already achieved. The number is increasing and better techniques of improving water are developed. Goal 8: Develop a global partnership for development. Target 18: In cooperation with the private sector, make available the benefits of new technologies, especially information and communication. Cellular subscribers per 100 population 29.7% 2000: 0.66% 2006:17.47% The number of phone users is increasing as the need for communication. By 2015 not

everybody will have phones but the number must have greatly increased since nowadays even children possess and use phones Internet users per 100 population 8.3% 2000:0.25% 2006: 2.03% This number is increasing and by 2015 about 20%of the population will be able to use the internet since children are taught computer as a subject nowadays.

3.6 Situation of water borne diseases, risks factors, proposed preventive methods and recommended treatment Waterborne diseases are illnesses caused by pathogenic microorganisms. These microorganisms are transmitted by bathing, washing, drinking and preparing food with contaminated water or consumption of infected food. In the KMHA the common waterborne diseases are: Typhoid, Gastroenteritis, Amoebiasis, Worms (helminthic infections like schistosomiasis) and Skin infections. Prevalence: Appendix Table 4 Transmission: Faeces Flies Water Food Mouth Risk Factors Poor sewage and improper garbage disposal Overcrowding Poor quality of water Burst/exposed water pipes Uncovered wells Poor constructed toilets (close to water source, built with sticks and exposed). Proposed Preventive Methods Most of the preventive methods will be to break the transmission routes which are: Educate people on advantages of disinfecting drinking water either by boiling or by use of disinfectants like chlorine (Tell them the MIC necessary for purification) and also safe storage of water. Talk to people on importance of covering their wells and sensitization against bathing in rivers. Educate people on proper handling and cooking of food. Hands

Education on proper hygiene and sanitation i.e. waste disposal, sewage disposal, cleaning of toilets to avoid flies, and hand washing with soap. Recommended Treatment. Diseases Gastroenteritis and Amoebiasis Worms Skin infections Typhoid Treatment

Ciprofloxacin, Caftriaxone

CHAPTER FOUR PARTICIPATION IN PREVENTIVE HEALTH ACTIVITIES AND IN HEALTH EDUCATION ACTIVITIES IN THE HEALTH FACLITY/HEALTH AREA. Health Facility The BHC offers the following services: IWC, ANC, Nutrition Education, Family Planning, Under5 clinics, HIV/AIDS Prevention, and also participates to identify additional interventions. This is done daily due to lack of space to accommodate many patients on specific days and also because the turnout is usually low. We could not participate in the above activities because they were done on a one on one basis for reasons listed above and so we only had the opportunity to sit and listen to the nurse talk to the patients. The BHC also participated in outreach activities on a weekly basis which we still did not participate. Health Education It was carried out in the Apostolic Primary School and the talk was on personal hygiene and sanitation. We spoke to the pupils on how to care for their hair, nose, ears, teeth, hands, feet, skin, genital organs and their clothes (uniforms inclusive).To assess their participation, each speaker asked a number of questions to the pupils and gifts (pens) were awarded to deserving pupils At the secondary school level we could not give them a talk (on STIs since it was common in CCAS quarters which is a student residential area) since they had their sequence exams going on by the time we went there to seek permission from the principal. In the community as we moved around asking questions to the people we used the opportunity to talk to them about good hygiene and sanitation.