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A Report on Community Health Diagnosis
Melamchi VDC, Sindhupalchowk
Submitted By Group-B
BPH Second Year (First Batch) Valley College of Technical Sciences
Submitted to Department of Public Health
Valley College of Technical Sciences Mid-Baneshwor , Kathmandu
2010
A Report on Community Health Diagnosis
Melamchi VDC, Sindhupalchowk
Submitted By Group: B
BPH Second Year (First Batch)
Valley College of Technical Sciences
Submitted To Department of Public Health
Valley College of Technical Sciences
Mid- Baneshwor, Kathmandu
2010
GROUP MEMBERS
1. ANIL DHUNGANA 2. ANJANA DAHAL
3. BISHAKHA POKHREL 4. DEEPA POKHREL
5. DINESH RUPAKHETI 6. MOHAN DC
7. PRABESH GHIMIRE 8. SAILAJA GHIMIRE
9. SAMEER SHRESTHA 10. SUJEETA THAPA
11. SWEETY PANNACHAN 12. UTTAM GAUTAM
VALLEY COLLEGE OF TECHNICAL SCIENCIES
SUBMITTED TO
MIDBANESHWOR, KATHMANDU
(Affiliated to Purbanchal University)
i
AACCKKNNOOWWLLEEDDGGEEMMEENNTT Behind successful accomplishment of our one month long Community
Diagnosis field programme lies the candid abutments and sumptuous kindness of
many luminaries. This field report is therefore, not the exclusive product of our group.
We owe much of the credit to the support and assistance of many helping hands.
We express a deep gratitude to the people of Melamchi VDC for their
invaluable cooperation and magnanimous hospitality. Special thanks goes to Mr.
Ganesh Oli, local teacher of Jyamire VDC who helped us immensely, letting us pilfer
times to us out of his busy schedules. Our sincere thanks go to Mr. Radha Krishna
Shrestha (Headmaster, Indreshwori H.S. School), Mr. Dol Bahadur Ghale (VDC
assistant secretary) and the whole VDC family. We are very much grateful to Dr.
Romi Dahal, Mr. Jaya Krishna Shrestha (VHW) and all the staffs of PHC.
We cordially gratify all the teachers of Indreshwori High Secondary School, for their
colossal support. Pragati Boarding School, Samata Secondary School, also deserve
special thanks for their help and support. Mr. Sagar Shrestha, chairman of Melamchi
Club, Mr. Mahesh Dulal, Community Yuva club, Mr. Hari Sapkota, Chairman of
BalClub is pertinent for heartfelt acknowledgements.
We are also indebted to the local leaders of the VDC, Rajendra Prasad
Shrestha, Siddhi Charan Shrestha, for attending the community presentations and
imparting valuable suggestions to us. We are indebted to inspector Mr. Chiranjibi
Dahal (Area Police Office, Melamchi) & Mr. Krishna Shrestha (Melamchi Drinking
Water Development Committee). Mr. Tirtha Man Tamang (Melamchi Point Guest
House) also could not be forgotten for his valuable support during our stay at
Melamchi.
We thank the director of Valley College of Technical Sciences Dr. Yubin
Pokhrel, Campus Chief Prof. Hari Bhakta Pradhan; Mr. Dillee Prasad Paudel (field
co-ordinator), Mr. Pramod Koirala, Mr. Subash Adhikari, Mr. Om Sharma and all the
staffs of Valley College of Technical Sciences.
We also would like extend our warmest appreciation to our colleagues for
their cheerful encouragement, amiable affection and ongoing support.
Last but not the least we would like to gratify all those who helped us directly
or indirectly to make our field visit successful.
Group B
ii
PROLOUGE
“of] 6'sL d'gLsf] c+Wof/f] efUf xf] .”
The much pessimistic expression articulated by literati and ex-headmaster of
Shree Indreshwari Higher Secondary School, Mr. Rajendra Shrestha. The expression
could apparently connote the problem of water including genuine picture of
Melamchi.
Despite the two major rivers, The Melamchi & The Indrawati, graceful at the
heart of Melamchi as the chattels of the entire nation, the setback of drinking water in
Melamchi is really an insignificant co-incidence. In the dearth of apt utilization of
local resources, the people of Melamchi are still to live in despair and misery resulted
by paucity, ignorance and hardship.
Moreover, we understood that the above expression was indirectly pointing
towards the hope and confidence for the dawn, the ray of development to fall upon the
Melamchi. There is an undeniable fact that although Melamchi being the only
marketplace for more than fourteen nearby VDCs, the coin is yet to turn in favour of
Melamchi. Regardless the much possibilities for development, the blossom of
prosperity, socio-economic change, educational development & optimum health are
yet to sprout.
Now the time has come for the people to explore their potentialities, ignite the
lamp and diffuse the ray of brightness at all the dimensions to prove the
overwhelming change.
Group - B
iii
ABBREVIATIONS
AHW = Auxiliary Health Worker
AIDS = Acquired Immune Deficiency Syndrome
ANC = Ante Natal Care
APD = Acute Peptic Disorder
ARI = Acute Respiratory Infections
ASDR = Age Specific Death Rate
ASFR = Age Specific Fertility Rate
BCG = Bacille Calmette Guerin
BPH = Bachelor of Public Health
CBR = Crude Birth Rate
CBS = Central Bureau of Statistics
CD = Community Diagnosis
CDR = Crude Death Rate
CHD = Community Health Diagnosis
CPR = Contraceptive Prevalence Rate
DDC = District Development Committee
DFTQC = Department of Food Technology and Quality Control
D/J = Dhami/ Jhankri
DOHS = Department of Health Service
DPHO = District Public Health Office
DPT = Diptheria Pertusis Tetanus
FCHV = Female Community Health Volunteer
FGD = Focus Group Discussion
FP = Family Planning
GFR = General Fertility Rate
HH = Household
IEC = Information, Education and Communication
IMR = Infant Mortality Rate
INGO = International Non Governmental Organisation
KAP = Knowledge Attitude and Practice
iv
KDS = Kami Damai Sarki
MCH = Maternal and Child Health
MDWC = Melamchi Drinking Water Committee
MHP = Micro Health Project
MMR = Maternal Mortality Rate
MOH = Ministry Of Health
MUAC = Mid Upper Arm Circumference
NGO = Non Governmental Organisation
NHEICC = National Health Education, Information and Communication
Centre
ORS = Oral Rehydration Solution
PHC = Primary Health Center
SDK = Safe Delivery Kit
TB = Tuberculosis
TBA = Traditional Birth Attendant
TFR = Total Fertility Rate
TT = Tetanus Toxoid
U5
VCTS = Valley College of Technical Sciences
MR = Under 5 Mortality Rate
VDC = Village Development Committee
VHW = Village Health Worker
v
SUMMARY
This report is the output of Community Health Diagnosis field study
conducted in Melamchi VDC of Sindhupalchok district conducted in an effort of a
team of twelve members, student of BPH 2nd
The goal of Community Diagnosis was to learn from community people to be
with them in the process of acquiring knowledge and skill to identify the health
related problems, their causes and resources available in the community.
year, 1st batch (Group B), Valley
College of Technical Sciences, Mid-Baneshwor, Kathmandu in the duration of one
month dated from 27 Chitra 2066 to 27 Baisakh 2067 BS.
This report includes an analysis of findings from household surveys,
interviews, FGD held with students in Melamchi VDC as well as secondary data
obtained.
A total of 737 households with a population of 4582 were observed from the
DDC record. Among them, we selected one third of households following cluster
sampling technique. The sample consists of 676 females (49.70%) and 684 males
(50.3%), male female ratio of our study was101:100.
The average family size was 6.07. The total dependency ratio of the Melamchi
was 61.14 per 100 populations with a child dependency of 53.79 per 100 and the
elderly dependency of 7.35 per 100.Disability rate was found to be 16.18 per 1000
populations.
The Crude Birth Rate and Crude Death Rate was 19.12 and 8.82 per 1000
population. No any case of maternal mortality was found in our sample study.
The majority female got married at the age below 20 years.
Regarding the educational status, the total literacy rate was 70.19% with a
male literacy of 77.62% and female literacy of 64.05%.
84% people were engaged in agriculture, 6.25% Service, 15.35%, business,
2.6% labor and the rest other.
27.37% populations over 15 years of age were smokers, 25.38% were alcohol
consumers and 15.34% were reported chewing tobacco.
vi
The top 5 diseases found from the household survey were APD/gastritis,
dental problem, diarrhoeal disease, skin disease and eye problem.
Majority of the women of this VDC i.e. 52.06% had their first child before 20
years of age. Only 38% of pregnant women obtained 4 ANC or more.75.34%
pregnant women were immunized with TT and Iron tablets coverage was 39.7%. It
was found that 50% women used to do heavier works during pregnancy period and
only 34.25% consumed more nutritious food.
64.34% of the births were taken at home and among them only 33% used safe
delivery kit. Out of those who did not use SDK, 27.66% used sickles/old instruments
for cutting cord .Out of the 158 eligible couples included in our study 61.39% were
found currently using family planning devices.
It was found that the coverage of BCG was 100%; DPT, polio and hepatitis B
95.3% and Measles 83%.
90% of children were fed with the colostrum rich milk whereas; only 43.84%
had exclusive breast feeding up to 6 month.
Among the children of 1-4 years only about 66% had their MUAC in normal,
26% were in risk and 8% were found having severe malnutrition.
The toilet coverage was 62.95% with 33.33 % sanitary latrine.
83% household used dhara/ dhungedhara for taking water and 93% did not use any
purification method.
26% and 43.75% households threw solid and liquid waste haphazardly.
Only 27% washed their hand before meal.
51% used soap and water, 33% used water only and remaining used ashes,
mud and water for washing hands whereas 6% did not wash their hands after
defecation.
78% knew about the causes of disease. The population preferred going to
health institution first after getting sick was 66% whereas 30% people still believed
upon Dhami/ Jhankri
25% did not have knowledge on transmission of diarrhea and 79% knew about
Jeevanjal.
vii
Only 74% heard about pneumonia and among them 84% went to health
institution for the treatment of pneumonia.
Among total respondents 57% heard about TB out of which only 49.6% had
right knowledge about mode of transmission and 73% knew that TB is curable.
Among total respondents still 41% did not know about AIDS. 85% of total
known about AIDS knew that it is a communicable disease.
38% did not know about polio disease, among known 85% did not know about
transmission of polio.
viii
TABLE OF CONTENT
Content Page No.
GROUP MEMBERS
APPROVAL SHEET
ACKNOWLEDGEMENT i
PROLOGUE ii
ABBREVIATIONS iii
SUMMARY v
TABLE OF CONTENTS viii
LIST OF TABLES x
LIST OF FIGURES xi
CHAPTER I: INTRODUCTION 1-6
1.1 Introduction to Community Health Diagnosis 1
1.2 Purpose and Objectives 1
1.3 VDC profile 3
1.4 Social map 5
1.5 Work Plan 6
CHAPTER II: METHODOLOGY 7-11
2.1 Study Methodology 7
2.2 Validity and Reliability 8
2.3 Exclusion criteria 10
2.4 Ethical consideration 10
2.5 Logistics 10
2.6 Limitations and constraints 11
CHAPTER III: MAJOR FINDINGS OF MELAMCHI VDC 12-56
3.1 Major Findings 12
3.2 Observation findings 50
3.3 Discussion 52
ix
CHAPTER IV: FOCUS GROUP DISCUSSION 57-60
CHAPTER V: COMMUNITY PRESENTATION 61-63
5.1 First Community Presentation 61
5.2 Final Community Presentation 63
CHAPTER VI: MICRO HEALTH PROJECT (MHP) 64-71
6.1 Introduction 64
6.2 Goal and Objectives 65
6.3 Process of MHP 65
6.4 Sustainability of the programme 70
6.5 Learning and experiences 70
CHAPTER VII: CONCLUSION AND RECOMMENDATION S 72-76
7.1 Conclusion 72
7.2 Recommendations 75
CHAPTER VIII: MOMENTS TO SHARE 77-78
CHAPTER IX: EPILOGUE 79
CHAPTER X: BIBLIOGRAPHY 80
CHAPTER XI: ANNEX 81
x
LIST OF TABLES
Table No. Title of tables Page No.
Work plan 6
1. Age sex composition by caste 12
2. Literacy rate and Educational status 16
3. Observation findings 50
4. Comparative figures 52
5. Staffing pattern at PHC 54
6. No. of patients getting free health
services at PHC 54
7. No. of pregnant women attending
for ANC check-up 55
8. Vaccination coverage 55
9. No. of children taking Vit. A and
De-worming tablets 55
10. No. of pregnant women taking iron and
De-worming tablets during pregnancy 56
11. No. of people using FP contraceptives
from PHC 56
12. Felt Needs and Observed Needs Of VDC 67
13. Real Need of VDC 67
14. Planning for MHP 68
xi
LIST OF FIGURES
Figure No. Title of figures Page No.
1. Social map of Melamchi VDC 4
2 Pyramid 13
3. Types of family 14
4. Main source of income 15
5. Main source of water 17
6. Water purification methods 18
7. Solid waste management 18
8. Liquid waste management 19
9. Place of defaecation 19
10. Cause of having no latrine 20
11. Practice of washing hands after defaecation 21
12. Practice of washing hands before having meals 21
13. Cause of disease 22
14. Prevention of disease 23
15. First contact after being ill 23
16. Reasons for not visiting health facility 24
17. Knowledge on transmission of Diarrhoea 24
18. Knowledge on management of Diarrhoea 25
19. Heard about Jeevan- Jal 25
20. Knowledge on Jeevan- Jal preparation 26
21. Knowledge on communicability of Diarrhoea 26
22. Knowledge on symptoms of Pneumonia 27
23. Treatment of Pneumonia 27
24. Heard about TB 28
25. Knowledge on transmission of TB 28
26. Treatment prognosis of TB 29
27. Smoking, Alcoholism and chewing tobacco 29
28. Heard about HIV/ AIDS 30
29. Knowledge on communicability of AIDS 30
30. Knowledge on transmission of AIDS 31
xii
31. Treatment prognosis of AIDS 31
32. Knowledge on AIDS prevention 32
33. Heard about Polio 32
34. Knowledge on transmission of Polio 33
35. Immunization coverage 33
36. Use of Family Planning methods 34
37. Choice of Family Planning methods 35
38. Reasons for not using Family Planning devices 35
39. Knowledge on preparation of super-flour 37
40. Salt using practice 37
41. Vit-A & De-worming tablet coverage 38
42. Reasons of intestinal worming 38
43. Practice of washing vegetables 39
44. Cause of malnutrition 39
45. Control of malnutrition 40
46. Nutritional assessment of U-5 children by MUAC 40
47 Nutritional assessment by Gomez classification 41
48. Age at marriage 42
49. Age at first pregnancy 42
50. Frequency of ANC check-up 43
51. Food habit during pregnancy 43
52. Workload during pregnancy 44
53. Complications during pregnancy 44
54. Pregnant women receiving TT vaccine & de-worming tablet 45
55. Place of delivery 45
56. Use of safe delivery kits 46
57. Substances used for cord-cutting 46
58. Substances used after cord-cutting 47
59. Fed on colostrums 47
60. Frequency of breast-feeding 48
61. Start of weaning food 48
62. Iron supplementation 49
63. Phases of MHP 60
1
Chapter I
INTRODUCTION
1.1 Introduction to Community Health Diagnosis
Community diagnosis is a comprehensive assessment of health status of the
community in relation to its social, physical and biological environment. The purpose
of community diagnosis is to define existing problems, determine available resources
and set priorities for planning, implementing and evaluating health action, by and for
the community. (Dr. Cynthia et al, 1996)
Besides, community diagnosis is not only the most important tool for the field
based learning, but also a foundation approach to develop innovative graduates who
can accept the challenges of diagnosing the health problems and developing the
appropriate programs to solve them at district level without depending on others. As
per the new health delivery system, a medical graduate should work as a health expert
and should manage the district health system for which community diagnosis gives a
foresighted vision.
It is a process for finding out the health and disease status of a community by
examining and analyzing the pattern of factor influencing the health and disease
condition of a community to successfully carry out health program to solve the health
and disease problem of the community.
1.2 Purpose and Objectives
1.2.1 Purpose
• To define existing problems.
• To explore existing and potential resources.
• To set priorities for planning, organizing and implementing health action or
program.
2
1.2.2 Objectives
General Objectives
1. To achieve basic concept and skill in diagnosing community health and
management plan.
2. To identify health problems, their underlying causes and conduct micro health
project by the use of locally available resources in community.
Specific Objectives
1. To assess the demographic, educational, cultural, and socio-economic status of
the community.
2. To assess the prevalent health problems and the determinants influencing
health and diseases.
3. To assess the knowledge, attitudes and practice of the community people
regarding health and disease and change it accordingly.
4. To assess the nutritional status of the under 5 year children in common.
5. To find out health seeking behavior/health service utilization pattern of the
community.
6. To identify the major health needs of the community and prioritize it.
7. To present our major findings and recommendation at the VDC and University
level.
8. To assess the knowledge, attitude and practicing pattern of the community
about MCH/FP.
9. To identify the environmental status of the community.
3
1.3 Profile of Melamchi VDC
Melamchi is one of the prototypes among 79 VDCs of Sindhupalchowk
District. It is about 80 km away from Kathmandu and 23 Km from the nearest
highway, The Araniko Highway. Duwachaur & Bansbari VDCs surround this village
on the north & south respectively, Sindhukot & Talamarang VDCs on the west.
‘Indrawati & Melamchi Rivers’ separate it from Jyamire & Shikharpur VDCs in the
east.
Melamchi VDC experiences mild temperate type of climate, neither too hot
nor too cold, and with average rainfall.
1.3.1 Geography
Boundaries
• East: Jyamire VDC, Shikhapur VDC
• West: Sindukot VDC, Talamarang VDC
• North: Duwachaur VDC
• South: Bansbari VDC
Topography
• Area: 11.98 sq.km
• Region: Hilly
• Altitude: 800-1500m
1.3.2 Socio-economic
• Occupation: Agriculture, Service, Business, Labours, Animal husbandry etc.
• Religion: Hinduism, Buddhism, Christianity
• Language: Nepali, Tamang, Newari
• Costumes: Kamij, Suruwal, Topi, Kachhad, etc.
Ethnicity
Brahmin, Chhetri, Tamang, Newar, Danuwar, Ghale, Damai, Kami, Sarki, etc
4
Educational Status
No. of primary schools:
Government Schools: 4
Panchakanya Pra. Vi.
Bhairabi Pra. Vi.
Daduwa Pra. Vi
Jageshwari Pra. Vi
Private School: 1
Community School
No. of secondary schools
Government schools: 1
Jana-Jagriti Ma. Vi
Private schools: 2
Samata Sikshya Niketan
Pragati Secondary School
No. of higher secondary schools
Government schools: 1
Indreshwari Higher Secondary School
Natural Resources
Rivers:
Indrawati
Melamchi
Nwar Khola
Community forests
Organizations
Local Clubs: 8
5
1.4 Social Map of Melamchi VDC
Social mapping was done on 30/12/2066. It was accomplished through
information provided by the community people and some local leaders. The VDC
boarders was first sketched based on the VDC map available at the PHC. Wards were
then divided with the help of VDC and PHC offices. Various landmarks and points of
information on the map such as important locations of health facilities, schools, VDC
office, drinking water source, roads, jungles, temples etc. were plotted, according to
the information obtained from those officials. Later the map was corrected based on
our observation and information by community people. Finally the map was revised
by assistant speaker of VDC office to give it a concrete shape.
Figure 1: Social map of Melamchi VDC
6
Work - Plan
S.
No
Date Activities
1 27/12/2066 • Departure from college
• Arrival at Melamchi
2 28/12/2066-29/12/2066 • Rapport building
3 30/12/2066-01/01/2067 • Secondary data collection
• Social mapping
• Sampling
4 02/01/2067-09/01/2067 • Household survey
5 10/01/2067-11/01/2067 • Data processing, analysis, interpretation
• Prioritization of observed needs
• Planning for FGD
6 12/01/2067 • Focus group discussion
7 13/01/2067-14/01/2067 • Preparation/planning for first community
presentation
8 15/01/2067 • First community presentation
9 15/01/2067-17/01/2067 • Preparation/ planning for MHP
10 18/01/2067-25/01/2067 • Implementation of MHP
11 26/01/2067 • Evaluation of MHP
12 26/01/2067 • Final community presentation
13 27/01/2067 • Departure to college
14 30/01/2067-08/02/2067 • Report writing
• Preparation for College Presentation
15 09/02/2067 • College Presentation
16 11/02/2067 • Final Report Submission
7
Chapter II
METHODOLOGY
2.1 Study Methodology
Study area: Melamchi VDC of Sindupalchowk district
Study population: total population of Melamchi VDC
Study type: descriptive cross sectional study
Unit of analysis: households
Sampling frame: total number of households of Melamchi VDC
Sampling technique: cluster sampling for clusters
simple random sampling for households
Sample size: 30% of total house holds
2.1.1 Data collection techniques
• Structured interview
• Observation
• Focus group discussion
• Anthropometric assessment
• Records review
• Social mapping
2.1.2 Data collection tools
• Structured questionnaire
• Interview guidelines
• Observation checklist
• FGD guidelines
• Anthropometric instruments (Salter balance, measuring tape, MUAC tape)
• Secondary data review formats
8
2.1.3 Literature review
• Various books, articles and manuals were reviewed namely
• Community diagnosis reports of various collages
• Various data of concerned VDC and district
• Various books and papers related to community diagnosis
2.1.4 Data sources
Primary data
• Household heads or members of the family
• Mothers having under five children
• Children below 5 years of age
• Local leaders, PHC staffs
Secondary data
• DDC report
• VDC records
• PHC records
• CBS report
• Annual report, DOHS
2.2 Validity and Reliability
• Lectures on CHD
Four months community health diagnosis classes imparted adequate
theoretical knowledge on us.
• Orientation
Before going to assigned community, we were given six days orientation
classes on survey techniques, possible problems and their solutions.
9
• Pre-testing
Necessary modifications were made after pre-testing the questionnaires. Pre-
test was done in Chapagaun VDC of Lalitpur.
• Group division
We were divided into 6 subgroups so as to minimize errors and to maintain
uniformity to some extent.
• Standardization of test instrument
Instruments were properly checked and calibrated.
Every one of us practiced repeatedly to measure the weight, height, and
MUAC of the children, which helped us to obtain accurate, unbiased and
uniform readings
• Rechecking
Each filled questionnaires and observation check-lists sheets were re-checked
just after completing the interview so that any mis/under responding could be
corrected.
• Post-dinner discussion
Post-dinner discussions were held every day to discuss the problems faced
during the day, and setting the program for the next day.
• Tabulation of data
Cross checking of tables was done among the subgroups to minimize errors as
far as possible.
• Supervision
Intermittent supervision was done by field co-coordinator from VCTS and
Mr.Ganesh Oli, who was assigned as the local supervisor.
10
2.3 Exclusion criteria
• Individuals missed from repeated two visits during data collection period.
• Non responsive individuals.
2.4 Ethical considerations
• Permission from VDC office & health post was taken prior to the beginning of
our study.
• Purpose & objective of study were explained to all respondents.
• Verbal consent was taken from each respondent at the beginning of the
interview.
• Assurance of the confidentiality of the information was done.
2.5 Logistics
• Lodging
We booked four rooms in Hotel Melamchi Point for Rs. 18000.
• Fooding
We managed with our fooding in the same hotel where we had to pay Rs. 50
per meal.
• First-aid and Medicine
Valley College of Technical Sciences provided us with first-aid materials and
essential drugs.
• Anthropometric Tools
Valley College of Technical Sciences provided 6 Shakir’s Tape and 6 Salter
scales. We bought the measuring tapes by ourselves.
11
• Health Education Material
Posters, Pamphlets and Booklets on AIDS awareness, FP, environmental
health and sanitation, personal hygiene, diarrhoea, leprosy, TB, etc. were
collected from NHEICC, DPHO Lalitpur, DFTQC, Library[VCTS], etc.
We prepared some education materials by ourselves.
• Stationeries
Questionnaires, Checklist and all the required stationeries were provided by
our college.
• Camera and Computing equipments (Laptops)
We took 2 digital cameras and 1 movie camera. We had 2 laptops and 6
calculators for computation.
• Financial support
An allowance of Rs. 150 per day for fooding and lodging was provided for
each student by VCTS.
• Transportation
Two way transportation was managed by VCTS.
• Communication
Each of the group members had cell phones for communication.
2.6 Limitation and constraints of our study
• Difficult to find some of the respondents even after repeated visits.
• Insufficient time for survey and conduction of micro health programme.
• Insufficient stationary equipments.
• The VDC had a difficult geography with few houses scattered over a wide
area.
• Questions were too subjective which led to confusion in observation and
analysis
12
Chapter III
MAJOR FINDINGS OF MELAMCHI VDC
3.1 Major Findings
3.1.1 Demography
Demography is the scientific study of human population. It helps to identify a
community in relation to its composition, distribution in space, and changes in context
of biological, socioeconomic and other settings occurring over a period of time. It is
important as it includes births, deaths, migration, marriage, and provides information
about social mobility and population dynamics.
Table 1: Age-sex composition by caste
Age-
group
Brahmin Chhetri Tamang/ Ghale Newar KDS Others Total Grand
Total M F T M F T M F T M F T M F T M F T M F
0-4 18 24 42 5 3 8 27 23 50 6 3 9 1 0 1 2 0 2 59 54 113
5-9 24 30 54 3 5 8 31 32 63 9 5 14 2 2 4 2 3 5 72 77 149
10-14 37 38 75 4 2 6 49 28 77 6 7 13 2 3 5 3 5 8 109 83 192
15-19 38 39 77 3 3 6 27 37 64 5 6 11 7 4 11 3 0 3 82 92 174
20-24 21 32 53 4 2 6 20 27 47 3 9 12 5 0 5 0 2 2 53 72 125
25-29 20 27 47 4 3 7 28 24 52 7 6 13 3 5 8 0 0 0 62 65 127
30-34 21 25 46 2 1 3 14 14 28 4 3 7 2 1 3 1 2 3 44 47 91
35-39 19 17 36 4 4 8 11 14 25 2 3 5 0 0 0 2 1 3 38 40 78
40-44 14 16 30 0 0 0 11 15 26 5 2 7 1 2 3 1 1 2 32 36 68
45-49 12 10 22 0 0 0 15 9 24 1 3 4 2 1 3 0 0 0 30 23 53
50-54 13 10 23 0 0 0 15 12 27 3 5 8 0 1 1 1 0 1 32 28 60
55-59 5 5 10 0 0 0 6 7 13 2 0 2 1 1 2 0 0 1 14 13 27
60-64 6 11 17 0 3 3 8 9 17 2 0 2 1 1 2 0 0 0 17 24 41
65-69 6 6 12 0 2 2 7 2 9 2 1 3 0 0 0 0 0 0 15 11 26
70-74 6 3 9 2 0 2 2 4 6 0 0 0 0 0 0 0 0 0 10 7 17
75-79 4 1 5 2 0 2 1 1 2 0 0 0 1 1 2 0 0 0 8 3 11
80+ 2 0 2 0 0 0 4 1 5 0 0 0 1 0 1 0 0 0 7 1 8
Total 274 298 572 34 28 62 276 260 536 57 53 110 28 23 51 15 14 29 684 676 1360
13
3.1.2 Population pyramid
From the pyramid, we can assume that the fertility of the Melamchi VDC is
decreasing since last 10 years compared to previous 14 years. The causes for the
declining of fertility in Melamchi VDC might be:
• Increased use of contraceptives
• Increase in mortality
• Age shifting
• Increased awareness about F/P methods and family size.
• Increased level of educational status.
Thus, from the pyramid, we can conclude that the population pyramid of
Melamchi VDC is of constrictive type which indicates that the VDC is moving
towards the development.
Figure 2: Population pyramid of Melamchi VDC
No of females above 80 years are lesser than males which show that male is
expected to live more than females in Melamchi VDC which is contradictory to
national figure. The reasons could be that females are more suffered from burden of
household works and also because of high morbidity patterns in females.
Population of the age group 60-64 yrs is higher than that in the age group 55-
59 years possibly because of age shifting and old age allowance.
4.33%5.29%
8.01%6.02%
3.89%4.55%
3.23%2.79%
2.35%2.20%
2.35%1.03%1.25%
1.10%1.84%
3.97%5.66%
6.10%6.76%
5.29%4.77%
3.46%2.94%
2.65%1.69%
2.06%0.96%
1.76%
0.81%0.81%
0-4 yrs5-9 yrs
10-14 yrs15-19 yrs20-24 yrs25-29 yrs30-34 yrs35-39 yrs40-44 yrs45-49 yrs50-54 yrs55-59 yrs60-64 yrs65-69 yrs
70+Female
Male
14
The total child dependency (0-14 years) population is about 54% and old
dependency (60 years +) population is about 7%. Thus, about 61 inactive populations
depend upon 100 active populations.
The no. of males in the age group 20-24 is less than that of females possibly
because most of males in this group got married, separated from their family and
migrated to urban areas.
3.1.3 Types of family
According to our study most of the households in Melamchi seemed to be
heading towards the nuclear family. Almost 50% of the sample households were
living in nuclear family, while about 36% lived in extended family. Only 14% were
joint family. On an average each family comprised of 6 members.
Figure 3: Family types
3.1.4 Socio-economic
Socio-economic factors prevalent in a community have a direct influence on its
health. Poverty, malnutrition, poor sanitation, lack of education, inadequate housing,
unemployment, poor working conditions, cultural and behaviour factors all predispose
to ill health. So it is necessary to know about the socio-economic status of the
community in order to assess the health condition of the community.
50%
14%
36%
Nuclear Family
Joint Family
Extended family
15
a) Occupation
Among the productive population (15-64 years), agriculture was found as the
major source of income comprising more than 84% of the sample households. Service
(6.25%), business (5.35%), labour (2.6%), were other means of livelihood. Almost all
posed piece of land for farming and animal husbandry.
Figure 4: Source of income
b) Economic status:
We didn’t have any standard tool to assist the economic status of the people.
So, we tried to reflect the economic status of the people of the community based on
their monthly income.
According to our study, 36.67% of the people were below poverty line having
monthly income less than 2200.
c) Educational Status
Schooling
Out of 195 households with school aged children 96% of households send
their children to school.
Literacy rate:
Literate person is one who is able to read and write. The rate of literate
persons in Melamchi (70.19%) was found to be good compared to national figure
(64%). The female literacy rate (64.05%) was also better compared to national figure
84.38%
6.25% 5.36% 2.68% 1.34%0.00%
10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%
Agriculture Service Business Labour Others
16
51%) but the male literacy rate (76.57%) was found low with respect to national
figure (77%).
Table 2: Literacy Rate and Educational Status
Educational Status Sample figure National figure
Male literacy rate 76.57% 77%
Female literacy rate 64.05% 51%
Total literacy rate 70.19% 64%
The existing literacy rate shows satisfactory educational status of this VDC. It also
indicates that the future educational status of this VDC will be better.
Currently, Female literacy rate is higher than national figure.
3.1.5 Environmental sanitation condition
Environmental welfare and health status are not exclusive to each other. The
ambience around us has a great effect on our body, mind and soul. Our environment
all around does a lot in causing diseases and deformities in our life. Pollution of every
sort, all around has made life and the environment around so unhealthy. Even our
staple foodstuffs are being adulterated. With all these risks to the physical well being,
diseases are bound to aggravate and spread. Adverse environmental factors such as
water pollution, soil pollution, air pollution, poor housing conditions and presence of
animal reservoirs and insect vectors of diseases cause much of the ill health in Nepal’s
context.
Nevertheless, man himself is largely responsible for these environmental
conditions. But a healthy environment and healthy lifestyle should be maintained to
Illiterate Literate Primary L.
Secondary
Secondary H.
Secondary
Bachelor+
M F M F M F M F M F M F M F 23.43
%
35.95
%
4.58% 8.17% 29.88
%
27.29
%
16.47
%
10.95
%
15.96
%
10.46
%
5.94% 4.9% 3.74% 2.28%
17
achieve Health for All. This in turn, can be attained only by building in men, positive
behaviour towards their environment.
Here, environmental health condition of Melamchi VDC has been assessed in
terms of following factors:
a) Source of water
According to the survey, dhara / dhunge-dhara (82.96%) was found as the
major source of drinking water while 9.46% used natural spring water as the
direct source. Few of the households used kuwa and even rivers or stream.
Fig 5: main source of water
83%
6%1% 9% 1%
Dhara/dhungedhara (83%)
Kuwa (6%)
River (1%)
Mul (9%)
Others (1%)
18
b) Water purification practice
The storage and treatment of drinking water wasn’t found to be satisfactory. Most
of the households were found to leave water uncovered and almost 92.86% didn’t
treat water before drinking. Only about 1.34% boiled their water before drinking.
Very few used filtration process.
Fig 6: Water purification method
c) Waste disposal practice
• Solid waste disposal
Significant proportion of households (45.98%) used burning method
for solid waste disposal. Moreover, more than 28% used to manage
solid wastes through practice like burial. Composting was also found.
Fig 7: Solid Waste management
0.00%5.00%
10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%50.00%
Burning Composting Burial Haphazardly
46%
6%
29% 26%
19
• Liquid waste disposal
The practice of liquid waste disposal was quite unsatisfactory as
compare to solid waste disposal. Major proportion of households i.e.
43.75% used to throw liquid waste haphazardly. However, similar
proportion of households 41.52% used such wastes in their garden.
Fig 8: Liquid waste management
d) Toileting practices:
• Place of defecation
The private use of latrine was not so satisfactory in Melamchi VDC.
There was only about (59.82%) of latrine coverage. The problem
seemed more significant in ward no 4 and 9. More than (24.55%) of
the households used to defecate wherever they like. Some households
even used river bank and open fields for defecation.
Fig 9: Place of defeacation
0.00%5.00%
10.00%15.00%20.00%25.00%30.00%35.00%40.00%45.00%
Kitchen Garden
Feed to cattle Haphazardly Others
41.52%
12.95%
43.75%
5.35%
59.82%4.46%
8.93%
24.55%
2.23%
Toilet (59.82%)
Jungle/ open place (4.46%)
River bank (8.93%)
Haphazardly (24.55%)
Others (2.23%)
20
• Causes of having no latrines
Almost 40% households were found to have no latrines.
The most common cause was found to be financial problem followed
by ignorance & proper place.
Fig 10: Causes of having no latrines
3.1.6 Personal Hygiene
a) Teeth brushing Practices
91.52% of the respondents had practice of brushing teeth.
b) What they use while brushing?
83.48% of the respondents had practice of using brush & paste while
brushing teeth.
c) Practice of washing hands after defecation
There was a satisfactory proportion (79%) of households using soap &
water to wash their hands after defecation. However, large proportion
(34.37%) used only water; few used ash, soil/ water while 6.25% didn’t
wash hands at all.
24%
2%
47%
12%
15%
Not necessary(24%)
Didn’t know (2%)
No money (47%)
No place (12%)
Others (15%)
21
Fig 11: Practice of washing hand after defeacation
d) Practice of washing hands before having meal
Large number of households (70.98%) used only water to wash their hands
before having meal, only about (27.23%) used soap and water. Few
households even used ash, soil/ water etc.
Fig 12: Practice of washing hands before having meal
3.1.7 Knowledge, attitude and practice on diseases
Health hazards are at every corner and in every aspect of life. Lack of
knowledge, attitude and practice among the rural populace has added to it.
Even today we found some old people relating cause of disease to curse by
god. This type of belief would certainly mould one to death and true
knowledge on health and illness needs to be imparted to dispel ignorance like
this. If we throw a glance on general health awareness among people in
70%
27%
2% 1%
Only water (70%)
Soap & water (27%)
Ash (2%)
Mud & water (1%)
33%
51%
8%6% 2%
Only water (33%)
Soap & Water (51%)
Ash (8%)
Don’t wash (6%)
Others (2%)
22
general we would feel aghast and distressed at the lack of the health sense
among people.
Knowledge: The understanding of fact and process, which is acquired
through information and experience.
Attitude: The feeling towards someone or something, which results in
readiness to act or behave in a certain way.
Practice: The way in which people do various activities.
- H.B. Pradhan, 1998
KAP of people has a direct impact on their health. It’s by the change of people’s
KAP that the change in a community’s health status can be brought about. But it is
not easy to battle many problems that results due to lack of knowledge. It is usually
the individual that require initiative, and then, the family and the community.
So we appraised the KAP of the people regarding health and diseases and we
culminated the following findings
a) Knowledge about cause and management of disease
About 3/4th of the people in Melamchi VDC could explain the scientific
reasons about the cause of disease. During the course of our survey it was found that
3% HHs believed evil spirit (deuta ko shrap lagnu ) as the cause of disease. Almost
14% were unknown about the actual cause of disease.
Fig 13: Cause of disease
78%
8%
14%
Right answer (78%)
Wrong answer (8%)
Don’t know (14%)
23
Moreover most of them (72%) replied that environmental sanitation could
prevent the incidence of disease. However, still 4% of the respondents had faith on
god & supernatural powers responsible for preventing diseases.
Fig 14: Knowledge on disease prevention
b) First visit for treatment
Majority of our sample household (66%) were found to visit the health
institute for the first contact of treatment. However, still 30% preferred to visit
indigenous healers (dhami, jhakri). Only about 1% used home based treatment.
Fig 15: First contact after being ill
66%
30%
1% 3%
Health institutions (66%)
Dhami/ Jhakri (30%)
Home (1%)
Others (3%)
4%
72%
1%
6%
17%
Pray god (4%)
Sanitation (72%)
Immunization (1%)
Have nutritious food (6%)
Others (17%)
24
Those who didn’t visit health institution gave their reason as no faith, long
distance to PHC, financial crisis and culture. Some believed that disease caused by
evil spirits could only be healed by D/Js.
Fig 16: Reason for not visiting health institution
c) Diarrhoea
The significant proportion (79%) of sample households knew about the
causation of the diarrhoea. However (20.52%) of our households had no idea about
the cause.
Fig 17: Knowledge on diarrhoea transmission
Long distance
20%
No faith30%No time
5%
No money20%
Others25%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
Unclean environment
Faeco-oral route
Unhygienic food
Contaminated water
Others Don’t know
38.83%
8.03%
35.26%
15.17%
0.40%
20.52%
25
The most surprising thing about treatment of diarrhoea was that more than
20% households still hadn’t heard about ORS. Only about 50.89% HHs used ORS as
the treatment of diarrhoea.
Fig 18: Knowledge on diarrhoea management
Even though ORS is cheap and widely accessible means to manage diarrhoea,
still 21% hadn’t heard about Jeevan Jal.
Fig 19: Heard about Jeevan Jal
50.89%
10.71%
34.38%
3.57%
4.90%
6.63%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%
ORS
Home made ORS
Take health facility
Dhami/ Jhakri
None
Others
Yes79%
No21%
26
Among 79% of the respondents who had heard about Jeevan Jal, still 49% of
them did not know about the method of preparation of Jeevan Jal.
Fig 20: Knowledge on Jeevan Jal preparation
d) Pneumonia
Out of the 224 respondent almost 26.73% had no any idea about
Pneumonia. Among those who had heard about it, only 55% could reply that
pneumonia is non- communicable.
Fig 21: Knowledge on communicability of Pneumonia
Yes51%
No49%
21%
55%
24%
Communicable (21%)
Non- communicable (55%)
Don’t know (24%)
27
Out of 73.21% respondents who heard about it, about 74% had appropriate
knowledge about its symptoms.
Fig 22: Knowledge on symptoms of pneumonia
Action taken for treatment
The practice for treatment of Pneumonia was found to be satisfactory.
83.53% of the respondents consulted the health institutions although 7.93% visited
Dhami/Jhakri. Of 3% households who used home based treatment, 60% used
herbal products, while other kept their baby warm by keeping away from cold,
dust, smoke and giving enough fluid.
Fig 23: Treatment of Pneumonia
Know74%
Don’t know26%
84%
8%
3% 3% 2%
Take health institute (84%)
Dhami/ Jhakri (8%)
Home treatment (3%)
Don’t know (3%)
Others (2%)
28
e) Tuberculosis (TB)
Tuberculosis is a major health threat not only in developing but also in
developed countries. To reduce the morbidity, mortality and transmission of
tuberculosis, it becomes quite necessary to change the KAP of the people.
According to our survey, about 43.3%of respondent had never heard about
TB.
Fig 24: Heard about TB
Out of the proportion who heard about TB, only 49.6% had known about its
transmission.
Fig 25: Knowledge on transmission of TB
Yes57%
No43%
Know49.6%
Don’t Know50.4%
29
Only about 59% of the respondents could explain about its symptoms.
Despite the few respondents who consulted Dhami/Jhakri after TB, large
proportion (92.31%) visited the health institutions. 73% of the respondents had
known that tuberculosis is curable.
Fig 26: Treatment prognosis of TB
f) Smoking, alcoholism & tobacco chewing habits
According to our study, out of 617 respondents, 16% were found to use all
three; alcohol, cigarettes & tobacco. Majority of the population being Tamangs, the
problem was further pronounced in ward no. 4, 7, & 8. The Danuwar community of
ward no. 9 was also found to use alcohol, cigarettes and tobacco in massive manner.
Figure 27: Drinking, smoking & tobacco chewing habits
15.70% 16.70%
9.90%9.60% 10.50%
5.40%
0.00%2.00%4.00%6.00%8.00%
10.00%12.00%14.00%16.00%18.00%
Drinking Smoking Chewing tobacco
MaleFemale
73%
7%
20%
Curable (73%)Non- curable (7%)Don’t know (20%)
30
g) HIV/AIDS
According to the information obtained from PHC and local people, AIDS
was the major problem affecting the neighboring VDCs. Even then, 40.63% of the
respondents hadn’t so far heard about AIDS.
Fig 28: Heard about HIV/AIDS
Among those who had heard about it 84.36% had known that AIDS is a
communicable disease.
Fig 29: Knowledge on communicability of AIDS
Know59%
Don’t Know41%
85%
5%10%
Communicable (85%)Non- communicable (5%)Don’t know (10%)
31
Knowledge about transmission
Among those who had heard about HIV/AIDS only 3.53% of the answers
about transmission were good enough i.e. could identify four major modes of
transmission like unsafe sex, blood transfusion, trans-placental and unsterile
syringes. 13.27%, 23% and 43.39% could identify three, two and one of the modes
of transmission respectively. 3.53% gave irrelevant answers while 13.27% could
not answer at all.
Fig 30: Knowledge on transmission of AIDS
Knowledge about prevention
More than 74% respondents responded satisfactorily about its prevention.
Fig 31: Treatment prognosis of AIDS
4% 13%
23%43%
13% 4%Know all 4 means (4%)
Know at least 3 means (13%)
Know at least 2 means (23%)
Know only 1 means (43%)
Don’t Know (13%)
Others (4%)
30%
52%
18%
Curable (30%)
Non-curable (52%)
Don’t know (18%)
32
The options were use of condom, avoiding unsafe/multiple sex, use of
sterile syringe, etc. Only about 6.89% were poor answers although 19.54%
couldn’t answer at all.
Fig 32: Knowledge on AIDS prevention
h) Polio
As compared to other diseases, the knowledge level on Poliomyelitis was
found unsatisfactory. Only 61.60% had heard about it.
Fig 33: Heard about polio
18.04%
46.61%
9.02%
19.54%
6.80%
0.00% 10.00% 20.00% 30.00% 40.00% 50.00%
Use condom
Avoid unsafe sex
Use sterilized syringes
Don’t Know
Others
62%
38%
YesNo
33
Among those who had heard about it, 73.53% of them couldn’t answer at
all about its transmission while 8.63% gave irrelevant answers. Only about 1%
respondents could give appropriate answers about its transmission.
Fig 34: Knowledge on transmission polio
3.1.8 Immunization coverage
The most successful aspect of public health in Melamchi was found to be
its immunization coverage. During our survey, we had assessed 12-23 months
(130 children) children of which 81.53% were found to be immunized.
Of those immunized children, we found 100% coverage of BCG, 95.3% of
DPT, Hepatitis B and Polio and 83% coverage of Measles.
14.60% of the mothers could not respond us whether their children were
immunized or not.
Fig 35: Immunization coverage
10%2% 1%
2%
85%
Contaminated water (10%)
Curse of god (2%)
Faeco-oral (1%)
Doesn’t transmit (2%)
Don’t know (85%)
0% 20% 40% 60% 80% 100%
BCG
DPT3/ Polio
Measles
100.00%
95.30%
83.00%
95.30%
81.53%
95.38%
PHC figure
Sample figure
34
3.1.9 Family planning
“Family planning is a way of thinking and living that is adopted voluntarily,
upon the basis of knowledge, attitude and responsible discussions by individual and
couples in order to promote the health and welfare of the family group and thus
contribute effectively to the social development of a country.”
-An expert committee of WHO (1971)
Above definition of Family planning clearly elucidated that it does not merely
mean birth control. Rather it is better determiner of health of the mother and is
concerned with the welfare of family and ultimately that of the society and the nation.
Of the 158 eligible couples included in our study 61.39% were found
currently using family planning devices.
Fig 36: Use of family planning
Causes of not using family planning methods
38.61% of the respondents did not use any family planning methods.
Among them the common causes for not using were fear of side effects, absence
of husband at home, no faith, religious causes, etc.
61.39%38.61%
UsersNon- users
35
Acceptance of family planning methods
Among the users of family planning methods (97 couples), 64 were found
using temporary devices while 33 using permanent methods. It was also found that
females were significantly more among those using temporary devices while more
males used permanent methods. Among these all methods Depo-Provera was
found to be accepted by most of the couples (43.20%).
Fig 37: Choices of family planning methods
Out of 34 respondents who didn’t use family planning methods, 10% didn’t have
faith on any methods and 81% didn’t have necessity to use.
Fig 38: Reasons for not using FP devices
4.10%
43.20%
9.20%
5.10%
9.20%
24.70%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Pills Depo-provera Norplant Copper-T Minilap Vasectomy
10% 2%
7%
81%
No faith (10%)
Religious Cause (2%)
Fear of side effects (7%)
Others (81%)
36
Advantage of family planning
The knowledge about advantages of family planning was found to be
satisfactory. Besides 3% irrelevant answers and 15% non responsive respondents,
all others could explain possible advantages of family planning.
3.1.10 Nutrition
Nutritional status is one of the key indicators of health and its assessment is a
must in diagnosing community health. It is determined by various factors like
availability, distribution, intake and proper utilization of foodstuffs. Access to
resources, work, employment and income has also crucial impact on household
nutritional status.
Nutrition is primarily concerned with the growth, development and maintenance of
body. In our survey, the nutritional status of under 5 children were assessed with the
help of different anthropometric methods. We used anthropometric tools like Salter
balance and Shakir’s tape, to take measurements, processed and compared with the
standard values.
Anthropometry is the measurement of the variation of physical dimensions
and growth composition of the human body at different age levels and degree of
nutrition. Anthropometric measurements such as height, weight, skin fold thickness
and MUAC are valuable indicators of nutritional status. If anthropometric
measurements are recorded over a period of time they reflect the pattern of growth
and development and how individuals deviate from the average at various ages, in
body size, build and nutritional status
Knowledge on mothers about Super flour
Our findings revealed that 75.30% of mothers in Melamchi VDC had proper idea
about the preparation of Super flour.
37
Fig 39: Knowledge on preparation of super floor
Salt using practice
According to our study, only about 69.11% families were found using iodized salt.
Remaining 30.89% used dhike salt.
Fig 40: Salt using practice
75.30%
24.60%Respondent females (%)
Yes No
69%
31%
Iodised salt (69%)Dhike noon (31%)
38
Vitamin A supplementation / de-worming tablet
In our study, we found that 90.22% of children (0-5 years) were supplemented by
Vit.A capsule while 88.64% were provided with de-worming tablet.
Fig 41: Vit A. & De-worming tablet coverage
Cause for intestinal worming
According to our survey, 48.14% responded that consuming of sweet food items
causes intestinal worming. Beside this 22.2% said the correct cause for intestinal
worming.
Fig 42: Cause for intestinal worming
0.00% 20.00% 40.00% 60.00% 80.00% 100.00%
Vitamin-A capsule
Deworming tablet
90.22%
88.64%
9.78%
11.36%
Not taken
Taken
48.14%
18.52%
3.70%
29.63%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Consuming sweet items Consuming contaminated food
Consuming raw food items
Others
39
Practice of washing vegetables
According to our survey, 52.12% of the respondents washed their vegetables prior to
cutting while 30.31% washed it after cutting. 16.36% of respondents were found to
wash both the times.
Fig 43: Practice of washing vegetable
Knowledge on Malnutrition
Malnutrition is one of the major killers of children in countries like Nepal. So, to have
an understanding of the knowledge of people on its cause and management is
necessary.
The Knowledge on cause of malnutrition was found significantly poor in
Melamchi. Of the total respondents, only 30.48% responded the lack of nutrients as
the cause. However, 45.71% could not answer at all while 9.52% gave irrelevant
answers. Moreover, 10.48% replied that malnutrition occurred if pregnant women
touched the children, which was one of the major taboos prevalent at Melamchi.
Fig 44: Causes for Malnutrition
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Before cutting After cutting Both times Doesn't wash
52.12%
30.31%
16.36%
1.21%
4%10%
30%
46%
10%
Consuming contaminated food (4%)
By touching pregnant women (10%)
Deficiency of nutrients (30%)
Don’t know (46%)
Others (10%)
40
Control of malnutrition
Due to taboos on malnutrition, 24.39% respondents replied that they take their
children to dhami-jhankris during malnutrition. 25.61% explained that it is necessary
to provide nutritious food.
Fig 45: Control of Malnutrition
Nutrition status of under-5 children
MUAC
MUAC was measured by Shakir’s tape. We had observed 86 children between the
ages of 12-59 months in Melamchi VDC among whom 6.98% and 9.30% of female
and male respectively found to be severely mal-nourished.
Fig 46: Nutrition assessment by MUAC
24.39% 25.61%
17.10%
2.44%
28.05%
2.44%0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Dhami/Jhakri Give nutritious
food
Take health centres
Cures itself Don’t know Others
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%
Green (Normal)
Yellow (At risk)
Red (severe)
65.12%
25.58%
9.30%
67.44%
25.58%
6.98% Female
Male
41
The nutritional status of under 5 children based on Gomez Classification is shown in
the chart below.
Fig47: Nutritional status by Gomez classification
3.1.11 Maternal and child health
The health of a mother and a child can be better studied under a single topic,
“Maternal and Child Health”, since a foetus in the mother’s womb or a child after
birth closely depends on mother's health for its growth, development and health status,
so can be considered as a single unit.
Maternal and child health refers to the promotive, preventive, curative and
rehabilitative health care for mothers and children. Mothers and children constitute a
large and vulnerable group in any population. Therefore, their health status is a key
indicator of overall health and health care delivery and utilization status of the
community.
0%
10%
20%
30%
40%
50%
60%
70%
Norm
al
Mild
mal
nutr
irion
Mod
erat
e m
alnu
triti
on
Seve
re m
alnu
triti
on
68.6%
19.6%6.8%
5%
42
Age at marriage
Early marriage was prevalent in Melamchi VDC with 75.34% females being married
before the age of 20 years.
Fig 48: Age at marriage
Age at first pregnancy
Study has shown that 52.06% of the women were pregnant at the age of less than 20
years. This proportion is highest among the Tamangs.
Fig 49: Age at first pregnancy
75.34%
21.92%
2.74%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
< 20 years 20-25 years > 25 years
52.06%
43.84%
4.11%0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
< 20 years 20-25 years > 25 years
43
ANC check up
According to WHO, woman should have at least 4 ANC visit without complications
to provide sufficient antenatal care. In Melamchi, only about 38% of pregnant women
were found to have 4 antenatal check up.
Fig 50: Frequency of ANC check-up
Work and Food during pregnancy
In Melamchi, according to our survey, only about 34.25% of pregnant women had
taken more nutritious food, 9.49% has less than before due to reasons such as loss of
appetite, poverty etc.
Fig 51: Food habits during pregnancy
0%
10%
20%
30%
40%
Once 2-3 times 4 times > 4 times
4%
32%38%
26%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
As usual Extra nutritious food Lesser
56.16%
34.25%
9.49%
44
The situation was further pathetic as more than 50% of the pregnant women had to do
heavier work and only 2.74% had done lighter work during the pregnancy.
Fig 52: Workload during pregnancy
Complications during pregnancy
As per our study in Melamchi, 26% of mothers had complications like dizziness,
swelling, etc due to high work load and low intake of nutritious foods.
Fig 53: Complications during pregnancy
0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%
Normal
Heavier
Lighter
46.58%
50.68%
2.74%
26%
74%Yes
No
45
TT vaccine coverage and intake of De-worming tablets
TT coverage in Melamchi was found to be 75.34% where as the number of mothers
taking de-worming tablets during pregnancy was found comparatively low (60.27%)
compared to TT coverage.
Fig 54: Pregnant women receiving TT vaccine and De-worming tablets
Place of delivery
Our study shows that 64.34% of the delivery was taken place at home. Remaining
deliveries were assisted in the health facility.
Fig 55: Place of delivery
75.34%
60.27%
21.92%
35.62%
2.74%
4.11%
0.00% 20.00% 40.00% 60.00% 80.00%
TT Vaccine
Deworming tablet
Don’t remember
Not-taken
Taken
65%
31%
4%
Home (65%)
Government health centre (31%)
Private health centres (4%)
46
Use of safe delivery kits
Safe delivery kit helps to protect the health of mother and child during home delivery.
In our survey, out of those who delivered their babies at home, only 33% used safe
delivery kits.
Fig 56: Use of safe delivery kits
Cord cutting practice
It is necessary to use safe instruments for the prevention of neonatal tetanus. A
marked proportion (27.66%) was still using sickle/old instruments to cut the cord.
Fig 57: Substance used for cord-cutting
33%
67%
YesNo
27.65%
10.65%61.70%
Sickle (27.65%)
Scissors (10.65%)
New Blade (61.70%)
47
Substances applied after cord cutting
Majority of our respondents (63.83%) did not use anything and 35.04% used turmeric
and oil after cord cutting.
Fig 58: Substance used after cord-cutting
Colostrums feeding practices
Colostrums, the first immunization of a child was fed to almost 90% of the infants in
Melamchi within one hours of delivery.
Fig 59: Colostrum feeding practice
34%
2%64%
Oil & turmericAntisepticNothing
90%
7% 3%
Yes (90%)
No (7%)
No answer (3%)
48
Frequency of breast feeding
Frequency of breast feeding, one of the major source of nutrient for children was
found satisfactory as over 38% fed their child more than 8 times a day.
Fig 60: Frequency of breast feeding per day
Exclusive breast feeding and weaning food practice
In Melamchi V.D.C, we had taken the information from mothers of 73 children about
exclusive breast feeding or initiation of weaning food; among them we found the
following practices.
• 43.84 % of children initiated weaning food within six month,
• 43.84% of children initiated weaning food exactly in six months
• 6.85 % of children initiated weaning food after six months.
Fig 61: Start of weaning foods
20.55%24.66%
38.36%
13.70%
2.74%0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
<6 times 6-8 times > 8times Others No answer
43.84%
43.84%
6.85% 5.48%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
< 6 months 6 months 6-12 months No answer
49
Iron intake during pregnancy
In Melamchi, only 39.7% of the pregnant women had taken tablets for 225 days while
24.66% had not taken any iron during pregnancy.
Fig 62: Iron tablet supplementation
24%
7%
25%1%
40%
3%
No (24%)
Only for some duration (7%)
Only during pregnancy (25%)
Only after delivery (1%)
Full dose (40%)
Don’t remember (3%)
50
3.2 Observation findings
Table 3: Observation findings
S.N Particulars Percentage (%)
1. Housing pattern
• Kachha-pakka
• Kachha
• Pakka
94.2%
3.57%
2.23%
2. Roofing material
• Tin
• Slate/stone
• Cement
• Thatch
82.14%
13.84%
2.23%
1.79%
3. Ventilation
• No
• Yes
89.29%
10.71%
4. Kitchen
• Attached
• Separated
85.27%
14.73%
5. Types of stoves
• Traditional stove
• Gas stove
• Improved stove
89.89%
8.48%
2.23%
6. Water source
• Clean
• Dirty
69.64%
30.36%
7. Water disposal
• Kitchen garden
• Random
• Drainage
51.79%
45.98%
2.23%
51
8. Water accumulation area
• No
• Yes
87.5%
12.5%
9. Surrounding environmental sanitation
• Satisfactory
• Dirty
• Clean
57.14%
28.57%
14.29%
10. Toilet
• Yes
• No
62.95%
37.05%
11. Condition of toilet
• Dirty
• Clean
66.678%
33.33%
12. Cattle shed
• Attached with house
• Away from house
• Inside the house
• No
• >15 Meters away
48.66%
25.47%
16.07%
5.36%
4.46%
52
3.3 Discussion
Table 4: Comparative figures
S.N. Parameter Sample
figure
VDC figure National
figure
1 Demography
• Total population 1360 4582 -
• Male population 684 2284 -
• Sex ratio(M:F) 101:100 99.4:100 99:100
Dependency ratio
• Child dependency 53.79%
65.32%
72.7%
• Old dependency 7.35% 11%
12%
• Total
61.14%
77.8% 84.7%
Total households 224 737 -
Family size 6.07 6.22 -
Population density - 382.47
person/sq.km
-
2 Fertility
• Crude Birth Rate(CBR) 19.12/1000 28.4/1000 30/1000
• General Fertility Rate
(GFR)
73.86/1000
118.39/1000 -
• Child Women Ratio
321.02/1000 254.1/1000 492/1000
53
3 Mortality
• Crude Death Rate (CDR) 8.82/1000 4.36/1000 8.7/1000
• Maternal Mortality Rate
(MMR)
0
0
281
4 Morbidity
• Incidence rate
63.24/1000
-
-
• Disability rate 16.18/1000
7.2/1000 -
5 Population change
• Natural Increase Rate 1.03 2.4 1.03
6 Literacy Rate
• Male literacy rate 77.62% - 77%
• Female literacy rate 64.05% - 51%
• Total literacy rate 70.19% - 64%
7 Immunization
• BCG 100% 95.30% -
• DPT 95.3%
81.53%
-
• Measles 83% 95.38% -
54
Health service utilization pattern of Melamchi
The VDC has one PHC at ward no. 2. The PHC provides its services to all wards
of the VDC including other neighboring VDCs although there is some problem for
distance from the ward no.4, 7 & 9 and some other VDCs. There are 9 FCHVs
serving the community. Besides these people were attending private medical halls
also. Some of the information on Melamchi, as obtained from PHC has been
summarized as follows:
Staffing pattern
Table 5: Staffing pattern at PHC
S.N. Post Sanctioned Fulfilled
1 Doctor 1 1 (with 1 extra doctor)
2 Staff nurse 1 1
3 HA 1 1
4 ANM 3 3
5 LA 1 1
6 VHW 1 1
7 OA 2 2
OPD Registration on fiscal year (65/66)
Total: 7244
Received free health service: 74
Table 6: No. of patients getting free health services at PHC
Age No of patients
>60 63
<60 11
55
MCH services
Table 7: No. of pregnant women attending for ANC check-up
First ANC visit. Months
Age of pregnant women Magh (2066) Falgun (2066)
<20 11 6
>20 34 39
4 ANC visits Months
Magh Falgun
Total visits 18 17
PNC visits (65/66) = 207
Vaccination coverage (shrawan/poush 2066)
Table 8: Vaccination coverage
Name of vaccine Coverage
BCG 95.30%
DPT 1 106.15%
DPT 3 81.53%
Measles 95.38%
Nutrition
None of the malnourish children were reported during the past 6 months.
Nutrient supplement for children
Table 9: No. of children taking Vit. A and de-worming tablet
Vitamin A 624
Albendazole 542
56
Nutrient supplement during pregnancy
Table 10: No. of pregnant women taking iron and de-worming tablet during
pregnancy
Iron supplement 42
Albendazole 42
Family planning (65/66)
Table 11: No. of people using FP contraceptives from PHC
Pills 16
Depo provera 169
IUD 37
TOP 5 DISEASES
a) Acute Peptic Disorder
b) Dental problem
c) Diarrhoeal problem
d) Skin disease
e) Eye problem
57
Chapter IV
FOCUS GROUP DISCUSSION
Date: 2067/01/12
Time: 11:30-12:20
Venue: Indreshwari Higher Secondary School
FGD was conducted on “Students role on personal hygiene and environmental
sanitation”. Focus group consisted of 10 secondary school students representing
different communities of Melamchi VDC. All 10 students participated actively in the
FGD in presence of Health teacher of Indreshwori H.S. School. The FGD lasted for
about fifty minutes. The FGD was moderated by group leader Prabesh Ghimire and
recorded by Anil Dhungana, and note was taken by Bishakha Pokhrel and Sailaja
Ghimire. Remaining friends observed the process of FGD.
FGD was started with warm welcome to participants and introduction.
Objectives of the discussion were clearly explained and discussion was conducted
following the guidelines of FGD.
Why FGD on personal hygiene and environmental sanitation?
• By our quantative study, we found 37.05% of the total households do not have
toilet.
• 34% of the sample households use only water to wash their hands after toilet
and 6% do not wash their hands.
• 93% do not use any sort of water purification methods.
• 29% and 44% of the sample household use to throw solid and liquid wastes
haphazardly respectively.
Why students for FGD?
• Students are the pioneer sources for imparting awareness on personal hygiene
and environmental sanitation to their family members.
58
• Students can be good motivator to motivate their family members.
Objectives of the FGD
• To access the hygiene and sanitation practice among the family members and
community via students.
• To complement and cross-check the findings of our quantitative study.
• To access the personal hygiene level of the students.
• To find out determinants affecting environmental sanitation of the community.
Guidelines of the FGD
• Knowledge on personal and environmental sanitation?
• Purify water at house?
If yes, how?
If no, why?
• Methods of waste disposal
• Do you practice theoretical knowledge on personal hygiene and environmental
sanitation gained from your school?
• Do you motivate your family members to adopt hygienic practices?
• What do you think are the possible ways to motivate community people to
adopt hygienic practices?
• What can be the students’ role in improving the environmental sanitation of
the community?
Findings
• Knowledge on personal hygiene and environmental sanitation
It was found that almost all students had good understanding about personal
hygiene and environmental sanitation. Everyone was found aware about the
health problems due to unhygienic practices.
59
• Practice of water purification a household
Most of them don’t feel necessity to purify water. However, some of them had
adopted filtration and boiling processes.
‘’Hami ta sidhai mulko pani khanchhau.”
“Umalne, sodish garnae the jhanjhat hunchha”
‘’Mulko pani ho, mulko pani ta swochha bhai halchha ni.”
• Methods of waste disposal
Most of them used manure pits to dispose their wastes. Also many of them throw
their wastes on kitchen garden.
• Practice of theoretical knowledge
Almost all students practiced their theoretical knowledge on personal hygiene
and environmental sanitation. However, other members of their family were
still away from such practices.
‘’Bayktigat ta chha tara samudayik rup ma ta huna baki nai chha’’
• Motivation of family members
It was found that although most of the students try to motivate their family
members, they do not believe to their children’s opinion.
“Euta samashya chha. Bau bhanda chhoro janne, khukuri bhanda karda lagne
bhanyera hapkaunu hunchha’’
“Bhura le bhaneko ta ho ni k ternu bhannuhunchha.”
“Sikayo bhane ta afai janne , afai gar bhannuhunchha.”
• Possible ways to motivate community people
Most of the students placed their opinion to organize a youth club and generate
awareness program through slogans, mass media etc.
“Asikshya nai ho jasle samudiya lai durgandit banayako chha. Tesaile chhetana
failauna jaruri chha.”
“Yuwa barga ek joot hunu parchha, samuha banayera, natra, poster marfat
janachetana failaunu parchha.”
60
• Students role
All the students had similar voice; improving the environmental status of the
community is not the students’ role alone. There should be initiatives from all
levels of the community and government.
“Bidhlaya ra gabisa ko pahal bhaya hami hoste ma haise garna sakchhau,
nabhayae sakinna.”
Most of the students perceived illiteracy as the major cause of problem.
61
Chapter V
COMMUNITY PRESENTATIONS
5.1 First community presentation
Date: 2067/01/ 15
Time: 4:00 P.M. - 6:00 P.M.
Venue: Indreshwari H.S. School
Participants:
• 67 people attended the presentation
• VDC secretary, Primary health care center in-charge and other health worker
of PHC
• Former VDC chairman, school principals, teachers, social workers
• Members of local club
• Representatives of women group
• Representatives of NGOs
Main objectives of the programs:
• To present the findings by using diagrams and graphs
• To discuss about the observed and felt needs
• To assess the real needs
• To discuss about the topics for MHP
• To plan for implementation of MHP by mobilizing locally available resources
Subject matter we discussed
• VDC Profile
• Demographic profile
• Socio-economic and cultural status
• Environmental health and personal hygiene
62
• KAP on common health problems; TB, pneumonia, diarrhea and HIV/AIDs
• Health seeking behavior and health service utilization pattern
• MCH and FP
Details of the program
• Program conducted by:- Prabesh Ghimire
• Welcome speech:- Dinesh Rupakheti
• Seat taking
Chairperson:-
Mr. Krishna Bahadur Gyawali (V.D.C secretary)
Guests:-
Mr. Radha Krishna Shrestha (Principal of Indreshwori H.S. School)
Mr. Dharma Krishna Shrestha (Ex VDC Chairman)
Mr. Rudra Dulal (Chairperson ,Indreshwari H.S. School management
committe)
Mr. Mahesh Dulal (Melamchi Community Youth Club)
Dr. Romi Dahal (PHC In-charge)
• Objectives of the program:- Mohan D.C
• Dissemination of the action plan:- Uttam Gautam
• Presentation of findings:
Sameer Shrestha
Anjana Dahal
Bishakha Pokhrel
Sailaja Ghimire
Deepa Pokhrel
Anil Dhungana
• Conclusion of findings:- Sweety Pannachan
• Feedback from:-
Mr.Radha Krishna Shrestha (Principal, Indreshwari H.S. School)
Mr. Krishna Bahadur Gyawali (V.D.C secretary)
• Future plan of MHP: -Sujita Thapa
• Thanks giving and appeal for cooperation and participation:- Sujita Thapa
63
5.2 Final presentation
Date: 2067/01/26
Time: 4:00 P.M. – 5:00 P.M.
Venue: Indreshwari Higher Secondary School
Participants:
• About 38 people participated at our final presentation
• PHC doctor, VHW, school headmasters, teachers, intellectuals, students and
local community people participated at the programme.
Objectives:
• To present information about implementation and implementation and
evaluation of the MHP.
• To hand over the program to local people for sustainability.
• To thank people for their support during our study and obtain feedback of our
study.
Activities:
• The programme was conducted informally with no chairmanship.
• Information about implementation and evaluation of MHP were informed.
• Participants were found influenced & convinced and committed to continue
the programme in near future.
64
Chapter VI
MICRO HEALTH PROJECT (MHP)
6.1 Introduction
Micro health project is a miniature form of short-term project; designed to
develop health related skills and self-reliance, on the priority basis of real needs
among the common people, through maximum utilization of available resources and
technique.
“Together the health workers and community will look at and consider what
they already know about themselves, an action may be planned that is wanted by the
people, appropriate to their culture and sustainability within the support structure
that already exists within the community.”
-David Werner
After the completion of household survey, data analysis and first community
presentation, our next task was to search for and prioritize the needs of the community
and based on that we had to conduct a MHP. So, we extracted the needs from our data
which were the observed needs. We also talked to different formal and informal
leaders and intellectuals of the community and tried to know the needs of the
community. Also we had enlisted major problems of the community during the
‘focus group discussion’ and ‘first community presentation’. Then we compared the
two needs and found out the real needs of the community. We formulated certain
prioritization bases to prioritize our real needs, based on that we selected our topic for
the MHP. Then we made a week long schedule for the MHP and with the help of the
community people, school staffs, health workers, students and club members, we
successfully conducted our MHP. Three phases are involved in MHP conduction:
Planning, Implementation and Evaluation.
Our MHP was health awareness program on following areas:
• Environmental sanitation
• KAP on specific diseases
65
• Water
• Early marriage
• Mal nutrition
6.2 Goal and Objectives
6.2.1 Goal:
• To raise the level of understanding of the community on above areas through
health awareness by various methods.
6.2.2 Objectives:
• To explain the importance of personal hygiene and environmental sanitation
• To explain the importance of toilet
• To help the community people to change KAP regarding the specific diseases
• To explain the importance of safe drinking water and help them to know the
methods of purification.
• To motivate the people to discourage early marriage and develop
understanding about appropriate age at marriage.
• To clear out the misconceptions and rumors about malnutrition.
6.3 Process of MHP
6.3.1 Planning for MHP
MHP planning was based on Dr. Johan Brynt’s problem solving circle which
includes:
• Defining objectives and target groups
• Resources collection
• Fixing date and place for implementation
66
Fig 63: Phases of MHP
Need identification
Felt Needs
Felt needs are what people think and feel they need in order to solve a health or health
related problems. Felt needs were collected from questionnaire, FGD with AHW,
FCHVs and TBAs, in-depth interview with community leaders and teachers.
Observed Needs
These are those health and/or development needs, which can be scientifically shown
to be needed, in order to solve a community health or health related problem and so,
to improve health status. These were based on the observation checklist and the
results of Household Survey.
BRYNT’S PROBLEM SOLVING CIRCLE
Formulate problem
Evaluation Decide priorities
Planning the problems and
implement Define
objective
Altering solution and
choosing the best
solution
Decide target population
67
Table 12: Felt and observed need
Real Needs
These needs are those needs which are the developed jointly from the understanding
of priority needs of the local people and the priority needs as observed by us at
Melamchi.
Table 13: Real needs
REAL NEEDS OF THE VDC
• Pure drinking water.
• Latrine construction
• Health awareness
• KAP on specific diseases
• Environmental sanitation & personal hygiene
• Improved stoves
Felt needs of the VDC Observed Needs Of The VDC
• Pure Drinking water
• Latrine construction by NGOs
• Health awareness
• KAP on diseases
• Upgrading of PHC
• Ambulance service on PHC
• Transportation for easy access to
health facility
• Environmental sanitation
• Improved stoves
• Environmental sanitation
• Availability of safe drinking water
• Health awareness
• KAP on specific diseases
• Latrine construction
• Knowledge on malnutrition
• Knowledge on proper age at
marriage
• Personal hygiene
• Improved stoves
68
Work plan of MHP
S.N Date Programs/activities Target
group
Venue Methods
and media
1. 2067/01/19 Discussion with
Melamchi Drinking
Water Development
Committee for
availability of safe water
supply
Members of
MDWC
MWDC
office
(ward no. 6)
Group
discussion
2. 2067/01/21 Awareness on school
enrolment, early
marriage, use of toilets
and environmental
sanitation
All
households
of
Dadhuwa
(ward no.
4)
Ward no. 4 Motivation
through
examples
3.
2067/01/24
Environmental
sanitation of Melamchi
bazzar and awareness on
importance of toilet and
environmental
cleanliness
All
community
people
Melamchi
bazzar
(ward no 02)
Awareness
through
motivation,
warning, etc.
4. 2067/01/24 Health exhibition on
KAP on diseases,
environmental
sanitation, water, MCH
and food and nutrition
All
community
people
Jarayatar
ayurvedic
ausadhalaya
(ward no 02)
Exhibition,
posters,
pamphlets,
flipcharts,
demonstration
and
explanation.
5. 2067/01/25 School health
programme on KAP on
diseases, environmental
sanitation, water and
MCH
Students of
lower
secondary
and
secondary
level
Indrehwari
H.S. school,
Melamchitar
(ward no. 5)
Exhibition,
mini-lecture,
poster,
pamphlets and
demonstration
69
6.3.2 Implementation of MHP
MHP on previously explained areas was brought into implementation by using
the following strategies:-
1) Commitment
• Numbers of informal discussion were conducted in order to share ideas
and experiences related to the problem and find effective way to solve the
problem.
• Interpersonal communication related to the problem was held with
teachers, social workers, PHC members and local people so as to develop
interest on the programme.
• Finally commitment for the successful implementation of the programme
was obtained from teachers, social workers, club members as well as
community people.
2) Mobilizing and utilizing resources
• Local human resources i.e. school principal, VHW, local club members,
teachers and community people were mobilized for implementation of the
programme.
• School principal, Radha Krishna Shrestha was the resource person to
orient people during most of our programmes. Teachers also actively
participated in the School Health Programme.
• Members of Melamchi Youth Club, social workers, teachers from
Indreshwari H.S. School and 11 police youths including Police Inspector
from area police office, Melamchi participated actively in environmental
sanitation of Melamchi Bazzar.
• For the conduction of School Health Programme, local school building
was used. Similarly, Jarayatar Ayurvedic Ausadhalaya was used for Health
Exhibition.
3) Community participation
• For the effective participation of community people, we had
established co-ordination with key persons of the community.
70
• Further, we had arranged meetings with different formal and informal
groups of the community.
• Community people were also formally and informally notified about
our programme.
6.3.3 Evaluation
We were really happy to obtain too many feedbacks of our program. People
seemed very much impressed and influenced with our health exhibition pragramme.
They were very much curious to know about the various kinds of nutrients present in
locally available foods.
• KAP regarding disease was answered correctly by majority of students when
asked by us.
• Most of the people were found to be motivated during the course of our door
to door awareness programme at Dadhuwa.
• Even a person from nearby Jyamire VDC, who happened to participate in our
exhibition said “Sir! yo kayakram ta hamro gaun ma awashyak cha. Baru
yeslai mathi po garnuparcha.”
6.4 Sustainability of the programme
Strong commitments have been expressed by the club member and local
leaders for the formation of the sanitation management committee for the
sustainability of our sanitation programme.
VHW was convinced to focus awareness programmes on KAP regarding
common health problems and environmental health issues through FCHVs.
6.5 Learning and experiences
“You were the fishes thrown into a new and strange pond. It was you
yourselves who learnt to swim and adapt the new environment.”
71
It was the quotation expressed by a local campus teacher Buddhi Khadka
during the last day of our stay at Melamchi depicted how much we had strived and
learnt in such a short span of time. It was really a challenge for us been left to adapt in
completely strange environment assigned with lots of tasks to be accomplished.
However, we considered it as an opportunity knocking us with lots of learning and
experiences to explore.
• Community Health Diagnosis is really a platform to bring all the theoretical
aspects of our learning into actual field situation.
• We became able to realize what community health problems really are.
• We could develop our personality towards making interactions, organizing
meetings, conducting programmes and find the possible solutions of the
problems ourselves.
• We learnt to adapt at community with respect to socio-cultural aspects.
• We learnt to come across various problems that arise during the course of our
study.
72
Chapter VII
CONCLUSION AND RECOMNDATION
After our one month field study, we could conclude that the health status of the
community was not so satisfactory and still to pace much to regain a state of health. The
co-operative and helpful hands from the community could make our study easier.
Moreover, effective participation from the community during our survey encouraged us
for successful completion of our micro health project.
At a glance, the health status of people in the Melamchi can be described as
follows:
7.1 Conclusion
Demographic Status
1) Total population in the VDC is 4582 and total households are 737, as obtained
from the report of DDC.
2) The sample size of our study was 1360 population from 224 households.
3) Average family size is 6.07
4) Total dependency ratio is 61.14 per 100 independent.
5) Crude Birth Rate is 19.12 per 1000 population and Crude Death Rate is 8.82 per
1000 population.
6) Child Woman Ratio is 321.02 per 1000
7) Sex-Ratio is 101 males per 1000 females.
8) The top five diseases are: APD/ gastritis, dental problems, diarrhoeal diseases,
skin diseases and eye problems.
Socio-economic Status
1. The main occupation of people is agriculture (84%).
2. Overall literacy is 70.19% with male literacy 77.62% and female literacy 64.05%.
3. The prevalence of all three: smoking, alcohol consumption & tobacco
consumption is 16%.
73
Environmental Sanitation
• Source of drinking water is dhara/ dhungedhara in 82.96% households.
• Approximately 93% families drink water without purification
• Toilet coverage of the VDC was found to be 59.82%.
• About 41.52% of the households dispose waste water in kitchen garden.
• Majority of the households (45.98%) use burning method for disposal of solid
wastes.
• 34.37% of the respondents use only water to wash their hands after defecation and
6.26% even do not wash their hands.
Health seeking behaviour and KAP on disease
• Majority of the people i.e. 65% go to health institution for the first time after
illness although the proportion is not so satisfactory.
• Majority of the population i.e. 78% respondents believe poor sanitation, stale food
and dirty environment as the cause of disease.
KAP on Diarrhoea
• Only 79.25% of the people had heard about Jeevan- Jal, remaining 20.75% were
still unknown to it.
• Only 51.47% could explain the correct method of preparing JJ, while only 50.89%
uses JJ for management of diarrhea.
KAP on Pneumonia
• 26.22% of the respondents were still unknown to pneumonia.
• Out of the remaining 73.78% of the respondents who heard about pneumonia,
only 83.53% visited health institutions.
74
KAP on Tuberculosis
• Approximately 56% were found heard about TB of which only 59% could explain
possible symptoms of TB.
• Among heard ones, only 49.6% could reply correct means of transmission.
KAP on HIV/AIDS
• Among total respondent, 59.37% have heard about HIV/AIDS.
• Approximately 43.39% replied at least one means of transmission. Only 3.53%
replied all four means of transmission.
• Almost 75% respondents had correct knowledge on methods of HIV/AIDS
prevention.
KAP on Polio
• One of the unanticipated findings was that despite of 95.3% coverage on polio
immunization, only 61.60% replied that they had heard about poliomyelitis.
• Almost no one could reply correct means of polio transmission. The correct
response rate was only 0.72%.
Immunization
• Almost 81.53% of the children were found to be completely immunized.
• Of the immunized children, BCG coverage was 100%, DPT3/ Polio was 95.3%
and Measles coverage was 83%.
Family Planning
• About 61.39% of the eligible couples were found using family planning devices of
which 65.98% used temporary methods.
• Among family planning users it was found that acceptance of temporary methods
were more among females whereas more males were found to adopt permanent
methods.
• Depo- provera has the highest prevalence i.e. 43.20%.
75
Nutrition
• Approximately 75% of the mothers had adequate knowledge on preparation of
super flour.
• Only 69.11% households’ use packed iodized salt in their houses.
• Almost 90% of the children were supplemented with Vit-A capsules and 88.64%
were provided with de-worming tablets.
• Only 22% respondents had correct knowledge on intestinal worming.
• 30.48% had adequate knowledge on cause of malnutrition. Remaining of the
answers was irrelevant to the cause of malnutrition.
• MUAC assessment of under- five children showed that 9.3% & 6.98% of the male
and female children respectively was severely malnourished.
Maternal & Child Health
• More than 75% of the women were found to be married too early; before the age
of 20 years.
• Almost 52% women were pregnant before the age of 20 years. However, only
26% of the total females had complications during pregnancy.
• Approximately 75% females received vaccine at the time of pregnancy.
• More than 64% females had their delivery at home of which nearly 27.66% had
used sickle to cut the cord. Only 2.13% had used antiseptic after cutting cord.
• More than 43% of the children were weaned before six months of age. About
43.84% of the children were exclusively breastfed.
• Only about 39.7% of the women had taken iron tablets for complete duration.
7.2 Recommendations
To ameliorate the health status of the people of Melamchi, and different
imperfections of our field diagnosis programme, following recommendations to
different organizations and institutions can be commendable.
76
• V.D.C. must try to bring in some Non Government Organizations (NGO’s)
and International Government Organizations (INGO’s) to improve the health
status of community by launching programs like Toilet construction (esp.In
wards 4 and 9) and improved stoves.
• V.D.C. must take some immediate steps for water source purification.
• FCHVs should be well mobilised.
• Ambulance service should be made available.
• Services need to be upgraded.
• It is necessary to extend the infrastructures (PHC building, equipments).
• Lack of toilets in wards no. 9 and 4 is a major problem, so, the families which
do not have toilets must construct.
• Since faecal contamination is found in the water sources, the community must
undertake steps to purity water sources.
• Though the knowledge and attitude of community seems good practice is
lacking, so the people must put their knowledge into practice for better health.
• The college should provide logistics sufficiently.
• Supervision and guidance should be regular
• Completion of theoretical classes should be assured prior to the field study.
77
Chapter VIII
MOMENTS TO SHARE
Recoiling with few memorable Junctures…
1. We had to walk uphill to collect primary data. One day, while returning back to
lodge after collecting data from ward no. 5, one of our friends somersaulted due to
imbalance as we had walked long distance continuously and all of our legs were
shaking due to tiredness. During that time, she lost her balance in such a way that
she somersaulted a complete turn and fell into a ditch full of stones. We ran
towards her: thanks god! She was fortunate not to have any sorts of injuries. Oh
God! Her new umbrella was completely ruined and was of no use.
2. We had 62 meals in a lodge at Melamchi. In each meal we never got a single
chance to miss df;sf] bfn, cfn'sf] t/sf/L / d'nfsf] crf/ . Good luck! Two days while
collecting data from ward no. 4 and ward no. 7 & 8, for which we had to walk
continuously for 3 hours, we got a chance to taste ;]n /f]6L and we all were happy to
miss the meal.
3. We cannot erase a thrilling moment faced at Dadhuwa, Ward no. 4, where one of
our friends was chased by an old drunkard woman with a large stick on her hand
thinking that we were there for money.
4. An interesting moment at Ghale Gaun, Ward No.9, one of our respondents, said to
two of our friends (a boy and a girl) “k tapai haru yesari sangi hidda hiddai pachi
bibaha harnu huncha?” Similarly, at same place, the other respondent said to our
one friend to marry with her daughter and take her with him.
Our preeminent memories at Melamchi
will always be cherished…
78
Chapter IX
EPILOGUE
Human health cannot be viewed in isolation, as there are always personal,
socio economic, cultural factors which influence the patter of health and disease in the
community. Thus health activities should be fully integrated with the activities of
other sectors involve in the community development e.g. Agriculture, education,
transportation, communication, housing and sanitation etc. As we have already stated
that the prioritized felt needs of the VDC were water, road, and electricity, in our
view, these problems should be solved first, only then they could be motivated to
solve the health problems in a real sense.
What Melamchi needs now is a change, a change in every direction, for
progress and development. Melamchi! Clear your vision, you will find out a new
horizon at your doorstep…..
79
Bibliography
1. Park’s Textbook of Preventive and social Medicine; 20th Edition, 2009.
2. H.B. Pradhan; A Textbook of Health Education; 4th Edition, 2003.
3. Subash Adhikari; Foundations of Epidemology; 1st Edition, 2008.
4. Ramjee Prasad Pathak & Ratna Kumar Giri: A Textbook of Public Health and
Primary Health Care Development; 1st Edition, 2007.
5. Dirgha Raj Shrestha: Reproductive Health, 1st Edition.
6. Annual Reports, Department of Health services; MOH, 2006/07.
7. Dr. Krishna Adhikari: Review of Health Sciences, 8th edition, 2005.
8. Gartaula R.P; An Introduction to Medical Sociology & Anthropology, 2008.
9. Saroj K.C; Applied Epidemiology.
10. DDC, Sindhupalchowk; A Household Survey Report of Melamchi, 2064
11. Hale C, Shrestha I.B., Bhattachang A; Community Diagnosis Manual; 1906
12. B.K. Mahajan; Methods of Biostatics.
13. Bonita, Beaglehole, Kjellstrom; Basic Epidemiology; WHO, 1993
14. Reports produced by Senior Batches of other institutions
15. Handouts of Community Diagnosis Orientation
16. Class Notes
ANNEX
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— ============== lnË =============== wd{ M— kl/jf/sf] ;+VofM @= kfl/jfl/s hfgsf/L (Demography)
qm=;+= Gffd pd]/ lnË 3/d'nL;+usf] gftf
k]zf j}jflxs l:ylt
lzIff dWokfg Wfd|kfg ;"tL{ ;]jg
s}lkmot
!=
@=
#=
$=
%=
^=
&=
*=
(=
!)=
!!=
!@=
Annex: 1
@=!+ kl/jf/sf] lsl;dM -s_ Psn -v_ ;+oQm -u_ a[xt #= dxTjk'0f{ tYofª\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_
!= @= #= $= #=@ tkfOsf] aRrfsf] hGdbtf{ u/fpg ePsf] 5 ? -s_ 5 - v_ 5}g #Þ Þ# ut Ps dlxgf leq tkfO{sf] kl/jf/sf] s'g} ;b:o lj/fdL kg'{ ePsf] lyof] <
s_ lyof] v_ lyPg #=#=! olb lyof] eg], s] ePsf] lyof] < qm= ;+=
/f]u sf/0f k|yd pkrf/ :yfg
!= @= #= #=$= ut Ps jif{ leq tkfO{sf] kl/jf/sf] sf]lx ;b:osf] d[To' ePsf] lyof] <
s_ lyof] v_ lyPg lyof] eg], qmÞ ;Þ d[tssf] pd]/ lnË sf/0f s}lkmot != @= #= #Þ % ut Ps jif{ leq tkfO{sf] kl/jf/sf] sf]lx ;b:osf] ljjfx ePsf] lyof] <
s_ lyof] v_ lyPg lyof] eg]
qmÞ ;Þ lnË pd]/ s}lkmot != @= #=
#Þ ^= tkfO{sf] 3/df sf]lx ckfË 5/5}g
s_ 5 v_ 5}g
5 eg] s:tf] vfnsf] ckfËtf qm= ;+= k|sf/ sf/0f s}lkmot != @= #= $Þ
cfly{s – ;fdflhs cjZyf (Socio-Economic)
$=! $=!ÞÞÞ ! tkfO{sf] cfDbfgLsf] d'n ;|f]t s] xf] <
cfly{s
s_ s[lif v_ gf]s/L u_ dhb'/L 3_ Jofkf/ ª_ j}b]lzs /f]huf/ r_ cGo====================== -olb s[lif d'n ;|f]t xf] eg] k|Zg g+ $=!ÞÞÞ=@ df hfg]_ $=! @= tkfO{sf] s[lifjf6 x'g] jflif{s pTkfbgn] slt ;do ;Dd u'hf/f ug{ k'U5 < s_ )—^ dlxgf v_ ^—!@ dlxgf u_ !@ dlxgf eGbf dfly gf]6M )—^ dlxgf = cltu/Lj ^ —!@ dlxgf ;Dd u/Lj !@ eGbf dfly ;DkGg $=!=# 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 $=@ $=@=!= tkfO{n] cfkm\gf] 5f]/f5f]/L b'j}nfO{ ljBfno k7fpg'x'G5 <
;fdflhs
s_ k7fp‘5' v_ k7fp‘lbg u_ 5f]/fnfO{ dfq 3_ 5f]/LnfO{ dfq $=@=@= tkfO{sf] 5f]/f / 5f]/L s:tf] ljBfnodf hfG5g\ <
lghL ;/sf/L 5f]/f -;+Vof_ 5f]/L -;+Vof_
% %= != tkfO{n] lkpg] kfgL sxfFjf6 Nofpg'x'G5 <
jftfj/0fLo ;/;kmfO{ ( Environmental Sanitation)
s_ 9'Fu]wf/f v_ wf/fjf6 u_ s'jfjf6 3_ vf]nfjf6 ª_ 3/df g} 5 r_ cGo=========
%=@= 3/af6 kfgLsf] ;|f]t;Dd k'Ug slt ;do nfU5 < s_ kfFrldg]6 jf ;f] eGbf sd v_ kfFr b]lv kGw| ldg]6
u_ kGw| b]lv lt; 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/]/ ª_ cGo========
%=$= 3/sf] sfdsfhaf6 lgSn]sf] kmf]x/ kfgLnfO{ s] ug]{ ug'{ ePsf] 5 < -Liquid Waste) s_ s/];faf/L xfNg] v_ ufO{ j:t'nfO{ v'jfpg] u_ htfkfof] Tot} kmfNg] 3_ cGo
%=%= 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] ª_ cGo
%=^ tkfO{ lb;flkzfj sxfF ug'{x'G5 < s_ rkL{df v_ h+undf u_ vf]nfdf 3_ hyfefjL -v'Nnf d}bfg /jf/Lsf] kf6f]df_ ª_ cGo=============
%=&= -obL rkL{ 5}g_ eg] lsg gagfpg' ePsf] < s_ cfjZos geP/ v_ yfxf geP/ u_ k};f geP/ 3_ 7fpF geP/ ª_
cGo===========
^= ^=!= tkfO{ bfFt dfem\g'x'G5 <
JolQmut ;/;kmfO{ (Personal hygiene)
s_ dfem\5' v_ dfem\lbg -k|Zg g+= ^=@ df hfg'xf];\_
^=!=! 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 v_ b'O{k6s u_ slxn]sfFxL 3_ cGo ========
^=@= tkfO{ vfgfvfg' cl3 s] n] xft w'g'x'G5 < s_ kfgL dfq v_ ;fj'g kfgL u_ v/fgL 3_ afn'jfdf6f] ª_ w'Flbg r_ cGo
^=#= tkfO{ lb;f lkzfj ul/;s]k5L xft s] n] w'g'x'G5 < s_ kfgL dfq v_ ;fj'g kfgL u_ v/fgL 3_ afn'jfdf6f] ª_ w'Flbg r_ cGo==========
&= &= !=
/f]u ;DalGw hfgsf/L
&= != != tkfO{sf] ljrf/df /f]u nfUg'sf] d'Vo sf/0f s] xf]nf< /f]u ;DaGwL 1fg, wf/0ff / cEof;M (Knowledge, Attitude & Practice )
s_ ;/;kmfO{sf] sdL v_ sL6f0f'sf] sf/0fn] u_ b'lift kfgL/vfgfsf] sf/0fn] 3_ b]jL b]ptfsf] >fk ª_ yfxf 5}g . r_ cGo ==============
&= != @= tkfO{ lj/fdL kbf{ sxfF hfg'x'G5 <
s_ :jf:Yo rf}sL v_ wfdL emfFqmL u_ 3/d} pkrf/ ug{] 3_ dlxnf :jf:Yo :j+o ;]ljsf ª_ cGo===============
&= != #= -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];\_ v_ ljZjf; geP/ u_
;dosf] cefjn] 3_ k};f geP/ ª_ cGo===============
&= != #=!= tkfO{sf] 3/af6 :jf:Yo rf}sL sltsf] 6f9f 5 < s_ $% dLg]6 eGbf sd v_ $%—! 306f u_ ! 306f—@ 306f;Dd
3_ @ 306f a9L
&= != $= tkfO{n] :jf:Yo ;DalGw gofF hfgsf/L s;/L kfpg] ug'{ePsf] 5<
s_ :jf:Yo sdL{jf6 v_ lzIfsaf6 u_ ;+rf/ dfWodaf6 3_ dlxnf :jfYo=:jo+ ;]ljsf ª_ kfplbg r_ cGo===============
&= != %= tkfO{sf] ljrf/df /f]u nfUg glbg s] ug'{knf{ < s_ eujfgnfO{ k'sfg'{ k5{ v_ ;/;kmfO{ ug'{k5{ u_ jRrfnfO{ vf]k nufpg'k5{ 3_ kf]if0fo'Qm vfgf v'jfpg'k5{ ª_ cGo===================
&=@ &=@=! tkfO{sf] ljrf/df emf8fkvfnf s;/L ;5{ <
emf8f kvfnfM
s_ kmf]xf]/ jftfj/0f v_ lb;fdf ePsf k/hLjLjf6 u_ c:j:Yos/ vfg]s'/f vfPdf 3_ b'lift kfgL lkPdf ª_ yfxf 5}g r_
cGo========== &=@=@=emf8fkvfnfsf] pkrf/ s;/L ug'{x'G5 <
s_ hLjg hn v'jfpg] v_ 3/d} tof/ kfl/Psf] g"g lrgL kfgL v'jfpg] u_ :jf:Yo rf}sL n}hfg] 3_ emf/km's ug]{ ª_ s]xL gug]{ r_ cGo =======
&=@=@=! -obL hLjg hn gv'jfPdf_ s] tkfO{n] hLjg hnjf6 x'g] pkrf/sf] jf/]df ;'Gg'ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+ &=# df hfg]_
&=@=@=@ s] tkfO{sf] hLjghn jgfpg] t/Lsf yfxf 5 < s_ 5 v_ 5}g
&=@=@=# obL yfxf 5 eg] s;/L tof/ kfg'{x'G5 < -ljwL_ s_ 7Ls v_ j]7Ls
gf]6M ljlw =========================== ^ lrof uLnf; ;kmf kfgL jf ! ln= kfgLdf ! k'/Lof hLjg hn ldnfpg] / @$ 306f leq lkpg]
&=#=!= s] tkfO{n] lgdf]lgof /f]uaf/] ;'Gg'ePsf] 5 < &=# Zjf; k|Zjf; ;DjGwL M
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' v_ vf]sL nfUg' u_ Hj/f] cfpg' 3_ ;f; km]g{ ufxf] x'g' ª_ sf]vf xfGg' r_ 5ftL £of/ £of/ ug'{ 5_ yfxf 5}g h_ cGo ==========
&=#=$= aRrfnfO{ lgdf]lgof ePdf sxfF nfg'x'G5 <
s_ wfdL emfs|L sxfF hfg] v_ :jf:Yo ;+:yf hfg] u_ 3/}df pkrf/ ug]{ -k|Zg g+= &=#=% df hfg]_ 3_ yfxf 5}g ª_ cGo=================
&=#=%= 3/]n' pkrf/ u/]df s] ug'{ x'G5 <
s_ Gofgf] kf/]/ /fV5' v_ pDn]sf] tftf]kfgL v'jfpF5' u_ lr;f]af6 arfp5'' 3_ vf]k nufp5' ª_ emf]lnnf] kbfy{ VfjfpF5' r_ cGo ==============
&=$ &=$=! s] tkfO{n] Ifo/f]usf] af/]df ;'Gg' ePsf] 5 <
Ifo /f]u
s_ 5 v_ 5}g -k|Zg g+= &=% df hfg]_
&=$=@= tkfO{sf] ljrf/df Ifo/f]u s;/L ;5{ xf]nf < s_ vf]Sbf/xfR5\o' ubf{ v_ vfgfsf] dfWodaf6 u_ lb;f lk;fjaf6
3_ /f]uLnfO{ 5f]P/ ª_ yfxf 5}g r_ cGo ============== &=$=#= Ifo/f]u nfu]df pkrf/ ug{ ;lsG5 ls ;lsb}g <
s_ ;lsG5 v_ ;lsb}g u_ yfxf 5}g &=$=$ of] /f]usf] nIf0fx? s] s] x'g< -ax'pQ/_
s_ vsf/df /ut b]lvg] v_ b'Anfpb} hfg] / ;fFemkv Hj/f] cfpg] u_ 5flt b'Vg] 3_ b'O{ xKtf eGbf a9L nuftf/ vf]sL nfUg] ª _ cGo===============
&=$=%=Ifo/f]u, (T.B) nfu]sf] a]nfdf pkrf/sf] nflu sxfF hfg'x'G5 <
s_ :jf:Yo ;+:yf v_ wfdL emfs|L u_ lj/fdLnfO{ cnUu} /fVg] 3_ cGo
&=% &=%=!= tkfO{n] P8\; /f]usf] af/]df ;'Gg' ePsf] 5 <
HIV/AIDS
s_ 5 v_ 5}g -k|Zg g+= *=! df hfg]_
&=%=@=of] s:tf lsl;dsf] /f]u xf] < s_ ;g]{ v_ g;g]{ u_ yfxf 5}g
&=%=#= -;5{ eg]_ of] /f]u s;/L ;5{ < -ax'pQ/_ s_ c;'/lIft of}g ;Dks{ v_ ;+qmldt ;'O{ ;f6f;f6 ugf{n] u_ ;+qmldt JolQmsf] /ut ln+bf 3_ ;+qmldt cfdfaf6 hlGdg] aRrfnfO{ ª_ cGo r_ yfxf 5}g
&=%=$= 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 v_ kl/jf/ lgof]hgsf] ;fwg pkof]u u/]/ (Condom) u_ w]/} hgf ;+u of}g ;Dks{ gugf{n] 3_ cGo
&=%=^= 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
*= *= != s] tkfOFn] kf]lnof] /f]usf] af/] ;'Gg'ePsf] 5 <
kf]lnof] ;DaGwdf:
s= 5 v= 5}g -k|Zg g+= (=! df hfg]_
*= @= -obL 5 eg]_ of] /f]u s;/L ;5{ < s= kmf]xf]/ kfgL lkP/ v= b]jLb]jtfsf] >fkn] u_ lb;f lk;faaf6 3=;b{}g ª_ yfxf 5}g r_ cGo==========
(=
(=! tkfO{n] aRrfnfO{ vf]k nufpg' ePsf] 5 < vf]k (Immunization) kfFr jif{d'lgsf] aRrf ePdf
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] k'/f gePsf] s}lkmot
! 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
(=@= olb nufpg'ePsf] lyPg eg], lsg <
s_ vf]ksf] ;'ljwf geP/ v_ :jf:Yo ;+:yf 6f9f eP/ u_ hl6ntf -vf]ksf] g/fd|f] c;/ b]lvP/_ 3_ hfgsf/L geP/ ª_
cGo========== !)=
kl/jf/ lgof]hg ;DjlGw -!% b]vL $( aif{ ;Ddsf ljjflxt bDktLnfO{ ;f]Wg]_
!)=!= tkfO{n] kl/jf/ lgof]hgsf] s'g} ;fwg k|of]u ug'{ ePsf] 5 . s_ 5 v_ 5}g
!)=!=!= 5g eg] s'g < c:yfoL :yfoL
s}lkmot Dflxnf s}lkmot k'?if s}lkmot Dflxnf s}lkmot k'?if lkN; s08d ldgLNofk Eof;]S6f]dL l8kf] -;+lugL # dlxg] ;'O{_
g/KnfG6 sk/- 6L
!)=!=@= -5}g eg]_ lsg k|of]u ug'{ ePg <
s_ ljZjf; gnfu]/ v_ wfld{s sf/0fn] ubf{ u_ gsf/fTds c;/n] ubf{ 3_ cGo -v'nfpg'xf];\_
!)=@+= k/Ljf/lgof]hgsf] kmfObfx? s] s] x'g< s_ hGdfGt/sf nflu v_ of]g /f]ujf6 jRg u_ ue{ /xg lbb}g To;}n] 3_ yfxf 5}g ª_ cGo==========
!)=#= -obL k|of]u u/]sf] eP_ tkfOn] kl/jf/ lgof]hgsf] ;]jf sxfFaf6 k|fKt ug'{ePsf] 5 < s_ :jf:Yo ;+:yf v_ k|fOe]6 lSnlgs
u_ :jo+ ;]ljsf 3_ cGo================== !)=$= tkfO{sf] ljrf/df b'O{ aRrfsf] hGdfGt/ stL x'g'k5{ <
s_ @ jif{ eGbf sd v_ @ jif{ u_ # jif{ 3_ $ aif{ ª_ % 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— ===========================================
!!= !!=! -% aif{ d'lgsf aRrf ePsf dlxnfnfO{ ;f]Wg]_ s] tkfO{nfO{ ;jf]{Qd kL7f] /ln6f] agfpg]
ljwL sf] af/]df yfxf 5 <
kf]if0f (Nutrition)
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 v_ Kofs]6sf] cfof]l8g o'Qm g"g u_ jL/] 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/ v_ cfjZos g7fg]/ u_ :jf:Yo ;+:yf 6f9f eP/ 3_ sf]lx v'jfpg cfPgg\ ª_ 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] v_ kmf]xf]/ vfg]s'/f vfgfn] u_ sfFrf] vfg]s'/f vfgfn] 3_ cGo==================
!!=%=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/ v_ cfjZos g7fg]/ u_ :jf:Yo ;+:yf 6f9f eP/ 3_ sf]lx v'jfpg cfPgg\ ª_ cGo=======================
!!=^= ;fukft / t/sf/L tkfO{ s'ga]nf kvfNg' x'G5 <
s_ sf6\g' cl3 v_ sfl6;s]k5L u_ b'j} k6s 3_ kvflNbg
!!=&= tkfO{sf] ljrf/df s'kf]if0f -;'s]gfz / km's]gfz_ /f]u s] sf/0fn] nfU5 < s_ kmf]xf]/ vfgf vfgfn] v_ k/ ;/]sf] dlxnfn] 5f]P/ u_ kf]lifnf] vfg]s'/f gvfP/ 3_yfxf 5}g ª_ cGo
!!=*= tkfO{sf] ljrf/df s'kf]if0f /f]u lgsf] kfg{ s] ug'{knf{ < s_ wfdL emfFs|L jf]nfpg' v_ kf}li6s cfxf/ v'jfpg' u_ :jf:Yo ;+:yfdf n}hfg' 3_ cfkm} lgsf] x'G5 ª_ yfxf 5}g r_ cGo
!!=(= kfFr jif{ d'lgsf jRrfx?sf] kf]if0f l:yltM
jRrfsf] kf]if0f ;DjlGw ljj/0fM l;=g+=
aRrfsf] gfd
pd]/
lnË
tf}n
prfO{
kfv'/fsf] gfk xl/of] -/fd|f]_
kx]+nf] -xf]l;of/_
/ftf] -vt/f_
! @ # $
!@=
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 !@= #=@= -olb lyof]_ eg] sxfF hfFr u/fpg' ePsf] lyof]<
s_ :jf:Yo ;+:yf v_ k|fOe]6 lSnlgs u_ :jo+ ;]ljsf 3_ cGo==================
!@= #=#= -olb lyPg_ eg] lsg < s= yfxf geP/ v= :jf:Yo;++:yf 6f9f eP/ u= ;do geP/ 3= d=:jf:YosdL{ geP/ ª cfjZostf g7fg]/ r= cGo !@=$= uef{j:yfdf s:tf] vfgf vfg'x'GYof] < s= ;fljs h:t} v= ;fljs eGbf kf]lifnf vfgf u= ;fljs eGbf sd !@=%= uef{j:yfdf s:tf] lsl;dsf] sfd ug'{x'GYof] < s= ;fdfGo sfd v= uf¥xf] ;fdfg p7fpg] sfd u= s]lx klg ul/gF 3= cGo !@=^= s] tkfOFnfO{ uef{j:yfdf s'g} lsl;dsf :jf:Yo ;d:ofx? b]vf k/]sf] lyof] < s= lyof] v= lyPg !@=^=!= -olb lyof] eg]_ s:tf k|sf/sf ;d:ofx? b]vf k/]sf lyP < s= xftv'§f ;'lGgg] v= l/Ë6f nfUg] u= 6fpsf] b'Vg] / j]xf];x'g] 3= /ut hfg] ª cGo !@=&= tkfOFn] uef{j:yfdf 6L= 6L vf]k nufpg'ePsf] lyof] < s= lyof] v= lyPg !@=&=!= olb lyof] eg] slt k6s nufpg'ePsf] lyof] < s= ! k6s v= @ k6s u= # k6s 3= ;f] eGbf a9L !@=*= tkfOFn] uef{j:yfdf h'sfsf] cf}ifwL vfg'ePsf] lyof] < s= lyPF v= lyOFg !@=(= tkfOFsf] klxnf] jRrf sxfF hlGdPsf] lyof] < s= 3/d} v= uf]7df
u=;/sf/L :jf:Yo ;+:yfdf 3= lghL :jf:Yo ;+:yf ª_ cGo===================================
-obL 3/df g} hlGdPsf] eP dfq k|Zg g+ !@=!) b]vL !@=!# ;Dd ;f]Wg]_ !@=!)= jRrfsf] gfnsf6\bf s] k|of]u ug'{ePsf] lyof] < s= xFl;of /r'n];L / rSs" v= s}+rL u= gofF An]8 3= jFf; /rf]of ª= cGo !@=!!= tkfOFnfO{ ;'Ts]/L ;fdfu|Ljf/] yfxf 5 < s= 5 v= 5}g !@=!@= -olb yfxf 5 eg]_ jRrf hGdfpFbf ;'Ts]/L ;fdfu|Lsf] k|of]u ePsf] lyof] < s= lyof] v= lyPg !@=!#= gfn sf6]sf] 3fpdf s] nufpg' ePsf] lyof] < s=a];f/ / t]n v= uf]j/ u= cf}ifwL 3_ cGo========================= !@=!$= jRrfnfO{ lauf}tL b"w v'jfpg'ePsf] lyof] < s= lyof] v= lyPg !@=!$=!= olb lyPg eg] lsg < s= rng geP/ v= kmf]xf]/ x'G5 eg]/ u= xfgL x'G5 eg]/ 3= cGo !@=!$=@= tkfOFn] jRrfnfO{ sltk6s b'w v'jfpg' x'G5 < s= ^ k6s eGbf sd v= ^ * k6s u= * k6s eGbf al9 3= cGo !@=!$=#= jRrfnfO{ cfdfsf] b"w dfq slt ;do;Dd v'jfpg'ePsf] lyof] < s= ^ dlxgfeGbf sd v= ^ dlxgf k"/f u= ^ - !@ dlxgf 3= ! jif{eGbf dfyL !@=!% != 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 u= hfpnf] 3= cGo !@=!%=#= tkfOFn] k"0f{ cjwL;Dd Iron rSsL vfg'ePsf] lyof] < s= vfFb} gvfPsf] v= s]xL cjwLdfq u= ue{jtL cj:yfdf dfq} vfPsf] 3= ;'Ts]/L cj:yfdf dfq ª= k"0f{ cawL vfPsf] 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
ldtL: b[io cjnf]sg kmf/d -Observation Check-List)
kmf/d g=: !_ 3/sf] k|sf/
s= sRrf v= kSsf u= sRrf kSsf gf]6 : sRrf : df6f]n] ag]sf]/ sfFrf] O{§f/v/n] 5fPsf] kSsf : ;Ld]G6n] ag]sf] sRrf kSsf: 9'Ëf df6f/] h:tfn] 5fPsf] /6fonlem+u6L sf7 h:tf cflbn] ag]sf] @_ 5fgfsf] k|sf/
s= v/sf] v= h:tf u= 9'Ëf,6fO{n 3= k/fnsf] ª=l;d]G6 #_ sf]7f leq pHofnf]
s= kof{Kt -;j} ;fdfg :ki6 b]lvg]_ v= ckof{Kt -;j} ;fdfg :ki6
glb]lvg]_ $_ e]G6Ln];g - /f];gbfg _
s= 5 v= 5}g %_ efG5f 3/
s= 5'\6} ePsf] v= Ps} 7fpdf ePsf] ^_ r'Nnf]sf] k|sf/
s= w'jfF cfpg] v= UoFf; r'Nnf] u= :6f]e/dl§t]n 3= ;'wf/LPsf] r'Nnf] &_ kfgLsf] ;|f]t
s= ;kmf v= kmf]xf]/ *_ 3/af6 lg:s]sf] kmf]xf]/ kflgsf] Aoj:yfkg
s= s/];faf/Ldf v= gfnL/9ndf u= cJjl:yt (_ kfgL hd]sf] 7fpF
s= 5 v= 5}g !)_ kmf]xf]/ d}nfsf] Aoj:yfkg
s= hnfP/ v= sDkf]i6 dn agfP/ u= k"/]/ 3= hyfefjL !!_ 3/ j/k/sf] jftfj/0f
s= ;kmf v= kmf]xf]/ u= l7s} !@_ rkL{
s= 5 v= 5}g !#_ 5 eg] s:tf] <
s_ kSsf v_ sRrf !$_ 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 ª= 5}g
Formulae used
Fertility
1. Crude Birth Rate= Total live birth in a year *1000
Total mid
2. General Fertility Rate =
year population
Total live birth in a year
Total female population of 15-49
*1000
3. Age Specific Fertility Rate= No. of live births to
Total no. of women of that specific
women of specific age group *1000
age group
4. Total Fertility Rate=5*
1000
∑ASFR
Mortality
1. Crude death rate=
Total mid year population
no of death during a year*1000
2. Infant mortality rate=
Total live births in that year
no of deaths of infants in a given year*1000
3. Maternal mortality rate= no of maternal death in a year
Total live births in that year
*100000
Morbidity
1. Incidence rate= total no. of new cases of diseases that
Population at risk
occur during a specific time*100
2. Prevalence rate=
Population at that time
No of existing cases *100
or average population
3. Sex ratio =
Total female population
total male population *100
Annex: 2
4. Total dependency ratio =
Total population of 15-64 years
Total population of<15 years and >64 years*100
5. Child ratio=
Total population of 15-64 years
Total population of <15 years*100
6. Old dependency ratio =
Total population of 15-64 years
Total population of >64 years*100
7. Child women ratio =
Total no. of women age 15-49 years
Total population of 0-4 years children *1000
8. Natural increase rate= CBR-CDR
Average family size = Total population of observed data
Total no. of household in observed data
lgb]{lzsf(Guideline)
!) k|ZgfjnLx? ;a} g]kfnL efiffdf ;f]Wg] .
@) ! aif{ eGbf d'lgsf aRrfx?sf] pd]/ dlxgfdf pNn]v ug]{ .
#) kfl/jf/Ls ljj/0fsf] w'd|kfg / dWokfgsf] nflu !% aif{ eGbf dflysfnfO{ dfq
;f]Wg] .
$) kl/jf/sf] k|sf/ M
s) Psn kl/jf/ M cfdf, j'af, cljjflxt 5f]/f 5f]/L
v) ;+o'Qm kl/jf/ M cfdf, j'af, 5f]/f, a'xf/L
u) a[xt kl/jf/ M cfdf, j'af, sfsf, sfsL, xh'/j'af, xh'/cfdf
%) ;fdflhs–cfly{s cj:yf
=! s[lif af6 x'g] aflif{s pTkfbgn] slt ;do u'hf/f ug{ k'U5 egL d'n
cfdbfgLsf] ;|f]t ePsfnfO{ ;f]Wg] .
=@ z}lIfs l:ylt
– Kff+r (%) aif{ eGbf al9 pd]/ ePsfnfO{ dfq ;f]Wg] .
s) lg/If/ M n]v k9 ug{ ghfGg]
v) ;fIf/ M cgf}krfl/ lzIff h:t} k|f}9 lzIff k|fKt ul/ ;fwf/0f n]v k9 ug{
hfGg]
u) k|fylds tx M !–% sIff k9]sf
3) lg=df=lj tx M ^–* sIff k9]sf
ª) df=lj tx M (–!) sIff k9]sf
r) pRr tx M !!–!@ sIff k9]sf
5) pRr lzIff tx M Bachelor & above
^) k]zf M
– !% b]lv ^$ aif{ ;Dd pd]/ ePsf nfO{ ;f]Wg]
&) k|Zg g+=( (vf]k ;DaGwL) kf+r aif{ d'lgsf aRrf ePdf dfq ;f]Wg]
*) k|Zg g+=!) (kl/jf/lgof]hg ;DaGwL) !%–$( aif{ ;Ddsf ljjfxLt bDkQLnfO{ dfq ;f]Wg]
() k|Zg g+= !!.(kf]if0f ;DaGwL) %aif{ d'lgsf jRrf EfPsf dlxnfnfO{ dfq ;f]Wg]
!)) ;jf]{Qd lk7f] eGgfn] cfwf efu u]8fu'8L, cfwf efu cGg (b'O{ y/L cfwf–cfwf)
!!) k|Zg g+=!@.(dft[ lzz' :jf:Yo ;DaGwL) kf+r aif{ AfRrfx?sf] cfdfnfO{ dfq ;f]Wg]
:jf:Yo ;+:yf k|d'vnfO{ cGtjf{tf k|ZgfjnL
s) :jf:Yo ;+:yfsf] gfd M=========================================================================
v) :jf:Yo ;+:yfsf] 7]ufgf M==================================================================
u) :jf:Yo ;+:yfsf] k|d'vsf] gfd M===============================================================
3) :jf:Yo ;+:yfaf6 pknAw u/fOg] ;]jfx? M
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ª) :jf:Yo ;+:yfdf acfp[g] d'Vo :jf:Yo ;d:ofx? s] s] x'g ?
r) lt :jf:Yo ;d:ofx? ;dfwfg ug{ ljz]if sfo{qmdx? 5g\ ls 5}gg\ ?
5) olb 5g\ eg], s] s] x'g ?
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h) :jf:Yo ;+:yfnfO{ cfOk/]sf ;Df:ofx? s] s] x'g ?
em) o; :jf:Yo ;+:yfdf s'g hfltsf la/fdLx? w]/} cfFp5g\ ?
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`) tFkfO{sf] ljrf/df d]ndrL uf=lj=;sf jfl;Gbfx?sf] :jf:Yo cfjZoQmf s] s] x'g ?
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6) o; :jf:Yo ;+:yfnfO{ ;'wf/ ug{ g]kfn ;/sf/nfO{ tFkfO{sf] s] ;'emfj 5 ?
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PHOTO GALLERY
Photo 1: Group members at the time of rapport building
Photo 2: Secondary data collection
Photo 3: Primary data collection
Photo 1: Data analysis
Photo 2: Focus Group Discussion
Photo 3: Preparation of first community presentation
Photo 4: First community presentation
Photo 5: Observation of drinking water supply in Melamchi
Photo 6: Door to door health education at Dadhuwa
Photo 7: Sanitation program in Melamchi Bazaar
Photo 8: Health exhibition program
Photo 9: School Health Program
Photo 10: Group members with teachers of IHSS
Photo 11: Condom box donation to PHC
Photo 12: Group members with field supervisor
Photo 16: College presentation
