Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM1 FIELD REPORT 2068 B.S. Group-C, 31st Batch MBBS, IOM Phulpingdanda VDC, Sindhupalchok Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM2 . . Submitted by Group-C, Phulpingdanda VDC, Sindhupalchok 31st Batch of MBBS, IOM Submitted to Department of Community Medicine and Family Health Maharajgunj Medical Campus Maharajgunj, Kathmandu Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM3 Group Members From left to right: Upper row:Sudeep Bhandari Prabin BhattaraiSandip Bhandari Utsav Joshi Prajwol Bhattarai Lower row:Shailesh Niroula (Group leader) Rubina Paudel Jenisha UpadhyayaSheetal Khanal Pradeep Regmi Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM4 Table of Contents S.N.TitlePage no. 1Prologue9 2Acknowledgements10 3Abbreviations12 4Social map of Phulpingdanda VDC14 5Executive Summary15 6Chronology of events18 7Introduction A.Introduction to Community Health Diagnosis B.Objectives C.Village Profile D.Methodology E.Logistic management F.Validity and Reliability G.Limitations and Ethical considerations H. Protocol for data collection I.Sampling 19 21 22 25 27 28 29 30 33 8Findings and Discussions A.Demography B.Socio-economic status C.Knowledge, attitude and practice D.Environmental Health E.Personal hygiene F.Nutritional status G.Gender status H.Maternal and Child Health I.Family planning 35 43 44 49 53 54 59 61 68 9Focus group discussions69 10In-depth Interview70 11Community presentations A.First community presentation B.Second community presentation 72 73 12Micro health project74 13Recommendations83 14Learning reflection84 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM5 15Moments to share85 16Annex A.Questionnaire B.Formulae C.Bibliography D.LettersE.Certificates F.Photo Gallery 87 98 100 101 113 114 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM6 List of Tables elba on .gaedaoHeHa on .1stngrggo go everts18 2sgyyorit sgnest cgrsoyen ongoC23 3aist go ipOs Lctive ir atoCiro LriL23 4netteyert LneLs rLye ir atoCiro LriL 24 5nggs osei ioniro iLtL cgectigr26 6sinst stnLtoy go nLyCiro33 7necgri stnLtoy go nLyCiro34 8eygonLCtic CLnLyetens36 9aoe seg cgyCgsitigr ir atoCiro LriL37 10eLnitL ntLtos go CegCe40 11aoe sCecioic oentiit nLte41 12ngonce go ircgye43 13tse go LonicotonL Cngioct43 14sLose go iiseLse44 15eeLsones tg Cnevert iiseLses44 16seLsgr ogn rgt ogiro tg teLtt irstitotigrs45 17niye tg neLct teLtt oLciit45 18ergdeioe gr igiire45 19sgrceCt neoLniiro sgonce go ritLyir a46 20Concept regarding transmission of tuberculosis46 21sgrceCt neoLniiro cLose go siLniLsis47 22sgrceCt neoLniiro ngote go tnLrsyissigr go siLniLsis47 23sgrceCt neoLniiro Cnevertive yeLsone go siLniLsis47 24Concept regarding treatment of Filariasis47 25Distance of water source from house49 26aLce go ieoecLtigr50 27seLsgr ogn rgt tLviro tgiet50 28Major solid waste51 29isCgsL go sgii dLste51 30isCgsL go iooii dLste51 31Hgose tCes51 32avenLoe royben go dirigds Cen nggy52 33istLrce betdeer stei Lri tgose52 34Bathing habit53 35HLbit go deLniro siCCen53 36seonerce tLbe ogn pgyef cLssioicLtigr55 37seonerce tLbe ogn raa cLssioicLtigr55 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM7 38seonerce tLbe ogn WLtengds cLssioicLtigr57 39iotnitigrL stLtos Lccgniiro tg WLtengds cLssioicLtigr57 40seonerce tLbe ogn etas Lssessyert57 41seLsgr ogn tLviro Lt eLst L sgr ir oLyi60 42aoe go yLnniLoe go dgyer ditt ctiiner orien 5 eLns go Loe61 43Age at 1st pregnancy61 44sneooerc go CneorLrc62 45sneooerc go ais visit62 46seLsgr ogn Lck go ais visit62 47sLne ioniro CneorLrc63 48seLsgr ogn rgt oeeiiro cggstnoy64 49sgrceCt neoLniiro cLose go areoygriL65 50sgrceCt neoLniiro cLose go ascLniLsis 66 51sgrceCt neoLniiro cLose go iLnntgeL66 52sgrceCt neoLniiro tneLtyert go iLnntgeL66 53ryyorifLtigr cgvenLoe67 54angCgntigr go oLyi CLrriro ievices osei68 55sgrceCt neoLniiro bintt sCLciro68 56anginitifLtigr yLtnig76 57ngCics ogn eHa78 58nctgg bLsei yicng-teLctiro scteioe80 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM8 Last nf Hrephs eod daeHrems eaHgrappaatbaeHa on. 1eLCngciL yLCCiro14 2agCoLtigr CnLyii37 3aie ctLntnttric iistnibotigr39 4eotiCe bLn iiLonLy nttricit dise seg dise itenLc nLte39 5niyCe bLn iiLonLyiseLse ygnbiiit nLte go Lst ygrtt42 6aie ctLntanevLerce go dLten tneLtyert CnLctice beogne inirkiro 49 7niyCe bLn iiLonLyiotnitigrL stLtos Lccgniiro tg pgyef cLssioicLtigr 55 8niyCe bLn iLonLyiotnitigrL stLtos Lccgniiro tg WLtengds cLssioicLtigr 56 9niyCe bLn iLonLyetas go ctiiner58 10eotiCe bLn iLonLyneg dise eiocLtigr stLtos59 11aictoneBrynts Problem solving Circle 74 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM9 1. Prologue A month long Community Health Diagnosis in a new village-when this thought came in our minds for the first time, we were quite excited as well as quite anxious about the stay and works to be done there. As we moved farther from the capital city, the pleasing environment of the countryside started soothing our anxiety. We were wondering how the environment would be there, how the local people would treat us, how well would the fooding and lodging be and so on. After seventy five kilometers drive from Kathmandu, Phulpingdanda VDC at the very first sight cherished us by its natural beauty. Green plains at the base of hills and bank of Sunkoshi river made us feel we were in for an unforgettable experience. For a few days, it was quite difficult to adjust in a completely new environment. As time passedby,welearnttosharehappinessandsorrowsamongthepeople.Everynewdaywas moreexcitingthanthepreviousdaywithlotsofassistance,timelycooperationandunlimited participation from the locals. All these paved way for an interesting field experience as we were abletoachieveourobjectives;atthesametime,teachingthecommunityandlearningfrom theminturn.WearegladtobesuccessfulinincorporatingwiththerealityofNepal.Our combinedefforttobringaboutminimalchangesinPhulpingdandaVDCisoneofourgreatest achievements.This was a lifetime experience for each of us. Staying under a single roof, we shared our moments of happiness and sorrow. We had been friends from the beginning of our college, but thebonddevelopedatPhulpingdandacannotbeexplainedinwords.Wehadopportunityto learn from each other as well. All the days were tiresome yet entertaining; with friends, bitter experiencesturnsweet.Allofusactuallyenjoyedthehardshipofrurallife.Anditwouldnot have been possible if we were not in group.Phulpingdanda will always remain in our memory ogn it dLs a source of new experience and knowledge to us. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM10 2. Acknowledgements Our Community Health Diagnosis program would not have been a success without a number of handsmovingforwardtohelpus.Weexpressourheartilythankstoallthosepeoplewhose direct and indirect supports provided us a new experience and knowledge. WewouldliketoextendoursincereregardstotheDepartmentofCommunityMedicineand Family Health (DCMFH) for its continuous and prompt support from the very beginning. We are duly obliged to Prof. Dr. Ram Prasad Uprety (Campus Chief), Dr. Sharad Onta (HOD of DCMFH), Prof.Dr.BharatManiPokherel(BasicScienceCoordinator),Dr.ArchanaAmatya(eBBncg-gniirLtgn),Prof.ChitraKumarGurung,Dr.RajendraRajWagle,Dr.MadhuDixitDevkota,Dr. Ananda Ballav Joshi, Dr. Bandana anLitLr, Mr. Ramesh Sigdel, Mr. AjLy Thakur, Mrs. Brinjwala Shrestha, Mns. Rajani Joshi, Mr. Shiva Prasad Sapkota, Mr. Prem Basyal Lri Mr. Durga Pahari in orienting and coordinating the field work. Wehavetriedtoaddressthesuggestionsprovidedbyourteachersregardingthereport preparation during thecollege presentation. We would like to be grateful to their support and teC in this matter. WewouldliketoexpressourgratitudetoallthepeopleofPhulpingdandaVDCasthey welcomeduswithpleasure,appreciatedourworks,helpedusandco-operatedwithus.Had therebeen noinvolvement of thelocal peopleinhouseholdsurvey,communitypresentations and MHPs we conducted, those programs would have been vain. Since there was no VDC office, the only administrative body of the government in the village, it was not easy for us to get the secondary data in time. However, the absence of the VDC office wasfulfilledbyBinjelCommunityLearningCentre.Ourbothcommunitypresentationswere heldatthesamevenue.WewouldliketoexpressourdeepestgratitudetoMr.Sadhuram Nepal,chairpersonofCommunityLearningcentreforprovidingussupportineverypossible way. We would like to thank Mr. Kamal Timilsina for his enormous help during our stay. Our thanks gofurthertoMns.ChatraKumariNepal(ssHr),Mr.NetraTimilsina,Mr.RupLalShah (aHW), Mr. Resham Tamang and Mr. Fadindra Nepal. Itwouldbeablunderifwemisstomentiontheco-operationofalltheschoolsoftheVDC, especially Shree Jalapa Higher Secondary School for assisting in social mapping and conducting MHPs. Our thanks also go to the teachers of the local schools who were always there to help us in every matter. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM11 Last but certainly not the least; we would like to thank Mr. Ishwori Shrestha and his family for providing us with the lodging, fooding, caring and a homely environment. Lastly we apologize and thank to all those whom we might not have mentioned above but they will remain forever in our cherishing memory. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM12 3. Abbreviations AHW= Auxiliary Health Worker AIDS = Acquired Immune Deficiency SyndromeANC = Ante Natal CareARI= Acute Respiratory Infection ASDR = Age Specific Death RateASFR= Age Specific Fertility Rate BCG = Bacille Calmette GuerinCBR = Crude Birth RateCBS = Central Bureau of StatisticsCHD = Community Health DiagnosisCDR = Crude Death RateCPR = Contraceptive Prevalence RateDCMFH = Department of Community Medicine and Family Health DDC= Dairy Development CommitteeDOTS = Directly Observed Treatment Short CourseDPT = Diphtheria Pertussis TetanusFCHV = Female Community Health VolunteerFESU = Field Education Support UnitFGD = Focus Group DiscussionGFR = General Fertility RateHE = Health EducationHH = Household HIV= Human Immuno Deficiency Syndrome HOD = Head of Department IEC = Information, Education and CommunicationIMR = Infant Mortality RateIOM= Institute Of Medicine KAP = Knowledge Attitude and PracticeMCH = Maternal and Child Health MCHW= Maternal and Child Health Worker MHP = Micro Health ProjectMMR = Maternal Mortality Rate MOH= Ministry Of HealthMUAC = Mid Upper Arm Circumference NDHS= National Demographic and Health SurveyNGO= Non Governmental Organization Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM13 NHEICC = National Health Education, Information and Communication CentreORS= Oral Rehydration Solution PEM= Protein Energy Malnutrition RCC = Reinforced Cement ConcreteSHP = Sub Health PostTB = TuberculosisTBA= Trained Birth Attendant TFR = Total Fertility RateTT = Tetanus ToxoidVDC = Village Development CommitteeVHW = Village Health Worker Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM14 4. Social Map of Phulpingdanda VDC Figure 1 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM15 5. Executive summary As a part of curriculum, we went for Community Health Diagnosis from 2068/5/1 to 2068/5/30. Thereportisbasedonthefindingsandmicro-healthprojectthatwecarriedoutduringthe month's stay. Wecarriedouttheprograminthe4differentphases:datacollection,dataanalysis,planning andmicro-healthproject(MHP).Fordatacollection,wedidHouseholdsurveythatincluded structuredinterviewandObservation.Similarlywetookanthropometricmeasurementof childrenbelow5yearsofageforassessingthenutritionalstatus.Also,weorganizedfocus groupdiscussionwithFCHVsandinterviewedlocalschoolteacher,villagehealthworkerand maternalandchildhealthworkertocollectqualitativedata.Wediddataanalysisofprimary data collected through household survey, secondary data as well as qualitative data. According to our analysis, we planned and conducted the MHP on the basis of feedback obtained from the community stakeholders in first community presentation.There were 883 household in the VDC with a total population of 6178, out of which 3051 were femalesand3127weremales.ThemajorethnicgroupswereBrahminfollowedbyChhetri, Tamang,NewarandDalit.HinduismwasthemainreligionalongwithBuddhismand Christianity. The major occupation was agriculture followed by business.WeusedStratifiedProportionateRandomSamplingasthesamplingmethodandthesample size was 27% (239) of total household.Our major findings were: Demographic findings Regarding the major demographic findings, Crude Death Rate and Crude birth rate of the V.D.C were19.78perthousandand5.86perthousandrespectively.PopulationGrowthRatewas 1.39%andhencetheCopulationioublingtimewas50.28years.Similarlyyedianageof population was 25.4 years and sex ratio was found to be 107.8 males per 100 females. Socio-economic findings Literacy rate was 76.92% and deCerierc nLtig dLs 44.44%. Major occupation of the V.D.C was agriculturewith78%peopleinvolvedinit.82%ofhouseholdwerekacchatypeand63%had satisfactory lighting in the room. 67% of household still used smoking stove. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM16 Health related findings Themorbidityprevalenceratewas6.33%andthe5mostcommonmorbiditysignswereoever, headache,tonsillitis,typhoidandgastritis.Smokingprevalenceamongmenwas18.22%and womenwere10.5%whereasdrinkingprevalenceamongmenwas22.18%andwomenwas 14.61%. 86% directly drank water without treatment. Fecal water contamination was found in all drinkingwatersources,whichwetested.Toiletprevalencewas64%.Opendefecationwas prevalent in ward 1, 2 and 3. All respondents washed hands beforemeals and after defecation, 63%% using soap and water. Though we didnt find any cases of complications related withuterire CngLCse, but information fromtheV.H.W.andM.C.H.W.presentedhigherprevalenceofuterineprolapse.Therewas iceberg phenomenon with uterine prolapsed. Findings related to MCH The median age of marriage was 18.2 yrs. 53.33% of women gave the 1st delivery below 20 yrs. 74.29% women practiced ante-natal visit of which 37.78% visited less than 4 times.Also, 58.52 % of delivery is conducted in house. Among those, 79% did not use delivery kit. 63% of women didnt know how to prepare Sarbottam Pitho properly and 56.1% of women didnt know about Jeevanjaloritspreparation.Theimmunizationcoverageamongchildrenwasreally statisfactory. Findings related to family planning CPR of Phulpingdanda VDC is 74.06 %.Among the temporary methods available, Depo-Provera wasthefirstchoiceandamongthepermanentdevicestheproportionofcouplespreferring vasectomy to Minilap or laparoscopy was larger. Nutritional status of children 69.09% of children were normal while 22.27% were 1st degree malnourished while 3.63% were 2nd degree malnourished. We didnt find any cases of 3rd and 4th degree malnutrition. Findings related to KAP on Diseases The knowledge, attitude and practice of the people ofthe VDC regarding various diseases were foundtobequitepoor.About65%respondedgermsandlackofsanitationtobethecauseof disease but more than half had not heard of malnutrition or night blindness and about the same proportionthoughtworminfestationwascausedbysweets.EventhoughSindhupalchokisthe prioritized district for anti-filariasis campaign, only 51% had knowledge about the filariasis. 60% ofparticipantshadheardoftuberculosis(TB)butmanyhadnotheardofitstreatmenti.e. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM17 directlyobservedtreatmentshort-course(DOTS).Similarlyonly56%hadcorrectknowledge about anemia. Afterfirstcommunitypresentation,therealneedsweredecidedwithactivediscussionswith the stakeholders. Then real needs were prioritized with the help of prioritization matrix.Our prioritized needs were: Knowledge on personal and environmental hygiene. Knowledge on water disinfection methods Knowledge on uterine prolapse and its preventive methods Knowledge on family planning Knowledge on reproductive health Knowledge on common disease Knowledge on uterine prolapse ergdeioe gr yLtenrL Lri ctiis teLtt cLne WeconductedMHPonabovelistedtopics,conductingschool-basedaswellascommunity-basedprograms.WecgriocteiCngonLysneoLniirootenireCngLCse,yLtenrLLrictiis teLttcLneLrioLyiCLrriroyettgisdittsCeciLogcostgDepo-ProveratggcLayyL sLyotLLrissHr.WeLsgcgriocteiCngonLygrLnoescLectgnirLtigrtggcLnirkiro dLtencgyittee.OttenCngonLysdenesctggbLseidittkrgdeioegrneCngioctiveteLtt yLir ogcosei tg secgriLn eve stoierts. sgn gden secgriLn even stoierts, de ogcosei gon CngonLyyeyLirneoLniiroCensgrLLriervingryertLtoiere.angonLygrkrgdeioegr cgyygriiseLseLridLteniisiroectigryettgi(nOrnLristgnirLtigr)dLsigreogcosiro bgtt agden secgriLn Lri secgriLn eve stoierts. asognevLotigr,ognsctggbLseiCngonLysessLdnitirocgyCetitigrLriooifcgyCetitigr dene tei. asg ieygrstnLtigr b tte stoierts dLs osei Ls tgg ogn evLotigr. sgn cgyyorit eve CngonLy, yLi oeeibLck ongy CLnticiCLrts iyyeiiLte Loten tte CngonLy dLs osei Ls tgg ogn evLotigr.sirL, we conducted a final community presentation to thank the community and to explain to them the activities conducted during the period. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM18 6. Chronology of events DateEvents 2068/5/1Departure from IOM, Lodging and fooding management 2068/5/2Rapport building2068/5/3Social Mapping and In-Depth Interview with local teachers 2068/5/4-12Secondary data collection and Sampling by household survey 2068/5/13-15Data entry, processing and analysis 2068/5/16FocusgroupdiscussionwithFCHVandIn-depthInterviewwithMCHWandriLoe Health Worker and analysis of the findings 2068/5/17Data analysis and preparation of Community presentation 2068/5/18First Community presentation2068/5/19-20Priority setting and planning of MHP 2068/5/21Preparation of MHP 2068/5/22School Based Micro-Teaching (Keureni Primary School and Janasewa Lower Secondary School) 2068/5/23SchoolBasedMicro-Teaching(ShreeSetideviLowerSecondarySchoolandJalapa Higher Secondary School, eLnLroLinL agden necgriLn nctgg)2068/5/24Preparation of materials for oontten MHP 2068/5/25SchoolbasedMicro-teaching(BalephiSecondarySchool,FalatePrimarySchool)and Community based Micro-teaching for FCHVs 2068/5/26Micro-teachingonwaterpurificationand demonstrationoflargescalechlorinationto local drinking water committee 2068/5/27Community based Micro-teaching for the Aama Samuha 2068/5/29 sirL sgyyorit anesertLtigr 2068/5/30Farewell and arrival to college Table 1Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM19 7. Introduction 7A. Introduction to Community Health Diagnosis InstituteofMedicine(IOM),thepioneermedicalcollegeofNepal,wasfoundedin1972A.D. with an aim to produce health and medical manpower so as to meet the health needs of people of Nepal. It began to conduct MBBS courses after 7 years of its establishment in 1978 A.D. Since then,ithasgainedfame,bothatnationalandinternationallevel,asbeingoneofthebest medical colleges in this region.Community Health Diagnosis is a month long community based field program exclusive to IOM syllabusandaffiliatedcolleges.Itsinstitutionalgoalistocontributetoproducetechnically competent and socially responsible health workers.Community Health DiagnosisCommunitydiagnosisisacomprehensiveassessmentofhealthstatusofthecommunityin relation to its social, physical and biological environment. The purpose of community diagnosis istodefineexistingproblems,determineavailableresourcesandsetprioritiesforplanning, implementing and evaluating health action, by and for the community. -Dr. Cynthia et al (1996) Inotherwords,CommunityHealth Diagnosisis aprocessofexaminingthe patterns ofdisease orhealthstatusinthecommunityinordertopromotehealth,preventdiseaseandmange health services for community. Importance of Community Health Diagnosis Ithelpstofindthecommonproblemsordiseases,whicharetroublesometothe cgyyorit and are easily preventable in the community.Duetothelackofsufficienttime,resourcesandmanpower;itisalmostimpossibleto provide healthfacilities toall the peopleof the ruralcommunity.Communitydiagnosis can be a pioneer step for betterment of rural community health.It is a tool to disclose the hidden problems that are not visible to the community people but are being affected by them.Ithelpstoaccessthegroupofunderprivilegedpeoplewhoareunabletousethe available facilities due to high poverty, prevailing discriminations or other reasons.Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM20 Ithelpstofindtherealproblemsofthecommunitypeoplewhichmightnthave perceived by them as problems.Thepeoplemaynothavetheknowledgeofwhy,whatforcetheproblems.Their ignorancemayaddtheproblemovertheother.Communitydiagnosishelpstoimpart knowledge and attitudes to turnover their problems towards the light of solution. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM21 7B. Oljactavas General ObjectiveWe will learn to work together in group and involve community actively to identify health problems, prioritize, plan and implement micro-health project through use of locally available resources.Specific Objective We will learn to:-I.Interact with community people and develop communication skills regarding data collection on health data II.Use the prepared tools to collect data III.Apply methods (eg. Household survey, focus group discussion) to collect both qualitative and quantitative data IV.Analyze the health status and identify the existing health problem of the community from data collected V.To work with community to prioritize their needs and design micro health project VI.Use local resources to implement micro health project Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM22 7C. Village Profile Location Phulpingdanda is hilly VDC of election constituency no 1 of Sindhupalchok district. It is bordered bySunkoshiRiverinSouthandBrahmayaniRiverinWest.Itiselevatedfrom700metersto 2100meters.Itislocatedbetween852'15''Eto858'Elongitudeand2744'Nto2747'N latitude.ItisborderedtoMankhaVDCineast,KubhindeandIrkhuVDCinwest,Phulpingkot andMankhaVDCinNorthandKadambasVDCinsouth.Thetopographyhereissomewhere besi, somewhere tar and somewhere rocky. Population The VDC has total population of 6178, out of which 3051 are females and 3127 are males. The total number of household is 884. ReligionThere are 4365 Hindus (70.65%), 1611 Buddhist (26.08%) and 202 Christian (3.27%). Ethnic distribution and Culture Thereare1318Brahmins,1631Chettri(Bhujel,Thakuri,andKarki),1623Tamang,939Newar and388Dalit(Kami,Bishwakarma,ThamiandSarki)and596others(Magar,Gurungand Sanyashi).Deusi,Bhailo,Bhajan-KirtanandGhanse-geetaresomeoftheculturalidentitiesof the VDC. Occupation Most of the people in this VDC are involved in Agriculture. Teaching as an occupation is carried out by some and few are involved in Business. Education Thereis1HigherSecondarySchool,3LowerSecondarySchoolsand6PrimarySchools.Major educationalactivitiesarecarriedoutbyBinjelCommunityLearningCentreandvariousclubs. Though the number of literate people involved in teaching seems to be large, the VDC isnt well forward in terms of literacy percentage. Transport All the 9 wards of this VDC have road access. Araniko Highway trails along Sunkoshi River across Balephi and Kothe. Similarly, Jalbire Highway trails along Brahmayani River in the west side. Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM23 Agriculture Major production of this VDC is maize, millet, paddy, wheat and vegetables. Animal husbandry is also flourished in this VDC. Cows, buffaloes, goats and hens are reared in almost every house oftheVDC.Involvementofvariousco-operativeorganizationsindairyproductionand distributionhasmade thisVDC quiteaheadinDairyindustry. Themilk fromtheentireVDCas well as other VDCs is collected at the cooling plant at Balephi from where milk is transported to theDDCoffice,Lainchaur.Thefacilityofirrigationisntworthmentioningandtheterrace farming of the besi is conducted by the waters of local mools and streams. Religious sites and Touristy sites Balephi Kapileshwor MahadevisapopulartemplelocatedatthemeetingpointofSunkoshi andBrahmayaniRiver.FalateKalikaTemple,GolmadeviTemplearerecognizedfortheir religiouspietyandnaturalbeauty.Grandfairsareheldatthesesitesontheauspicious occasionsofDhanyaPoornima,JanaiPoornima,GuruPoornima,HaritalikaTeejandRishi Panchami. The Sunkoshi River offers adventurous rafting and scenic beauty to the both national and international tourists.Community forest 775HectaresofthisVDCiscoveredby4CommunityForests.Underthesecommunityforest consumer groups, the major forestry related activities are carried out. SnWard noName of the forest groupChair person 11,2,3,4Nibuwabote Community Forest Consumer groupKrishna Bahadur Tamang 24,5Chaampbote Community Forest Consumer groupRavilalTimilsina 36,7,9Falante Community Forest Consumer groupBadriPoudel 47,8Dharampani Community Forest Consumer groupDirghaBahadurSubedi Table 2 NGOs SnNameWard no Dateof establishment Areaof action Chairperson 1Binjelcommunitylearning centre 82062 BSArea no 1Sadhuram Nepal Table 3 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM24 Health facilities ThisVDChasasubhealth-post,whichisstaffedwithauxiliaryhealthworker(AHW),village health worker (VHW), maternal and child health worker (MCHW) and a peon to provide health services to the people. Development and Potentialities The water of local streams of the VDC like Dhodeni, Bhutyaha, Khalde, Bagua, Chacharekhola possessahugepotentialoftheproductionofhydroelectricity.Balephi,Binjel,Kole, Dandagaun,Kothe,Adhmara,Gurdum,Kavre,Karangaira,NaubiseandKeureniarethemajor settlementshere.Thoughtherearenomajormarkets,BalephiandKotheontheAraniko Highway offer some urban view. All the wards are well equipped by roads but they are not well managed.AllwardsoftheVDCreceiveelectricpowerfromthecentraltransmissionlinebut everyhouseisnotlit.Thus,thegenerationofelectricpowerviamicrohydropowerprojects might prove helpful. Rivers 1.Lapse khola8. Majuwakhola 2.Khaldekhola9. Chhatekhola 3.Bhutyahakhola10. Bramhayani 4.Bagua11. Sunkoshi 5.Chachare 6.Kharanekhola 7.Dhodenikhola SettlementsWard noSettlements 1Karangaira, Karki tole, Keureni, Dhami tole, Lama tole, Dandakateri, Thulchaur 2Dandagaun, Lapse, Gahate, Pipaldanda, Koldanda, Batamuni 3Naubise,Kerabari,Tunibote,Kole,Dandagaun,Keureni,Magargaun,Karkitole, Tari 4Adhmara, Gurung gaun, Kavre, Bingate, Jangare, Sarki gaun, Kuddare 5Gairaghartole,Timilsinatole,Mulabari,Lamatole,Bhotebinjel,Adhmara, Damaigaun, Raikar 6Gurdum, Bhadaure, Kavre, Gairigaun, Besarti, Chanaute, Jangare, Chiuribote 7Jyamire, Kothe, Goujeni 8Rataghar tole, Sahudadali tole, Majhagaun, Unichaur, Tallagaun, Binjelbesi 9Balephi, Pujarigaun, Waglegaun, Gairigaun Table 4 Community Health Diagnosis Field Report-2068 BS Phulpingdanda VDC, Sindhupalchok Group C - 31st Batch of MBBS, IOM25 7D. Methodology Study methodology 1.Community Diagnosis Orientation TheDepartmentofCommunityMedicineandFamilyHealth(DCMFH)hadconducted orientationclassesfrom17thShrawanto28thShrawan.Theweeklongorientationclasses reviewedvarioustheoreticalaspectsaswellasprovidednecessarypracticaltipsnecessaryto tackle possible problems. 2.Preparation of QuestionnaireGroup discussion was done and questionnaire was made accordingly. 3.Pretesting of Questionnaire: Totestthevalidityofourquestionnaire,pre-testwasconducted.Accordinglynecessary improvements were made and final questionnaire was prepared. It was then typed and printed. 4.Social mapping 5.Household survey 6.Observation 7.Focus Group Discussion 8.In-depth Interview 9.Anthropometric measurement The tools used were: ToolsMethodParticipant 1.Questionnaire Socio-economicstatus, KAP on disease,Nutrition,Sanitation andPersonalHygiene, Genders Status Structured interview Householder 2.MCHStructured interview Mother of children 80Normal 70-7910 malnutrition 60-6920 malnutrition 50-5930 malnutrition 13.5Normal Yellow12.5 - 13.5 At risk of under nutrition Red90 %>95 % Mild80-90 %87.5-95 % Moderate70-79 %80-87.4 % Severe 5 yrsX 100 Total population of > 5 yrs Total no. of maternal deathsin one yearin obeserved dataX1,00,000 Total live births in one yearin one year in observed data Women practicing contraception X 100 Total eligible women Total no. of dependent population (64)X 100 Total no of independent population (15-64) Total population < 15 yrs_________ X100 Total no of independent population (15-64) Total population > 64 yrs_________ X100 Total no of independent population (15-64) Total population