Community Health Diagnosis of Melamchi VDC Sindhupalchowk, Nepal

A report submitted to fulfill the partial requirement of Bachelor Degree of Public Health

Submitted to: Public Health Department Central Institute of Science and Technology Pokhara University August, 2013

Submitted to: Group A (Melamchi) Batch, 2010

Approval Sheet
The Community Health Diagnosis report presented by group A (Melamchi VDC) entitled Community Health Diagnosis of Melamchi VDC, Sindhupalchowk, Nepal has been accepted for the fulfillment of the partial requirement of Bachelor Degree of Public Health (BPH), sixth semester.

Approved by

Mr. Raj Kumar Subedi Field Supervisor CiST College Date:

Mr. Ram Bahadur Shrestha Head of Department Public Health Department CiST College Date:

Acknowledgement
Writing these acknowledgement was difficult as writting the report itself. There is no word in a dictionary which could do justice to support the cooperation extended to us by the friends and teachers, because this report is an emergent property, an outcome of many individual an institutional right moment. Community diagonosis is indeed a very complicated and hard work for any surveyor. To conduct a community diagonosis sucessfully requires intense dedication and overall coordination with the stakeholders. For genuinely sharing their experience and inside with the study team, we would like to express our sincere gratitude with deep appreciation to all respondent, institution, key informant for their invaluable guidence, support, cooperation, contribution and participation for making this community diagnosis programme a success. We would like to express our special thanks of gratitude to our Principal Dr. BD Chataut, Mr. Ram Bahadur Shrestha (HoD of Public Health), Mr. Narayan Regmi (Coordinator of 6th sem, BPH), our subject teacher Mr. Raj Subedi as well as Mrs. Sushma Subedi for helping us during our PRA training. Furthermore we would also like to acknowledge with much appreciation the crucial role of the staff of CIST College, who gave the permission to use all required equipment and the necessary materials to complete the task. We are very thankful to our College management and administration for their constructive feedback and encouragement during the period of our study, without their support and encouragement we could have remain idle to accomplish the study. We are previlaged by the people of Melamchi VDC for their invaluable cooperation and magnaminous hospitality. Special thanks goes to Mr. Devi Shrestha (local teacher of Indreshoweri H.S school). Our sincere thanks goes to Radha krishna Shrestha (Headmaster of Indreshoweri H.S school). We are much greatful to Dr. Pradeep Puri and all staff of the PHCC. We are also very thankful to Mr. Ram Bahadur Tamang (Headmaster of Janajagriti Secondary School). We cordially gratify all teachers of Indreshoweri H.S school for their colossal support. Due to that cooperative environment we conducted 1st, 2nd and 3rd presentation

successfully. We are also indebted to local leaders of the VDC, Buddhi Bahadur Khadka, Ratna Prasad Chaulagain, Pitambar Pandey, Mohani Prasad Chalise, Bijaya Kumar Dulal, Kamala Dulal, Labi Dutta Sapkota, Ram Bahadur Tamang, Dharma Krishna Shrestha, Jaya Krishna Shrestha, Biraj Neupane, Prakash Shrestha, Hari Basnet, Devi Shrestha, Bal Krishna Deuja, Bal Chandra Sapkota, Kumar Prasad Dulal, Ram Paudel, Shanta Chalise, Bharat Prasad Nepal and Jaya Maya Ghale for attending community presentation and imparting valuable suggestion to us. We are indebted to inspector Uddhav Karki (Area Police Officer,Melamchi). We also extend our special thanks to Mr. Bhimsen Dangol and Mr. Tirtha Lama for providing full support in fooding and lodging during our one month stay in Melamchi VDC. We appreciate all kinds of assistance extended to the study team and thanks to all those individual who became a part of the study. Finally we would like to thanks everyone who has helped us directly or indirectly during our one month stay of community diagnosis to accomplish this study.

Executive Summary
This report is about one month Community Health Diagnosis (2070/5/9-2070/6/9) in Melamchi VDC of Sindhupalchowk district. The team of twelve members of BPH sixth semester students (CIST College, Sangam Chowk, New Baneshwor) had conducted the field study successfully. The goals of this field study was to share and get to know the health related issues of the community through the community people and enhancing our knowledge and skill in identifying the common health problems, their causes and resources available in the community.This study was based on the study of population of VDC through sampling technique. Consequently, the information was achieved from various tools like household surveys, interview, observation, FGD with FCHVs and other secondary data. The analysis of findings through application of different tools and techniques are thoroughly mentioned below in the adjacent paragraph. The study covered 352 households with population of 1918 where 916 were female and 1002 were male. Along with family planning, modernization has increased nuclear family i.e. 61.3% in respect to joint family that is only 38.7% and population pyramid is tapering. Literacy rate is around 70% which is low in female population. Commonest source of income was agriculture and income was enough for 83% of population for a year. The purification of water was not found to be popular. 82.2% dont purify their drinking water due to which the prevalence of typhoid, diarrhea, and fever seems to be on high rate. The prevalence of toilet use was 88.8% and VDC and other organizations were working hard to make Melamchi as ODF zone. Above 90% of the people were alert regarding the personal hygiene like habit of bathing, brushing teeth, washing clothes and cutting nail. In total population 62.8% of people used soap water to wash their hands before having a meal where 80.4% used soap water and 11.2% used water only to wash their hand after the defecation.The main illness seen within last 3 months was: Typhoid, Diarrhea, Headache, ARI, Skin problems and others. The awareness regarding communicable and non-communicable diseases was not satisfactory. Most of the people seem to have good knowledge on how the disease is transmitted, 68% believe that personal hygiene and 13% population believe microorganism is the cause of transmission of diseases while

3.9% of population believe on god and witch. Although 67.4% people believe that use of ORS can manage the diarrhea, only about 61% of them can prepare ORS solution correctly. It was found that 11.9% female and 20.76% male smokes and around 9% of total population consumes alcohol regularly. In time of our study 3.3% of population was out of country for job and study. There were improvedMCH services but early pregnancy and home delivery is barrier on improving MCH status along with health centers out of reach from remote population. The contraceptive prevalence rate (CPR) was found to be 60.8% where permanent method of use was 33.6% and temporary method 66.4%. In married couple interviewed 4.5% thinks more than 5 years of birth gap is essential while more than half i.e. 54% believed that birth gap should be 2-5 years. Being only around 60KM away from capital city, Melamchi has not been able to get proper planning and intervention to reduce simple diseases and are living away from the basic right to get proper health services.

Acronyms
AIDS Acquired immuno deficiency syndrome ANC Antenatal care ANH Auxiliary nurse midwife ARI Acute respiratory infection BCC Behaviour change communication BPH Bachelor in Public Health BMI Body mass index CBO Community Based Organization CBS Central Bureau of Statistic

CHC Community health centre CHD Community health diagonosis CHW Child health worker CODEF Community Development Forum COPD Chronic Obstructive Pulmunory Disease CPR Contraceptive prevalence rate

CVD Cardiovascular diseases FCHV Female child health volunter FGD Focus Group Discussion FP IDD Family Planning Iodine deficiency disorder

IMR

Infant mortality rate

INGO International Non-government Organization KAP Knowledge attitude and practice LBW Lower birth weight MCH Maternal child health MHP Micro Health Project NCD Non communicable diseases NHP Nepal health policy NGO National govermental organization ORS Oral rehydration solution PEM Protein energy malnutrition PHCC Primary health care centre RIT Respiratory tract infection STDS Sexually transmitted diseases TBA Trained birth attendent TT Tetanus Toxoide VDC Village Development Committee WHO World health organization

Table of Figures
Figure 1 Population pyramid .............................................................................................................. 12 Figure 2 Religion composition ............................................................................................................ 12 Figure 3 Types of family ...................................................................................................................... 13 Figure 4 Marital status ........................................................................................................................ 13 Figure 5 Out migration of people ....................................................................................................... 14 Figure 6Time of being out of country ................................................................................................. 14 Figure 7 Disabled people in the family ............................................................................................... 15 Figure 8 History of Suicide .................................................................................................................. 15 Figure 9 Perception of people regarding transmission of diseases .................................................... 18 Figure 10 First Place of Consultation during Illness ............................................................................ 19 Figure 11 Knowledge about Mental health ........................................................................................ 19 Figure 12 Knowledge about Diarrhea ................................................................................................. 21 Figure 13 Peoples Perception regardaing causation of diarrhea ...................................................... 22 Figure 14 Knowledge on prevention of diarrhea ................................................................................ 22 Figure 15 Knowledge on management of diarrhea ............................................................................ 23 Figure 16 Knowledge on preparation of ORS ..................................................................................... 23 Figure 17 Walking distance to nearest health facility ........................................................................ 24 Figure 18 People's perception on the benefits they got from PHCC .................................................. 24 Figure 19 Satisfaction from services of PHCC ..................................................................................... 25 Figure 20 Use of health services through FCHV.................................................................................. 26 Figure 21 Perception towards the age of FCHV .................................................................................. 26 Figure 22 Perception towards FCHV ................................................................................................... 27 Figure 23 Source of drinking water..................................................................................................... 27 Figure 24 Wayof water purification .................................................................................................... 28 Figure 25 Practice of covering the pot ................................................................................................ 28 Figure 26 Coverage of toilet use ......................................................................................................... 29 Figure 27 Toilet used by 2-5 years child ............................................................................................. 29 Figure 28 People's perception regarding the benfit of toilet use ....................................................... 30 Figure 29 Place to throw waste from home ....................................................................................... 30 Figure 30 Place to throw liquid waste ................................................................................................ 31 Figure 31 Practice of washing hand before having meal .................................................................... 31 Figure 32 Washing hand after using toilet.......................................................................................... 32 Figure 33 Personal hygiene activities ................................................................................................. 32 Figure 34Know about Family Planning ............................................................................................... 33 Figure 35 Use of family planning services .......................................................................................... 34 Figure 36 Methods of Family Planning .............................................................................................. 34 Figure 37 Permanent methods of Family Planning ............................................................................ 35 Figure 38 Temporary method of family planning ............................................................................... 35 Figure 39 Perception on the importance of Family Planning ............................................................. 36

Figure 40 Number of children for happy family ............................................................................ 36 Figure 41 Perception on Birth Gap ................................................................................................ 37 Figure 42 Start of weaning food .................................................................................................... 37 Figure 43 Iron intake during pregnancy ......................................................................................... 38 Figure 44 Age at first pregnancy .................................................................................................... 38 Figure 45 Age at first marriage ...................................................................................................... 39 Figure 46 Complication during pregnancy ..................................................................................... 40 Figure 47 Place of delivery ............................................................................................................. 40 Figure 48 Instruments used for cord cutting ................................................................................. 41 Figure 49 Colostrum feeding practices .......................................................................................... 41 Figure 50 ANC checkup .................................................................................................................. 42 Figure 51 Food habits during pregnancy ....................................................................................... 42 Figure 52 Working habit during pregnancy ................................................................................... 43 Figure 53 De-worming tablet intake .............................................................................................. 43 Figure 54 TT vaccine coverage ....................................................................................................... 44 Figure 55Use of safe delivery kit .................................................................................................... 44 Figure 56 Substance applied after cord cutting ............................................................................. 45 Figure 57 Frequency of breast feeding .......................................................................................... 45 Figure 58Distance between road to home .................................................................................... 46 Figure 59 Leaking roof in rainy season .......................................................................................... 46 Figure 60 Possibilities of breeding flies and mosquitoes ............................................................... 47 Figure 61 Sunlight around house ................................................................................................... 47 Figure 62 Provision of sewage ....................................................................................................... 48 Figure 63 Proper source of drinking water .................................................................................... 48 Figure 64 Safety tank 50 feet away................................................................................................ 49 Figure 65Provision of kitche garden...49 Figure 66 water in latrine ............................................................................................................... 50 Figure 67 Soap in toilet .................................................................................................................. 50 Figure 68 Cleanliness of kitchen .................................................................................................... 51 Figure 69 Types of stove ................................................................................................................ 51 Figure 70 Distance between toilet and kitchen ............................................................................. 52 Figure 71 Distance between animal shed and kitchen .................................................................. 52 Figure 72 Types of toilet ................................................................................................................ 53

List of tables
Table 1 Educational Status.16 Table 2Employment Status....17 Table 3Habit of smoking...17 Table 4Habit of drinking alcohol....18 Table 5 Knowledge about Communicable diseases .......20 Table 6 Knowledge about Non communicable diseases ........21 Table 7Perception towards Service of PHCC ........................25

Table of Contents
Acknowledgement ..................................................................................................................... i Executive Summary .................................................................................................................. v Acronyms ................................................................................................................................ vii Table of Figures ....................................................................................................................... ix List of tables ............................................................................................................................. xi Chapter I.................................................................................................................................... 1 1. Introduction ........................................................................................................................... 1 1.1 Introduction of Community Diagnosis:........................................................................... 1 1.2 Background of Melamchi VDC: ..................................................................................... 1 1.3 Objectives of community Health Diagnosis.................................................................... 3 1.4 Organization of the community diagnosis ...................................................................... 3 Chapter II .................................................................................................................................. 5 2. Methodology ......................................................................................................................... 5 2.1Study Area ........................................................................................................................ 5 2.2Study Population .............................................................................................................. 5 2.3Study Type ....................................................................................................................... 5 2.4Unit of Analysis ............................................................................................................... 5 2.5Sampling Techniques ....................................................................................................... 5 2.5.1 Sampling frame......................................................................................................... 5 2.5.2 Domain ..................................................................................................................... 6 2.5.3 Sample size ............................................................................................................... 6 2.5.4 Sample selection ........................................................................................................... 6 2.6 Tools and Techniques for data collection ....................................................................... 6 2.6.1 Tools ......................................................................................................................... 6 2.6.2 Techniques ................................................................................................................ 7 2.7 Sources for data collection .............................................................................................. 7

2.7.1 Primary data sources ................................................................................................. 7 2.7.2 Secondary data sources ............................................................................................. 7 2.8 Validity and reliability .................................................................................................... 8 2.9 Ethical consideration ....................................................................................................... 8 2.10 Community Orientation ................................................................................................ 8 2.11 Community presentation ............................................................................................... 9 2.12 Community health intervention ..................................................................................... 9 2.13 Micro health project .................................................................................................... 10 Chapter III ............................................................................................................................... 11 3. Findings............................................................................................................................... 11 3.1 Quantitative Findings: ................................................................................................... 11 3.1.1Socio demographic findings .................................................................................... 11 3.1.2 Personal Behavior ................................................................................................... 17 3.1.3 KAP Finding ........................................................................................................... 18 3.1.4 Health facilities ....................................................................................................... 24 3.1.5 Environmental Health ............................................................................................. 27 3.1.6Personal Hygiene ..................................................................................................... 31 3.1.7 Family Planning ...................................................................................................... 33 3.1.8 Maternal Child health ............................................................................................. 37 3.1.9 Findings from observation checklist....................................................................... 45 3.2Qualitative Findings ....................................................................................................... 53 3.2.1 Interview with VDC In charge ............................................................................... 53 3.2.2 Interview with PHCC Incharge and observation of PHCC .................................... 54 3.2.3 Findings from FGD with FCHV:............................................................................ 55 3.3 Prioritization .................................................................................................................. 57 3.4 Micro Health Project ..................................................................................................... 59 Activity 1: Exhibition ...................................................................................................... 64 Activity 2: School health program................................................................................... 64 Activity 3: School Health Program ................................................................................. 65 Activity 4: Street Drama .................................................................................................. 66 Chapter IV ............................................................................................................................... 68

4. Discussion ........................................................................................................................... 68 Chapter V ................................................................................................................................ 73 5. Conclusion and Recommendation ...................................................................................... 73 Bibliography ........................................................................................................................... 77 Annexure ................................................................................................................................. 78

Chapter I 1. Introduction 1.1 Introduction of Community Diagnosis:

WHO says community diagnosis is a quantitative and qualitative description of the health of citizens and the factors which influence their health. It identifies problems, proposes areas for improvement and stimulates action. Community Diagnosis (community assessment) is the foundation for improving and promoting the health of community members. The role of community assessment is to identify factors that affect the health of a population and determine the availability of resources within the community to adequately address these factors (Google 2009). In general, community diagnosis is the identification of the disease or health related event. In our country, it is taken as the prominent tool for identifying the health problems of community and implementing the works to solve those problems (K.Park 2011).

1.2 Background of Melamchi VDC:

Melamchi is one of the VDC in Sindhupalchowk district of Bagmati zone in Central Development Region. Although this district is close to Nepal's capital Kathmandu, it is one of the least developed districts in Nepal. The Araniko Highway, also called Kodari Highway, (114 km) extending from Kathmandu to Kodari links this district with Tibet. The district is mountainous and rich in natural resources. The Melamchi VDC is easily accessible from Kathmandu, but is not well developed. Melamchi VDC occupies total area of 10.4 square kilometres. It is about 80 km away from Kathmandu and 23km from nearest point of Araniko Highway. On the North of this VDC, Duwachaur VDC lies and on the South Bansbari VDC while Sindhukot and Talamarang VDC lies in the West and Jyamire in the East, Indrawati River separate this VDC from Shikarpur VDC. It lies at the height of 800 meter to 1500 meter above from the sea level.

The climate of Melamchi is neither too hot nor too cold. It has got an average rainfall. There are 1179 households in Melamchi VDC and total 5230 people are living in this VDC in which 2,531 are male and 2,699 are female. [National Population and Housing Census,2011(NPHC2011)]. Whereas only 1017 households were identifies through the VDC Office records. Most of the people here are involved in agriculture and animal husbandry while some are in service, business and other. In context of religion Hindus are found higher than Buddhists and Christians here. The language preferred here are mainly Nepali, Newari and Tamang. People of different caste like Brahmin, Chhetri, Newar, Danuwar, Tamang, Damai, Kami, Sarki, etc reside here. 1.1.1 Health Facility One Primary Health Care Center One Ayurvedic Clinic Few drugstores and clinic 1.1.2Educational Facility Government Indreshwari Higher Secondary School and College JanaJagriti Secondary School Panchakanya Primary School Daduwa Primary School Jageshwari Primary School Bhairabi Primary School Private SamataSikshyaNiketan Pragati Secondary School Melamchi Community School

1.3 Objectives of community Health Diagnosis

The general objectives of community health diagnosis was to assess the heath status of the people ,their health needs, implement and evaluate a micro health project to improve health status of Melamchi VDC. Furthermore the specific objectives were: To describe the geographic, demographic, socio economic and cultural status of the community To identify personal behaviour of the people To identify the common health problems of the community To assess KAP regarding common health problems(diarrhoea, ARI, HIV/AIDS ,TB)and service utilization pattern (MCH, FP ,immunization, curative services)of the community To find out the nutritional status of under 5 children To describe the environmental status of the community To find out the health care seeking behaviour of the community To assess satisfaction of people regarding health institution and FCHV To prioritize the health problems To identify the real needs of the community To select the prioritized the problems for MHP To plan, implement, and evaluate the MHP

1.4 Organization of the community diagnosis

The community diagnosis of 2013 to Sindhupalchowk was second community diagnosis conducted by CIST however toward the Sindhupalchowk it was first. Sindhupalchowk was chosen considering the health status of the community, topography related disease and to conduct successful MHP. Four groups of 7-12 students were created and each group was assigned a VDC of Sindhupalchowk for community diagnosis. Questionnaires were prepared in the college before starting the community diagnosis with the full participation of students and help of our teacher. The questionnaires were pretested and revised according to

recommendation. The instruments and tools required for the entire programme was managed and provided by the college. The facility of transportation was managed by the college management. As, for lodging and fooding the college has provided Rs.12000 to each students and for conduction of MHP Rs.2000 was given to each group. After arrival to Melamchi VDC we looked for suitable hotel and we choose hotel Melamchi for our lodging and fooding. The group members had already chosen a group leader and co leader to guide and manage the activities amongst the group members themselves. During the first two days of community diagnosis the group members spend their time planning for their activities to be done and transect walk was conducted to better understand the community including a geographic situation of the community. Between these two days we invite many representative people of VDC, PHC incharge, other health worker, partys leader, FCHVS, Principal and teacher of college, school, representatives of social organization and so on through letters and phone. Next day we conducted orientation program and described the purpose of our community diagnosis and they heartly welcomed our initiation. From next day we started the data collection process and other activities were planned and implemented accordingly.

Chapter II 2. Methodology
2.1 Study Area
The study area selected for community diagnosis was Melamchi VDC of Sindhupalchowk district.

2.2 Study Population

The population to be studied for community diagnosis was the total population of Melamchi VDC through sampling technique.

2.3 Study Type

The type of study conducted on Melamchi VDC was descriptive cross sectional study. This study was conducted to describe the patterns of disease occurrence in relation to variables such as person, place and time and possibly some other variables which is related to disease occurrence at that point of time.

2.4 Unit of Analysis

The unit of analysis was individual households. However, not only household information but also detail study of mothers with children below 3 years of age and married couple of age group 15-49 years and so on was also carried out.

2.5 Sampling Techniques

Stratified proportionate random sampling technique was used to select sample of household from total household of Melamchi VDC.

2.5.1 Sampling frame

A total of 1179 households were identified from the census report of Nepal, 2011 but according to the VDC report the total number of household were 1017. During our observation and discussion with local authorities, the VDC report for selecting the household numbers were seen appropriate.

2.5.2 Domain
Melamchi VDC was divided into nine wards. Each ward was also divided into different Tole according to as per caste or geographical area. Then considering each Ward as a stratum, samples were drawn from each stratum randomly in proportion to the size of strata and the required sample size of strata and the required sample size were taken.

2.5.3 Sample size

For the calculation for sample size, thirty three percentage of household were selected from total household 1017 which gave 335 for a sample. For the non responsive household few more data were being collected to reduce the non respondent error. So, the final sample size was 352.

2.5.4 Sample selection

For the selection of household sample, the total number of household of each ward was obtained from the VDC office. Then 33% of total household from each ward was considered as a sample selection. Households in each ward were randomly selected in order to maintain the randomness.

2.6 Tools and Techniques for data collection

2.6.1 Tools Structured Questionnaire for household data collection, VDC secretary, FCHV and Health Post In charge Self administered questionnaire for local leaders, teachers Observation checklist FGD Guidelines Interview guidelines

 Anthropometric instruments {Weighing machine, measuring scale and Mid upper arm circumference(MUAC) tape} 2.6.2 Techniques Social mapping Structured interview Questionnaire Focal Group Discussion Anthropometric survey Observation Record review Self administered questionnaire

2.7 Sources for data collection

2.7.1 Primary data sources Household heads or family members Local leaders FCHV School Teachers and Principal Mothers having children less than 3 years of age Married individual of age group 15-49 years Health staffs 2.7.2 Secondary data sources VDC records for general information of village

 Health post records regarding communitys health status Community Health Diagnosis Report of Valley Colleges

2.8 Validity and reliability

The maintenance of accuracy, quality and appropriateness of study procedures is important and for this validity and reliability of procedures has to be assured. This was done by pretesting of questionnaire, checklists, and survey instruments like Salter scale, weighing machine and spring balance. Rechecking of questionnaire and checklists was done by subject teacher. Data correction and group discussion was done before and after data collection each day to minimize errors. Supervision and guidance was provided by subject teachers and coordinator during the community diagnosis. Data editing was also done during and after completion of survey to improve or eliminate errors.

2.9 Ethical consideration

The ethical aspect was also considered during the community diagnosis for maintaining four basic principle of ethics i.e. respect for dignity of persons, beneficence, justice and respect for environment. For this, permission from VDC office and health post was taken prior to beginning of our study. The purpose and objectives of study were explained to all respondents and written and verbal consent was also taken from respondents at beginning of interview. The confidentiality of information was assured to respondents and they were given freedom in decision making regarding whether to answer the questions or not. All respondents were treated with equality; justice and dignity of people were being respected.

2.10 Community Orientation

Community orientation in Melamchi VDC was conducted on 2070/05/12. The main purpose of community orientation was to inform community people about the objectives of our study and the different activities to be carried out during and after completion of the community diagnosis.

Local community people including HP incharge, VDC secretary, teachers, FCHVs, community leaders and representatives of various organizations were also invited for the orientation program. During the orientation program, people showed their full interest by expressing their felt needs and major health problem of community. After completion of the orientation program, community people assured their full support and committed to help us during and after the study.

2.11 Community presentation

The first community presentation was held on 2070/05/30 after completion of analysis of data. It was done to make people aware about the major health problems of the community. The community people were also informed about the type of health intervention to be held and need of their full co-operation while conducting micro health project in a post discussion session after the presentation. The second community presentation was conducted on 2070/06/04 after completion of micro health project. It was done to motivate people to take positive actions to reduce and solve health problems. It was also conducted to thank community people for their support and participation in the study and to inform them about the completion of the community diagnosis. The third and final presentation was held on 2013/10/04 in CIST College. The main purpose of this presentation was to inform teachers and other group members about the activities that were carried out in Melamchi VDC and achievement of the study after the completion of community diagnosis. 2.12 Community health intervention The identified health problems of the community were first prioritized for planning the health intervention. The felt need and the observed need were both analyzed to find out the real need of the community. Then, various health interventions were planned as a part of micro health project to address and solve the health problem with full participation of the community people.

2.13 Micro health project

MHP planning was based on Dr. Johan Brynts problem solving circle which includes: Defining objectives and target groups Resources collection

Fixing date and place for implementation Formulate problem Evaluation Decide priorities

Planning the problems and implement

Define objective

Altering solution and choosing the best one

Decide target population

Fig: Micro health project

Chapter III 3. Findings 3.1 Quantitative Findings:

Finding from household questionnaire Demographic Characteristics
Demography is the collective study of human population. It can be defined as the scientific study of human population focusing attention on readily observable human phenomenon, e.g. changes in population size, its composition and distribution in space. 3.1.1Socio demographic findings 3.1.1.1Sex ratio It determines the number of males per 100 female which was found to be 109.38:100. 3.1.1.2 Crude death rate The crude death rate was found to be 2.67 per thousand populations. 3.1.1.3 Average family Size In demography, family size means the total number of children women has born at a point in time. But in the study total number of family members was taken for the calculation of family size. The family size in household survey was found to be 5.79 in average. 3.1.1.4 Household population by age and sex The graphical presentation of age and sex composition of a population is termed as population pyramid. The pyramid represents the rapid growth pattern however; the base of the pyramid is constricted for the age groups 0-4 years. The highest number of population was among the age group 0f 10-14 years which is 12.21%.

80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10--14 5--9 0-4 8

0.79 0.37 0.68 0.84 1.89 1.05 2.15 2.78 2.30 3.09 4.24 4.40 4.92 5.71 5.92 4.30 2.25 6 4 2 0

0.84 0.26 0.68 0.58 1.57 2.36 1.83 2.20 3.14 3.35 4.30 5.50 6.39 6.44 6.29 4.30 2.30 2 4 6 8

Age (years)

%male %female

Percent

Figure 1 Population pyramid

3.1.1.5 Religion Composition

Others 1.4% Buddhist 14.5%

Hindu 80%

Figure 2 Religion composition

The study revealed that most of the sample population of the VDC was Hindu i.e. 80% similarly 14.5% Buddhist and 1.4% others.

3.1.1.6 Types of family

38.7% Nuclear 61.3% Joint

Figure 3 Types of family

In the study, majority of the families were nuclear i.e. 61.3% and 38.7% were joint family. 3.1.1.7 Marital Status of population
60 50

52.5 43.5

Percentage

40 30 20 10 0 Married Un married Widowed N/A 3.6

0.4

Marital status

Figure 4 Marital status

Fig.4 shows the marital status of the Melamchi VDC, where 52.5% of total population were married , 43.5% were unmarried and similarly 3.6% were widowed.

3.1.1.8 Out migration of people

3.3%

Yes No

96.7%

Figure 5 Out migration of people

Figure 5 shows that, out of total sample population, 3.3% population of Melamchi VDC migrated out of the country for abroad job and study. 3.1.1.9 Time of being out of country
40 35 30 34.78 34.78

Percentage

25 20 15 10 5 0 <1 year 2 - 3 years 4 - 5 years >6 years 13.04 17.39

Figure 6 Time of being out of country

Figure 6 shows that majority of sample populations being out of the country were below 3 years which is almost 69.56% .Mainly people migrate abroad for the job and education.

3.1.1.10 Disabled people in the family

Yes 0.9%

No 99.1%

Figure 7 Disabled people in the family

Figure 8 shows the presence of physically disable person on household, 99.1 % of household replies that there were no any disable people on their home and 0.9% household replied that they contain physically or mentally disabled family members on their home. Similarly disability rate was found to be 8.86 per thousand populations. 3.1.1.11 History of suicide

N/A 1.8%

Yes 4.8%

No 93.4%

Figure 8 History of Suicide

Large proportion of the population i.e. 93.4% had no suicide cases in their house within last 1years.

3.1.1.12 Educational Achievement

Educational attainment (Grades)

Sex Female Frequenc y 310 88 23 166 106 Percentag e 33.84 9.60 2.51 18.12 11.57 Male Frequenc y 201 94 25 198 125 Percentag e 20.05 9.38 2.49 19.76 12.47 Total Frequenc y 511 182 48 364 231 Percentag e 26.64 18.16 4.79 36.32 23.05

Illiterate Literate Pre-primary Primary Lower Secondary Secondary Higher.Secondar y Higher Education Total

110 66

12 7.20

163 93

16.26 9.28

273 159

27.24 15.86

47

5.16

103

10.27

150

14.97

916

100

1002

100

1918

100

Table 1 Educational status of Melamchi VDC

Table 1 shows the educational status according to sex of the Melamchi VDC, among the total sample population 33.84% female and 20.05% male were illiterate. Higher education attained by sample population was only 14.97% which seems to be very low in female as compared to male population. 3.1.1.13 Employment status Table 2 shows the employment status of the total population of Melamchi V.D.C according to sex. The major occupation of the population was agriculture where 31.07% average both male and female is engaged.

Occupation

Agriculture Business Household Labor Abroad Service Student N/A Others Total

Sex Female Frequency 278 60 162 3 7 35 303 7 61 916

Percentage 30.34 6.55 17.68 0.32 0.76 3.82 33.07 0.76 6.65 100

Male Frequency 318 107 8 44 30 80 356 4 55 1002

Percentage 31.73 10.67 0.79 4.39 2.99 7.98 35.52 0.39 5.48 100

Total Frequency 596 167 170 47 37 115 659 11 116 1918

Percentage 31.07 8.70 8.86 2.45 1.92 5.99 34.35 0.57 6.04 100

Table 2 Employment status

3.1.2 Personal Behavior

3.1.2.1 Habit of Smoking

Female Regular Smoking 6.65 % Sometime Smoking 5.24 % No smoking 88.10 %

Male Regular smoking 13.57 % Sometime smoking 7.18 % No smoking 79.24 %

Table 3 Habit of smoking

Table 3 shows the habit of smoking according to the sex wise among the sample population. It was found that 6.65% female and 13.57% male smoke regularly on Melamchi VDC, whereas 88.10% female and 79.24% male never smokes.

3.1.2.2 Habit of drinking alcohol

Female Regular drinking 3.27 % Sometime drinking 8.62 % No drinking 88.10 %

Male Regular drinking 5.78 % Sometime drinking 13.57 % No drinking 80.63 %

Table 4 Habit of drinking alcohol

Table 4 shows the habit of drinking alcohol on Melamchi VDC where 3.27% female and 5.78% male use alcohol daily on total population. On average 9% of total population consume alcohol regularly.

3.1.3 KAP Finding

3.1.3.1 Perception of people regarding transmission of diseases
68 70 60 50 40 30 20 10 0

Percentage

13 3 0.9 2.1

13

Figure 9 Perception of people regarding transmission of diseases

Majority of population i.e. 68% believed that transmission of disease was due to lack of personal hygiene. Only 13% of population thought that micro-organism was the reason behind the disease transmission. Whereas, 3% and 0.9% of people believed that act of God and Witch were responsible for disease transmission respectively.

3.1.3.2 First place of treatment Majority of people, 61.6% in Melamchi gave priority to PHC. But still 15.7% of people still visited the traditional healers as the first place of treatment.
70 60 Percentage 50 40 30 20 10 0 Traditional healers Hospital PHC First place for treatment others Home 15.7 19 0.3 3.3 61.6

Figure 10 First Place of Consultation during Illness

3.1.3.2 Knowledge about Mental health

Yes 37.8% No 62.2%

Figure 11 Knowledge about Mental health

More than half of the population i.e. 62.2% didnt have knowledge about the mental health whereas only 37.8% have knowledge on mental health.

3.1.3.3 Communicable diseases Communicable Heard about it diseases Yes (%) Tuberculosis Scabies Diarrhea Leprosy Bird flu Polio Diphtheria HIV/AIDS Malaria 42 67.7 89.4 38.7 42.3 49.2 65.6 55.6 46.2 No (%) 58 32.3 10.6 61.3 57.7 50.8 34.4 44.4 53.8 Know about way of Know about Know about transmission symptoms prevention Yes (%) 37.4 48.6 61.6 19.9 24.5 16.6 33.8 41.4 33.5 No (%) 62.6 51.4 38.4 80.1 75.5 83.4 66.2 58.6 66.5 Yes (%) 39.9 47.7 61 20.2 17.5 24.2 39.9 30.2 32 No (%) 60.1 52.3 39 79.8 82.5 75.8 60.1 69.8 68 Yes (%) 31.4 57.7 53.5 18.7 21.7 25.7 32.3 35 31.4 No (%) 68.6 42.3 46.5 81.3 78.3 74.3 67.7 65 68.6

Table 5 Knowledge about communicable disease

Question was made in order to know the knowledge level regarding the way of transmission, symptoms and prevention about the communicable diseases which are most prevalent in Nepalese context. The result after the questionnaire is shown in above figure. 3.1.3.4 Non communicable diseases The remarks regarding the knowledge level about different kinds of non-communicable diseases were not found to be satisfactory. Most of the people dont have any idea regarding symptoms and the way of prevention. The condition regarding knowledge level is worse than communicable diseases. The result after the questionnaire is shown in above figure.

Heard about it Diseases Yes (%) 27.5 36.6 31.4 51.2 40.2 29.9 No (%) 72.5 63.4 68.6 48.8 59.8 70.1

Knows symptoms Yes (%) 13.9 25.1 16.9 31.7 25.7 14.1

about Know prevention No (%) 86.1 74.9 83.1 68.3 74.3 85.9 Yes (%) 11.2 25.4 16 29 24.2 83.1 No (%) 88.8 74.6 84 71 75.8 16.9

about

Breast cancer Lung cancer Heart problem Asthma Uterine collapse Diabetes

Table 6 Knowledge about Non-communicable diseases

3.1.3.5 Knowledge about Diarrhea

10.60%

Yes No 89.40%

Figure 12 Knowledge about diarrhea

About 90% of the people knew about the diarrhea whereas more than 10% hadnt heard about it. 3.1.3.6 Peoples perception regarding the causation of Diarrhea On a multiple answer question, majority of the people i.e. about 76% of people believe that the reason for diarrhea was polluted environment whereas 47.4% and 43.8% believed that no soap use after defecation and unhealthy food respectively were also the reasons for diarrhea.

Reason for Diarrohea

Dont know Parasites in faeces Polluted water Not using toilet Unhealthy food No soap use after defication Polluted environment 0

4.2 24.8 29.9 37.8 43.8 47.4 76.1 10 20 30 40 50 60 70 80

Percentage
Figure 13 Peoples perception regarding causation of diarrhea

3.1.3.7 Knowledge on prevention of Diarrhea

Dont know Prevention from diarrohea soap use after defication keep surrounding clean Cover remaining food Eating unfresh food Drinking clean water

4.2 28.4 35.6 46.3 46.8 55.6

Washing hand before eating 59.5 0 10 20 30 40

50

60

Percentage

Figure 14 Knowledge on Prevention of diarrhea

People who believed that drinking clean water and washing hands before taking meals can prevent from diarrhea was 55.6% and 59.5% respectively. 4.2% of the people didnt have any idea about the prevention from diarrhea.

3.1.3.8 Knowledge on management of diarrhea

Management of Diarrohea

Give injection Herbal treatment Home treatment Give medicine Prepare and give other fluid Use salt and sugar Go to HI Use ORS 0

0.9 3 3.3 9.7 16.6 21.1 32.6 67.4 10 20 30 40 50 60 70

percentage
Figure 15 Knowledge on management of diarrhea

The above figure shows that 67.4% of people use ORS for management of diarrhea while 32.6% visit health institution for its management. Likewise, different management aspects of diarrhea are shown in the above figure.

3.1.3.9 Knowledge on preparation of ORS

39%
Yes No

61%

Figure 16 Knowledge on preparation of ORS

Above figure shows that only 61% of people knew the right way of preparation of ORS. But unfortunately only 39% people are still unknown about the correct preparation of ORS.

3.1.4 Health facilities

3.1.4.1 Walking distances to nearest health facility

30 min 13.6% >30 min 47.4% <30 min 39%

Figure 17 Walking distances to nearest health facility

Figure 17 shows that around 47% household can reach PHCC in less than 30 minutes, around 13% in 30 minutes and 39% needs more than 30 minutes.

3.1.4.2 Peoples Perception on the benefits they got from the PHCC
100 80 60 40 20 0 87.9

Percentage

12.1 Yes Percentage of people benifitted from HP No

Figure 18 Peoples Perception on the benefits they got from the PHCC

According to figure 14, in Melamchi VDC 87.9 people said that they are benefitted from Health service of PHCC. 3.1.4.3 Satisfaction from the service provided of PHCC The above figure 14 shows that approximately 84% of people in Melamchi VDC are satisfied from services of PHCC.

84.3 100 Percentage 50 0 Yes No Satisfaction of People from PHCC 15.7

Figure 19 Satisfaction from services of PHCC

3.1.4.4 Perception of people towards various aspects of services provided by PHCC Perception (%) Aspects of services Behavior to the Patients Drinking patients water Good 50.2 Average 39 37.2 Bad 6.3 3.3 Dont know 4.5 4.8

to 54.7

Toilets for patients Provision of drugs Quality of drugs

61.6 41.4 32.3

32.6 36.3 43.5 48.6

2.4 16.3 16.3 6

3.4 6 7.9 4

Waiting time to take 41.4 service Time given by Health 42.9 Workers Physical infrastructure Free health care service Information given health workers 55.6 39.9

45.3

7.9

3.9

40.2 42.6 40.5

2.1 13.3 8.2

2.1 4.2 3

by 48.3

Table 5 Perception towards services of PHCC

People in Melamchi had different perceptions regarding different services provided by health institutions. The above table says that around 50% people agree of good response by doctors to their patients while around 6% said doctors do not behave well with patients. Similarly, other aspects of services given by PHCC are depicted in the above chart. 3.1.4.5 Service seeking through Female Community Health volunteers

Average 39.6%

More 13.6% More Never Never 35% Less Average

Less 11.8%

Figure 20 Use of Health services through FCHV

The above pie chart in depicts that approximately 13% of people use FCHVs services while 35% people do not use. Likewise, around 11% people use less services provided by FCHVs and average use is made by around 39%. 3.1.4.6 Perception towards the age of the FCHV
Don't Know 28.4% Good 26.3% Bad 1.5%

Average 43.8%

Figure 21 Perception towards the age of the FCHV

The diagram above shows that around 26% people think age of the FCHV is good and appropriate for their profession.

3.1.4.7 Perception towards the FCHV

60 50 Percentage 40 30 20 10 0 Education Knowledge Availability Availability Behaviour level about of FCHV of Drugs health Age of FCHV 20.4 17.7 6.8 1.3 6.8 1.3 53.2 43.4 30.5 18 7.1 1.3 39.6 34.9 36.5 28.1 23.8 17.1 10.4 1.3 3.5 1.3 3.2 1.3 28.1 16.2 28.9 20.1 50.9

46.2 Bad` Average Good Dont know Never used service

Figure 22 Perceptions towards the FCHV

The above diagram says that 6.8% of people in the VDC think the educational level of FCHV is bad for their profession while 53.2% people say that their educational level is average for their profession. Also, 17.7% people say their educational level is good for their profession while 20.4% said that they dont know about their educational level. In this way, the above figure represents various characteristics of FCHV in regard to their profession through the perception of people in Melamchi VDC.

3.1.5 Environmental Health

3.1.5.1 Sources of drinking water
100 Percentage 80 60 40 20 0.9 0 Dhungedhara Kuwa Tap River Well No source Others 5.4 88.5

0.9

0.9

1.2

2.1

Figure 23 Source of drinking water

Tap water was the major source of drinking water for the people of Melamchi VDC which accounts for the 88.5% of the total population. 3.1.5.2 Ways of water purification
45 40 35 Percentage 30 25 20 15 10 5 0 Boiling Candle filter Chemicals Sedimentation Sodis Use of cloth 3.5 1.75 15.78 22.8 17.54 38.59

Figure 24 Ways of water purification

Particular method was not popular for purification of water in Melamchi VDC as different methods were used by community people for purifying water. Nearly 40% population applied boiling method whereas nearly quarter of population i.e. 22.8% used sedimentation method and Sodis method was popular among only 1.75% of population. 3.1.5.3 Practice of covering the water pot

Cover the water pot

12.7%

Yes No

87.3%
Figure 25 Practice of covering the pot

The study revealed that majority (87.3%) of the household cover their drinking water pot whereas only (12.7%) do not. 3.1.5.4 Toilet use

Toilet Use
11.2 Yes No 88.8

Figure 26 Coverage of toilet use

About 89% population used toilet whereas remaining 11% did not use toilet because of various reasons like misbelieve, lack of knowledge, resources, habit etc. 3.1.5.5 Toilet used by 2-5 years child

16.6% 8.5% Yes No N/A 74.9%

Figure 27 Toilet used by 2-5 years child

About 75% of 2-5 years old children were found to use toilet whereas only 8.5% same population did not use toilet for the concern age group children.

3.1.5.6 Peoples perception on benefit of toilet use

Dont know Reputation of family Less flies and mosquitoes Conrol disease Easyness Cleanliness

2.10% 31.70% 46.50% 52.20% 72.30% 86.70%

Figure 28 Peoples Perception regarding the benefit of toilet use

Since, the questionnaire was design to get the perception of people on benefit of toilet use was of multiple choices, the majority of people gave more than one answer. 3.1.5.7 Place to throw waste from home
40 35 30 33.8 24.4 16 13 9.7 1.2 Burn Haphazard Kitchen garden Manure pit Pit Others 1.8 N/A

Percentage

25 20 15 10 5 0

Figure 29 Place to throw waste from home

Different methods were used to dispose household wastes. Among them, manure pit and pit was the favorite among the population of Melamchi VDC accounting for 33.4% and 24.4%

respectively. About 16% population threw waste haphazardly. This shows that majority of people knew how to dispose their household waste. 3.1.5.8 Place to throw liquid waste
60 50 Percentage 40 30 20 10 0 Feed cattles Kitchen garden Pit Others N/A 4.8 9.4 5.1 25.1 55.6

Figure 30 Place to throw liquid waste

About 56% of total population of Melamchi VDC disposed liquid waste in kitchen garden whereas only 25.1% pour it in pit. 3.1.6Personal Hygiene 3.1.6.1 Practice of washing hand before meal
70 60 62.8

Percentage

50 40 30 20 10 0 Ash water Mud water Soap water Water only Others 4.3 1.5 1.5 30.5

Figure 31 Practice of washing hand before having meal

The above figure shows 62.8% of people use soap water to wash their hands before taking meals. The use of water only is 30.5% and still 4.3% and 1.5% people use ash water and mud water respectively to wash their hands before taking meals. 3.1.6.2 Washing hand after using toilet
90 80 70 60 50 40 30 20 10 0 80.4

Peercentage

5.1 Ash water

11.2 1.5 Mud water Soap water Water only 1.8 Others

Figure 32 Washing hand after using toilet

About 80.4% of population washed hand with soap water after using toilet. About 11% used water only. Few populations i.e. 5.1% and 1.5% used ash water and mud water respectively for cleaning hand after using toilet. 3.1.6.3 Personal hygiene activities
100 98 Percentage 96 94 92 90 88 86 Brushing teeth washing clothes Bathing Cutting nails 90.9 93.4 90

97.9

Figure 33 Personal hygiene activities

The personal hygiene activities of people living in Melamchi VDC was admirable, more than 90% people perform activities like brushing teeth, washing clothes, bathing & cutting nails in a regular manner.

3.1.7 Family Planning

Out of 352 sample population, there was 250 married couple being interviewed to gain their knowledge and perception about family planning. The questions about family planning were being asked to married couple of age group 15-49.

Frequency

Percent

Valid Percent

Cumulative Percent

No Valid Yes Total

35 215 250

14.0 86.0 100.0

14.0 86.0 100.0

14.0 100.0

Figure 34 Know about Family Planning

Eighty six percent of population of married couple aged group 15-49 had knowledge about family planning whereas rest proportion of married couple population aged group 15-49 i.e. 14% did not know about family planning. 3.1.7.2 Use of Family Planning services Nearly 61% of married couple who were interviewed used family planning services whereas rest i.e. about 39% had not use family planning services.

Have they used any?

Frequency No Valid Yes Total 98 152 250 Percent 39.2 60.8 100.0 Valid Percent 39.2 60.8 100.0 Cumulative Percent 39.2 100.0

No Yes

Figure 35 Use of family planning services

3.1.7.3 Methods of Family Planning

50 Temporary method of FP Permanent method of FP 102

Figure 36 Methods of Family Planning

Among 250 married couple who were interviewed for use of family planning service 152 couple used family planning services. Among 152 married couple using family planning services, 50 of them used permanent method of family planning services and rest i.e. 102 used temporary methods of family planning services.

3.1.7.4 Permanent methods of Family Planning Among 250 married couple who were interviewed for use of family planning service 152 couple used family planning services. Among 152 married couple using family planning services, 50 of them used permanent method of family planning services. Vasectomy, minilap and laparoscopy were used by 39, 9 and 2 of the married couple respectively.
50 40 Numbers 30 20 10 0 Laproscopy Minilap Permanent method Vasectomy 2 9

39

Figure 1 Permanent method of Family Planning

3.1.7.5 Temporary methods of Family Planning Among 152 married couple, 102 of them used temporary method of family planning services. Dipo was used by most of married couple as temporary method family planning service accounting for 33 out of total married couple interviewed. After dipo, condom was second best among married couple for temporary method accounting for the 27 and only 22 used oral pills. Norplant and Copper-T was used by 14 and 6 of married couple interviewed.
40 35 30 Numbers 25 20 15 10 5 0 Condom Copper-T Dipo Norplant Oral pills 6 14 27 22 33

Figure 2Temporary methods of Family Planning

3.1.7.6 Perception on the importance of family planning

Perception on importance of family planning

other Proper care of children Happy family gaping fix no of children 0

1.2 14.8 33.6 32.4 59.2 10 20 30 40 50 60 70

percentage

Figure 39 Perception on the importance of Family Planning

On the multiple answer questions regarding the perception on the importance of family planning, majority of respondents i.e. 59.2% believed that family planning helps to have fix number of children. Nearly 33% respondents answered that family planning would contribute to happy family and 32.4% answered it would help on having birth gap. 3.1.7.7 Number of children for happy family
8.4 5.2

1 2 3 to 4 86.4

Figure 40 Number of children for happy family

Among 250 married couple interviewed, nearly 87% believed that having 2 children will contribute to happy family. Nearly 8% thought that having 3-4 children is better whereas only 5% of married couple considered of having 1 child for happy family.

3.1.7.8 Perception on Birth Gap

60 50 Percentage 40 30 20 10 0 2 Years 2-5 Years <2 years >5 years Perception on Birth Gap 13 1.6 4.5 54

Figure 41 Perceptions on Birth Gap

Among 250 married couple interviewed, more than half i.e. 54% believed that birth gap of 25 years is necessary whereas only 13% thought that 2 years of birth gap is enough. Only 1.6% population considered having less than 2 years of birth gap and 4.5% believed more than 5 years if birth gap is essential.

3.1.8 Maternal Child health

For the purpose of getting an idea regarding the MCH we questioned 70 mothers who had children to the age of 0 to 3. The questionnaire were designed to know the aspects they performed during pregnancy and giving the appropriate care to their newly born children. 3.1.8.1 Start of weaning food
percentage 50 40 30 20 10 0 <6 months 6 months 6-12months N/A Start of weaning food
Figure 42 Start of weaning food

43.84

43.84

Within the six months 43.84% of mothers had started the weaning food. Less than half i.e. 43.84% had started the complementary feeding at six months.

6.84

5.48

3.1.8.2 Iron intake during pregnancy

45 40 35 Precentage 30 25 20 15 10 5 0 No Only for some duration Only during pregnancy Only after delivery Full dose Dont remember 7 1 5 24 23 40

Iron intake during pregnancy

Figure 43 Iron intakes during pregnancy

This figure shows that only 40 percentages of pregnant women take full dose of iron during and after pregnancy, 23 percentages only during pregnancy, only 1 percentage follow after delivery and 24 percentages never use iron tablet. 3.1.8.3 Age at 1st pregnancy

60 50 Percentage 40 30 20 10 0

52.06 43.84

4.11 <20 years 20-25years

Figure 44 Age at first pregnancy

>25 years

This figure shows that the age of 1st pregnancy is at less than 20 years is 50.06 and only 4.11 percentages is at more than 25 year. 3.1.8.4 Age at marriage
80 70 60 percentage 50 40 30 20 10 0 <20 years 20-25years Age at marriage >25 years 2.74 21.92 75.34

Figure 45 Age at first marriage

This figure shows that the age at marriage of Melamchi V.D.C.at less than 20 years was 75.34 percentages where more than 25 years was only 2.74 percentages.

3.1.8.5 Complication during pregnancy

Complication during pregnany

26% Yes No 74%

Figure 46 Complication during pregnancy

This figure shows that the 74 percentage of pregnancy had no complication during pregnancy and only 26 percentages has complicated pregnancy.

3.1.8.6 Place of delivery

70 60 50 Percentage 40 31 30 20 10 0 Home Government health centre Place of delivery Private health centre 4 65

Figure 47 Place of delivery

This figure shows that the 74 percentage of delivery was at home and 31 percentages at government health centre and only 4 percentages at private hospital. 3.1.8.7 Cord cutting practices
70 60 Percentage 50 40 30 20 10 0 New blade Sickle instruments Scissor 27.65 10.65 61.7

Figure 48 Instruments used for cord cutting

This figure shows that 61.7 percentages used new blade during cord cutting and 27.65 percentages by sickle. 3.1.8.8 Colostrum feeding practices

Colostrum feeding practices

3% 7%

Yes No N/A

90%

Figure 49 Colostrum feeding practices

More than 90% of mothers fed their baby with colostrum milk.

3.1.8.9 ANC checkup

40 35 30 Percentage 25 20 15 10 5 0 Once 2-3times 4 times >4 times ANC check up 4 Series 1 32 26 38

Figure 50 ANC checkup

This figure shows that 38 percentage of pregnancy had 4 times ANC checkup and 26 percentages more than 4 times and only 4 percentages had 1 time ANC checkup. 3.1.8.10 Food habits during pregnancy
60 50 Percentage 40 30 20 10 0 As usual Extra nutritious food Food habits during pregnancy Lesser 9.49 34.2 56.16

Figure 51 Food habits during pregnancy

This figure shows that 56.16 percentages had as usual food habits during pregnancy while 34

percentages had extra nutritious food and 9.49 percentages had lesser food than usual during pregnancy.

3.1.8.11Working habit during pregnancy

Working habit during pregnancy

2.74%

46.58% 50.68%

Lighter Heavier Normal

Figure 52 Working habit during pregnancy

This figure shows that 50.68 percentages had heavier working habit during pregnancy while 2.74 percentages had lighter working habit during pregnancy in Melamchi VDC. 3.1.8.12 De-worming tablet intake
70 60.27 60 50 percentage 40 30 20 10 0 Taken Not taken Deworming tablet intake Dont know 4.11 35.62

Figure 53 De-worming tablet intakes

This figure shows that 35.62 percentages had taken de-worming tablet and 60.27 percentages had not taken.

3.1.8.13 TT vaccine coverage

80 70 60 percentage 50 40 30 20 10 0 taken Not taken TT vaccine coverage dont know 2.74 21.92 75.34

Figure 54 TTvaccine coverage

Majority of pregnant women i.e. 75.34% of women had not taken the TT vaccine. So the TT vaccine at that place is not satisfactory as only 21.92% only had received the vaccine. 3.1.8.14 Use of safe delivery kit

Use of safe delivery kit

33%

Yes 67% No

Figure 55 Use of safe delivery kit

67% of pregnant lady didnt use safety kit during their delivery. This condition mainly aroused when delivery is done at home.

3.1.8.15 Substance applied after cord cutting

Substance applied after cord cutting

34% Nothing 64% Antiseptic Oil and turmeric 2%

Figure 56 Substance applied after cord cutting

64% of people didnt apply anything at the time of cord cutting. 3.1.8.16 Frequency of breast feeding
50 40 Percentage 30 20 10 0 <6 times 6-8 times >8 times others N/A Frequency of breast feeding 20.55 24.66 13.7 2.74 38.36

Figure 57 Frequency of breast feeding

Frequency of breast feeding was quiet good result as 38.36% of mothers feed their children for >8 times.

3.1.9 Findings from observation checklist

3.1.9.1 Excess of road

46.40% 53.60%

Yes No

Figure 58 Excess to road

More than half i.e. 53.6% had good excess to road to home while still 46.4% household did not have excess to proper road.

3.1.9.2 Leaking of roof in rainy season

70 60 50 percentage 40 30 20 10 0 Yes leaking of roof No 38 62

Figure 59 Leaking roof in rainy season

Out of total sample, 62 % household had leakage in their roof during rainy season.

3.1.9.3 Possibilities of breeding flies and mosquitoes

23.10% Yes No 76.90%

Figure 60 Possibilities of breeding flies and mosquitoes

Out of total sample households 23.10%of the households of Melamchi VDC had possibilities of breeding flies and mosquitoes around their house and rest i.e. 79.90% had no possibilities of breeding flies and mosquitoes near their house.

3.1.9.4 Sunlight around house

100 80 Percentage 60 40 20 0 Yes Sunlight around house No 18

82

Figure 61 Sunlight around house

Out of total sample households 82%of the households of Melamchi VDC had possibilities to enter sunlight around house and rest percentage i.e. 18% had no possibilities to enter sunlight around house.

3.1.9.5 Provision of sewage Out of total sample households 13.20%of the households of Melamchi VDC had provision of sewage and rest percentage i.e. 86.80% had no provision of sewage.

13.20%

Yes No 86.80%

Figure 62 Provision of sewage

3.1.9.6 Proper source of drinking water

80 70 60 50 40 30 20 10 0 73.1

Percentage

26.9

Yes Proper source of drinking water

No

Figure 63 Proper source of drinking water

About 73.1% of the households of Melamchi VDC were found with proper source of drinking water and rest 26.9% didnt have proper good source of drinking water.

3.1.9.7 Safety tank distance

80 70 60 50 40 30 20 10 0 71.3

Percentage

28.7

Yes Safety tank 50 feet away

Figure 64 Safety tank 50 feet away

No

About 28.7% of the households of Melamchi VDC had maintained safety tank 50 feet away and rest 71.3 had not maintained safety tank 50 feet away. 3.1.9.8 Provision of kitchen garden

16.80%

Yes No

83.20%

Figure 65 Provision of kitchen of garden

Only 16.80% of the households had kitchen garden and rest about 83.20% had no kitchen garden in the house.

3.1.9.9 Water in latrine Among the household in the Melamchi VDC, 27.2% household had water in toilet whereas 72.8% household did not have water in toilet.

27.20% Yes No 72.80%

Figure 66 Water in latrine

3.1.9.10 Soap in toilet

70 60 Percentage 50 40 30 20 10 0 No Yes 37.1 62.9

Figure 67 Soap in toilet

Among the household in the Melamchi VDC, 37.1% household had soap in toilet whereas 62.9% household didnot not have soap in toilet.

3.1.9.11 Cleanliness of kitchen

39.20% Yes No 60.80%

Figure 68 Cleanliness of kitchen

60.8% of household regularly cleaned kitchen while 39.2% did not give emphasize to it. 3.1.9.12 Types of stove
80 70 60 Percentage 50 40 30 20 10 0 Gas Improved Smokeless Traditional Types of stove 3.8 2.7 21.3 72.2

Figure 69 Types of stove

Total 72.2% of the households were found to use traditional type of stove for purpose of cooking food. Only 2.7% used smokeless stove and 3.8% used improved types of stove. 21.3% used modern way through gas.

3.1.9.13 Distance between toilet and kitchen

80 70 60 Percentage 50 40 30 20 10 0 5-20m 20-35m 30-45m 40-55m 55mabove 12.7 4.4 6.6 5.6 71

Distance between toilet and kitchen

Figure 70 Distance between toilet and kitchen

Out of total sampled households 71%f the households of Melamchi VDC had 5-20m distance between toilet and kitchen and rest percentage of distance between toilet and kitchen i.e. 12.7% to 20-35m, 4.4% to 30-45m, 6.6% to 40-55m, 5.6% to 55m above. 3.1.9.14 Distance between animal shed and kitchen
50 40 Percentage 30 20 10 0 <10m 10-20m 20-30m 30-40m 40-50m >50m Distance between animal shed and kitchen 8.1 10.2 5.6 3.7 27.5 44.9

Figure 71 Distance between animal shed and kitchen

Out of total sample households 44.9%f the households of Melamchi VDC had less than 10m distance between animal shed and kitchen and rest percentage of distance between animal shed and kitchen i.e. 27.5% to 10-20m, 8.1% to 20-30m, 5.6% to 30-40m, 3.7% to 40-50, 10.2% was above 50m.

3.1.9.15 Types of toilet Among the household surveyed in the Melamchi VDC, about 59.1% had kachha type of latrine, about 28.4% had semi-pukka whereas only 22.5% toilet had pukka type of toilet.

70 60 50 40 30 20 10 0

59.1

Percentage

28.4

22.5

Kachha

Semi-pukka Types of toilet

Figure 72 Types of toilet

Pukka

3.2Qualitative Findings
3.2.1 Interview with VDC Incharge Interview was carried out with VDC in charge in order to collect the qualitative data regarding the following situation: Different programs conducted in VDC Situation of drinking water in The VDC Community participation in different programs Status of health programs conducted Under VDC Co-ordination of VDC with Other health institution

According to the VDC incharge it was found that different programs like: drinking water programs, ODF programs, awareness programs and other development programs were running in the Melamchi VDC. Also the drinking water facility was satisfactory with tap water in every house. But sometime the sources of drinking water get contaminated with different agents that lead to many waterborne diseases like: Typhoid, Diarrhoea, Fever, etc. It was also found that during summer season people may have to face scarcity of drinking water. The level of community participation was found admirable in different programs.

Community people were well known about role of community people in different programs. Similarly different health awareness programs, Vaccination programs, Water purification programs and so on were conducted successfully under the VDC control. Co-ordination was done regularly with health institution and PHCC in order to provide cost effective and wideranging services. The VDC incharge was solely devoted to provide effective services through VDC in co-ordination with other sectors in order to fulfill the needs of the community people. VDC in charge has adopted various strategies to address different problems of community people. So overall VDCs activities regarding upliftment of health status was satisfactory but need some extra effort and commitment. 3.2.2 Interview with PHCC Incharge and observation of PHCC At the time we went to Melamchi Primary Health Care Center, Dr.PradeepPuri was incharge on duty. He has been working there for 14 month. In his view common health problem in Melamchi VDC were mostly communicable like water borne diseases, viral infection with non-communicable like ARI and COPD. According to him Government supply is not enough for dealing with these problems so they have to refer to private drug stores and hospital if required. Organization like MDM is supporting PHCC in maternal and child health sector with supply for instruments and other requirements for safe delivery. Their coverage is around 80% and PHCC was able to organize only immunization program in outreach clinics. Although government had not been able to support much on the infrastructure of PHCC, the committee running PHCC has been able to provide ambulance service and had added lab service with few additional staffs. This health facility has following numbers of staffs: Position Medical Doctor Number 2 Years of experience 2 1 18 15 18 4 4

Staff Nurse Health Assistance/SAHW ANM

1 1 3

CMA Lab Assistance VHW Office Helper

1 1 1 3

1 1 24 17 17 4

Going through observation checklist for PHCC we come to know that it has good infrastructure. They had a concrete building with following facilities: Proper source of water supply Clean toilets Enough rooms for services Source of electricity and provision of generator Lots of IEC materials Was maintained clean

3.2.3 Findings from FGD with FCHV: FCHV of each ward were called for Focus Group Discussion (FGD) during community diagnosis period to know the health status of community people. FGD was done in coordination with Community Development Forum (CODEF) which was conducted for an hour. It was done to learn about their community health problem and their effort towards promoting health of their community. Female Community Health Volunteers (FCHV) refer to self-motivated person, selected by local mothers group for health for supporting various health activities conducted by local health institutions, and who commit themselves to work as volunteer for a certain period of time and who have been trained as per the basic curriculum of FCHV. (SOURCE: National Female Community Health Volunteers Program Strategy, 2067). They are close to community people. So it was relevant to conduct FGD with FCHVs to know overall health status of community people during community diagnosis phase. FGD was focused on the existing health issues in community, peoples views and actions on it, etc.

FCHVs were also shown the documentary called CharpiBihe after FGD was over. They said it would be better to show the documentary to community people for controlling the open defecation problem in their community. Out of 9 only 7 were able to attend this program. Their education level is form only literate to higher secondary level. Some of them were new, as two have been FCHV only for only 2 years while longest working FCHV has been for 24 years. Following were the findings from the FGD with FCHVs: Open defecation was the main problem in the community which was addressed most by FCHVs. FCHVs said that the common health problems of their community were mainly diarrhoea, typhoid, fever, and pregnancy related problems and child health problems. It was known that FCHVs were trained about family planning issues and were regularly supplied with pills and condoms through PHC in order to supply it to community people. FCHVs were found to be providing awareness to community people about use of toilet, maintenance of personal hygiene and sanitation, maintenance of child health, supplying pills and condoms to community people, promoting safe motherhood, etc. They said they conducted the mass rally programme all over the VDC to reduce the open defecation problem in their community. They said that they supplied ORS, make people learn to prepare ORS correctly, supply vitamin A capsules and they said they refer complicated cases to PHC. They said awareness programmes still lacked in their community in regard to personal sanitation and hygiene, controlling open defecation due to ignorance of people. They said health problems in their community would be reduced through effective educational programs, providing health facilities to all and solving open defecation problem with collective efforts.

3.3 Prioritization
Prioritization is a process whereby an individual or group places a number of items in rank order based on their perceived or measured importance or significance.(APEXPH 2011) Prioritizing issues is an important process, in that it assists an organization in identifying the issues on which it should focus its limited resources.

3.3.1 Observed Need

Those needs which the observer determines in the preliminary phase through various methods in the community are termed as observed needs. The observed needs can be identified through analyzing secondary data, questionnaires and from the observation of various activities/situation in the community. In our community health diagnosis process, BPH 6th semester group 3 students were observer. The observed needs identified during our study were: Observed Needs Techniques

1. High Prevalence of Communicable Secondary data analysis Diseases like common cold, typhoid, fever, etc. 2. Unsafe Drinking Water 3. KAP on disease and health Observation Observation

4. Accessibility, Affordability and Observation acceptability problems of health institution 5. Personal hygiene Observation

3.3.2 Felt Need

Felt needs are the priority need of the people in the community. It is 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 FCHV, stakeholders of community and in-depth interview with community leaders and teachers. Felt Needs Techniques

1. Upgrading of PHC, essential medicine Questionnaire 2. Health awareness 3. KAP on disease FGD with FCHV Questionnaire

4. Transportation for easy access to Discussion with stakeholders of community health facility 5. Urban waste problem 6. Unsafe Drinking water Discussion with stakeholders of community In-depth interview with community leaders and teachers In-depth interview with community leaders and teachers

7. Open deafication and lack of toilets

3.3.3 Real Need

Real Needs are those needs which are developed jointly from the understanding of priority needs of the local people and the priority needs as observed by the observer. There are various methods of identifying the real need. During our community diagnosis we used Strategy Grids method to identify the real need of the Melamchi VDC. 3.3.3.1 Strategy Grid Strategy grids facilitate agencies in refocusing efforts by shifting emphasis towards addressing problems that will yield the greatest results. This tool is particularly useful when agencies are limited in capacity and want to focus on areas that provide the biggest bang for the buck. Rather than viewing this challenge through a lens of diminished quality in services, strategy grids can provide a mechanism to take a thoughtful approach to achieving maximum results with limited resources. This tool may assist in transitioning from brainstorming with a large number of options to a more focused plan of action. (NACCHO)

As according to this method, we categorize the observe need and felt need in four categories and then choose the list of real needs. Low Need/High Feasibility Urban waste problem High Need/High Feasibility Unsafe drinking water, Lack of latrines, Health awareness, High prevalence of communicable disease

Low Need/Low Feasibility Ambulance service

High Need/Low Feasibility Transportation for easy access to health facility, Upgrading of PHC, essential medicine

Low

Need

High

Through this method the identified real needs were: 1. Unsafe drinking water 2. Lack of latrines 3. Health awareness 4. High prevalence of communicable disease like typhoid, fever, etc. We concluded that the real needs were interrelated with each other. The lack of toilet and health awareness was causing the problem of unsafe drinking water which resulted in high prevalence of communicable disease like typhoid, fever, etc. And as per the need, we organized the proper Micro Health project.

3.4 Micro Health Project

Introduction
Micro Health Project is 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 (Pradhan 2009).

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. The observed needs were extracted from the data we collected and on the basis of the interaction and Focus Group Discussion, felt needs was identified. Then, we compared the two needs from which real needs were listed down. Then, prioritization of the needs was carried out with the help of community people to schedule four days of MHP on three phases; planning, implementation and evaluation. The work plan of the MHP is shown in the table below: SN Date Programs/ Activities 1. 2070/04/29 Exhibition on Local people Indreshwori community and Target group Venue Methods and media Chartpaper

H.S. School, presentation, Melamchitar IEC material, Presentation

health issues Secondary and

post level students (ward no. 5)

discussion 2. 2070/05/01 School health Secondary Indreshwori Lecture,

education on level students H.S. School, Group common diseases Melamchitar (ward no. 5) Discussion

3.

2070/05/02

Health education and Awareness on adolescent and reproductive health

Higher secondary

Indreshwori

Power point

H.S. School, slides, Group discussion, Role play

level students Melamchitar (ward no. 5)

4.

2070/05/02

School health Secondary program ODF

Janajagriti

Discussion, Role play

on level students Secondary School, Katunje (ward no. 7)

5.

2070/05/03

Street drama Community on care diarrheal case proper people of students

Daduwa

Role

Play,

and Primary School, Daduwa (ward no. 4)

Discussion

Goal
To raise the level of understanding of the community on different areas through health awareness by various methods.

Objectives
To explain importance of personal hygiene and environmental sanitation. To built up awareness upon health issues to the students of the community. To motivate people to use safe drinking water through their own effort by using simple methods of purification. To help community people to change KAP regarding specific diseases.

Process of MHP
Planning MHP planning was based on Dr. Johan Brynts problem solving circle which includes (Kaphle 2010): Defining objectives and target groups Resources collection Fixing date and place for implementation Formulate problem Evaluation Decide priorities

Planning the problems and implement

Brynts problem solving circle

Define objective

Altering solution and choosing the best one

Fig: Phases of MHP

Decide target population

Implementation 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 was the resource person to orient people during most of our programmes. Teachers also actively participated in the School Health Programme. Local leaders, community health volunteers, community people were supportive to participate and encourage the students to be a part of the overall program.

Evaluation All the people had active participation and interacted well to all our community programs. The response from the community was good and supportive. It was good and successful MHP where the participants were cooperative and were curious to learn and share their opinions to us. The major feedbacks that evaluated our MHP are given below: KAP regarding disease were answered correctly by majority of the participants after the health programs at school. Most of the people were found to be motivated by observing their expressions and opinions during the street drama. The principal Indreshwori H.S. School of said, Thank you so much for visiting our VDC and helping people to promote their health status. Please come to visit our VDC with more effective programs like this.

Activity 1: Exhibition
Objectives: To demonstrate the charts, social map and dummy sheets of the data collected regarding the community diagnosis To encourage community participation and give knowledge about the current health situation of the community Date: 2070/04/29 Venue: Indreshwori H.S. School, Melamchitar Participants: Community people Methodology: The Principal, teachers, local leaders, community people and students of Indreshwori H.S. School, Melamchitar were predetermined about the objective of the intervention of the community health diagnosis. The permission was taken from the college administration before the due date of the intervention. First of all, the charts and dummy sheets were displayed on the school ground. Then all the people were gathered and the purpose of our visit was elaborated. The methods of data collection were told and the results from the data collected were briefed to the people. Then, there was a good interaction regarding the clearance of queries of the people. Finally, all of the participants took a round to the displayed charts where we explained about various issues.

Activity 2: School health program

Objectives: Indreshwori H.S. School, Melamchitar To increase the knowledge of students regarding general health, adolescent health and gender violence. To promote the health education with special focus on sanitation and personal hygiene, pregnancy, personal behavior and awareness. Date: 2070/05/01 and 2070/05/02

Venue: Indreshwori H.S. School, Melamchitar Participants: Secondary and Higher Secondary level students No. of participants: 50 students Methodology: The students of Indreshwori H.S. School, Melamchitar were predetermined about the objective of the intervention of the community health diagnosis. The permission was taken from the college administration before the due date of the intervention. There were two groups divided into two different classes of secondary level students and higher secondary level students. First of all an introductory session was conducted to make the participant as well as ourselves comfortable in the teaching learning environment. After that, objective of the program was explained to the participants and the expectations of the participants from the program were collected. Then the health messages were given to the participants by the use of materials, chart papers prepared by the study group itself and through PowerPoint presentation. After the program was finished, the participants were made to interact and have active discussions through which their knowledge was found to be increased. Finally, the participants were also given open chance to express their opinion about the program.

Activity 3: School Health Program

Objective: To increase the knowledge of participants about common health problems including communicable and non communicable diseases of the community To enhance the knowledge and attitude of the community people regarding health problems. Date: 2070/05/02 Venue: Janajagrit Secondary School, Katunje No. of Participants: 36 students

Target Group: Secondary level students Methodology: The students of Janajagriti Secondary School, Janajagriti were predetermined about the objective of the intervention of the community health diagnosis. The permission was taken from the school administration before the due date of the intervention. All the students were assembled in the classroom and introductory session was conducted to create a good teaching and learning environment. All the students were given knowledge about the general communicable and non communicable diseases through the papers and board presentation which were common in the community. Also, the students were allowed to clear their queries regarding any health issues. The students were made to participate and perform a drama by themselves regarding the HIV/AIDS which was very interesting. Finally, there was a discussion among the students to clear their doubts on different health problems.

Activity 4: Street Drama

Objectives: To aware the community people about sanitation and water purification to enhance the open defecation free community Date: 2070/05/03 Venue: Daduwa Primary School, Daduwa Target Group: Community people Methodology: Script of the drama was written by the team members suitable to the environment and cultural background of the community people. Anjel Bikram Bista first gave introduction about the drama and the theme of it. Amogha Shrestha (Mailadai) was potrayed as father, Kopila Khadka (Maili) as mother and Sharada Poudel (Kanchi) daughter who was the victim of diarrhea. Puskar Basnet (Kazi) was potrayed as the traditional healer of the community. Similarly, Deepa Sharma, Suchana Phuyal and Bipin Singh were potrayed as the community people who were aware about the proper sanitation. Suruchi Pandey (Sainli) was potrayed as

the FCHV, Bibek Balla (Bijaya) as Publich Health Officer and Pabita Poudel (Sharmila) as doctor who gave proper education to the family regarding proper way of sanitation. Through this drama the team tried to convey the information regarding importance of use of toilet, water purification method and value of health institution. Evaluation: Post drama statements were taken from the viewers of the drama for the evaluation of this activity. The reaction of people towards different characters of the drama was also assessed. People did not accept the unsupporting behavior of Maila towards his daughter and community people. People were encouraged by the positive role of community people and the health workers promoting the health education. Everyone liked change bought at the last about improving the behavior. Some of the post drama statements are listed below: The actors have done a good job by giving a good try to the community scenario. We support the encouragement you have given to us regarding the sanitation with water purification method. It was a good effort you people made to explore the real situation of the community which is still deprived of toilets in their homes.

Chapter IV 4. Discussion
Demographic characteristics:
The total study population was 1918 including 916 female and 1002 male and the numbers of household were 352. The sex ratio was found to be M: F 109.38:100 which slightly receded the national figure (94.4:100 Census 2011) .The highest age group population was 10-14 years and the base of the population pyramid was tapering which might be due to the success of family planning programme. The average household family size was 5.36 which are higher than the national average household size i.e. 4.7 (census 2011). The nuclear family were higher i.e. 61.3% in respect to joint family that is only 38.7%. The literacy rate was 73.38% in total where female literacy rate was 66.15% and that of male was 79.94% which exceeded the national literacy rate i.e. 57.4%in average which include male literacy 71.1% and female literacy 46.7% ( CBS 2011). Major occupation was agriculture as it was 70.4% which is slightly lesser than national level which is 76% (central bureau of statistics 2011).The alcohol consumption was found to be 31% where female represented 12% and male represented 19%. The prevalence of smoking was 35% and among that 13% represented female and 22% represented male. The income was enough for 83% of population for their daily expenses whereas rest 17% population had hard time managing the expenses from their income.

Environmental health
The main source of drinking water was found to be tap with 88.5% of people use it. The purification of water was done by only 17.8% of household where 38.59% adopted the method of boiling for the purpose of filtration. 82.2% didnt purify their drinking water and that may be the reason for the high prevalence of typhoid, diarrhea, and fever. However the community people in Melamchi believe that the source of water is very pure and it dont need any purification. Melamchi was not still declared as ODF zone. The prevalence of toilet use

was 88.8% but still 11.2% were not using the toilet. So, the concern organization and VDC were working hard enough to make Melamchi ODF zone. Among the sample household outof 352, only 291 had toilet and out of that 289 household used the toilet and three household were not found to be doing so. Therefore, the toilet use coverage was 98%. The people had an idea regarding compost pit so higher rate of household (33.8%) preferred compost pit for the disposal of their household waste. Also 16% of household disposed their waste haphazardly. 55.6% of liquid waste of house was sited into the kitchen garden. Above 90% of the people were alert regarding the personal hygiene issue. They regularly performed the habit of bathing, brushing teeth, washing clothes and cutting nail. 62.8% of people used soap water to wash their hand before having a meal whereas 80.4% used soap water and 11.2% used water only to wash their hand after the defecation. Also 71.3% of houses didnt have safety tank 50m away from home. The average distance between kitchen and toilet was found to be in between 5-20m. Similarly between kitchen and animal shed was <10m. One of the major problems was diarrohea at Melamchi VDC as people were highly affected and it was among top 5 diseases. But people were well familiar with the disease as they had good knowledge level regarding the diarrohea. 89.40% of people knew the disease. People believed polluted environment as the major aggregating factor that strain in causation of diarrohea. People had a satisfactory level of perception about the prevention against

diarrohea as more than 50% of people assumed that drinking clean water and washing hand before having a meal could suppress the prevalence of it. For the management and treatment of diarrohea 67.4% and 32.6% gave preference to ORS and Health institute respectively. On a question about the preparation of ORS about 61% of people had good knowledge and skill about its preparation but still 39% of people were unfamiliar about its making. Since ORS is best way and cost effective in fighting against the diarrohea though 89.4% knew diarrohea but unfortunately only 61% of people only knew about the way of its correct method of preparation. So this gap is very much needed to be sorted out and fill up the dots as soon as possible.

Maternal and child health

According to NDHS report 2011 among women and men age group 20-49, 70.5% women and 33.9% of male get married by the age of 20 years. Among married couple who were

interviewed in Melamchi VDC, nearly 73.34% of people got married before the age of 20 years. This was mainly because of lack of education, poverty, socio-cultural reasons and early need of child to support family occupation. NDHS report 2011 suggest that, 50% of pregnant women makes 4 or more ANC visits whereas 66% of pregnant women makes 4 or more ANC visit in Melamchi VDC indicating good coverage of maternal health services during pregnancy. In Melamchi VDC still 62% of birth took place at home because of various reasons like belief in traditional birth attendance, long distance in reaching health facility, lack of proper education among people specially women and so on. Comparing with the NDHS report 2011, where more than 70% of pregnant women received 2 or more tetanus injection during their last pregnancy only 22% of pregnant women received tetanus vaccine in Melamchi VDC. This was probably because most women even though they had been given tetanus vaccine did not know about the vaccine. So even when they were interviewed they answered that either they have not heard about or not given tetanus vaccine. Iron intake during pregnancy with full dose is also less than half i.e. 42% in Melamchi VDC and rest is either not taken or not completed full dose of iron tablets. More than 50% of female get pregnant before the age of 20 years get pregnant and nearly 47% of women do heavy work during pregnancy. Melamchi VDC has high frequency of early marriage resulting in high number of female getting pregnant in early age and being at risk of complication during pregnancy. Complication during pregnancy is also high in Melamchi VDC i.e nearly 22% because of various reasons like home delivery, heavy work load during pregnancy, early pregnancy etc. Colostrums feeding practice is high i.e. 90% in Melamchi VD but weaning practice among babies before the age of 6 months is still high i.e. 43.84%. This indicates still high number of babies not getting exclusive breastfeeding till age of 6 months.

Family planning
The family planning questionnaire was made for married couple aged between 15-49years. For this 250 participants were asked question regarding the FP. The questions were designed in order to know the perception regarding the FP and the method (permanent or temporary) if they used any. Most of them I.e. 86% were known about the FP. The contraceptive prevalence rate (CPR) was found to be 60.8% in Melamchi VDC where according to NDHS report 2011 the CPR prevalence is 43%. The permanent method of contraceptive use was 33.6% whereas 66.4% used temporary method of contraceptives. The major focus for the permanent method was given to 78.43% whereas for temporary method depo had been prior in Melamchi as it was under taken by 33.66% and condom with 25.74% of couple. Birth spacing is very essential to maternal and child health promotion, 54% of the respondents were found to prefer duration of birth spacing of 2-5 years. This indicated that though their knowledge was good but appropriate attitude and practice was lacking. KAP You cannot be healthy; you cannot be happy; you cannot be prosperous; if you have a bad disposition. -Emmet Fox. As the quote explains, healthy knowledge, behavior and attitude of people is the key to be healthy, happy and prosperous. However this is not seen in real life scenario in most of the Nepalese community. During our community health diagnosis in Melamchi VDC, we analyzed the various aspect of KAP of the communicable, non communicable diseases and different factors related to them. Most of the people seem to have good knowledge on how the disease is transmitted, 68% believed that personal hygiene and 13% population believed microorganism is the cause of transmission of diseases. It was a good aspect that only 3.9% of population believe on god and witch as a disease source. On the positive note most of the people knew about the various aspects of diarrhea. 90% of population knew about diarrhea. 55.6% believed that drinking water and 59.5% believed that washing hand before meal can prevent diarrhea. Adding to that 67.4% people believed that use of ORS can manage the diarrhea. These data suggests that people have positive knowledge and attitude toward diarrheal disease management but through our observation we did not really see its

implication on behavior. One of the study Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site concluded that there is gap between in knowledge, attitude and behaviour. Talking about the KAP we found the harsh reality in Melamchi VDC. People are so busy in attaining the basic needs that the importance of health has been left far behind. We asked the community people about some of the basic health problems prevalent in Nepalese community. In case of the communicable disease majority of the people didnt not know the basic concept of the way of the transmission of the disease, its symptoms, and most importantly the measure of prevention. Only 31.4%, 57.5%, 18.7%, 21.7%, 25.7%, 32.3%, 35%, 31.4% of population knew about the preventive measures of Tuberculosis, Scabies, Leprosy, Bird flu, Polio, Diphtheria, HIV/AIDS and Malaria respectively. This data signifies the poor preventive health situation in Melamchi VDC. The same situation can also be seen in non-communicable diseases. Only 11.2%, 25.4%, 16%, 29%, 24.2%, and 83.1% of population knew about the preventive measures of breast cancer, lung cancer, heart problems, asthma, uterine prolapse and diabetes respectively. The reason behind these poor situation can be lack of knowledge, negligence towards health, lack of proper preventive program from various health stakeholders and the over emphasis on curative health service as a way of tackling the health problems in the community. In the case of KAP on family planning 86% of married population aged between15-49 had knowledge about family planning methods. Among them 61% of the married couple used family planning methods. The KAP on family planning seems satisfactory.

Chapter V 5. Conclusion and Recommendation

Behind sucessful accomplishment of our one month long community diagonosis field programms lies the candid abutments and sumptouous kindness of many luminaries. This field report was not the exclusive product of our group. We owe much of the credit to the support and assistance of many helping hands. We had to face lots of difficulties during one month stay but in reality we had chance to know the actual village lifestyle. Thus we had a lots of experience and interesting pleasent during that moment. After our one month study we could conclude that the health status of the Melamchi community was not satisfactory. Melamchi VDCs people face lots of health problems like water purification problem, open field defication, and lack of health awarness. In sociodemographic major finding conclude that the population of aged (10-14) years was higher which might be due to the high fertility rate and poverty. Most of the family were nuclear. Accourding to the data 80% people were Hindu. Male poupulation was higher than female population, among them majority of male population were litrate than compare to female population which might be due to the gender discrinination. The figure shows that the major source of income was agriculture, both men and women were actively participate in agriculture. It was one of good things that only 20% population were smokers among them male were higher. The housing condition of that area was kacchi and pakki. The major problem of that village was unsafe drinking water, open field defication, lack of health awarness. Tap water was the main source of drinking water. Only 45% people purify the water and rest of the population drank directly as a result of spread of water borne diseases. Figure shows that 89% household had toilet among them most of them were not

used as a result of open field defication was common. Among the population 75% of household chilkdren 2-5 years used toilet. Most of the people disposed their solid waste in pit and liquid waste in kitchen garden. Health seeking practice was good. Most of the people went to health post and few of them believed in traditional practice. Average age of marriage was below 20years.there was high fertility rate among the reproductive aged group women. Figure shows that 62% of delivery took place at home with the helped of their family members. Nutritional status of child and mother was satisfactory. Most of the people had knowledged about family planning, majority of them used permanent methods. Majority of the people were satisfactory with medicine provided by health post. Most of the population do not have knowledge about communicable and non communicable disease as a result there is high prevalence of typhoid, diarrhoea, headache, ARI, skin problem with in past 3 months. Beside these problem people are helpful and cooperative to our work. We heartly thank all the people for their cooperation. We conducted MHP on purification of water and open field defecation with school health program. This program helped in changing the KAP of the local people to some extent. Finally, we would like to express our heartful thanks to all those who has directly and indirectly helped us for successful and effective program. And lets hope in coming future, health status of Melamchi VDC will improve.

Recommendation
TO community Awareness raising programmes on real health problems should be continued. CBOs and NGOs should be encouraged to work in coordination with the Health post and schools regarding different important health issues. Promotion of the use of manure pit and toilet is the priority. Water source protection and drinking water management needs to be encouraged. School health program on different heath issues need to be conducted regularly.

Forming a new health support group in the community in which members of clubs, NGOs, Health Post management committee and local health workers, to act as a representative of civil society in health related issues.

Community people should be aware about emerging health problems. Health services should be upgraded in PHCC.

To college Provision of enough logistics materials for students. Students should be oriented for dealing various situations that may come across CHD. The ongoing activities of students should be monitored on regular basis. Student representatives should be involved in feasibility study. Study area should be chosen in such a way that students can learn more effectively rather than being physically exhausted. Students should be sent for community health diagnosis in appropriate season. There should be provision for rewarding letter of appreciation to the people who helped the study group in the field. Provision of health insurance for each student should be made by the campus during the community health diagnosis field. Adequate logistic supply like Saltre Scale, Shakirs Tape, measuring rod etc. should be provided, and these logistics should be in well-functioning state.

To VDC Services should be upgraded VDC must take immediate action regarding purification ofdrinking water Should launche different awareness programmes to improve the health status of the community. VDC should cooperate with NGOs and INGOs to improve the health status of community by launching programs on toilet use and knowledge on harmful effects of open defecation.

VDC should improve the intersectoral coordination with various stakeholders to have overall improvement of health. VDC should show active participation during any activity in the community which can improve the condition of VDC.

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Annexure
Survey questionnaire

CIST College ;]G6n OGi6LRo"6 ckm ;fOG;\ P08 6]Sgf]nf]hL ;+udrf]s, afg]Zj/, sf7df08f} ;d'bfo :jf:Yo lg?k0f, @)&) 3/d'lnnfO{ ;f]Wg] k|ZgfjnL sf]8 g+ =============== cGtjf{tf{ lng]sf] gfd M----------------------------------cGtjf{tf{ ldlt M--------------

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gd:sf/, xfdL ;]G6n OGi6LRo"6 ckm ;fOG;\ P08 6]Sgf]nf]hLdf :gfts txdf cWog/t hg:jf:y t];|f] jif{sf ljBfyL{ xf}+ . xfdL :jf:Yo ;DaGwL sfdn] cfPsf xf}+ . xfdL ;d'bflos :jf:Yo lg?k0f ug{sf] lglDt tkfO{x?sf] :jf:Yo l:ytLaf/] hfgsf/L lng cfPsf 5f} . tkfO{ o; cGtjf{tf{df ;xefuL x'g'x'g]5 eGg] ljZjf; u5f{+} . xfdL tkfO{ / tkfO{sf] kl/jf/sf] :jf:Yo l:ytL af/] k|Zg ;f]Wg] 5f}+ . tkfO{n] lbPsf] hfgsf/Lx?af6 xfdLn] agfPsf] k|ltj]bgn] tkfO{sf] uf=la=;=df :jf:Yo ;DaGwL of]hgfx? th{'df ug{ d2t k'Ug]5 . tkfO{n] lbg' ePsf] ;Dk'0f{ hfgsf/Lx? clt uf]Ko /flvg] 5g\ . o; cGtjf{tf{df ;xefuL x'g] jf gx'g] tkfO{sf] :j]R5fsf] s'/f xf] . tkfO{n] o; k|ZgfjnLdf ePsf] s'g} jf ;Dk"0f{ k|Zgx?sf] pQ/ glbg klg ;Sg' x'G5 t/ xfdLnfO{ cfzf 5 tkfO{ cGtjf{tf{df ;xefuL x'g'x'g]5 lsgsL tkfO{sf larf/x? dxTjk"0f{ 5g\ . s] tkfO{ cGtjf{tf{ ;DaGwL s'g} s'/f ;f]Wg rfxg' x'G5 < s] xfdL ca cGtjf{tf{ z'? u/f}+ < pQ/bftfsf] d~h'/LM 5 5}g

d~h'/L ePdf cGt/jftf{ lbg]sf] ========================================== ;lx5fkNofKr]

--pQ/bftf3/d'ln :jod -!* jif{ pd]/ k'/f ePsf] kl/jf/sf] ;b:o olb 3/d'ln ge]l6Psf] v08df_
1.

kl/ro lhNnf M ufFp6f]n M k|Zg ;f]Wbfsf] ;do M 3/d'lnsf] gfdy/ M uf=la=;= M j8f=g+= M 3/ g+= M +pQ/bftfsf] gfdy/ M

2.

hg;+Vof ;DaGwL ljj/0f M kl/jf/sf] lsl;d Psn 3/d'ln ln ;Fusf] ;DaG w ;+o"Qm z}lIf JolQmut afgL s 3'd|kf dBkf Jofo l:ytL g g d

qm=; ;b:ox?s = f] gfd ! @ # $ % ^ & *

pd] /

a}aflx k]z Wfd s l:ytL f {

( gf]6 M dof{bfs|dsf] 36\bf] s|d ;+Vofdf cfjZos ;+s]tM lnM k'?if = M dlxnf= F t];|f] lnL =T cfjZos ;+s]t M j}jflxs :yLlt k]zf Zf}lIfs :yLlt w'd|kfg :yLlt dBkfg :yLlt Jofodsf] :yLlt

U=cljjflxt M=ljjflxt D=;DjGw ljR5]b W=ljwjfljw'/

A= s[lif B=Jofkf/ Joj;foL S= hfuL/] L= sfdbf/ H= u[x0fL St= ljBfyL Ab= j}b]lzs O= cGo

0= w'd|kfg gug]{ u/]s]f] L= ;fIf/ 1= w'd|kfg sfxL PP= Nursery slxn] ug]{ u/]sf to UKG I= lg/If/ P=Kf|fylds tx -!% sIff _ L.S=lg=df= -^* sIff_ S=df= -(!) sIff_ H.S=pRr df= -!!!@ sIff _ H.E=pRr lzIff -!@ eGbf dflYf _

O=dBkfg gu/]sf] 1=dBkfg slxn] sfxL ug]{ u/]sf 2= dBkfg 2= w'd|kfg lbgxF' ug]{ ug]{ u/]sf u/]sf]

0= Jofod gu/]sf] 1= Jofod slxn] sfxL ug]{ u/]sf 2= Jofod lbgxF' ug]{ u/]sf]

a;fO{ ;/fO{ ;DaGwL k|Zg != tkfO{ oxfFsf] :yfoL afl;Gbf xf] < s_ xf]
3.

v_ xf]Og

tkfO{ xfn al;/xg' ePsf] ufFpdf nuftf/ a:g nfUg' ePsf] slt aif{ eof] < s_ ^ dlxgf eGbf a9L u_ hGd} b]lv xfn ;Dd v_ ^ dlxgf eGbf sd 3_ cGo =========================

4.

clxn] tkfO{sf] kl/af/sf] s'g} ;b:o ufFp eGbf aflx/ a;f]af; ug'{ x'G5 < s_ ug{'x'G5 v_ ug{'x'Gg -k|Zg g+=^ df hfg] _

5. 6.

olb ug'{x'G5 eg] slt hgf ======================== clxn] tkfO{sf] kl/jf/sf] s'g} ;b:o j}b]l;s /f]huf/df hfg' ePsf] 5 < s_ 5 v_ 5}g

7.

olb 5 eg], s_ slt hgf =================================== v_ ;dob]lv================= slt

cfly{s ;fdflhs If]q ;DaGwL k|Zg

8.

tkfO{sf] kl/jf/sf] cfDbfgLsf] d'Vo ;|f]t s] xf] < s_ s[lif u_ Jofkf/Jofj;fo v_ gf]s/L 3_ >lds

_ cGo -v'nfpg]_ ======================================

9.

tkfO{sf] cfDbfgLaf6 !@ dlxgf 3/ vr{ rN5 < s_ rN5 v_ rNb}g

10.

kl/jf/sf] cf};t jlif{s cfDbfgL ==================================== ?k}+of

/f]u ;DaGwL k|Zg

11.

ljut # dlxgfdf tkfO{sf] kl/jf/sf] sf]lx ;b:o la/fdL x'g' ePsf] lyof] < s_ lyof] v_ lyPg -k|Zg gDa/!@ df hfg]_

11.1

olb lyof] eg] ln pd]/ /f]unIf0fx slt pkrf/ lsl;d k6s

s|=;= la/fdLsf] gfd !=

@=

#=

$=

pkrf/sf] lsl;d L = Home based treatment TH = Traditional Healer HI = Health Institution

12.

tkfO{sf] 3/df sf]xL zf/Ll/s c;Qm JolQmx? x'g'x'G5 < s_ x'g'x'G5

12.1

v_ x'g'x'Gg - k|Zg gDa/ !# df hfg]_

s|=; Gffd

pd]/ ln s] ePsf] 5 <

hGdhft

hGd olb hGdkZrft kZrft xf] eg] sf/0f

12.2

x'g'x'G5 eg], of] s'/fn] kl/jf/nfO{ s:tf] c;/ kf/]sf] 5 <-ax'pQ/_ s_ cfly{s ef/

v_ ;fdflhs cjx]ngf u_ cGo ;b:onfO{ dfgl;s tgfj 3_ ;dfhaf6 ;xof]u _ bft[ lgsfoaf6 ;xof]u r_ ;/sf/L Ifqaf6 ;xof]u 5_ s]xL km/s k/]sf] 5}g h_ cGo =======================================================
13.

tkfO{ jf tkfO{sf kl/jf/sf cGo ;b:o lj/fdL x'Fbf k|yd k6s sxfF hfg'x'G5 < s_ wfdLemf+qmL u_ c:ktfn v_ :jf:Yo rf}sL 3_ 3/df

_ cGo -v'nfpg]_==============
14.

olb :jf:Yo rf}sL c:ktfn ghfg] eP ghfg'sf] sf/0f < s_ ljZjf; gnfu]/ u_ pkrf/ gkfpg] eP/ v_ 6f9f eP/ 3_ cGo -v'nfpg]_==================

15.

tkfO{sf] 3/af6 lx+8]/ :jf:Yo ;+:yf k'Ug slt ;do nfU5 < s_ #) ldg]6 u_ #) ldg]6 eGbf sd v_ #) ldg]6 eGbf a9L 3_ cGo -v'nfpg]_==================

16.

:jf:Yo rf}sLn] tkfO{nfO{ s]lx kmfO{bf k'ofPsf] 5 < s_ 5 v_ 5}g

17.

tkfO{ :jf:Yo rf}sLsf] ;]jf k|lt ;Gt'i6 x'g'x'G5 < s_ 5' v_ l7s} u_ 5}g

18.

;/sf/L :jf:y ;+:yf k|lt wf/0ff ;DalGw k|Zgx M /fd|f] l7s} g/fd|f] yfxf 5}g

;]jfsf kIfx lj/fdLnfO{ /fd|f] Jojxf/ :jf:ysdL{sf] pknAwtf lj/fdLnfO{ vfg]kfgLsf] Joj:yf lj/fdLnfO{ zf}rfnosf] Joj:yf cfjZos cf}ifwLsf] Joj:yf cf}ifwLsf] u'0f:t/ k|ltIfnosf] Joj:yf

;]jf lng kv{g] ;do :jf:y sdL{n] lbg] ;do :jf:y sdL{ f/f lj/fdLnfO{ hfgsf/L :jf:y ;+:yfsf] ef}lts jgfj6 lg M z'Ns :jf:y ;]jf 19. tkfO{+n] dlxnf :jf:y :jo+ ;]ljsf;Fu slQsf] :jf:y ;]jf pkef]u ug'{x'G5 < s_ w]/}
20.

v_ l7s}

u_ yf]/}

3_ slxNo} gug]{

dlxnf :jf:y :jo+ ;]ljsf ;DaGwL wf/0ff M kIfx plrt pd]/ zf}lIfs of]Uotf :jf:Yosf] 1fg pknAwtfe]6\g ;lhnf] cf}ifwLsf] kof{Ktf Jojxf/ /fd|f] l7s} g/fd|f] yfxf 5}g

s|=;= ! @ # $ % ^

dfg;Ls :jf:Yo ;DalGw k|Zgx?

21.

s] tkfO{ PSnf]kg dx;'; ug'{x'G5 < s_ u5'{v_ ulb{g u_ slxn] sfFlx

22.

tkfO{ ;fyLefO{x?;+u 3'nldn x'g slQsf] ?rfpg'x'G5 < s_ ?rfpF5' v_ ?rfpGg u_ cln slt dfq}

23.

= tkfOnfO{ cfgf] lhjgk|lt s:tf] wf/0ff 5 < s_ ;sf/fTds v_ gsf/fTds

24.

tkfO{ cfkm'n] u/]sf] sfd k|lt sltsf] ;Gt'li6 ug'{x'G5 < s_ ;Gt'i6 5' v_ ;Gt':6 5}g u_ l7s}

25.

tkfO{nfO{ lgGb|f, ef]s slQsf] nfU5 < s_ nfU5 v_ nfUb}g u_ slxn] sflxdfq nfUg] gnfUg] u5{

26.

s] tkfO{ slxn]sfFlx lagfsf/0f 8/fpg] ug'{x'G5 < s_ 5' v_ 5}g

27.

tkfO{nfO{ 3/df sf]lx dfg;Ls la/fdL x'g'x'G5 <

s_ 5
28.

v_ 5}g

s] tkfO{nfO{ dfg;Ls /f]uaf/] yfxf 5 < s_ 5 v_ 5}g

29.

tkfO{sf] larf/df dfg;Ls /f]u s] sf/0fn] nfUg ;S5 < u_ hGdhft 3_ ;/;kmfO{sf] sdLn] _ cGo -

s_ b]ptf l/;fP/ v_ ls6f0f'n] ubf{ v'nfpg]_

30.

tkfO{sf] 3/df laut s]lx jif{ leqdf cfTdxTofsf] 36gf 36]sf] lyof] < s_ lyof] v_ lyPg

:jf:Yo l:ytL ;DaGwL k|Zg -1fg, wf/0ff / Jojxf/ _

31.

tkfO{sf] ljrf/df /f]u s] sf/0fn] nfU5 <-ax'pQ/_ s_ ;/;kmfO{sf] sdLn] u_ b]ptf l/;fP/ v_ ls6f0f'sf] sf/0fn] 3_ af]S;L nfu]/

_ cGo -v'nfpg]_ =============================

32.

/f]ux?af/] cGo hfgsf/L yfxf 5 Yffxf 55}g yfxf 5}g s;/L /f]syfd ug{ ;lsG5 .

cfjZos ;+s]t ;?jf /f]ux? Ifo/f]u n'tf] emf8fjfGtf s"i7/f]u Jf8{ n" kf]lnof] bfb'/f Pr=cfO=eLP8\; dn]l/of

olb 5 eg] nI0fx? s] s] x'g\ s;/L ;5{

g;g]{ /f]ux? SofG;/ s_ :tg

Yffxf 55}g

/f]unfUg] sf/0fx?

/f]syfdsf pkfox

v_ kmf]S;f] d'6'sf] ;d:of Bd cf v:g] /f]u dwd]x 33. tkfO{sf] larf/df ufFpsf kfFrj6f d'Vo :jf:Yo ;d:ofx? s]s] x'g <
a) b) c) d) e) 34.

-----------------------------------------------------------------------------------------------------------------------------------

ljut ! jif{df tkfO{sf] 3/df s;}sf] d[To' ePsf] lyof] < s_ lyof] v_ lyPg -k|Zg gDa/ @^ df hfg]_

35.

olb lyof] eg] pd]/ ln d[To'sf] sf/0f pkrf/sf] nfuL :jf:Yo ;+:yf nfg' s}lkmot eof] ePg

qm=;= != @=

jftfj/0fLo tyf JolQmut :jf:Yo ;DaGwL k|Zg s_ kfgL

36.

lkpg] kfgL k|foM sxf+af6 Nofpg' x'G5 < s_ wf/f u_ Ogf/ _ 9'\u]wf/f v_ s'jf 3_ vf]nf r_ cGo -v'nfpg]_ ===================

37.

tkfO{n] kLpg] kfgLnfO{ z'l4s/0f ug'{ x'G5 < s_ u5'{ v_ ulb{g -k|Zg g+= #( df hfg]_

38.

olb ug'{x'G5 eg], tkfO{n] kLpg] kfgL s'g tl/sf af6 Zf'l2s/0f ug{'x'G5 < s_ pdfn]/ u_ lyu|fP/ v_ ;fwf/0f sk8fn] 5fg]/ 3_ cf}iflw /fv]/

_ lkmN6/sf] k|of]u

r_ ;f]l8; ljlw

5_ cGo -v'nfpg]_========================
39.

tkfO{ 3/df lkpg] kfgL s;/L /fVg' x'G5 < s_ 5f]k]/ v_ g5f]k]/

v_ rkL{ ;DaGwL k|Zg

40.

tkfO{sf] 3/df rkL{ 5 < s_ 5

40.1

v_ 5}g -k|Zg g+= $)=$ df hfg] _ s] tkfO{ rkL{sf] k|of]u ug'{ x'G5 < s_ u5'{ v_ ulb{g - k|Zg g+=$)=# df hfg]_

40.2

s] b'O{b]lv kfFr jif{sf d'lgsf s]6fs]6Ln] klg rlk{sf] k|of]u u5{g\ < s_ u5{g\ v_ ub}{gg\

40.3

rkL{sf] k|of]un] s] s] kmfO{bf x'G5 <-ax'pQ/_ s_ ;kmf ;'U3/ x'G5 v_ cfkm'nfO{ ;lhnf] x'G5

u_ lem+uf nfdv'] sd x'G53_ /f]u nfUb}g _ 3/sf] OHht a9\5 r_ yfxf 5}g

5_ cGo ========================
40.4

rkL{sf] k|of]u lsg ug'{ x'Gg <-ax'pQ/_ s_ kfgL geP/ u_ afgL geP/ v_ lg;fl;o/ 3_ c7\of/f] eP/

_ cGo ============================
40.5

k|foM h;f] sxfF hfg] ug'{ x'G5 < s_ v]taf/Ldf u_ vf]nfsf] 5]pdf v_ afF;sf] em\ofdf 3_ v'nf d}bfgdf

_ h\un 5]p5fp

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

41.

tkfO{+nfO{ yfxf 5 , hyfeflj lb;f lk;fa ubf{ :jf:yodf s] s:tf] ;d:of b]vf k5{ < s_ f8fkvfnf v_ cfp u_ h'sf kg{] 3_ cGo -

v'nfpg]_================ u_ kmf]xf]/ d}nf lj;h{g ;DaGwL k|Zg

42.

tkfO{sf] 3/ j/k/ hDdf x'g] kmf]xf]/ sxfF kmfNg' x'G5 < s_ hxf+kfof] Tolx+ u_ hnfpg] v_ vfN6f] vg]/ k'g]{ 3_ dn vfN6f]df

_ cGo -v'nfpg]_==============================
43.

hyfefjL kmf]xf]/ kmfNgfn] s] x'G5 < s_ /f]u nfU5 u_ kmf]xf]/ x'G5 v_ lem+uf nfU5 3_ uGxfpF5

_ cGo -v'nfpg]_==============================
44.

tkfO{sf] 3/af6 lg:s]sf] kmf]xf]/ kfgL s] ug'{ x'G5 < s_ s/];f af/Ldf xfNg] u_ ufO{j:t'nfO{ v'jfpg] v_ vf8ndf xfNg] 3_ yfxf 5}g

_ cGo -v'nfpg]_============================
45.

3/df ar]sf] ls6\gf;s cf}iflwljiffwL s] ug{'x'G5 <

================================================================ ================================================================ ====== 3_ JolQmut ;/;kmfO{ ;DaGwL k|Zg

46.

JolQmut ;/;kmfO{sf nfuL tkfO{n] s] s] ug'{x'G5 < -ax'pQ/_

s_ g sf6\g] u_ g'xfpg]

v_ bf+t dfHg] 3_ n'uf w'g]

_ cGo -v'nfpg]_ ========================================

47.

tkfO{ vfgf vfg' cl3 xft w'g' x'G5 < s_ w'G5'

47.1

v_ w'Gg - k|Zg g+=$* df hfg]_

xft w'g s] k|of]u ug{' x'G5 < s_ ;fa'g kfgL 3_ ;fbf kfgL v_ df6f] kfgL u_ v/fgL kfgL

_ cGo -v'nfpg]_====================

48.

tkfO{ lb;f ul/;s]kl5 xft w'g'x'G5 < s_ w'G5' -#*=!df hfg]_

48.1

v_ w'Gg -$*=@df hfg]_

s]n] w'g' x'G5 < s_ ;fa'g kfgL 3_ ;fbf kfgL v_ w'Gg _ df6f] r_ u_ v/fgL cGo -

v'nfpg]_=======================
48.2

olb w'g'x'Gg eg], lsg <

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

dft[ lzz' :jf:Yo -# jif{ d'lgsf] aRrf ePsf] cfdfnfO{ ;f]Wg]_ cfdfsf] gfd M pd]/
49.

kmf/fd g+= @ aRrfsf]

pd]/ M

tkfO{ lajfx x'Fbf slt jif{sf] x'g'x'Gyf] <-k"/f ePsf] pd]/_ jif{

50.

klxnf] k6s ue{jtL x'Fbf tkfO{sf] pd]/ slt aif{sf] lyo]f < -k"/f ePsf] pd]/_ jif{

51. 52.

tkfO{ slt k6s ue{jtL x'g' eof] < tkfO{sf] xfn slt hgf 5f]/f 5f]/L 5g< s_ 5f]/f v_ 5f]/L u_ hDdf

53.

xfd|f] b]zdf ue{ ktg ;DaGwL lgod sfg"g af/] tkfO{n] ;'Gg' ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= $$ df hfg] _

54.

tkfO{nfO{ yfxf 5 , dfGotf k|fKt ue{ktg ;]jf sxf+ kfpg ;lsG5 <

================================================================ ============================================
54.1

tkfO{n] ue{ktg ;]jf lng'ePsf] 5 < s_ 5 v_ 5}g

55.

tkfO{ kl5Nnf] k6s uef{j:yf ePsf] a]nfdf ue{jtL cj:yf hfFr u/fpg' ePsf] lyof] < s_ lyof]
55.1

v_ lyPg -k|Zg g+=$^ df hfg]_

olb lyof] eg] ue{jtL cj:yf hfR+f u/fpg s;n] ;Nnfx lbPsf] lyof] < s_ >Ldfg 3_ cfdfa'af v_ ;f;' _ ;fyL u_ ;;'/f Rf_ l5d]sL

5_ :jf:y sfo{stf{

Hf_ :jo+

em_

cGo===================
55.2

ue{jtL ePsf] cj:yfdf tkfO{sf] :jf:Yo k/LIf0f sxfF ug'{ eof] < s_ c:ktfndf u_ x]Ny kf]i6 v_ gl;{ xf]d 3_ wfdL emfs|L

_ cGo -v'nfpg]_===========================

55.3

slt k6s hfg' ePsf] lyof] < s_ $ k6s eGbf a9L u_ $ k6s v_ $ k6s eGbf sd 3_ cGo -

=====================================_
55.4

s] tkfO{nfO{ yfxf 5 , ue{j:yfdf slt k6s hf+r u/fpg' k5{ < s_ $ k6s eGbf a9L u_ $ k6s v_ $ k6s eGbf sd 3_ cGo -

=====================================
56.

olb lyPg eg] ;]jf lsg glng' ePsf] < s_ yfxf gkfP/ u_ :jf:Yo ;+:yf 6f9f eP/ _ 3/sfn] gk7fP/ v_ ;do geP/ 3_ nfh nfu]/ r_ cGo -

=====================================_
57.

tkfO{nfO{ uef{j:yfdf s]lx ;d:of ePsf] lyof] < s_ lyof]

57.1

v_ lyPg - k|Zg g+= %* df hfg] _

olb lyof] eg] s:tf] ;d:of ePsf] lyof] < s_ /ut aUg] u_ hLp emdemd ug]{ v_ v'f ;'lGgg] 3_ lk;fa kf]Ng]

_ l/ufF6f nfUg] r_ cGo -v'nfpg]_ ===================================================

57.1.1

To:sf] ;dfwfgsf] nflu s] ug{'ePsf] lyof] < s_ u/]sf] -s]<_ v_ gu/]sf

===================================================== ========
58.

uef{j:yfdf tkfO{n] kfv'/fdf nufO{g] l6=l6 ;'O{ lng' ePsf] lyof]< s_ lyof]
58.1

v_ lyPg - k|Zg g+=%( df hfg] _

olb 5 eg] slt k6s nufpg' eof] < s_ ================= k6s v_ yfxf 5}g

59.

uef{cj:yfdf s] tkfO{n] cfO{/g rlSs vfg' ePsf] lyof] < s_ lyof]

59.1

v_ lyPg -k|Zg g+=^) df hfg] _

slt lbg ;Dd vfg' ePsf] lyof] < s_ =========== lbg v yfxf 5}g

59.2

-olb @@% lbg vfPsf] 5}g eg_, lsg k'/f gvfg' ePsf] <-ax'pQ/_ s_ yfxf geP/ u_ vfg la;]{/ v_ ;do geP/ u_ vfg dg gnfu]/

_ cGo -v'nfpg]_=========================
60.

tkfO{n] ue{fj:yfdf slt sfd ug'{ ePsf] lyof] < s_ ;fljssf] h:tf] u_ ;fljssf] eGbf sd v_ ;fljssf] eGbf a9L 3_ cGo

======================================
61.

tkfO{sf] kl5Nnf] aRrf sxfF hGd]sf] lyof] < s_ 3/df u_ gl;{ xf]d v_ x]Nykf]i6c:ktfn 3_ cGo

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

62.

olb :jf:Yo ;+:yf jfx]s xf] eg], s;n] ;xof]u u/]sf] lyof] < s_ :jf:Yo sdL{ u_] kl/jf/sf] ;b:o v_ ;'8]gL 3_ cGo ==============================

63.

s] tkfO{n] ;'Ts]/L ;fdfu|Lsf] k|of]u ug'{ ePsf] lyof] < s_ lyof] v_ lyPg

64.

gfn s] n] sf6\g' ePsf] lyof] < s_ goFf An]8 u_ rSs' _ yfxf 5}g v_ k'/fgf] An]8 3_ s}rL r_ cGo

=======================================
65.

gfn sf6]sf] 7fpFdf s] nufpg' ePsf] lyof] < s_ a];f/ / t]n u_ df6f] _ yfxf 5}g v_ cf}ifwL 3_ uf]a/ r_ cGo

=======================================
66.

tkfO{n] kl5NNff] aRrf hGd]sf] $% lbg leq :jf:Yo ;+:yfdf hFfr u/fpg' ePsf] lyof]< s_ lyof] v_ lyPg u_ yfxf 5}g

67.

tkfO{n] aRrf hGd]sf] $% lbg leqdf le6fldg P SofK;"n vfg' ePsf] lyof] < s_ lyof] v_ lyPg u_ yfxf ePg

cf v:g] ;DaGwL k|Zgx?

68.

dlxnfx?sf] cf v:g] -kf7]3/_ ;d:ofsf] af/]df tkfO{nfO{ yfxfF 5 < s_ 5

68.1

v_ 5}g -k|Zg g+= ^( df hfg] _ olb yfxf 5 eg], of] s] sf/0fn] x'G5 < s_ nfdf] ;do a]yf nfu]/ u_ l56f] l56f] aRrf kfP/ v_ ufxf] sfd u/]/ 3_ ux|f}+ ;dfg af]s]/

cGo

========================================================= ===_
68.2

s] tkfO{nfO{ o:tf] ;d:of k/]sf] lyof]5 < s_ 5lyof] -c;/x_ v_ 5}glyPg - k|Zg g+= ^( df hfg]_

============================================= =================================================
68.3

olb 5 eg],tkfO{n] pkrf/ u/fpg' eof] < s_ u/fPF -sxfF <_ v_ u/fOg

======================================
68.4

olb guPsf] eP, lsg < ======================================

:tgkfg ;DaGwL k|Zgx? -# jif{ d'lgsf] aRrf ePsf] cfdfnfO{ ;f]Wg]_

69.

aRrf hGd]kl5 cfdfsf] :tgaf6 lg:sg] kx]nf] vfnsf] aSnf] -lauf}tL_ b'w aRrfnfO{ v'jfpg' ePsf] lyof] < s_ lyof] -k|Zg g+= ^(=! df hfg] _ u_ yfxf ePg
69.1

v_ lyPg -k|Zg g+= ^(=# df hfg] _

olb lyof] eg], aRrf hGd]sf] slt ;dodf b'w -lauf}tL_ v'jfpg' ePsf] lyof] <

================================================================ ==================
69.2

lauf}tL b'w v'jfpgfn] s] kmfO{bf x'G5 < s_ aRrfnfO{ /f]u nfUb}g u_ yfxf 5}g v_ aRrf alnof] x'G5 3_

cGo=======================================
69.3

olb gv'jfPsf] eP, lsg <

s_ rng geP/ u_ xfgL x'G5 eg]/ _ kmf]x/ x'G5 eg]/

v_ yfxf geP/ 3_ aRrfn] krfpg ;Sb}g eg]/ r_ cGo

=======================================
70.

aRrfnfO{ :tgkfg u/fpg' cl3 c? s]lx vfg]s'/f v'jfpg' ePsf] lyof] < s_ lyof]
70.1

v_ lyPg -k|Zg gDa/ &! Dff hfg]_

olb v'jfpg' ePsf] lyof] eg] s] v'jfpg' ePsf] lyof] < s_ dx v_ kfgL u_ l3p, lrgL

3_ cGo -=========================_
71.

aRrfnfO{ lbgdf slt k6s b'w v'jfpg' x'G5 < s_ ^ eGbf sd u_ * k6s eGbf a9L v_ ^* k6s ;Dd 3_ cGo =============================

72.

slt dlxgfsf] pd]/ b]lv aRrfnfO{ 7f]; vfg]s'/f v'jfpg' eof] < dlxgf aif{ s_

v_

clxn]

;Dd

cfdfsf]

b'w

v'jfPsf]

-olb

7f];

vfg]s'/f

eP_==================================== u_ yfxf 5}g -k|Zg g+= &# df hfg] _

73.

7f]; vfg]s'/f s] s] v'jfpg' eof]] <-ax'pQ/_ s_ ln6f] u_ hfpnf] v_ 3/df ksfPsf] vfgf 3_ cGo ==============================

74.

;af]{td lk7f]af/]df ;'Gg' ePsf] 5 < s_ 5

74.1

v_ 5}g -k|Zg g+= &% df hfg] _ ;af]{td lk7f] aRrfnfO{ v'jfpg' x'G5 v'jfpg eof] < s_ v'jfp5' v_ v'jfplbg -k|Zg g &) df hfg] _

74.2

olb v'jfpg' x'G5 eg], ;af]{td lk7f] sxfFaf6 Nofpg' x'G5Nofpg' eof] < s_ cfkm} 3/df agfp5' v_ lsg]/ Nofp5'

u_ cGo ============================
74.3

;af]{td lk7f] agfpg cfpF5 < s_ cfpF5 v_ cfpFb}g - k|Zg g+= &% df hfg] _

74.4

olb cfp5F eg], s;/L agfpg' x'G5 < s_ l7s v_ unt

-b'O{ efu Ps} ls;Ldsf] u]8fu'8L, b'O{efu km/s km/s lsl;dsf] cGg 5'f5'} e'6\g], 5'f5'} lk;]/ ld;fpg]_
75.

tkfO{nfO{ aRrfdf x'g] s'kf]if0f?Gr];'s]gf;sf] af/]df yfxf 5 < s_ 5

75.1

v_ 5}g-k|Zg g &^ df hfg] _ s'kf]if0f x'+bf s] x'G5 < -ax'pQ/_ s_ b'Anfp+b} hfG5 3_ v_ a9L ?G5 cGo u_ vfg dg ub}{g -

========================================================= ========_
75.2

tkfO{sf] larf/df s'kf]if0f s] sf/0fn] x'G5 < -ax'pQ/_ s_ vfgfsf] sdLn] u_ ue{jtL dlxnfn] 5f]P/ v_ cfvfF nfu]/ 3_ b]jL b]ptfsf] s/0fn]

_ cGo ==========================================
75.3

tkfO{sf] aRrfnfO{ slxNo} s'kf]if0f ePsf] lyof] < s_ lyof] -s] ePsf] lyof]<_ v_ lyPg ========================================================

==============
75.4

s'kf]if0fsf] /f]syfd s;/L ug{ ;lsG5 <

s_ kf}i6s cfxf/ v'jfP/

v_ b]jLb]jtfsf] k"hf u/]/ cGo -

u_ aRrfnfO{ ue{jtL dlxnfnfO{ 5'g glbP/ 3_ ================================_

76.

s] tkfO{n] cfkm\gf] afnaflnsfnfO{ le6fldg P= Sofk;'n v'jfpg' eof] < s_ v'jfP

76.1

v_ v'jfPsf] 5}g v'jfPsf] jf gv'jfPsf] eP, lsg<

olb

===================================================== ================
77.

% jif{ eGbf d'gLsf jRrfsf] kf]if0f l:ylt M

qm=;= Gffd

pd]/

ln

tf}n

prfO{

kfv'/fsf] dflyNnf] dWoefusf] s}lkmot uf]nfO{ (MUAC)

!= @= #= vf]k ;DaGwL k|Zg -( dlxgf b]lv # jif{ ;Ddsf aRrfsf cfdfnfO{ ;f]Wg]_
78.

s] tkfO{nfO{ aRrfnfO{ nufpg] vf]k af/] yfxf 5 < s_ 5

78.1

v_ 5}g -k|Zg g+= &( df hfg]_ tkfO{sf] aRrfnfO{ vf]k nufpg' ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= &( df hfg]_, sf/0f

========================
78.2

olb nufPsf] 5 eg] Gff d pd ]/ ln la=l;= hL l8=lk=l6=, x]Kkf=la= kf]lnof] bfb' /f H]fO = Yk v'nfpg c/ o

s|=; =

]_ k| = != bf] = t ] k| = bf] = t ]

@=

#= gf]6 M -c_ sf8{af6 el/Psf] -o_ df]lvsaf6 el/Psf]

Efmf8f kvfnf / lhjghn ;DaGwL k|Zgx

79.

tkfO{n] emf8f kvfnf af/] ;'Gg' ePsf] 5 < s_ 5

79.1

v_ 5}g -k|Zg g+= *) df hfg]_ tkfO{sf] ljrf/df, emf8f kvfnf nfUg'sf sf/0fx? s] s] x'g\ < -ax' pQ/_ s_ kmf]xf]/ jftfj/0f v_ ;fa'g kflgn] xft gwf]Pdf u_ rkL{sf] k|of]u gu/]df r_ b'lift kflg lkPdf

3_ lbzfdf ePsf kl/hLljaf6 _ c:j:Yos/ vfg]s'/f vfPdf 5_ Yffxf 5}g

79.2

h_ cGo v'nfpg'xf];\

emf8f kvfnf /f]syfd ug{] d'Vo pkfox? s] s] x'g\ <-ax' pQ/_ s_ vfgf vfg' eGbf klxnf xft w'g] v_ ;kmf kflg lkpg] 3_ af;L vfg] s'/f gvfg]

u_ ksfPsf] / af+sL ePsf] vfgfnfO{ 5f]k]/ /fVg] _ lbzf u/]kl5 ;fa'g kflgn] xft w'g] 5_ yfxf 5}g

r_ cfkm' jl/kl/sf] jftfj/0f ;kmf /fVg] h_ cGo

v'nfpg'xf];\==========================

79.3

tkfO{sf] 3/df s'g} klg aRrfnfO{ emf8f kvfnf nfu]df s] s] ug{' x'G5 <-ax' pQ/_

s_ k'g{hlno 3/df agfpg] hLjghn, gjhLjg jf cGo o:t} k|sf/sf Kofs]6x? v_ 3/}df tof/ ul/Psf] emf]n vfg]s'/f v'jfpg] bfn / t/sf/Lsf] emf]n / eftsf] df8 cflb u_ g'g / lrgL kfgL 3_ :jf:Yo ;+:yfdf n}hfg] _ ;'O{ lbg] r_ wfdL emfqmL / emf/km's ug{]sf]df n}hfg] 5_ cf}ifwL v'jfpg h_ 3/}df hl8a'6L4f/f pkrf/ ug}{ em_ 3/]n' pkrf/ ug}{
79.4

tkfO{nfO{ yfxf 5 hLjghn s;/L agfpg] xf] < s_ ;lx v_ unt

- != ln6/@ dfgf^ lrof lunf;sf] ;kmf vfg] kfgL ! Kofs]6 lhjghn ld;fpg] - To;nfO{ 3f]n]/ Pp6f ef8fFdf 5f]k]/ /fVg] . - @$ 306f leq hlt kN6 kftnf] lb;f x'G5, Tolt kN6 la/fdLnfO{ v'jfpg] . - @$ 306f leq agfOPsf] emf]n ;lsPg eg] pQm emf]n k|of]udf gNofpg] . kl/jf/ lgof]hg ;DaGwL k|Zgx? - !%$( ljjflxt bDktLnfO{ ;f]Wg]_ pQ/bftfsf] gfd M
80.

pd]/ M

ln M

tkfO{nfO{ kl/jf/ lgof]hgsf] af/]df yfxf 5 < s_ 5

80.1

v_ 5}g -k|Zg g+= *! df hfg]_ tkfO{n] kl/jf/ lgof]hgsf] ;fwgsf] k|of]u ug'{ ePsf] 5 < s_ 5 v_ 5}g -k|Zg g+= *! df hfg]_

80.2

s] k|of]u ug'{ ePsf] 5 < c_ c:yfO{ s_ vfg] rSsL cf_ l:yfoL s_ Eof;]S6]dL

v_ l8kf] u_ g/Knf6 3_ sk6L{ _ s08d

80.3

v_ Nofk|f]:sf]kL u_ ldlgNofk 3_ cGo -=====================_

tkfO{sf] larf/df kl/jf/ lgof]hg lsg h?/L 5 <-ax'pQ/_ s_ plrt ;+Vof v_ plrt hGdfGt/ u_ ;'vL kl/jf/ 3_ plrt /]vb]v / kfngkf]if0f _ cGo -===============================_

81.

olb 5}g eg] lsg ug{'ePsf] 5}g < ============================================================= ============================================================= ===========

82.

tkfO{sf] ljrf/df @ j6f aRrf larsf] hGdfGt/ ;do slt x'g' k5{ < s_ b"O{ jif{ eGbf sd u_ b'O{ b]lv kfFr jif{ v_ b'O{ jif{ 3_ kfFr jif{ eGbf dfyL]

83.

;'vb\ bfDkTo hLjgsf] nfuL slt hgf afnaRrf pko"Qm x'G5 < s_ ! hgf u_ #$ hgf -cGtjf{tf{ v_ @ hgf 3_ cGo -==================_ ;lsPsf] ;do

=======================================================_

Observation checklist

cfjnf]sg kmf/d qm=;= 3/sf] cj:yf ufl8 rNg] af6f] af6 k'UgnfO{ 5'6\6} af6f] 3/ 5 5}g

avf{sf] ;dodf 3/ leq kfgL l5g{ 5 ;Sg] ;Defjgf ePsf] 3/sf] 5fgf] lem+ufnfdv'6\6] 3/sf] s'g} 7fFp j[l x'g] 5 5 != O6f eLaf6 cfpg]

5}g

5}g

3/ jl/kl/ / jftfj/0fdf xfjfsf] k|b'if0f

5}g @= wF'jf efG;fsf]

#= af6f]sf] w"nf] 3/ jl/kl/ / jftfj/0fdf 5 WjgLsf] k|b'if0f 3/ jl/k/L 3fdsf] ls/0f k5{ ls 5 kb}{g< 3/df 9nsf] Joj:yf 5< 3/df vfg]kfgLsf] /fd|f] ;|f]t Ogf/ 5 5 5 5}g 5}g 5}g 5}g 5}g 5}g 5}g 5}g

;]K6L 6\ofsL 5 eg] 3/b]lv %) 5 lkm6 6f9f 5< s/];faf/L < 3/df uf]7 5< 3/ / rkL{sf] agfj6 5 5

agfj6 3/ - _ kSsf - _ cw{kSsf - _ cw{kSsf - _ sRrf - _ sRrf

rkL{ - _ kSsf

14.1 14.2

rkL{df kfgL rkL{df xftw'g] ;fa'g

5 5

5}g 5}g

efG;fsf] agfj6 agfj6 s_ sRrf efG;f ;kmf s_ 5 v_ 5}g v_ kSsf u_ cw{kSsf

r'nf]sf] lsl;d s_ w'jf /lxt v_ Uof;

u_ ;'wfl/Psf] 3_ k/Dk/fut kfgL 5f]k]/ /fv]sf] s_ 5 v_ 5}g

efG;f sf]7f cnu ePsf] s_ 5 v_ 5}g

rkL{ / efG;fsf] b'/L ===================================ld6/ uf]7 / efG;fsf] b'/L ===================================ld6/

Interview Guidelines FCHV dlxnf :jf:Yo :jod ;]ljsfx?sf] ;d"x s]lGb|t 5nkmn lgb]{lzsf dlxnf :j+o;]ljsfsf] ljj/0f M Gffd pd]/ z}lIfs of]Uotf cg'ej

of] 7fpFdf slt hgf :jf:Yo :j+od;]ljsf x'g'x'g5, s]s] :jf:Yo ;]jf lbb} cfpg' ePsf] 5 < =========================================================== ================================================================ ====================================== la/fdLx? Klxn] sxfF hfg] ub{5g, tkfO{n] lbPsf] :jf:Yo ;]jfaf6 ufpn]x? slQsf] ;Gt'i6 5g < ================================================================ ================================================================ ======================== le6fleg P le6fldg P slxn] slxn] / slt pd]/ ;Ddsf] aRrfnfO{ v'jfOG5 <

================================================================ ================================================================ ======================== le6fldg P v'jfOb}5 eg]/ ufpFdf s;/L va/ cfbfg k|bfg ug'{x'G5 < ================================================================ ================================================================ ======================== le6fldg P sxfF v'jfpg] ug'{ePsf] 5 / o;df ufpFn]sf] slQsf] ;xefuL kfpg'ePsf] 5 < le6fldg P v'jfpg 5'6]sf] afnaflnsfnfO{ s] ug'{x'G5, of] sfo{s|d ;~rfng ug{ sf]sf] ;ls|o x'g'x'G5 < le6fldg P ss;nfO{ lbb} cfpg'ePsf] 5, o;df ue{jtL lxnfsf] ;xeflutf s:tf] 5 < o; ufpFdf le6fldg P sf] ;d:of b]lvPsf] kfOPsf] 5 < 5 eg] ss;nfO{ < le6fldg P sf] ;d:of /f]syfdsf] nflu tkfOn] ug'{ ePsf] kxn s:tf] 5 < kl/jf/ lgof]hg kl/jf/ lgof]hgsf af/]sf ufpn]sf] wf/0f s:tf] 5 < ;a} ljjflxt hf]8Lx?n] kl/jf/ lgof]hgsf] ;fwg ckgfPsf 5g < 5}g eg] lsgxf]nf < oxfF a9L k|of]u ug]{ ;fwgx? s'gs'g x'g, ug'{sf sf/0fx? tkfO{nfO{ yfxf xf]nf < hGdfGt/sf nfuL oxfFsf dlxnfx?n] s'gs'g ;fwg k|of]u ub}{ cfPsf 5g\ < gjljjflxt hf]8Lx?nfO{ tkfOn] s]s:tf] ;Nnfx lbb} cfpg'ePsf] 5 < ;fwgx? k|of]u ug]{ w]/} h;f] dlxnf 5g sL k'?if , logLx?n] ;fwgx? s;/L lnb} cfPsf 5g < s'g ;fwgx? a9L k|of]u u/]sf] kfOPsf] 5, k|of]u ug'{ cuf8L tkfOsf] ;Nnfx s] 5 < a9L k|of]u ug]{ s'g au{sf dflg;x? 5g < ;fwgx? lngsf] nflu sf]sf] cfpb5g, tkfO{;Fu slQsf] v'n]/ s'/f u5{g < ;fwgx? k|of]u ug{sf] nflu s'g} ;fdflhs tyf wfld{s unt cGwljZjf;sf af/]df ufpFn]sf] wf/0f s:tf] kfpg' ePsf] 5 < laafx eP/ klg s'g} ;fwgx? k|of]u gug]{ hf]8Lx? 5g < s'g} ;fwg klg k|of]u gu/]sf]n] of}g hGo /f]u nfu]sf] kfpg' ePsf] 5 <

cljjflxt lszf]/lszf]/Lx?n] s'g} ;fwgx? k|of]u u/]sf] af/] tkfO{nfO{ yfxf 5 ls < o:tf] s'/fdf tkfOsf] wf/0ff s:tf] 5 < ufpFdf ePsf] cfdf ;d'xsf] 5nkmndf kl/jf/ lgof]hsf] ;fwgx?sf] af/]df slQsf] 5nkmn ug'{x'G5 < ufpFn]x?n] kl/jf/ lgof]hgsf ;fwgx?sf] af/]df s;/L hfgsf/L lng] u/]sf] kfpg' ePsf] 5 < ;'vL / v';L kl/jf/ agfpg b'O{ bfDklQsf] k|d'v e'dLsf x'G5, To;sf nflu ;xL ;dodf ;lx lg0f{o lng'k5{, of] s'/fdf tkfO{sf] wf/0ff s:tf] 5 < dft[lzz' :jf:Yo x]/rfx dlxnfx? w]/} h;f] slt pd]/df ePsf] kfOG5 < klxnf] k6s ue{jtL ePsf] a]nfdf dlxnfx?nfO{ ue{jtL hfFr u/fp5g < ue{jtL x'Fbf l6=l6 vf]k nufPsf] kfOsf] 5 < dlxnfx?n] ue{jtL x'Fbf cfO/g rSsL lnG5g ls lnb}gg < tkfOx?n] ue{jtL dlxnfx?nfO{ s]s:tf ;'emfjx? lbg' x'G5 < ue{jtL x'Fbf dlxnfx?nfO{ s]s:tf ;d:ofx? b]lvG5g t < aRrfx? w]/} 3/df hlGdG5g ls :jf:Yo rf}lsdf < aRrfx?nfO{ klxnf] cfdfsf] b'w v'jfpg] k|rng s:tf] 5 < ;'Ts]/L ePkl5 dlxnfx? hrfpg cfp5g ls cfpb}gg < aRrfx?nfO{ slt pd]/;Dd cfdfsf] b'w v'jfp5g < dflg;x?nfO{ ;jf]{Qmd lk7f]sf] af/]sf 1fg 5 ls 5}g < s] oxfFsf ;a} aRrfx?n] ;Dk"0f{ aRrfx?df s'g /f]u jf s]s:tf :jf:Yo ;d:of b]vf k/]sf] 5 < s'g} :jf:Yo ;d:ofn] cfdf / aRrfsf] d[To' ePsf] kfOPsf] 5 < cfdf / aRrfsf] d[To'b/ s dug{ tkfOx?n] ;dhdf k'ofpg' ePsf] of]ubfg s:tf] 5 < emf8fkvfnf ;a}sf] 3/df rkL{ 5 ls 5}g < rkL{ uPkl5 ;fa'g kfgLn] xft w'G5g ls w'b}gg <

aRrfx?nfO{ lbzflk;fa sxfF u/fp5g < tkfO{x?n] xft w'g] k|ls|of pgLx?nfO{ l;sfpg' ePsf] < vfgf vfg' cl3 xft w'G5g ls w'b}gg < of] ufpFdf aRrfx?nfO{ slQmsf] em8fkvfnf nfU5 < emf8 kvfnf nfUbf s]s:tf vfg]s'/fx?sf] ;'emfj lbg'x'G5 < cToflws emf8fkvfnf nfu]/ aRrfx?sf] d[To' ePsf] 5 < 3/]n' pkrf/x? s]s] u5{g t < emf8fkvfnf nfUg] sf/0fx? pgLx?nfO{ yfxf 5 xf]nf t < of] /f]u k|lt dflg;x?sf] wf/0ff s:tf] 5 < pgLx? s:tf] cj:yfdf tkfOsf]df jf :jf:Yo rf}lsdf cfp5g\ < tkfOx?n] hLjghn agfpg l;sfpg' ePsf] 5 < k]6df kg]{ h'sfsf] af/] pgLx?n] ;'g]sf 5g t < tkfOx?n] lbg'ePsf] ;'emfj cg';f/ pgLx?n] ;/;kmfO{ u/]sf] x'G5g h:tf] nfU5 < emf8fkvfnf / le6fldg P sf] ;d:of slQsf] /f]syfd eP h:tf] nfU5 <

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VDC Incharge uf=lj=;= ;lrj;Fusf] cGtjf{tf gfdM pd]/M

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Formulae
ANNEX FORMULAE USED Total male population 1. Sex ratio = ---------------------------------------Total female Population

Total number of death in one year 2. Crude death rate = -------------------------------------------------- * 1000 Total Mid-year population Total population of observed data 3. Average family size = -------------------------------------------------Total number of households in the observed data

Number of couples using contraceptive methods at the given period of time 4. Contraceptive prevalence rate = --------------------------------------------------------------*100 Total Number of eligible couple at the same time

Number deaths of women due to pregnancy And related cause within 42 days of Postpartum period within one year 5. Materanal mortality ratio = ----------------------------------------------------* 100,000 Total No. of live births in the same year

Total live births in one year 6. Crude birth rate = ------------------------------------------ * 1000 Mid-year population

Total infant death in one year 7. Infant mortality rate = -------------------------------------- * 1000 Total live births within the year

Total number of vaccinated population 8. Vaccination coverage = - -------------------------------------------------------- * 100 Expected population to be vaccinated i.e. Target

Plan of action (Gannt Chart)

Letters

Photos

Household questionnaire

Melamchi VDC

Data analysis

Focal persons

Micro health project

Behind the scene