A REPORT ON COMMUNOTY HEALTH DIAGNOSIS Bhajani VDC 5th Falgun 2068 to 5th Baisakh 2069 Kailali, Nepal 2012

Submitted By 8th Batch, Group-A General Medicine students

Submitted to Bhageshwor academy for health sciences Santoshi tole, Dhangadhi, Kailali

A REPORT ON COMMUNITY HEALTH DIAGNOSIS Bhajani VDC

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5th Falgun 2068 to 5th Baisakh 2069 Kailali, Nepal 2011

Submitted By Gaurab Bohara (Team leader) Ramesh Kumar Kami Dipendra Pant Santosh Raj Joshi Dilip Deuba Harka Bahadur Thapa Haridas Rana Prakash rawat Karina Shahi Saraswati Subedi Submitted to Bhageshwor Academy for Health science Santoshitol, Dhangadhi, Kailali Council for Technical Education and Vocational Training Bhageshwor Academy for Health Science (BAHS) Dhangadhi, Kailali This is to certify that Mr.. Mr.. Mr..
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Mr. Mr.. Mr...

Mrs... Mrs...

Mr... Mrs...

The student of General Medicine of this Academy has completed community residential field program (Community Health Diagnosis) as requirement of General Medicine program and submitted A report on community health diagnosis of. .. External Examiner Date. .. Internal Examiner Date .. Campus Chief Date. .. Program Coordinator Date. Supervisor Date..

ABBREVIATION
AHW -Auxiliary Health worker ANM -Auxiliary Nurse Midwife ARI -Acute Respiratory Tract Infection AIDS -Acquire Immune Deficiency Syndrome ANC -Ante Natal Care ASFR -Age Specific Fertility Rate BCG -Bacillus, Cal matte, Guerin CBR -Crude Birth Rate
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CDD -Control of Diarrhea Diseases CDP -Community Drug Program CDR -Crude Death Rate CMR -Child Mortality Rate CMA -Community Medicine Auxiliary CHD -Community Health Diagnosis CPR -Contraceptive Prevalence Rate DPT -Diphtheria, pertussis, Tetanus DOTS -Direct Observed Treatment Short Course DPHO -District Public Health Organization EPI -Expanded Program on Immunization FP -Family Planning FCHV -Female Community Health Volunteers GFR -General Fertility Rate HMIS -Health Management Information System HA -Health Assistant HE -Health Education HIV -Human Immune Deficiency Virus IEC -Information Education & Communication IMR -Infant Mortality Rate INGO -International Non-Government Organization IUD - Intra Uterine Device ICDP - Integrated Child Development Program KAP -Knowledge, Attitude & Practice MB -Multi Bacillary
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MMR - Maternal Mortality Rate MCH -Maternal & Child Health MP -Malaria Parasite MDT -Multi Drug Therapy MUAC -Mid Upper Arm Circumference NGO - Non- Government Organization OPD -Out Patient Department ORT -Oral Rehydration Therapy ORS -Oral Rehydration Solution ORC -Out Reach Clinic PDT -Population Doubling Time PHC -Primary Health Center PHCC -Primary Health Care Centre PGR -Population Growth Rate RH -Reproductive Health STD -Sexually Transmitted Disease SHP -Sub-Health post SOHS -School of Health Science TB -Tuberculosis TT -Tetanus Toxoid TTR -Total Fertility Rate VHW -Village Health Worker VDC -Village Development committee BAHS -Bhageshwor Academy for Health Science WRA -Women of Reproductive Rate
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JE -Japanese Encephalitis i.e. That Is

PROLOGUE
Being the student of Bhageshwor Academy for health science Dhangadhi 8th batch H.A. 3rd year, We had been sent Bhajani VDC Kailalai for residential community health diagnosis field program, where we had exposures to the unique health problem of Far Western part of Nepal which are coupled with illiteracy, poverty & environmental problems. We get an opportunity to learn a lot from our stay duration of 60 days. Bhajani VDC lies on the eastern part of Kailali district; it is 24km far from HI ways at southern with Terai. It is naturally beautiful and contains diversities in populations. During our 60 days period, we had to conduct many program at Bhajani VDC ward no 1, 2 & 3 according to random system of selection & staffs of Bhajani PHCC. We collected data, analyzed and identified different health problems, [prioritized them and implemented Micro health project. We had also a valuable opportunity to expose on clinical practice and also some of the managerial aspects of PHCC. The duration of our community field very short for these purpose although the programs were conducted according to our plan of action. In our catchment area many people suffering from unhealthy behaviors and superstitions which give rise to many disease and health problems. There are many people who are not well informed and are not ready to use the health services provided, unhealthy attitude and practice are prevalent not only among the illiterates but also among the educated our health education can help to solve the problems by changing these knowledge , attitude and behavior appropriately. There might be some errors in linguistic approach & technical errors which should also be considered.

ACKNOWLEDGEMENT
We all ten, the students of H.A. 3rd year 8th batch group A would like to give heartily thanks to all the people generously helped in our community health diagnosis program and creation of this report, our marks expressed in words do not sufficiently convey our gratitude.

At first we were highly grateful to our program coordinator Mr. Bed Joshi for this constant encouragement and for providing the necessary information in our community work without whose help this program and our efforts would be meaningless.

We convey appreciation & fathomless regard to our campus chief Mr. Netraprasad Upadhaya for his kind cooperation persistent encouragement invaluable suggestion gracious guidance & great positive behavior during our survey. We also pleased to express our spiritual gratitude to respected store in charge Mr. Lokraj Bhatta, special thanks go to Mr. Kirana Bhandari, Mr. Beth Joshi & Dr. Padam Sharma (MO), Sita Bhatta(sr. ANM), Pravati Bhandary(AHW), Kailash Chaudhary(Sr. AHW), Birendra Sapkota(AHW) Shanti balampakhi (ANM) staffs of PHCC of Bhajani V.D.C.who were help us in community & clinical fields.

We are thankful to Bhajani VDC local leader different school & government offices different NGO & project, club & community people who were cooperative and helpful.

With best regards Group A GM 3rd year Community field student 2069(8th batch) BAHS

ABSTRACT

Comprehensive assessment of health status of a community in relation to its physical, biological, social & environmental aspect is called community diagnosis.
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Principle of objective of CHD was to assess the current health status, identify the problem and conduct a need based MHP on Bhajani VDC. VDC was selected by campus authority & the survey area was selected the coordination of our group & PHC staffs according to the population diversity & distance between PHC & ward. After completion of orientation program we arrived our community in 2068-11-4, pre testing was done in padariya village of Bhajani VDC and after collection name of household head we decide in no. of house for our survey. Among 1000 house of Bhajani VDC ward no. 1, 2.9, we choose 441 houses by simple random sampling of ward no. 1, 2 & 3.

Study found that 2524 people live in our sample area. Among them 1274 were males & 1250 were females. Male female ratio was 101.92:100 average family sizes 5.72 IMR was 35.08/1000, U5MR was 24/1000 CDR was 24.16/1000, 2.72% People of Bhajani Brahmin, kchhetri, Tharu, Dalit, newar & other were spontaneously 8.84%,62.58%.,23.80%,0.02%,3.17%.The study also shows that total 441 families use hand pump water. Almost 62.35 % use toilet & and also out of 59.63% families sanitary and only 2.04%house are Pakka for living. About % of deliveries was conducted by health person. female having child under two year of age heard about Sarbottam pitho and out of them . Able to give correct answer about preparation of sarbottam pitho. .. Fed colostrums to their baby. After finishing first community presentation we find out the existing real health need of the community. Then we prioritized the most important health problems to be shoed first. We run the MHP regarding MCH, JE, and TB, smoking and drinking. Public awareness programme was run by pestering the posters related to various public health aspects. Finally we made an evaluation program of MHP & other activities that we done during our stay. At last the conclusion according to MHP suggest, that transmission, incidence & epidemic of JE should be minimized and eradicate from that VDC and improved environmental sanitation, regular use of mosquito net. Positively change their mind into positive health.

Chapter 1: Introduction 1.1 Background

1.2 Overview of survey area 1.2.1 map of survey area 1.3 objective of survey
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1.4 Methodology
1.4.1 1.4.2 1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.4.8 1.4.9 Demographic information Variable of study Tools of study Mapping technique Data collection Data processing and analysis Validity and Reliability Limitations Ethical consideration

1.5 work plan Chapter 2 Major finding

2.1 demographic and socioeconomic finding
2.1.1 Major demographic finding 2.1.2 Religion 2.1.3 Caste 2.1.4 Family types 2.1.5 Education 2.1.6 Occupation 2.1.7 Total dependency ratio 2.1.8 Age and sex composition 2.1.9 Fertility 2.1.10 Mortality 2.1.11 Morbidity 2.1.12 Agriculture product and availability

2.2 Environmental health

2.2.1 Water
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2.2.2 Types of house 2.2.3 Shed house distance 2.2.4 Excreta disposal 2.2.5 Waste management 2.2.6 Cooking fuel

2.3 KAP about common diseases 2.3.1 KAP about Transmission of Disease & Treatment of TB. 2.3.2 KAP about Transmission of Disease & Treatment of HIV/AIDS 2.3.3 KAP about Malaria 2.3.4 KAP about JE 2.3.5 KAP about 1st contact for treatment

2.4 Maternal & child Health (MCH)

2.4.1 Age at first Pregnancy 2.4.2 Antenatal checkup (ANC) 2.4.3 Delivery 2.4.4 Breast Feeding 2.4.5 Sarbottam Pitho 2.4.6 Immunization 2.4.7 Family planning 2.4.8 Knowledge about Pneumonia 2.4.9 Diarrhea

Chapter 3 Need Identification

3.1 Felt need/problem 3.2 Observed need/problems
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3.3 Sharing of finding 3.4 Real Needs

Chapter 4 Micro Health Project

4.1 Criteria for prioritization 4.2 Topic of MHP 4.3 Rationale 4.4 Objective of MHP 4.5 Target population 4.6 Strategy 4.7 Evaluation

Chapter 5 PHCC Activities

5.1 Introduction 5.2 Function of PHCC

Chapter 6 Other activities

6.1 Community health education

Chapter 7 Recommendation & Conclusion

7.1 Recommendation 7.2 Conclusion

Annex
Bibliography Questionnaire Interview guideline Detail plan of action Special thanks to
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Name of household & Respondents Appraisal letters

Chapter 1: Introduction
1.1 Background
To upgrade the health status of people of remote area of Nepal, CTEVT is producing qualified middle class health manpower as Health Assistant {HA} through different health institutions of Nepal. Among them BAHS is one of the health institute and we are student of 8th batch of this institute. According to the syllabus, we have to complete our community diagnosis field practice. The duration of community residential field practice is 8 weeks. All the students of third are divided into four groups with equal number of students in each. Among the groups, we are
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group A sent Bhajani VDC for our residential field practice (CHD) and we went there with the help of our BAHS staffs. After our settlement we were fully engaged in our work. In short period, we were not able to take all the wards of Bhajani VDC. So it was decided that our programme was limited in wards no. 1, 2 & 3.

1.2 Overview of survey area

Bhajani VDC is beautiful VDC surround by Joshipor VDC (east), Khailad VDC (north), lalboji VDC (South west). It is nearly 24 km form Sukhad.

1.3 objective of the survey

The General objective of this study is to assess the current health status of the Bhajani VDC in relation to its social, physical, and biological environment to plan, implement and evaluate MHP by utilizing locally available resource with community people. The specific objectives of study are: To determine the demographic characteristics of the community. To determine the socio-culture and economic status of the community. To determine the determinants of health and common diseases of the community.
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 To assess the common health problems related to nutrition, MCH, FP, environmental sanitation and educational status. To assess the immunization pattern of under 5 years child. To assess the KAP of respondents regarding health problems. To plan, implement and evaluate MHP together with community people directed to solving to their prioritized problems. To conduct clinical field practice in the respective PHCC.

In overall, the central objective is how to diagnose the whole community rather than on individual and solving the existing health problems within the limited period of time with limited resource. i.e. in terms of man, money, materials, mind and minute.

1.4 Methodology
Method is a way of acting in a systematic pattern to achieve the determined goals and objectives to make the program successful. The study is based on door to door data collection, information were collected from the interview method and our collage provided questionnaire were put forward to the head of household, women having child of less than 2 years of age, FCHVs, community leaders etc.

1.4.1 Demographic information

Study site: Duration of study: Study design: ; Bhajani VDC ward no. 1, 2 & 3 30 days Cross section, descriptive study

Type of data: Unit of analysis: Total household: Total sample: Sampling method:

primary & secondary household, community leaders, FCHV 1000 household 441 household systematic simple random sampling

1.4.2 Variables of study

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Door to door visit for the collection of basic information was the type and the attributes such as serial, culture, behavioral, economy, health, knowledge, attitude, practice were the variables of the study these are grouped under following headings. a) Physical Housing type Drinking water supply Sanitary facilities Latrine facilities b) Social Educational status Occupation Economic status Religions Source of health care Smoking and drinking habits Family structure

C) Biological Age and sex of each family member Birth past 12 months Death past 12 months Disabling Immunization and WRA Symptoms of illness in past 3 months

1.4.3 tools for study

Tools are the pillars for any studies the following tools we used for our study are a) prepare questionnaire for our primary data collection b) direct observation and interview c) Secondary data from FCHVs, PHCC, and VDC such as name of head of household, total population of VDC, map of VDC. d) Information through local leaders, FCHVs, teachers etc. e) Other magazine
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1.4.4 Mapping technique

Map is mirror is the location of community thats why the following techniques were applies to obtain a reliable map of study area. a. First of all the study area was observed thoroughly and the boundary and other important place such as school, temple, main road, small river, platform wells and tops VDC building, jungle, bank, tower of NTC, house & side road. b. The rough map of the study area sketch by the help chief person of the village (valmonsha) c. The original map of the study area received by PHCC and matched with the rough sketch. d. Finally the required map was prepared by the necessary legends were filled as required such explained above. 1.4.5 Data collection Before collection of the data, the questionnaire was pre tested in room. Then the data was collected in ward no. 1, 2 & 3 of Bhajani VDC. The data collected from each and every house of the catchment areas. The questionnaire developed was asked with house leader but questionnaire related to MCH were asked with mothers having children less than2 years. For leader we made leadership questionnaire after group discussion was used. The questionnaire used is attached in annex of this report.

1.4.6 Data processing and analysis

The collected raw data was processed and analyzed with active involvement of the whole team by dividing responsibility like educational status, caste, male female, birth death etc. we decided them by using symbols like M for male, F for female, FP for family planning they were tabulated and presented in suitable figure and graphs. Major vital health in director was calculated by using formulae and also statistical method.

1.4.7 Validity and reliability Orientation program

We were oriented by our respected lectures before departure to community field practice that helped to us work properly in community. We discussed about many problems and their appropriate solution that might arise during our field time.
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Pre testing
The questionnaires were pretested before starting data collection before departure to community field practice pre-test was performed at campus. On the pretesting we collected many experiences about obstacles, taking style, rapport building and the way of data collection.

Rapport building
On the second day of stay in Bhajani VDC. The rapport building was done with PHCCs staffs and VDC staffs. We explained our aim and objectives of the visit to the field. They assured that they will help us during our stay in Bhajani.

Minimizing errors
Statistical errors, instrumental errors and personal errors were minimizing as for as possible by conducting error editing process. I.e. post dinner seminar was conducted and forms were checked by other so that some error was not committed in the next day.

Sub group formation

Then ten students in our group were divided into 2 sub groups for awareness programme in JE in sampling community and 5 sub groups for action on data.

Monitoring and supervision

Respected lecture of BAHS were found to performing, monitoring and supervision with helpful advice and active guidance in survey step of our field works.

1.4.8

Limitations

Limitation of our study include ass following In few of the household required respondents were not available due to busy schedule in their field. Recall bias on various health related subjects were frequently observed. Some calculated data might not be comparable to the national figures because of small sample size. Some people were non co-operative and unresponsive as they know that we were not going to provide them materialistic things
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1.4.9

Ethical consideration Informed

consent was taken prior to entering the community and the interview was made accordingly. matters of peoples life.

Appropriate precautions were taken while speaking about the person sensitive Assurance understandable term was given on the safety and confinable data. Ethical consideration was maintained to minimize the expectation community
people.

1.5 WORK PLAN

For fulfill the objective we had done our work according to the tentative plan of action developed by our school, BAHS which was as followings. SN Date Activities Purpose Responsibility th 1 4 Falgun Departure from collage, To be settled Collage make adjustment in administration community. th 2 5 Falgun Informal rapport building Rapport building Students 3 Meeting with VDC staffs & Enhance Students PHCC staffs community participation th 4 6 falgun Data collection Survey Students competency By interview FGD 5 7-10 falgun Data processing, analysis Summarization of Students & interpretation the findings 6 Planning & preparation of Develop planning Students community presentation competency 7 Community presentation, Disseminate Students, finding sharing & overall finding supervisors
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10 11 12

discussion Planning for MHP, To run MHP Resource collection & preparation among group Implementation (running) Solve the of MHP prioritized problems Awareness programme Minimized health with health education problems Feedback collection Evaluation of the programme PHCC clinical practice Clinical exposure (MHP)

Students

Students

Students Students

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14 15

16 17

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PHCCs in charge & staffs, students Visit HP/SHP of catchment To know Students area of the PHCC management & service providing to community people Planning, Preparation for Correction of students final PHCC presentation errors PHCC presentation Evaluate our Students clinical performance Return from community Collage administration Preparation for collage To more Students presentation attractive and confidence Collage presentation Evaluate our CHD Students, performance & collage staffs feedback

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Chapter 2 Major Finding

2.1 Demographic Socioeconomic finding
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The demography is the statistical and quantitative study of characteristics of human population, involving primarily the measurements of size, growth, distribution of the number of population living being born or dying in the same area of region and the related function of fertility, mortality and marriage. Population is effected by various variables on vital events in the area. The vital events are fertility, morbidity, marriage and mortality or death.

2.1.1. Major demographic findings Table no. 2: major statistical finding of the survey SN Particulars 1 Total population Male Female 2 Family size 3 Fertility rate CBR GFR TFR 4 Model age of first pregnancy 5 Sex ratio 6 Mortality rates CDR IMR U5MR 7 Total dependency ratio 8 Disability rate 9 CPR 10 Incidence rate 11 Literacy
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Value 2524 1274 1250 5.72/family 23.77/1000 81.63/1000 2.4 per women 101.92:100 24.16/1000 16.66/1000 4.44/1000 35.22/100 7.52/1000 20.58% 83.99/1000

12 13 14 15 16

Female Male Total T.T vaccines (at least two dose) BCG DPT+ OPV+ HepB:1 DPT+ OPV+ HepB:3 Measles

69.89% 69.83% 69.86% 67% 99.11% 98.66% 93.77% 90.66%

2.1.2 Religion Table no.3 religion by distribution S.N Religion 1 Hindu 2 Buddhist 3 Christian 4 Muslim 5 others total

No. 420 13 5 3 441

% 95.23 2.98% 1.13% 0.68% 100

As we know that Nepal was one of the Hindu countries in world. Now day freeness in religion however most of the people are Hindu as context of whole Nepal. Here also about 95.23 % Hindu. 2.1.3 Caste Figure no. 1 caste wise distribution of people

castewise distribution
3.17% 2.72% chhetri 8.84% .23.80% newar 0.02%

tharu 62.58%

2.1.4 Family type Table no.4 family structure S.N Types of family 1 Nuclear 2 Extended 3 Joint Total

No. of family 211 153 76 1

% 47.84 34.69 17.23 0.02

Our study showed that 47.84% families were nuclear, 34.69 % were extended and 17.23 % were joint family. The percentage of nuclear family shows the modern concept and standard of people. 2.1.5 Education Table no. 5 educational status (>5years) SN 1 2 3
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Education levels Illiterate Only read & write Primary

male No. 347 145 278

% 30.17 12.6 24.17

female No. 346 170 292

Total % No. 30.11 693 14.79 315 25.41 570

% 30.14 13.70 24.79

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Lower secondary Secondary Higher total

128 125 127 1150

11.13 10.86 11.07 100

123 121 97 1149

10.70 10.53 8.46 100

251 246 224 2299

10.91 10.70 9.76 `100

Education play vital role in development of community or nation, especially female literacy rate indicates the society development in various aspects i.e. family health, care of children. SN Literacy >5 years populations 1 male female Total No. % No. % No. % 803 69.83 803 69.89 1606 69.86

The communities of Bhajani VDC ward no.1, 2 & 3have 69.86% literacy rate, where female literacy rate is higher than males.

2.1.6 Occupation Figure no. 2 occupation status (>5 years populations)

6 5 4 Axis Title 3 2 1 0 agriculture1 bissiness 2 student 3 labour 4 household work service

Axis Title

Occupation is the source of income. It reveals the real productive population. According to our field survey, in sample community about 33.44% people were student,20.87% household worker, 22.92% were farmer, 15.96% were labor,2.56% people were related with various government and non- government services and retired.

According to our survey most of the female were household worker. It main cause may be low literacy rate of female in our survey area. 2.1.7 Total dependency ratio The dependency ratio is the ratio of persons in the dependent age (<15years and >64 years) to those in the economically productive age group (15-64years) in a population. Total dependency ratio of Bhajani VDC was found to be 35.22%.

2.1.8 Age and sex composition Age & sex wise distribution of total population of Bhajani VDC ward no. 1, 2 & 3 shows as bellow. SN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age group years 0-1 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 >70 Total in Male No. 46 78 136 165 194 122 89 136 69 55 30 35 59 18 14 28 1274 % 3.61 6.12 10.67 12.95 15.22 9.57 6.98 10.67 5.41 4.31 2.35 2.74 4.63 1.41 1.09 2.19 100 Female No. 11 90 117 130 183 151 127 77 103 54 40 52 59 35 10 11 1250 % 0.88 7.2 9.36 10.4 14.64 12.08 10.16 6.16 8.24 4.32 3.2 4.16 4.72 2.8 0.8 0.88 100 Total No. 57 168 253 295 377 273 216 213 172 109 70 87 118 53 24 39 2524 % 2.25 6.65 10.02 11.68 14.93 10.81 8.55 8.43 6.81 4.31 2.77 3.44 4.67 2.09 0.95 1.54 100

Age & sex composition of population can be displayed by constructing population pyramid that graphically shows the proportion of male and female in each group and consist of horizontal bars. The bar represents age group in ascending order from the lowest to highest pyramid horizontally on one another. Bar for males are given on left of central vertical axis and bar for female on the right taking age group in same class interval i.e. 5 years age group. The sum of the entire age-sex group in the population pyramid equals 100% of the population.

The population pyramid of Bhajani VDC is narrower in base border in 5-24 years of age group and is tapering towards old age. It is zero type of pyramid resembling the population pyramid of developed countries.

Sex ratio
It is the ratio of male female in a given population usually expressed as no. males for every hundred females. In Bhajani VDC, the sex ratio was found to be 101.92:100.

Disability rate
It is defined as any restriction or lack of ability to perform an activity in the range considered normal for human being. In Bhajani VDC the disability rate was found 7.52 per 1000 population.

Smoking and Drinking habit

Healthy behaviors have good effect on health while unhealthy habits have a hazardous impact on the health. Smoking and drinking habit are very harmful to the health of human being so it was also included in the survey. In our survey among 2299 Population only 1000 male, 900 female smoke which is spontaneously 78% & 86.95% male & 52.21% female have only drinking habits.

2.1.9 Fertility The fertility is defined as the total no. of live births given by the women of reproductive age
group (14-45 years) in a specified time & place if they follow current pattern of fertility rate.
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This is very important factor to measure the health status of people living in that place because of the deviation in the ratio of fertility directly effects to the size and composition of the population status and also signifies to the implementation and disease prevalence. According to our survey in Bhajani VDC 60.48 % women are of reproductive age group (1645age).

Crude Birth Rate (CBR)

It is the no. of live births per 1000 estimated mid-year population in a given year. CBR was found to be 23.77 per 1000 population of Bhajani.

General fertility rate (GFR)

It is the no. live birth per 1000 women in the reproductive age group (16-45) in a given year. GFR was found to be 81.63 per 1000 women of age 16-45 years in Bhajani VDC.

Age specific fertility rate (ASFR)

It is defined as the no. of child birth in a year to 1000 women in any specific age group. Table no. 8 age specific fertility rate Age group 16-20 21-25 26-30 31-35 36-40 Total Total no. of female 183 151 127 77 103 695 Total live birth 10 16 20 8 6 60 ASFR 54.64/1000 105.96/1000 157.48/1000 103.89/1000 58.25/1000

Total fertility rate (TFR)

It is the average no. of children would have if she were to pass through her reproductive years bearing children (15-49) at the same rate as the women now in each age group. It was found 2.4 per women in Bhajani VDC.

Median age at first pregnancy

The median age at first pregnancy is 20-24 years. National planning commission (10th 5 years plan for CBR =25.62 & TFR=2.95per women) the survey indicate that the CBR & TFR is
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low (23.77 /1000 and2.4/women) then the national data. The family planning service is successful & the community people are eligible & aware of population growth.

2.1.10 Mortality
It refers to death that occurs within a population while we all eventually die. Study of mortality in demography can simply be described as the study of the risk of the dying as it varies from one population to another.

Crude death rate (CDR)

It is the total no. of death per thousand populations in specific year in an area. The crude death rate of Bhajani VDC was found 24.16per 1000 population.

Infant mortality rate (IMR)

It is the no. of infants death (<1year) per 1000 live birth in a given year which is as good indicator of health status of population. In Bhajani VDC 61 Infants were reported from our respondents i.e. 16.66per 1000 live.

Under 5 mortality rate (U5MR)

It is the total death occurring in the under 5 age group. The rate can be used to reflect to both infant and child mortality rate. The less than 5 mortality rate of Bhajani was found 4.44 per 1000 per live birth.

2.1.11 Morbidity
Morbidity can be defined as the loss of normal physical or mental well being due to any cause. The data gives more comprehensive, accurate and clinically accurate information on patients characteristic than mortality data is taken as essential basic research.

Incidence rate
Incidence rate is defined as the no. of new cases occurring in a defined population during a specified period of time.(disease with in three month). In our survey 212 Cases of illness in a population of 2524 in a year the incidence rate would be 83.99 per 1000 per year.
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Table no. 9 most incidental disease (top 10 diseases) SN 1 2 3 4 5 6 7 8 9 10 disease ARI Skin disease No. %

2.1.12 Agriculture product and availability

Table no. 10 sufficiency of agriculture product SN 1 2 3 4 Time(duration) Less than 6 months 6 months to 1 year More than 12 moths Can to sell also Total Total no. of family %

The survey showed that, ..% of population was found to produce food that is sufficient for less than 6 months ,.% sample population had sufficient field for 6 to 12 months ,.% had food more than 12 months ,..% and % sample population had surplus and can even sell the food product.

Environmental health
Environment indicates all external factors, which are surrounding mankind that may be living and non- living materials. According to economical concept of health, health is a dynamic equilibrium between man and health unless there is equilibrium in between the ecological system of environmental no health life can be considered.

2.2.1 Water
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2.2.1.1 Source of water

Out of 441 families, the pattern of consumption of sources of water as follows. In our survey, the total populations of Bhajani VDC are using tube well water for all water needed activities including drinking purpose.

Figure no.4

DISTRIBUTION OF SOURCES OF WATER

tubell water

2.2.1.2 Water purification In our survey area most of the community people drink water without any purification. The
pattern of water purification is such as. FIGURE NO. 5

WATER PURIFICATION
0% purification 7.02% 0%

not purification 92.98%

2.2.1.3 Method of water purification Among the 441 Houses, which are using any procedure of water purification, are such as Table no. 11 water purification methods SN 1 2 3 methods Boiling Filter chemical No. 3 28 0 % 0.68 6.34 0

2.2.2 Types of house

Figure no.
pakka 2.04

types

of

house

types of home

semi-pakka 39.54 kachha 68.15

Out of 441 families. 68.15 % have kachha house 39.54 % semi-pakka house 2.04 % pakka house

2.2.3 shed- house distance

Among 441 families, only . Family have cow shed. House i.e. % are attached with house and . i.e. ..% are far than 25f, houses i.e. % have shed not attached with house but near than 25f. it suggest that health education should be given for there people on this topic. Table no. 12 shed-house distance SN 1 2 3 Shed-house distance Attached with house <25f >25f Total No. %

2.2.4 Excreta disposal

Human excreta are a major source of gastrointestinal disease manifestation and environmental pollution. Use if non sanitary toilet for excreta disposal and practice of open defecation is the main cause for disease transmission. The pattern of excreta disposal is shown here. Among 441 families 166 families practice open dedication and 275 Families using latrine.

2.2.4.1 Use of latrine

Figure no.7 distribution of latrine users

DISTRIBUTION OF USE OF LATRINE

62%

38%

user

non user

2.2.4. Types of latrine

Among latrine user 59.63% i.e.164 family using sanitary and 40.36% i.e. 111 family using non sanitary latrine. Figure no. 8 types of latrine

DISTRIBUTION OF USE OF LATRINE

Series 1 Series 2 Column1

59.63%

40.36%

sanitary

unsanitary

2.2.4.3 Distance between toilet and water source

Among 441 houses, only 275 Had got toilet, among 166 families toilet water source distance is following.

distance between toilet & water

<50ft >50ft

2.2.5 Waste management

Waste management is one of the important aspects of the environmental sanitation. Improper waste management lead too many health hazards due to vector borne disease water pollution, air pollution.

2.2.5.1 Solid waste disposal

Most of the people of our survey area, solid waste disposing by manure pit, they were 42.18% disposed by dumping4.54% by burning18.59% throwing haphazardly and 1.13% used others method. Table no. 13 solid waste disposal SN 1 2 3 4 5 Types of practice Manure pit Dumping Burning Haphazardly throw Other total No. 148 186 20 82 5 441 % 33.56 42.18 4.54 18.59 1.13 100

2.2.5.2 Disposal of cattle dung

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In our survey area, 48.91% dispose cattle dung in manure pit , 43.27% dispose by dumping, 0.89% dispose by dumping by burning, 3.11% by throwing haphazardly and 3.82% used other different methods.

2.2.6 Cooking fuel

Most of people in our survey area use firewood as cooking fuel. According to our survey, following are the cooking fuel. Table no. 14 Types of fuel SN 1 2 Cooking fuel Firewood Bio-gas total No. 420 21 441 % 95.23 4.77 100

All people using firewood had oven without chimney. It indicates that, they should be given health education about respiratory illness due to smoke of oven.

2.3 KAP about common disease

Knowledge is the understanding of fact and process which is acquired through information and experiences. Attitude is the feeling towards someone or somebody which readiness to act or behave in a certain way. Practice is the process of knowledge in certain way of applicable life. On our survey we study about following KAP KAP about transmission and treatment of TB KAP about transmission and treatment of HIV/AIDS KAP about transmission and protection from malaria and Japanese encephalitis. KAP of first contact for treatment of health care.

2.3.1 KAP about transmission and treatment of TB

Heard about TB

When the respondents were asked about TB whether they know about TB or not 69.84% that they knew about TB and best of 30.16% didnt know. Transmission of TB Out of the people who know about TB were asked the transmission of TB. Among them 55.10 % said it is transmitted disease, 30.16% said it is non-transmitted disease and 14.74% had no idea. Treatment or not Among the people, who were heard about TB, we asked TB is treatable or non-treatable disease 57.60% said it can be treated, 21.2% said it is untreatable and 21.2% had no idea.

2.3.2 KAP about HIV/AIDS

Heard about HIV/AIDS In our survey area 66.89% heard and 33.11% not heard. Transmission of HIV/AIDS
Out of the who were known about HIV among them 89.49 % said it is communicable disease, 5.08% said it is non-communicable and 5.43% had no idea.

Mode of transmission
Among the people who said that HIV/AIDS is transmitted, .% said that it transmitted by sexual contact, % through blood, .% through unsterilized syringe, ..% had no idea Table no. 15 MOT of HIV/AIDS SN 1 2 3 4 5 6
1

MOT Unprotected sex Infected blood Unsterilized Transplacental No idea Other

No.

Preventive measures of HIV/AIDS Among the respondent who know about HIV/AIDS, % of them said prevented by avoiding unsafe sex, .% said by using sterilized syringes, % said by using condoms, % said by avoiding birth by infected mother,% by avoiding syringe sharing during addiction, % had no idea and % said others ways. Table no.16ways of prevention of HIV/AIDS SN 1 2 3 4 5 6 7 Ways of prevention Avoiding unprotected sex Using sterilized syringe Using condoms Avoiding birth by infected mother Avoiding injection needle sharing No idea Other No. %

Treatability of HIV/AIDS Among the people, who were heard HIV/AIDS we asked it is treatable or not, % said it is treatable,.% it is untreatable and ..% had no idea.

2.2.3 KAP about Malaria

When respondents were asked about malaria, whether they know about malaria or not then, 73.70% know and 26.30% didnt know about the malaria. Cause of malaria Out of people who know about malaria were when asked the cause of malaria, 79.08% of respondents said that malaria is due to mosquito bite, 5.54% said other cause and 15.38% had no idea about cause of malaria. Figure no. 10 cause of malaria

CAUSE OF MALARIA
other 5.54% no idea 15.38%

0%

mmosquito 79.08%

PREVENTION FROM MALARIA Out of people who know about malaria were when asked the preventive measure of malaria the answer was following. Table no. 17 preventive measure of malaria SN 1 2 3 4 Preventive measured Use bed net Screening door/window Cleaning water ditches Other No. 248 66 133 50 % 49.90 13.28 26.76 10.06

2.2.4 KAP about JE

Heard about JE When respondents were asked about JE, whether they had heard about JE or not 34.47% heard and 65.53% didnt hear about the JE. Transmission of JE Out of the people who know about JE were when asked the transmission,47.64said that transmitted through mosquito bite, 39.91% said through pig,5.58% through waste and 6.87% other way. Table no.18 MOT of JE SN
1

MOT

No.

1 2 3 4

By Mosquito By pig By waste Other Total

111 93 13 16 233

47.64 39.91 5.58 6.87 100

Prevention of JE Out of the people who know about JE were when asked the preventive measure of JE,55.45% said using bed net,10.89% said screening door,25.74%said environmental sanitation and7.92% said other ways. Table no. 19 preventive measure of JE SN 1 2 3 4 prevention Use bet net Screening door Environmental sanitation others No. 112 22 52 16 % 55.45 10.89 25.74 7.92

2.3.5 KAP of first contact for treatment of health care

Knowledge about cause if disease Majority of respondent, i. e. 331 (75.06)% of them said the scientific answer of causation of disease such as poor sanitation pathogens, dirty food and water. And 30(6.8%) said the unscientific cause of disease such as evil, sprits of devils, and sin of god 80(18.44%) told no any idea. Table no. 20 knowledge about cause of disease SN 1 2 3 cause Scientific cause Unscientific cause No idea total No. 331 30 80 441 % 75.06 6.8 18.44 100

First place of treatment In our study, we asked about the place or institute were they used to go first treatment. Figure no. 10 first place of treatment
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Chart Title
Series 1 Column1 Column2

61.45%

31.29%

5.67%

1.59%

hospital/HP

medical

dhamijharki

other

Form above, only 5.67% people believe on traditional healers. This indicates still some people lack health knowledge. On the our survey for not going to PHCC are as following Table no 21 not going to PHCC SN 1 2 3 4 5 6 7 Cause HW not stay at PHCC Uncoordinated HW No faith No drug Due to far distance No money Others Total Knowledge on prevention of disease No. 5 1 5 42 82 20 15 170 % 2.9 0.59 2.9 24.7 48.24 11.76 8.91 100

In our survey area, when the respondents were asked about the preventive measure for disease about 74.38% said the correct answer (nutrition and sanitation or scientific cause) 21.77%said they had no idea 3.85% said worshiping god. Table no.22 preventive measure of disease SN 1 2 3
1

Preventive measure Correct answer Worshiping god No idea

No. 328 17 96

% 74.38 3.85 21.77

Total

441

100

2.4 Maternal and child health (MCH)

Maternal and child health refers to the promoting, preventive, curative and rehabilitative health care for mother and child, mother and child care taken as one unit because a healthy mother bring a healthy baby, still birth and abortion. Maternal and child health care is poor in our country as compared to other developed country. It is true for the context of Bhajani too. Emphasis is given on maternal and child health care. So as to reduce maternal and child health mortality the following data are obtained from those women who have child of under 2 years, who were 61 in number.

2.4.1 Age at first pregnancy

It is best to become pregnant only after 20yrs of age because the entire reproductive organ get matured and they get their baby easily delivery. It is found that more than 60% women were pregnant before 20yrs of age.

Table no. 22 Age at first pregnancy SN 1 Age group <15yrs 15-19yrs 20-24yrs 25-29yrs Total no. %

2
3 4

2.4.2 Antenatal care (ANC)

ANC is the care of mother during pregnancy i.e. after conception till the baby is born. Antenatal care is subjected to promote maternal and child health. It enables to defect our risk of mother and child during pregnancy. Among 107 mothers 93.45% of mother had visited ANC check up at health institution among them 98% had gone at PHCC/Hospital and rest 2% had gone at private clinic.
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2.4.2.1 Frequency of ANC visit On our survey, majority of mother in Bhajani VDC had visited to health services for 4 or more than 4 times, them are 75% of total ANC visitor.

Table no. 23 frequency of ANC visit

SN 1 2 3 4

Frequency Single visit only 2 visit 3 visit 4 visit Total

No. 0 4 21 75 100

% 4 21 75 100

2.4.2.2 Reason for not attending ANC Among the respondents who were not attending ANC, their main reason were, they dont have knowledge about it 71.42%, distance between PHCC and their house is far 14.28% and others 14.28%. 2.4.2.3 Rest in pregnancy It is recommended that pregnancy women should have adequate rest. However, in our survey we found that majority of women, had to work as usual during pregnancy. Very less % of the sample population used to have rest.

Table no. 24 Rest at pregnancy SN 1 2 Rest at pregnancy Done Not done total No. 45 55 100 % 45 55 100

2.4.2.4 Feeding practice during pregnancy The following fetus gets nutrition from its mothers diet. So additional food is required for mother herself as well as for the growing fetus. However, in our survey most of the mother
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68(68%) consumed the usual quantity of food and only 32(32%) at more quantity of food than before pregnancy.

2.4.2.5 T.T vaccination at last pregnancy To prevent mother as well as baby from tetanus. T.T vaccination is one of the best means. In our survey area, out of 107 Mother 93.45% had taken T.T. vaccination during their last pregnancy. And rest 6.54% respondent had not taken. Table no. 25 T.T. vaccination at last pregnancy SN 1 2 3 4 vaccine TT II TT III TT IV TT v total No. of female 67 20 12 1 % 67 20 12 1

This study shows that the vaccine coverage in our community is good although 6.54% of women are far from the service of TT immunization till now. 2.4.2.6 Iron tablets during pregnancy Anemia is the condition in which hemoglobin content of blood is lowered. Anemia due to deficiency of iron and folic acid during pregnancy period is one of the major problems resulting in pre-mature birth, post partum hemorrhage etc. since sufficiency iron and folic acid may not be available in daily diet of pregnant mother supplement iron and folic acid is supplied to pregnancy women from 2nd trimester of pregnancy to 4th day after delivery. Iron tablets supplementation during pregnancy Yes Complete: 59(59%) Incomplete: 41(41%)

No : 0(0%)

2.4.3 Delivery
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2.4.3.1 place of recent delivery Most of the delivery among our sample population were conducted in hospital Table no. 26 place of recent delivery SN 1 2 Site PHCC/hospital Home Total No. 71 34 105 % 67.61 32.38 100

Figure 12 place of recent delivery

place of recent delivery

0% 0% home 32.38%

PHCC/hospital 67.61%

2.4.3.2 assistant for home delivery In our survey we found that majority of the home delivery was assisted elder member of the community.

2.4.3.3 Use of delivery kit

Delivery kits are the set of instruments that contain sterile blade, thread, soap and plastic that are required during delivery. In the survey we found among the home deliveries. 24 i.e. 70.58% are delivery kit user and 10(29.42%) are delivery non-user.

2.4.3.4 Cord cutting practices

Cord cutting instruments after delivery of a baby should be sterilized. If it is contaminated, there would be high risk of disease like tetanus. In our survey, among those who delivered
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at home and didnt use delivery kit. Majority used new blade 60% some of them had even used old blade Instruments New blade Old blade sickle No. 6 3 1 % 60 30 10

2.4.3.5 Vitamin A capsule within 6 weeks of delivery

Vit. A is necessary to the women after delivery, so to fulfill the total demand of vitamin A for body can be supplemented by vitamin a capsule. In our survey, we know the majority of the women (72.89%) had taken vitamin A capsule within 6 weeks of delivery from PHCC/hospital/FCHV27.11% were not taken.

2.4.4 Breast feeding

2.4.4.1 Colostrums feeding
Colostrums is the best nutrient for new born baby that provides the baby more nutrient and immunity to fight against the disease. Fortunately colostrums feeding practice is high i.e. 97.19%. Table no. 28 Colostrums feeding SN 1 2 practice Colostrum feeding Colostrums non feeding Total No. 104 3 107 % 97.19 2.81 100

If not why? Among those who didnt feed colostrums to their baby, there were various cause, the cause that mother told were that it may harm to the child or think it as dirty thinks(66.66s%).

Table no. 29 Reason for not feeding colostrums

Reason Think it is dirty It may harm
1

No. 2 1

% 66.66 33.34

2.4.4.2 Period of breast feeding after delivery

Baby should be breast fed as soon as possible after the birth. Breast feeding should be initiated within an hour. Although there is little milk at that time, it helps to establish feeding and close mother child relationship, known as bounding. From our survey, we found that 76.85% of them fed within 1 hour, 21.29% 1-8 hours,1.85% after 8 hour of baby birth. Table no. 30 period of breast feeding after delivery SN 1 2 3 Period Within a hour 1-8hrs After 8hrs Total No. 83 23 3 109 % 76.85 21.29 1.85 100

2.4.4.3 Feeding immediately after birth

In our survey majority of babies (97.2%) were not fed thing immediately after birth before breast feeding. Among those who were fed, they fed sugar (1.8%), cow milk(0.91%) and honey(0.91%)

2.4.4.4 Exclusive breast feeding

Exclusive breast feeding up to 6 months age is recommended provided that mothers milk is sufficient to satisfy child hunger. Exclusive breast feeding up to 6 months provides all the necessary nutrients for growth and development of child. About 88.07% female have practiced Exclusive breast feeding properly. Table no. 31 exclusive breast feeding SN 1 2 3 4 months <5 months 5 months 6 months >6 months Total No. 5 4 96 4 109 % 4.5 3.66 88.07 3.77 100

2.4.5 Sarbottam pitho

Sarbottam pitho is the ideal supplementary food for the infants that consist of necessary nutrients for the growth and development of baby. It is one of the superior weaning foods given at the age of 6 months. In our survey, 49(44.95%) were found to be heard and 60(55.05%) found to be unheard about sarbottam pitho.

2.4.5.1Methods of preparing sarbottam pitho

Among the respondents, who were listened about it,27 (55.31%) can prepare it properly and other cant prepare.

2.4.6 Immunization
Expanded immunization is one of the prioritized programs of government of Nepal under this program; the available vaccines are against major eight killer disease. Those diseases are TB, diphtheria, pertussis, tetanus, poliomyelitis, measles, Hep-B and Japanese encephalitis. Table no.32 immunization coverage vaccines BCG DPT/HEP -B-1 DPT/HEP B--2 DPT/HEP B-3 POLIO MEASLES JE No. %

2.4.7 FAMILY PLANNING

Delay the first, postpone the second and prevent the child Family planning is way of thinking and living that is adopted voluntary upon the basis of knowledge, attitude and responsible division by individual and couple in order to promote
1

the health and welfare of family groups and thus contribute effectively to the social development of a country. Family planning service not only helps in reducing the fertility rate but also promotes the reproductive health and family health and also maternal and child health. High population growth rate is one of the burdens of developing countries to control PGR. Family planning methods should be employed effectively.

2.4.7.1 Concept of birth spacing

Birth spacing is one of the major factor in reducing family size along with this it also promotes the health of the mother and child as well. In our survey, % of respondents felt that birth spacing should be 4-5yrs even it is not in their practice .% felt it should be more than 2-3yrs. Those who thought 2-3yrs, feel that babies would grow together if the birth space lesser.% of the respondents said there should be the space of more than 5yrs for the health of both mother and child. Table no. 33 concept of birth spacing SN 1 2 3 Spacing 2/3yrs 4/5yrs 5yrs Total No. 88 122 69 279 % 31.54 43.72 24.74 100

2.4.7.2 Ideal no. of children

While asked about ideal no. of children for a happy family, majority mother (67.79%) replied that two children are enough. Table no. 34 ideal no. of children SN 1 2 3 No. of children 2 children 3 children 4 children Total No. 221 103 2 326 % 67.79 31.59 0.62 100

2.4.8 KAP on Pneumonia

1

When we asked the sample mother whether heard about pneumonia or not then 87.55% said they knew and rest of 12.45 % said they didnt know. 2.4.8.1 Cause of pneumonia Among them, who knew that pneumonia about the cause they said that

Table no.35 cause of pneumonia SN 1 2 3 Cause Cold Dust/smoke No idea Total No. 200 15 10 225 % 88.88 6.66 4.46 100

2.4.8.2 prevention from pneumonia Majority of respondents 86.66% said that they prevent babies from pneumonia by keeping warm,8.88% by taking health institution, 2.66% have no idea.

2.4.9 Diarrhea
Diarrhea is the one of the disease which takes away life of many people in our country. Realizing this fact we felt necessary to assess people KAP on diarrhea. 2.4.9.1 Definition of diarrhea Presence of watery stool more than 3 times in 24hrs or a day is diarrhea. Among 225respondents 40% were able to give correct answer. 2.4.9.2 Cause of diarrhea All mother of our survey are, poor hygiene, polluted water, damaged food is major cause of diarrhea. On the question of, should feed or not breast milk during diarrhea? Almost mother replied that breast milk should fed during diarrhea. 2.4.9.3 Management of diarrhea According to our survey majority of the sample population know that ORS can cure diarrhea
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Table no.36 management of diarrhea Management ORS Fluid diet No. fluid Other No idea Total No. 175 36 7 5 2 225 % 77.77 16 3.11 2.22 0.88 100

2.4.9.4 method of preparing ORS In our community 65.25% told correct answer and 30.74% told wrong and 4.01% had no idea on the question of can you prepare or do you know how to prepare ORS? NEED IDENTIFICATION Felt need/ problem Felt need are those health need which are realized or felt by community people themselves. Felt need are think by community people for the development of their health and socioeconomic status. Unstructured interview with local leader, traditional healer, FCHVs etc and the result obtained out 40 respondents were as follows. Felt health need experienced by the community SN 1 2 3 4 5 6 7 Problem/needs Numbers Percentage

From the above table. Is the top most health problem. We will prevent these problems by educating them. Who is responsible for these problem solving? SN 1 2
1

responsible Local leaders Government

Number

Percentage

3 5

Community Others Total It shows that the most of community people are assuming it is the responsibility of community to solve the problem. Above data is taken by questionnaire based interview with FCHVs, teachers, dhami, and paramedics of our survey area BHAJANI 1, 2,& 3. Top 10 disease of BHAJANI PHCC According to monthly report of BHAJANI ( falgun to baisakh )the top disease were as follows. 1. Upper rti 2. Gkkjkjdfjk 3. Jfhj 4. Fn 5. Bsh 6. Nfjf 7. dGkkjkjdfjk 8. Jfhj 9. Fn 10.Bsh This shows .. is the major problem towards the health of the catchment area of BHAJANI VDC. OBSERVED NEEDS/PROBLEMS Observed needs are termed those health and/or development needs which were find using different tools, techniques, findings, revealed that there were various problems in BHAJANI VDC.Some of the needs that had been identified through data collection by vs were as follows:hhhgd 1. Hhhh 2. Dd 3. F 4. Ff 5. Dff 6. Fgg 7. Gf 8. Hd
1

Sharing of the findings After we had identified felt and observed needs we had conducted community presentation. It was held on 29th falgun 2068. There were altogether 20 participants in the presentation including local leader, FCHVs, teacher, student, representative of VDC official and PHCC staffs. First community was base for us to prioritize the problem prevailing in the community. The presentation was an opportunity for us to disseminate the community with the major finding with further discussion on our observed needs and their felt needs for the identification of real needs. Objective To disseminate all the finding of survey to community people and to generate the possible solution. Identification and generalization of the real needs after the observed and felt need was emphasized. To participate the community people for planning and implementation for micro health projects. The conducted programmed in CHETANSIL SAMAJ hall, BHAJANI-1 we had arranged necessary sitting arrangement and had made necessary provision of drinking water. We prepare bar diagram, pie-chart, graph to present to participant. Although some members are illiterate our verbal expression helped them to understand. All the students 10 were present and analyzed data.name of the students and their subject matter is mentioned below:1. Gaurab bohara - announcer,present ANC 2. Ramesh kumar kami-present about iron taken by women 3. Santosh raj joshi-present-present about malaria disease 4. Dipendra pant present about top 10 disease of BHAJANI PHCC 5. Saraswati subedi present about postnatal checkup 6. Karina shahi-present about delivery done by women 7. Diil deuba-present about disease tuberculosis 8. Prakashrawat-present about vitamin taken 9. Haridas rana present about immunization in PHCC 10.Harka bdr thapa-delivery in PHCC Sr.AHW kailash chaudhary the staff of BHAJANI PHCC was the chairperson mr.bed joshi ,the HA coordinator of bhageswor academy and kiran bhandari class teacher were chief guest of the programme.
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At the end of the programme, some of the leader were requested ton put forward their option. All the speaker thank us and bhageswor academy for health science for conducting such a community based programme and at the same time they expressed that they are ready to help us . All the feedbacks and remarks made by us happy and more responsible to bring change regarding KAP of the entire community people. At last cold drinks, banana party was arranged to the present guest & participants. REAL NEEDS REAL NEED IDENTIFICATION FELT NEEDS (by community) OBSERVED NEEDS(by student)

HE on MCH HE on RTI (pneumonia) HE on JE HE on women health

AFTER DISCUSSION

Awareness on MCH Safe drinking water Awareness on JE

REAL NEEDS

Community health awareness on:Japanese encephalitis

Chapter 4: micro health project Like the name suggests, micro health project is a small form of a short-term project the fundamental nature of which is to develop health related skill and self relianceof the community people according to the prioritization of real needs through the identification and utilization of local resource. The essence of MHP is to stimulate community interest in health primitive , disease prevention activities. We should also consider that a micro-health project needs to be a simple action but effective and sustainable. We decided the topics of MHP by collection all the information expressed by the community people and local leaders and we analyzed them. After discussion according to following criteria we decided the topic MHP. 4.1 criteria for prioritization Severity of disease /problem State of harm caused by the problem Felt need Resource available National health policy Community participation Our knowledge on topics Time ,business of community people

4.2 Topics of MHP JAPANESE ENCEPHALITIES Causative agent of encephalitis Pathophysiology Sign and symptom Treatment Prevention

4.3 Rationale
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Why MHP on JE? JAPANESE ENCEPHLITIS It is common in rana, chaudhary and tharu community because every people of this community have duck and pig in their home. Most of people havent heard about these diseases about >60% people are unknown about these diseases. For the effective implementation of the programme , we have to consider so many things in mind. Man, money & material, mind and minute are the basic fundamentals for the effective implementation of the programme. So planning is important for the proper use of such fundamentals and to finish the task in determined time. We developed the detailed plan of action as shown in annex. 4.4 objective of MHP 4.5 JAPANESE ENCEPAHALITIS To provide health education to the community people. To disseminate cause symptom and preventive measure of Japanese encephalitis 4.6 Target Population To carry out MHP the target populations were. Mothers groups FCHVs Teacher, local leaders Student of lower secondary and secondary level. 4.7 Strategy Community health education 4.8 Evaluation Technique/method Group discussion Question answer/interview Re-demonstration For sustainability of MHP refreshing community health education program will be conducted by PHCC BHAJANI. Chapter 5: PHCC activities 5.1 introductions
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Primary health care centre of our catchment area is situated in BHAJANI VDC ward no.1 at behind of Nepal telecom. Catchment area of this PHCC is khailad vdc ,lalboji vdc.phcc have its own small building but now new building is in construction. There is staff quarter also. Staffing pattern The staffing patterns of BHAJANI VDC are as follows. a. b. Technical staff: Doctor-1 Health assistant/Sr.AHW-1 Staff nurse-1 AHW-2 Lab assistant-1 ANM-1 VHW-1 Non-technical staff Kharidar-1 Peon-1

As PHCC is the first referral centre of the electoral area level it provides preventive, promotive & curative health service to the people of catchments area. As well it also helps in administration of its office and two sub-health posts situated on khailad VDC & lalboji VDC. The summary of our PHCC activities in the PHCC of BHAJANI is as follows in which we were involve actively. Administrative function This function include planning of health service, record maintaining writing letters , dispatch & entry of letter coming from the other institution and DHO, maintain filling letters record register, logistic management, financial record, HMIS from billing and managing other. During the period of community field practice, we all were involved for all administrative function from our involvement we get lots of knowledge about administrative with the help and co-operation of PHCC staffs. TECHNICAL FUNCTION Daily activities
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a. patient registration Each patient patient is provided a ticket without cost (free).That include patients name, age, sex, and address, type of needed service such as FP, OPD and ANC. b. OPD service PHCC has been providing OPD service daily except government and local holiday. Provisional diagnosis is done and treated according to the available drug in PHCC.The complicated cases is referred to higher centre. c. Injection and dressings There are also services of dressing and injection. Dressing is provided for wound and minor surgical procedure. d. Sterilization and Disinfections There is autoclave for surgical instrument sterilization. Lifebuoy soap, spirit tincture iodine is available for disinfection. e. Abortion services There is free cost abortion service f. emergency service There is emergency service available 10 to 5 pm. g. Delivery services There are two beds for delivery. Delivery is conducted by medical officer and trained staff nurse and ANM. h. Lab services There is only one pathology room. In spite lack of necessary chemicals, equipments and manpower sputum AFB, MP test by RDT, HIV test by ELISA, blood grouping, TC,DC,UPT, ESR, urine/ stool routine and microscopic examination is done by lab assistant. MATERNAL AND CHILD HEALTH a. ANC services

SPECIAL THANKS TO 1. Dr. Padam prakash dev Sharma 2. Mr. kailash chaudhary 3. Mr. birendra sapkota 4. Mrs . parvati bhandari 5. Mrs hemanti awasti 6. Mrs sita bhatta 7. Kriti pathak 8. Shanti balampakhi 9. Ashok magar 10.Jag bahadur saud 11.Gunjan nath yogi 12.Arjun chaudhary (mahuniyal higher secondary school) 13.Shanty lama 14.Fulpati chaudhary 15.Chanda devi chaudhary 16.Gupta sweet house
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17.Minu joshi NAME OF HOUSEHOLD HEAD/ RESPONDENT Ward no.1 SN NAME 2 Milan chaudhary 3 Puspa sunar 4 Rupa chaudhary 5 Rampati chaudhary 6 Maya chaudhary 7 Tilak chaudhary 8 Sagar b.k 9 Prabhat chaudahry 10 Ashik Ram kumara dangaur Bimala chaudhary Dharma bk Sunita bk Gagan singh bk Niran cahudhary Nathuram chaudahry Pratap bk Kamala devi bk Sita chaudhary Kalaya devi chy Netra bdr chaudhary Jay singh bk Suntali bk Khema devi bk Shakiya khatun Binaya lal chaudhary Mitchya devi chaudhary Rajpati chaudhary Sandip chaudhary Laxmi bk Shiva Shankar chaudhary Asharam chaudhary Fuliram chaudhary Sumitra chaudhary Dungini chaudhary Nilam chaudhary Urmila pun Dil devi chaudhary
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Puja pun Bhojram chaudhary Sarita bk Sarad malla Puja bk Laxmi bk Indtra suaud Maya bk Shyam devi dangaura Rina khatri Kailash dangaura Jamuna pariyar Khadak singh bam Rajudevi bk Laxmi bk Bindu devkota Parsuram dangaura Ratna bk Poonam dangaura Pakhilal dangaura Fagura chaudhary Khusha devi chaudhary Ram bdr chaudhary Rampyari dangaura Anuradha cahudhary Laxmi chaudhary Bhakta bdr sunar Kaluram chaudhary Sunita gharti Bhim bdr shahi Anura bhushal Nurma devi bam Manju chaudhary Sitaram chaudhry Shankar bk Ram chaudhary Dil bdr bk Ram dulari chaudhari Ratana bk Binita saud Sapana khadka Bhukali dangaura
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Dipak pun Tularam kami Chandra devi bk Sunita devi shrestha Kamal singh saud Shova dangaura Rekha bk Jaluram kumal Rampati chaudhary Ramesh chaudhary Sudhiya dangaura Pancharam kumal Bhaguram chaudhary Munshi kumal Chotelal chaudhary Chandra singh bk Gautam chaudhary Hirasingh bam Harish singh bk Urmila chaudhary Devraj bk Tilak sunar Jagat ram kumal Shov bdr kumal Mani ram chaudhary Dagram chuadhary Anandram bk Indra devi bk Sangita devi chaudhari Arjun shah Shiva dangaura Arati devi chaudhary Dhana tamata Dipadevi chaudhary Mangali bk Asha gharti Sangita bk Ramlal dangaura Tekram chaudhary Hauwa dangaura Mahajan devi chaudhry Janaki chaudhary
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Prabat khatri Pharendra chaudhary Gulav chaudhary Netra khadka Lahami chaudhary Dil bdr bk Kamal raj chaudhary Kopila devi bk Jail devi khatung Ravendra kumal Chandralal chaudhary Krishnadevi chaudhary Sureshkumar chaudhary Birbhan bk Prem lal sunar Chengaura chaudhary Gulav lal chaudhary Olani devi chaudhary Devlal chaudhary Ram bdr bk Puran lal chaudhary Kushi lal chaudhary Sushil chaudahri Radha devi chaudhary Desh raj cahaudhay Pancharam chaudhary Pakul Husain Dilip kumar chaudhry Lok bdr pun magar Sharmila chaudhary Mahirul nisha Mayadevi chaudhary Sabita chaudhary Sunita chaudhary Holidevi dangaura Balini cahudhary Jayram dangaura Fulrani chaudhary Kailali devi chaudhary Dularam chaudhary Kamala devi chaudhary Fatya chaudhary
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Shanty devi chaudhary Sita devi dangaura Firulal dangaura Hariwa tharu Lok bam Tara singh bk Mangiram dangaura Rajendra chaudhary Sumitra chaudhari Laxmidevi chaudhary Ram kumara devi chaudhary Gohanidevi chaudhary Chedulal chaudhary Gopi chaudahry Binita chaudhary Balram chaudhary Ankita chaudhary Anarkali devi chaudhary Kushum devi chaudhary Babulal tharu Hira kumal Satish chaudhary Gajesh chaudhary Mangal kumar kumal Jayram dangaura Dhagiya devi chaudhary Laxmi sunar Lahar kumar kumal Bam bdr kumal Bathu dangaura Tuliram chaudhary Gauridevi chaudhary Mangaldash dangaura Marthari chaudhary Kalawati sunar Amar singh bk Ruplal chaudhary Biksharan kumal

Ward no .2 1. Chandra prakash chaudhary 2. Tulsa devi saud 3. Ranjita kumara chaudhary 4. Krishna chaudhary 5. Apeba chaudhary 6. Ram Milan chaudhary 7. Krishnadas chaudhary 8. Amir Prasad chaudhary 9. Ramkrishna chaudhary 10.Lautan chaudhary 11.sunita chaudhary 12.rajkumari chaudhary 13.bhagatram chaudhary 14.ramcharan dangaura 15.khina dangaura 16.chaturprasad dangaura 17.sundar chaudhary 18.bifi chaudhary 19.tikaram chaudhary 20.sumitra chaudhary 21.ravindra chaudhary 22.anjali chaudhary 23.rajesh chaudhary 24.arjun chaudhary 25.Krishna devi chaudhary 26.Shanty devi chaudhary 27.Radhe shyam chaudhary 28.Laxman chaudhary 29.Sagrani chaudhary 30.Bisa chaudhary 31.Ganga chaudhary 32.Soma chaudhary 33.Sitarani chaudhary 34.Dilipkumar chaudhary 35.Fachram chaudhary
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36.Aparna chaudhary 37.Bilesh dangaura 38.Kusum tharu 39.Amar chaudhary 40.Manish chaudhary 41.Sarad chaudhary 42.Fulmati chaudhary 43.Asharam chaudhary 44.Dilip chaudhary 45.Tikaram chaudhary 46.Ranipa chaudhary 47.Nirupa chaudhary 48.Ramkisan chaudhary 49.Thagni chaudhary 50.Kriti chaudhary 51.Rita devi chaudhary 52.Ramesh chaudhary 53.Haerani devi dangaura 54.Binita chaudhary 55.Ram bdr shahi 56.Asharam chaudhary 57.Chetarm chaudhary 58.Kaladevi chaudhary 59.Prem bdr dangaura 60.Bhagwandin chaudhary 61.Krishna bdr chaudhary 62.Choelal chaudhary 63.Krishna devi chaudhary 64.Dubnarayan chaudhary 65.Fulpati dangaura 66.Amir Prasad dangaura 67.Minadevi chaudhary 68.Sushmita chaudhary 69.Jhokiram chaudhary 70.Shreeram chaudhary 71.Pulsikumar chaudhary 72.Dulari chaudhary 73.Papatidevi chaudhary
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74.Chahari devi chaudhary 75.Laxmi chaudhary 76.Amrita chaudhary 77.purnaram chaudhary 78.jogram chaudhary 79.shanty chaudhary 80.gauri rawat 81.panthidevi chaudhary 82.pashupati chaudhary 83.batiya dangaura 84.rupadevi chaudhary 85.liladevi chaudhary 86.lalita chaudhary 87.rangila chaudhary 88.anita chaudhary 89.bijaya chaudhary 90.sitaram chaudhary 91.harilal chaudhary Ward no .3 1. Laxman bk 2. Dipak bk 3. Bisna chaudhary 4. Ratiram chaudhary 5. Janaki bk 6. Bhawana jaishi 7. Srijana bk 8. Ganga bk 9. Anita kumal 10.Sonika khatri 11.Babita chaudhary 12.Ramdin chaudhary 13.Bisram chaudhary 14.Sova chaudhary 15.Sugiram chaudhary 16.Deuma bohara 17.Ramrati chaudhary 18.Jogadevi kunwar
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19.Srijan dhami 20.Buslidevi chaudhary 21.Saraswati chaudhary 22.Gangarani chaudhary 23.Pabitra bk 24.Santari chaudhary 25.Sitajanaki chaudhary 26.Karisma chaudhary 27.Suji bohara 28.Desraj chaudhary 29.Lahun dangaura 30.Urmila devi chaudhary 31.Sunitadevi chaudhary 32.Sitadevi chaudhary 33.Sushmadevi chaudhary 34.Ramlal dangaura 35.Rajkumar chaudhary 36.Khusiram chaudhary 37.Befrani chaudhary 38.Isworimati kathariya 39.Tejram chaudhary 40.Ramprasad chaudhary 41.Sarada chaudhary 42.Kuniram chaudhary 43.Laxmi mijar 44.Ranga bk 45.Durgadevi bohara 46.Lalbdr tiruwa 47.Chandra bdr bohara 48.Hema bk 49.Krishna chaudhary 50.Ganesh bdr tiruwa 51.Devsara budha 52.Gauri bk 53.Radha bk 54.Rambhusan kalanki 55.Rangadevi bohara 56.Man bdr chaudhary
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57.Laxmi bohara 58.Jayarani chaudhary 59.Bal bdr bk 60.Minadevi bk 61.Ashadevi chaudhary 62.Karan singh bk 63.Ramkumar chaudhary 64.Tejram chaudhary 65.Jhuthari chaudhary 66.Khusiram chaudhary 67.Chandra bk 68.Mahabir bk 69.Panpati devi chaudhary 70.Urmila chaudhary 71.Ramkisan chaudhary 72.Jayram chaudhary 73.Bhojlal dangaura 74.Bhajan singh bk 75.Belaram chaudhary 76.Sagun chaudhary 77.Lotu dangaura 78.Dhan bdr tiruwa 79.Gita chaudhary 80.Bisna devi sarki 81.Jamuna pariyar 82.Kaludevi kathayat 83.Gagan bk 84.Narsingh bk 85.Dhana devi budha 86.Min bdr budha 87.Udayaram bk 88.Lalita puri 89.Dipak budha 90.Lautan chaudhary 91.Nandadevi bohara 92.Mata bk 93.Dhanbdr bohara 94.Minadevi dangaura
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95.Badal chaudhary 96.Yasodha chaudhary 97.Suliya chaudhary 98.Arunadevi chaudhary 99.Lila chaudhary 100. Khojram chaudhary 101. Krishna chaudhary 102. Gangadevi budha 103. Sunita chaudhary 104. Asha tharu 105. Khema kathayat 106. Dhanadevi kathayat 107. Diradevi chaudhary 108. Bishna devi bk 109. Chotelal dangaura 110. Hariram chaudhary 111. Premlal kathariya 112. Suraj chaudhary 113. Lalbdr budha 114. Balram chaudhary 115. Dhanbdr dangaura 116. Ram bdr chaudhary 117. Sunita basnet 118. Guhan tharu 119. Hariram dangaura 120. Fulmati chaudhary 121. Satnadevi chaudhary 122. Sundari chaudhary 123. Khushiram chaudhary 124. Fulmati chaudhary 125. Saradadevi bk 126. Rupa raji 127. Suman tharu 128. Jahari bk 129. Thaggu bk 130. Narjit bk 131. Haerani kumara chaudhary 132. Rup bdr bk
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133. 134. 135. 136. 137. 138. 139. 140. 141.

Sunita sop Devi tiruwa Ramkumari dangaura Kuniram dangaura Dikra kumal Basanti devi chaudhary Ganga budha Ram dulari chaudhary Manish chaudhary