CHD Report Final Printout

A Report Of
Community Health Diagnosis Field Program

Fujel, Gandaki Ward-03
Gorkha, Nepal
Submitted to
Department of Community Medicine and Public Health
Maharajgunj Medical Campus, Institute of Medicine
Tribhuvan University
Kathmandu, Nepal
Submitted by
MBBS 41st Batch (1st year)
Group B
2022
Declaration and approval sheet
We, the following students of MBBS first year have produced this report as an
outcome of the residential field from Bhadra 5, 2079 to Ashwin 5, 2079(August 21,
2022 to September 19, 2022) in FUJEL, GANDAKI-03,GORKHA. We have
invested our sincere efforts and consider this work to be original.
Group B
Roll No.
Name
Signature
1998
ABHISHEK SHAH (group leader)
1995
ABHAY KUMAR.
1999
ADITYA GIRI
2002
AMIT YADAV
2017
ASUTOSH SAH
2045
NEHA KAFLE
2048
PRAMATH KAPOOR
2053
PRIYA MAHATO
2059
SADMARG THAKUR
2084
TABASSUM THAKURAI
Date:2022/09/25 (2079/06/09)
This report has been accepted and forwarded for final examination.
………………………….. ………………………..
Assistant Prof. Prem Lal Basel Associate Prof. Dr. Khem BDr. Karki
Co-ordinator, CBL Unit Head of the Department
Date: Date:
ACKNOWLEDGEMENT
Community Health Diagnosis was altogether a challenging yet enlightening
experience for all of us. We cannot thank enough the Department of Community
Medicine and Public Health, Institute of Medicine for providing us this immense
opportunity of living and experiencing a different and wonderful method of life and
learning. We all were pretty apprehensive before visiting the field because we were
not prepared for the challenges we were to face. But this experience not only provided
us with a lifetime of memorable experience but also helped us look at our lives from a
very different perspective. Altogether this 30 days stay helped grow individually as
well as together as a group.
We would like to thank Department of Community Medicine and all our teachers for
providing constant guidance from the very beginning till the end of CHD program.
Our enormous gratitude to the Head of department, Associate professor Dr. Khem
Bahadur Karki; Professor Dr. Rajendra raj Wagle; Associate professor Pranil Man
Singh. We thank assistant professor Prem lal basel sir, asst. prof. Dr. Tanbir Ahamad
Mikrani, asst. prof. Dr. Smriti Panta, asst. prof. Dr. Namrata Karki, asst. prof. Dr.
Gambhir Shrestha for their constant supervision over our works and activities.
We whole heartedly thank out landlady Mrs Heera Shrestha who not only provided us
with a shelter to stay but also made sure that we had a homely environment around us
to function and carry out all our CHD related work efficiently. We thank Mrs. Sangita
Tiwari and Mr. Deepak Tiwari for serving us with the best food as per our request
throughout the stay.
Equally deserving of our gratitude are the ward representatives whose constant
scrutiny and guidance energized us to conquer the hurdles in out path. We also would
like to extend our thanks to each and every individual of the community who assisted
and cooperated with us throughout our stay with just the right words and actions and
their formative feedbacks
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 thank
everyone who has helped us directly or indirectly during our one month stay of
community diagnosis to accomplish this study
Summary
INTRODUCTION
Community Health Diagnosis is a quantitative and qualitative description of the
health of citizens and the factors which influence their health. It identifies problems,
its determinants, diseases, it’s causes with the associated health problems and
proposes areas for improvement and stimulates action. In a nutshell, community
medicine can simply be explained as:
What? –Primary health issues and needs
Where? –In the community
How? – Via community participation and utilization of local resources
Why? –To rule out necessary solutions for prevailing problems
We, the students of 41st Batch of Bachelor of Medicine and Bachelor of Surgery
(MBBS), Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University
conducted a comprehensive Community Health Diagnosis (CHD) from 2079/05/05
B.S. to 2076/06/03 B.S. in Fujel, Gandaki Ward no.3, Gorkha.
OBJECTIVES
The objective of the study was to analyze the health status of the community, to
identify and prioritize its real needs and to address them through active community
participation and optimum utilization of available local resources.
METHODOLOGY
• Cross sectional approach
• Census
• Descriptive study
Secondary data: From the Ward office, health post, Focused Group Discussion,
Female Community Health Volunteers (FCHVs).
Techniques and tools:
• Questionnaire
• Interview schedules
• Guidelines of FGDs
• General observation
• Record review from ward office and health post
• Anthropometric measurements for height and weight
Software: The open source software SPSS and MS Excel was used for both data
entry and analysis purposes. Both univariate and bivariate analyses were performed as
per requirements, and the findings were extracted in terms of rates, ratios and
proportions. MS PowerPoint was used for presentation.
FINDINGS:
DEMOGRAPHIC FINDINGS
Out of the 207 people surveyed, the sex ratio was at 95.7 males per 100 females. The
average family size was 2.63 members per family. Crude Birth Rate was found to be
12.4 per 1000. Total Fertility Rate was 3.12 children per woman. Crude Death Rate
was found to be 9.53 per 1000. Disability rate was 1.16 percent. No cases of infant
death and maternal deaths were recorded during the course of our study.
SOCIO-ECONOMIC STATUS
Brahmins constituted the major ethnic group (62.3%); followed by Newars at 21.7%.
All the people we surveyed were Hindu. The main source of income was agriculture
(56.3%). This sufficed the food demand annually in 69.5% of the families. Literacy
rate was found to be 79%. For most families, gender of the unborn child didn’t matter
(53%), while 43% preferred male child. Male dominance was seen, with 75.1% of all
property being owned by males, 60.1% involved in social gathering, 69% dominating
the economic decision making for the family.
MORBIDITY PATTERN
According to the data obtained from our household survey, any death occurring was
due to natural causes and old age.
ENVIRONMENTAL STATUS
In Gandaki ward no 03, about 81.1%% of the households reportedly used spring water
as their main source of drinking water. 79% of the houses did not purify water before
drinking. 21% purified water only when required eg: sickness.
MATERNAL HEALTH / FAMILY PLANNING
Among the 53 married women of 15-45 years of age interviewed, all of women of
reproductive age group were married within 14 to 26 years of age; 50 % were married
in 20-23 years of age. 13.6% were married early within 14-17 years of age, 31.8%
were married between 17-20 years age. 87.8% of them had heard of family planning,
out of which 50% used pills as major family planning device, followed by depo
use(44.4%) and IUD (5.6%) .
77% mothers of U5 children had PNC visits. 67.7% of them had taken 2 TD shots.
91.7% had completely taken iron tablets and folic acid supplements. The place of
delivery was noted at around 89% in government hospital, 4.5% at hospitals and 6.5%
at home.
CHILD HEALTH SITUATION
All the U5 children surveyed were found to be completely immunized with BCG.
OPV, pentavalent (DPT, HepB, Hib), IPV, MR, JE and PCV vaccines were
administered as per their age.
66.7% were exclusively breastfed for six months. All of the mothers had heard about
sarbottam pitho, while only 57.1% mothers knowing the actual method of making
sarbottam pitho. 26 (92.9%) of women replied that their children were given the
vitamin A capsule.
KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) ON

COMMUNICABLE DISEASES
Out of the 207 respondents interviewed, 58.2% had heard about HIV/AIDS, 61.7%
had heard about TB, 98.5% had heard about Covid-1919, 88.9% had heard about
Diabetes ,47.2% had heard about Heart disease, 59% had heard about Mental
disorders, Regarding HIV/AIDS, 90.7% responded that it is caused by unsafe sexual
contact and 2.8% having no idea of mode of transmission.
COMMUNITY ACTIVITIES
After the process of data analysis was completed, the first community presentation
was conducted at Shree Bhairavashram Madhyamic Vidhyalaya. The first presentation
allowed us to explain our findings based on data collection and FGD to important
community representatives. Then Focused Group Discussion, Micro health Project
and School health Project was conducted subsequently.
FOCUSED GROUP DISCUSSION

Two focused group discussions were conducted, one with Local community residents
and another with Female Community Health Volunteers. Our question for the focused
group discussion with local residents was “what is the health status of your
community and in which aspects do you expect improvements?” Our question for
focused group discussion with FCHV was “what are the problems that females of
your community usually come asking for help and assistance?” Mostly women and
young girls ask for help if somethings wrong with their menstrual cycle, like vaginal
discharge, bleeding and pain.
MICRO HEALTH PROJECT
Two MHPs were conducted on Non Communicable diseases (Hypertension, Joint
problem, Gastritis, Mental health) and Rabies, Environmental Sanitation, Menstrual
Hygiene, KAP on tobacco, Alcohol and Drugs.
CONCLUSION
Gandaki-03, Fujel, with its cultural, religious, economic and geographical diversity,
was found to be in a state of transition from a traditional rural setting to that of a
suburb. Many modern facilities including electricity and internet were present. Due to
some political changes, many aspects of health were not found to be nearly as good as
the National standards. Even for a simple health problem, the local people had to visit
Kathmandu or Gorkha Hospital due to the lack of a well equipped health post. The
KAP of the general public regarding majority of the communicable and non-
communicable diseases was found to be substantially poor. A significant number of
people were found to consult local health post as the 1 st choice for health service due
to lack of choice. Many changes thus remain to be introduced regarding the people's
knowledge, attitude and practices on health, for which appropriate initiatives should
be taken from both local and governing levels.
RECOMMENDATIONS TO THE PEOPLE OF FUJEL:
• Transportation should be improved.
• Establishment of emergency health services must be done as
soon as possible.
• Proper dissemination of information regarding vaccination
programs, health campaigns should be done.
• Waste management system should be establishment.
• Regulation and monitoring of drinking water sources should be
done.
Contents
Declaration and approval sheet 2
ACKNOWLEDGEMENT 3
Summary 4
List of Abbreviations 12
Chapter I: Introduction 15
1.1 Background 15
1.2 Rationale 16
1.3 Objectives 16
1.4 Methodology 17
1.5 Sources of data collection 18
1.6 Indicators in data analysis 20
1.7 Indicators 21
1.8 Validity and Reliability of Information 22
1.9 Inclusion and Exclusion Criteria 23
1.10 Ethical Consideration 23
1.11 Limitations of the study 24
1.12 Logistic management 24
Chapter II- Overview of the ward 25
2.1 Overview of Fujel, Gandaki ward no.03: 25
2.2 Social map of Fujel, Gandaki ward no.03: 26
Chapter III: Methods and approaches 27
3.1 Findings 27
3.2Qualitative Methods 28
3.3 Approaches of different activities 29
Chapter IV: Findings 31
4.1. Demographic findings 31
4.1.1 Demographic characteristics 31
4.1.2 Population Pyramid of Fujel ward-03 31
4.1.3 Major Demographic findings 33
4.2Socio-economic Findings:36
4.2.1 Family Type 36
4.2.1 Occupation 37
4.2.2 Economic Sustainability From Major Source of Income 37
4.2.3Habit of smoking, drinking and chewing tobacco 38
4.2.4 Gender status: 39
4.3 Common Health Seeking Behaviour 42
4.3.1Main source of health related information. 42
4.3.2First choice of health service 42
4.3.3Health insurance 43
4.4Diseases Related Knowledge 44
4.4.1 Knowledge, Attitude and Practice on HIV/AIDS 44
4.4.2 Behaviour shown to HIV infected individuals 46
4.4.3 Knowledge, Attitude and Practice on Tuberculosis 47
4.5Knowledge on Covid-19 49
4.5.1Information About Covid-19 49
4.5.2Mode Of Transmission Of Covid-19 50
4.5.3Information about Vaccine 50
4.5.4Vaccination Status 50
4.5.5history Of Covid-19 Infection 51
4.6Knowledge, Attitude and Practice on Heart Disease 51
4.7 Knowledge, Attitude and Practice on Diabetes 52
4.8 Knowledge, Attitude and Practice on Mental illnesss 54
4.9Environmental status 56
4.9.1 Water 56
4.9.2 Latrine 58
4.9.3 Waste 58
4.10Maternal and Child Health 60
4.10.1 Family planning 60
4.10.2 Maternal Health 63
4.10.3 Antenatal care 65
4.10.4 Delivery care/ Intra-natal care 68
4.10.5 Postnatal care 70
4.10.6 Child Health 73
4.10.7Complementary Feeding Practices 75
4.10.8Information about Basic Diseases Common to Child 76
4.10.9Respiratory Problems 78
4.10.10Immunization Status 78
Chapter V: Qualitative Findings 82
5.1 Focus Group Discussion 82
5.1.1 Focus Group Discussion with local residents 82
5.1.2 Focus Group Discussion with Female Community Health Volunteers (FCHV)
84
5.2 Key Informant Interview 85
Chapter VI: Micro Health Project 86
6.1 Planning of MHP86
6.2 Implementation of MHP 95
6.3 Implementation of School Health Project 95
6.4 Evaluation96
6.5 Sustainability of MHP 97
Chapter VII: Community Presentations 97
7.1 First community presentation 97
7.2 Final Community Presentation 99
Chapter VIII: Conclusion, Recommendations and Learning Reflections 101
8.1 Conclusion 101
8.2 Recommendations to people of Fujel, Gandaki-03,Gorkha 103
8.3 Learning Reflections 104
References 106
Annex- I: Plan of Action 107
Annex-II: Questionnaire for household head108
Annex-III: Questionnaire for mother with U5 child 115
Annex- IV: Formulae Used 121
Annex-V: Appreciation letters and other documents: 122
Annex-VI: Pictures Gallery: 125
List of Abbreviations
AIDS Acquired Immune Deficiency Syndrome
ANC Antenatal Check up
ARI Acute Respiratory Infection
ASFR Age-Specific Fertility Rate
BCG Bacillus Calmette Guerine
CBR Crude Birth Rate
CBS Central Bureau of Statistics
CDR Crude Death Rate
CHD Community Health Diagnosis
Cm Centimeter
CPR Contraceptive Prevalence Rate
DCM Department of Community Medicine
DoHS Department of Health Service
DOTS Directly Observed Treatment Short Course
DPT Diphtheria, Pertussis, Tetanus
EPI Expanded program on Immunization
FCHVs Female Community Health Volunteers
FGD Focus Group Discussion
FP Family planning
GFR General Fertility Rate
GHF Government Health Facility
Hep. B Hepatitis B
Hib Haemophilus Influenzae type b
HIV Human Immunodeficiency Virus
HW Health Worker
ICS Improved Cooking Stove
IEC Information Education and Communication
IMCI Integrated Management of Childhood Illness
IMR Infant Mortality Rate
INGO International Non-Governmental Organization
IOM Institute of Medicine
IUD Intra-Uterine Device
JE Japanese Encephalitis
KAP Knowledge, Attitude and Practice
LPG Liquefied Petroleum Gas
LRTI Lower Respiratory Tract Infection
MBBS Bachelor in Medicine and Bachelor in Surgery
MCH Maternal and Child Health
MDG Millennium Developmental Goal
MHP Micro Health Project
MMR Maternal Mortality Ratio
MoHP Ministry of Health & Population
MUAC Mid Upper Arm Circumference
NAYS Nepal Adolescent and Youth Survey
NCD Non Communicable Diseases
NDHS Nepal Demographic and Health Survey
NGO Non-Governmental Organization
NMR Neonatal mortality Rate
NNP Neonatal Period
ORS Oral Rehydration Solution
PEM Protein Energy Malnutrition
PHCC Primary Health Care Center
PNC Post Natal care
PNP Post Natal Period
Q and A Question and Answer
SBA Skilled Birth Attendant
SDK Safe Delivery Kit
SHP School Health Programme.
SN Serial Number
SODIS Solar Disinfection
Sq. km Square Kilometer
STD Sexually Transmitted Diseases
STI Sexually Transmitted Infections
TB Tuberculosis
TBA Traditional Birth Attendance
TCS Traditional Cooking Stove
TFR Total Fertility Rate
TT Tetanus Toxoid
TU Tribhuvan University
TV Television
U5 Under Five
U5MR Under five Mortality Rate
VDC Village Development Committee
WHO World Health Organization
Chapter I: Introduction
• Background
WHO defines Community Health Diagnosis as “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”.
Another comprehensive description of Community Health Diagnosis has been
procured by Dr. Cynthia Hale et al, who explains it as "a comprehensive assessment
of the health status of entire community in relation to its social, physical and
biological environment. Its purpose is to define existing problems, determine
available resources and set priorities for planning, implementing and evaluating health
actions by and for the community. "
Health is multidimensional, and so are its determinants. It is only after the assessment
of multiple factors that are capable of affecting one's health that we can come to a
valid conclusion on where the health status of a country stands. A community can act
as a basic unit allowing examination of several of these factors. Community Health
Diagnosis can therefore act as an effective indicator of national health situation.
The major objectives of Community Health Diagnosis are:-
• Analyze the health status of the community
• Evaluate the health resources, services, and systems of care
within the community
• Assess attitudes toward community health services and Issues
• Identify priorities, establish goals, and determine courses of
action to improve the health status of the community
• Establish an baseline information for measuring improvement
over time
Community health diagnosis is thus a process of assessing the overall health status of
a community using both qualitative and quantitative measures with an intention to
promote health, prevent disease and manage health services for the community people
through optimum utilization of locally available resources as well as active public
participation. It should be simple, comprehensive, efficient, effective and timely
updated so that it reflects the real health situation and provides a strong foundation for
further planning, resource allocation and formulation of health programmes for the
community.
1.2 Rationale
• Community Health Diagnosis, as the name implies, is
concerned with the identification of basic health needs of the community by
the comprehensive assessment of health determinants and available resources.
It helps to suggest priority areas for intervention and feasible solutions to
prevalent health problems.
• The information obtained after making community diagnosis
can be relevant to concerned authorities for planning, resource allocation and
for formulation of health policy for the community.
• When executed during the phase of learning, CHD can greatly
enhance a student's understanding of real-life situations and develop his/her
decision making skills, ethics, knowledge, attitude, cooperation and
participation in the society.
1.3 Objectives
General Objective
To develop knowledge and skill on the process of community health diagnosis
including assessment of health status of community and conduct appropriate action
regarding health problems that are prioritised as per available resources
Specific Objectives
• To study the geography and demographic profile of the
community and present status and trends of fertility, morbidity, migration and
mortality
• To assess the socioeconomic and environmental health related
scenario of the community including gender status and cultural practices
• To comprehend knowledge, attitude and practices, and health-
seeking behaviour of the community people regarding health and diseases
• To identify the situation of maternal, child, adolescent and
geriatric health of the community
• To use the existing and potential resources of the community to
aid micro-health projects on prioritised health needs with public participation.
1.4 Methodology
• Study area: Fujel, Gandaki gaupalika ward no.3
• Study population: Residents of Fujel ward-03
• Study design: Descriptive cross-sectional study including both
qualitative and quantitative methods
• Unit of analysis:
• Heads of household (for demographic, socioeconomic,
environmental, nutritional and disease related information)
• Mothers of U5 children (for maternal and child health
related information)
• Adolescents aged 10-19 years (for adolescent-health
related data)
• Sampling frame: approximately 700 as per ward office data (no
exact data due to restructuring of the ward after declaration)
• Sample size: 207 households
• Sampling unit: Each household of the sample
• Sampling technique: Stratified Proportionate Systematic
Random Sampling for household survey
The head of the household was considered as the primary respondent. In situations
where the head of household was not present or not compliant to provide us the
information him/herself, any member from the family above 16 years of age, or
one recommended by the head of household provided he/she was above 16 years
of age was considered as the interviewee. A mother of U-5 child and elderly above
60 of the same household were also selected for the interview. For the self-
administered adolescent questionnaire, adolescents were selected from local
schools.
1.5 Sources of data collection

Primary source: Primary data means original data that has been collected
specially for the purpose and presented for the first ti
0me. Primary data was collected through General observation, Focused Group
Discussions, Questionnaire survey, etc. The tools and techniques are explained as
follows:
Table I: Survey tools and techniques
SN
Techniques
Tools
Participant(s)
1
Interviews
Interview schedule: Tool 1
• Head of household
Interview schedule: Tool 2

• Mothers of U5 children
Informal question answer session

Self-administered questionnaire
School development board chairperson, Principal, teachers, staff members, local
leaders
2
Observation
Observation checklist
-
3
Anthropometry
Anthropometric instruments
Children aged 5 years or less
4
Examinations
Coliform test kit
-
5
Social mapping
Local resources
-
6
Focus Group Discussions
Guidelines
Ward members, ward chairperson, school principal, local people
Secondary source
Secondary data refers to data that is collected by someone other than the researcher.
Common sources of secondary data include censuses, information collected by
government departments, organizational records and data that was originally collected
for other research purposes.
The available ward profile, health post and school records, vaccination cards and
research publication work of one of the local resident Thakur Panta (a teacher in the
local school) were extensively studied.
Data processing and analysis
The preliminary data collected in our survey, though gathered systemically in the
form of structured questionnaires and checklists, was raw. After collection, the data
was classified into different categories and necessary coding was completed to
facilitate the entry. IBM SPSS software, was used for entry and analysis was done
using MS Excel and SPSS.
Data analysis followed the stage of processing. Descriptive method of analysis was
used that included preparation of tables, graphs and charts. Rates, ratios, proportions
as well as measures of central tendency were calculated to get the interpretation. Most
data underwent univariate analysis, while a few like education and gender status were
subjected to bivariate analysis as well.
1.6 Indicators in data analysis

Physical environment
• Type of house
• Ventilation in house
• Lighting in house
• Drinking water supply
• Sanitary facilities: toilet, waste disposal
• Presence and positioning of cowshed
Biological factors
• Name, age, sex of each family members
• Nutritional status of U5 children
• Immunization of children
• Births within the past year
• Symptoms of illness within the past month
• Mortality within the past year
Socio-economic factors
• Ethnicity, religion, occupation, employment status, family size
• Migration within the past year
• Economic status
• Educational status
• Child feeding practices-breastfeeding, weaning, supplementary
feeding, complementary feeding
• Nutrition supplementation practices- vit. A, iron tablets,
superflour, iodized salt
• De-worming tablets
• Family planning practices (temporary and permanent
contraceptive methods.)
• Maternal and child care practices- pregnancy, delivery and post
partum care
• Sources of health information
• KAP regarding communicable (HIV/AIDS, TB, COVID-19 19)
and non-communicable (heart disease, Diabetes Mellitus, mental disorders)
diseases
• Gender differences (child preference, property ownership, role
in decision making and financial management)
1.7 Indicators
Demographic indicators
• Total population
• Proportion of population above 65 years
• Proportion of population of age 0-14
• Crude birth rate
• Crude death rate
Natality indicators
• General fertility rate
Morbidity indicators
• Type of disease
• Frequency of disease
Socio-economic indicators
• Source of income
• Female ownership of family property (%)
• Child's gender preference (%)
• Proportion of population that smokes or drinks (%)
• Literacy Rate
Environmental status indicators
• Major source of drinking water (%)
• Population with access to safe water (%)
• Households having sanitary toilets (%)
• Households having adequate distance between shed and house
(%)
• Percentage distribution of household by types of fuel used
• Percentage distribution of households that use ICS
• Percentage of households with proper waste disposal
• Population with access to safe water (%)
• Percentage distribution of houses with adequate illumination
Primary health care coverage indicators
• Immunized children between (12-24) months (%)
• Dewormed and Vit-A tablets administered children (%)
• Pregnant women immunized with TT (%)
• Population with access to local health services (%)
• Delivery practices
• ANC/PNC practices
Reproductive health indicators
• Contraceptive Prevalence Rate

• Median age at first marriage(female)
• Median age at first childbirth (female)
• % of people using permanent method
• % of people using temporary method
Child health indicators
• % of immunized children
• % of children who get hospital facility during minor disease
like diarrhea, common cold, fever, etc
Nutritional health indicators
• Anthropometric measurements
Behavior health indicators
• % of people who smoke or chew tobacco
• % of people who drink alcohol
• % of people having health seeking behavior for 1 st time after
being illness
1.8 Validity and Reliability of Information
In order to assure the validity and reliability of the collected information, the
following activities were performed:
• Orientation classes were attended before the CHD program.

• Extensive literature review was carried out.
• Pretesting of questionnaire was done in Jhor, Tokha ,
Kathmandu
• The tools and instruments used for data collection were
properly examined and calibrated.
• Post dinner meetings, self-checking & cross checking of filled
information were executed.
• There was regular supervision and guidance from the teachers

and local supervisor throughout the field experience.
• Qualitative discussions to test quantitative findings, particularly
for women, elderly and health related issues were also carried out
1.9 Inclusion and Exclusion Criteria

Inclusion Criteria
• Only members of the household 17 years of age or older
without any major mental disability or intoxication were chosen as
respondents.
• For more than one under-5 children in the same household, the
information on anthropometry, immunization and intake of vitamin A and de-
worming tablets were taken for the all of the children.
• For more than one married woman of 15-45 years age group,
the data regarding family planning was obtained from the wife of house
owner.
• For more than one mother of under-5 child in the same

household, interview of all the mothers were taken.
Exclusion Criteria
• Non responsive households were excluded from the survey.
1.10 Ethical Consideration

• Purpose and objectives of study were explained to all
respondents before conducting any interview.
• Consent was taken after making sure that they understood the
interview’s theme.
• Confidentiality of information was assured and maintained.
• True assurances were made during the survey, and our status
was duly clarified.
• Freedom was allowed and explained to end the interview at any
given time, or to skip any questions if not comfortable with answering them.
• The self-respect and dignity of all respondents was taken with
high priority, and the behavior of all interviewers was kept strictly humble and
composed.
• Sources of water samples for the coliform kit were kept
confidential.
1.11 Limitations of the study
• Due to the very difficult landscape and topography, it was not
feasible to cover the distant households we estimated to collect.
• We were unable to meet several mothers of U5 children in the

village as the time for survey coincided with festival of Teej.
• Furthermore, entire families would often be absent from their

homes, living in Kathmandu or Gorkha, or gone for treatment and working
purposes.
• The anthropometric devices provided by the campus proved to

be insufficient, nor were the coliform kits enough to cover each tole.
• Sudden outbreak of Rabies and frequent attacks of rabid dogs

was one of the hindrances.
1.12 Logistic management

Stationery
Basic stationery materials including chart papers and colored markers were provided
by the campus. They proved to be insufficient throughout the field program and we
used A4 size papers, coloured pencils and other stationeries of our own.
Tools for anthropometric measurement

One of the major components of community diagnosis is the nutritional assessment
of U5-children. This assessment requires the use of certain measuring instruments
like weighing machine (bathroom scale), Shakir’s tape and tailor’s tape. The campus
provided us with one bathroom scales, one Shakir's tape and three Tailor's tape. The
health post provided us with just one additional Shakir’s tape, so the lack of these
tools created considerable limitations in the survey.
Financial support and transportation

The financial support of Rs.19,500 at the rate of 650 per day for thirty days was
provided to each student by the campus. The campus also arranged for our arrival
and departure from Fujel.
Lodging and fooding

Under the hospitality of Mrs. Heera shrestha and her family, the team was residing at
Aamdada tole of Fujel. We were accommodated in three rooms, two for boys and one
for girls. The lodging and fooding cost were affordable.
Chapter II- Overview of the ward

2.1 Overview of Fujel, Gandaki ward no.03:
Introduction:
The ward no. 03 of Gandaki Municipality in Gorkha District in Gandaki Province . It
is situated on the southern end of Gorkha district, nearly 74 Kilometers from
Charikot, its district headquarters. This ward in hilly region extend from 700m to
940m meters from the sea level. Its coordinates were 27.9122070ᴼ N and
84.7103875ᴼE. It is 99 Km from Maharajgunj Medical Campus, Kathmandu by road.
Phujel, Gandaki ward no. 03 is a very beautiful place with many scenic natural places
and the municipality of Gandaki also provided us a myriad of learning oppurtunities.
The climate is mostly hot. It is often foggy in the mornigs and evenings. Fujelhas a
limited diverse ethnicity. There are Brahmins and Newars in majority while there are
few Magars, Damai, baram and other ethnic communities. This roughly corresponds
to the languages spoken, where Nepali is the most common followed by Newari. The
only health institution in ward no. 03 is a temporary health post located in Arkhale
tole. A new modern Health Post was under construction. There are 2 schools, 1
primary and 1 secondary school. A police station was situated far away from the ward.
Resources:
The most important natural resource in Fujelis arable land present due to its
perennial water sources. Irrigation facilities are also well developed there. Natural
sources of water (spring) are major resources. Forests of the hills were important
source of firewood, timber. Many wild animals, exotic birds, butterflies and spiders
were also sighted during our stay.
2.2 Social map of Fujel, Gandaki ward no.03:
The social map of Fujelwas prepared by the help of people accustomed to the terrain
and localities, namely local leaders, teachers, following the true spirit of our Ward
Chairperson . The major points that we sought to include in the map were hills, foot
trails, forests, settlements, temples, health and educational institutions as well as any
other landmark that could assist us in the survey which was set to start soon.
A Social Map of the Ward was prepared via the use of local resources like sand, soil,
stones, grasses, leaves, water, mosses, papers, etc. We also used the reference of map
obtained from survey publication of Thakur sir. The maps we used is shown in the
picture below:
Figure: Social Map of Fujel ward no.03 – Outdoor Map
Figure: Social Map of Fujel ward no.03 – Printed Map
Chapter III: Methods and approaches

Considering the fact that the objective of the study was to gain a comprehensive
picture of the health scenario in Fujel ward no.03, both quantitative and qualitative
methods were used that acted complementary to each other, as well as helped to
validate and confirm our findings.
3.1 Findings
The ultimate tale-tellers in any research are numbers, and it is this very value of
statistics in research that made us give foremost priority to quantitative methods of
data collection in our study. As was mentioned before, both primary and secondary
sources of data were used to obtain quantitative values. The most important source of
primary quantitative data was the household survey conducted over a span of 9 days.
Coliform tests performed on water samples were also primary sources of qualitative
data. Upon thorough study of health records from ward office and health post, FCHV
registers, school records we obtained the secondary data which came of great help for
us to compare and analyse the information we collected. The data about stratification
of toles within the ward came out to be of enormous importance in conducting our
survey.
Sample Survey: We performed a sample survey visiting houses present in the
sample, interviewing them about their health as well as other demographic, socio-
economic and environmental indicators. Owing to the protracted distance between
two households, we allocated 9 days period completely for data-collection. The sparse
distribution of houses made us take hours to reach every households and even posed
many obstacles which anyway, was to become a sweet memory for us forever after.
Despite every turbulence, the total houses for our survey eventually counted 207.
With only four coliform kits available, water sources that maximum number of people
utilized were chosen for performing our tests. The source of the sample water was
taken from the natural spring.
Tools used in quantitative techniques of data collection:
Structured questionnaire was the tool used for household survey. Likewise,
anthropometric measurement of under five children was done using bathroom scale,
tailor’s tape and Shakir’s tape. For the development of the questionnaire, each team
had been provided a facilitator during the orientation classes, as well as appointed a
particular topic to cover. Later, the questions were provided by the campus and a
pretesting session was conducted in Jhor, Tokha municipality, Kathmandu. The
loopholes and errors in the tool were corrected, important questions were added and
necessary editing was done to bring the questionnaire to its final form.
3.2Qualitative Methods
Many of the quantitative findings in any research often require more than just plain
numbers to explain and understand. Further, their validity and necessary inferential
analysis is also not always possible with facts and statistics alone. This is where
qualitative methods come into play. Several informal interviews were conducted from
the moment we stepped into Fujel ward-03. The locals, ward chairperson and other
activists participated in our queries and provided much of the vital information needed
to understand Fujel ward-03, social mapping being a good example. For issues
demanding expert opinion, a more structured form of questionnaire was developed.
One such key informant interview was carried out- with a ward member. One focus
group discussion was also conducted aimed at identifying the major problems felt by
the ward chairperson, ward members, teachers and community people.
Interview guidelines, FGD guidelines and notes were the major tools used during
qualitative data collection.
3.3 Approaches of different activities
Focused Group Discussion was carried out not only for the verification of the major
issues that were analyzed from our findings but also to better comprehend topics
about which the quantitative results were not sufficient. The number of participants
was kept about 10. Moderators, observers and recorders were appointed in each
discussion session.
Key informant interview:
For practices we found contradicting to our previous beliefs, or those that needed
expert opinions to truly comprehend, key informant interviews were conducted
informally. It was carried out with ward chairperson, ward …… individually.
First community presentation:
After the process of data collection was over, the First Community Presentation was
conducted on 7 september,2022 at Shree Bhairavashram Madhyamik Vidhyalaya. A
descriptive demonstration of all findings from the data collection and FGD were
presented to the community. School development board chairperson, Principal,
teachers, staff members, local leaders from other tole of ward were the attendees.
Micro Health Project:
After first community presentation and FGD, Micro Health Project was conducted as
per the real needs drawn from observed needs and felt needs. The Micro Health
Project was conducted on the broad topic of Non Communicable Disease, which
included Hypertension, joint problem, gastritis, mental disorders;and Rabies ;and
included use of informative lecture with the aid of descriptive chartpapers. It was
primarily targeted towards working and old age population of the community. Further
evaluation and sustainability of the project was checked through informal question
answer session and discussion right after the program during the second community
presentation. Most of the people comprehended our teachings well enough and were
positive towards bringing positive changes for a healthy lifestyle and disease
prevention.
School Health Project:
School Health Project was an additional program, an add-on to our Micro Health
Project and a thank you gesture to the school for providing us with the resources,
presentation venue and valuable insight to their community people. The prime
objective of the program was to bring about positive behavioral and intellectual
changes regarding the following health topics: Tobacco, alcohol and drugs usage,
Environmental sanitation, menstrual hygiene. Health workshop using informative
chart papers, lecture, training session on correct handwashing technique was the
methodology used. The target group was teenagers and adolescents.
Final community presentation:
Final community presentation was carried out after the planning, implementation and
evaluation of MHP, with the objective of Experience sharing, Evaluation of outcome
of MHP, Suggestions to sustain the teachings from MHP, Vote of thanks. The
programme also acted as our formal farewell to Fujel, Gandaki gaupalika ward no. 03
and its residents.
Chapter IV: Findings

4.1. Demographic findings
4.1.1 Demographic characteristics
Literally implying the 'study of people', Demography is the scientific study of human
populations, primarily with respect to their size, their structure and their development
(U.N 1958). In other words, demography is the scientific study of human populations,
including their sizes, compositions, distributions, densities, growth and other
characteristics as well as causes and consequences of changes in these factors. It
deals with both static and dynamic aspects of population. Demography of a place
can have massive influences on its health status due to which CHD aims to understand
the demographic profile of the community being studied.
We took data from 207 households. The age-sex table is better elaborated in the
following pyramid.
4.1.2 Population Pyramid of Fujel ward-03

Population pyramid is the graphical representation of population composition by age
and sex. The total population of 808 was classified into different age groups with an
interval of 5 years and then further classified as per sex. The pyramid obtained is as
follows:
The pyramid is of early expansive and late constrictive type, a characteristic feature of
developing countries. Maximum proportion of the population (41.68%) is between the
ages of 40 and 60. Below this, however, the population seems to have taken a
constrictive pattern which can be accredited to increasing awareness of Fujel ward-03
families on contraception as well as on the need of a small family. The pyramid also
shows that the population above 65 stands at a substantial 5.13%.
4.1.3 Major Demographic findings

Following are our major findings obtained from Fujel, Gandaki Gaupalika ward-03
Table 1: Demographic findings
Demographic parameters
Finding
Total Population Fujel ward-03
2694
Sex Ratio
96 males per 100 females
Average Household Size
2.63 person per HH
Literacy Rate
73.6%
Crude Birth Rate(CBR)
12.4 per 1000
General Fertility Rate(GFR)
100.92 per 1000
Total Fertility Rate(TFR)
3.12 per woman
Crude Death Rate(CDR)
9.53 per 1000
Disability Rate
1.16%
Total Dependency Ratio
45.01
Child Dependency Ratio
37.57
Elderly Dependency Ratio
7.44
Source: Field Survey, 2022
1. Sex ratio
The total number of males for every 100 females in a population is known as sex
ratio. Certain countries like India also calculate this as the total number of females per
1000 males. The survey showed that there were a total of 96 males for every 100
females, which is higher than the national statistic of 94.2 males per 100 females. Out
of, males occupied 49.02% of the total population, while females occupied 50.98%.
2. Family size
When total population was divided by the number of households, the average
household size was determined to be 2.63 members per family, larger than the
national value of 4.7. The largest family encountered had 8 members, while the
smallest had 1.
3. Literacy rate
Part of the population equal to or above five years of age was considered in
calculation of literacy rate. The survey showed that 73.6% of Fujel ward-03's
residents were literate. The national average for literacy is 65.9%, compared to which
the ward’s is ahead.
4. Fertility
Fertility is the actual child bearing performance of a woman, in contrast to fecundity
which is her natural capacity to procreate. Fertility is one of the three major
determinants of population dynamics. Some indicators of fertility in Fujel ward-03
ward are explained here:
• Crude Birth Rate (CBR):

CBR is defined as the total number of live births per 1000 mid-year population of
the given year. Fujel ward-03's CBR was calculated to be 12.4 per thousand, more
than the national figure of 21.8 per 1000.
• General Fertility Rate (GFR):

GFR is defined as the number of total live births per 1000 women of reproductive
age group (15- 49 years) in a given year. It was 100.92 per 1000 women of
reproductive age, also nearly equal to the national statistic of 95 per thousand
women.
• Total fertility rate (TFR)

The total fertility rate (TFR) is the average number of children that would be born
to a woman during her reproductive period if she were to pass through all her
childbearing years conforming to the age-specific fertility rates of a given year.
For Fujel ward-03, the survey showed that each woman bore 3.12 children during
her reproductive years. This figure is greater than the national value according to
which each Nepali woman bears 2.5 children on average (NDHS 2011).
Regarding birth control, Fujel ward-03 thus seemed quite ahead of the national
scenario. Much of this progress can be attributed to the high literacy rate as well
as the active advocacy of the use of contraception.
5. Dependency ratio
The proportion of people above 65 years of age and children below 15 years of
age are considered to be dependent on the economically productive age group of
15-64 years. Child dependency ratio was found to be 37.57 per 100 independent
people, which is much smaller than the national value of 61.3. This is due to the
declining trends of all fertility indicators. The elderly dependency ratio, at 7.44
per 100 independent people, stands less than the national average of 14.3 which
can again be accounted to the less geriatric population in the ward. Yet, the
overall dependency of 45.01 percent is still much smaller than the national data
of 75.6 accountable to the fact that much of the population is present in the 15-24
age group.
6. Mortality:
Mortality refers to the permanent disappearance of all signs of life. It is an important
demographic determinant responsible for decline in population. It is also a good
indicator of health status of a community.
• Crude Death Rate (CDR):

The total number of deaths per 1000 mid-year population within a given year of a
defined area is called the Crude Death Rate. Fujel ward-03's CDR was calculated
to be 9.53 per thousand, which is more than the national value i.e. 7.9 per
thousand.
7. Migration
Data for permanent migration of people wasn’t found accurately. However, most
families had few of their members migrated permanently to Kathmandu, Gorkha or
other urban areas.
8. Disability
Disability is defined as a physical or mental impairment that substantially limits one

or more major life activities. In our survey, any physical or mental impairment
including the inability to walk were considered to be a disability. Based on this,
1.16% were found to be disabled compared with the national figure of 1.94%.
9. Morbidity
Morbidity is defined as “any departure, subjective or objective from the state of
physiological well being”. Morbidity rates are used to quantify morbidity of
population in terms of Number, duration and severity. They serve as starting point for
etiological studies and thus play a crucial role in disease prevention and control. The
most common diseases seen in Fujel ward-03 during our survey are: Common cold,
diarrhea, fever and headache, generalized body ache, asthma, arthritis, gastritis.
4.2Socio-economic Findings:
4.2.1 Family Type
According to our findings from tool 1, the family type that was most common was
joint, i.e. 3 generations of the family living under the same roof. However, family
constituting of only elderly couple with the other members residing in cities were also
prominent.
4.2.1 Occupation
Agreeing with the national figure, 45.3% of Fujel ward-03's residents were recorded
to be involved or majorly associated with agriculture. Other professions are shown
here:
Table 2: Occupation wise distribution of people of Fujel
Major source of income
Percent
None
5
Agriculture
45.3
Business
4.7
Service
5.9
Student
21.8
Labour
0.9
Foreign employment
5.4
House Wife
11
Total
100
These were the primary sources of income for the family, and not necessarily the
occupation of each member of the family. 'Others' here includes answers like labour,
freelance jobs and other forms of service that did not fit the specified classes of
occupation.
4.2.2 Economic Sustainability From Major Source of Income
The interviewees were asked if their main source of income was sufficient enough to
arrange food for the family throughout the year. The statistics obtained are presented
in the table below:
Table 3: Economic Sustainability from Major Source of Income
Criteria
Percentage
Enough
57.3
Not enough
42.7
Out of the total population surveyed ,57.3 percent were unable to sustain their
expenses and living for a year just from their major sources of income. Their income
were further supplemented by livestock, labour work in cities, foreign employment,
social security etc.
4.2.3Habit of smoking, drinking and chewing tobacco
When asked the respondent whether he/she smoked, drank, or was indulged in
chewing tobacco, they replied in different ways of which we have classified on the
following tables:
Table 4: Smoking pattern
Number
Percent
Often
44
21.2
Sometimes
6
2.8
Never
157
75.8
Table 5: Alcohol consumption

Number
Percent
Often
13
6.2
Sometimes
3
1.4
Never
191
92.2
Table 6: Tobacco
Number
Percent
Often
45
21.7
Sometimes
2
0.9
Never
160
77.2
A number of population that smoked or drank can be attributed with the fact that a
considerable part of the population was composed of Newars in whose culture
drinking is acceptable and practiced often. The rates seem very low from the survey
but actually, as per our assumption are a lot higher than this because the people don’t
openly admit to their habits and this creates the iceberg result.
4.2.4 Gender status:
Table 7: Preference of male children
Number
Percent
Male
89
43
Female
9
4
Both
109
53
Total
207
100
Gender preference in Fujel ward-03's society seems reasonable and excellent. Out of
207 households surveyed, 53%of the respondents answered they would prefer either
of boy or girl as their first child. 43 % preferred boy, whereas 4% of the respondents
answered that they would prefer girl.
B. Participation in Social works and event
Table 8: Participation in Social works and event
Number
Percent
Male
124
60.1
Female
23
10.8
Both
60
29.1
Total
207
100
In most of the family (60.1%) males were found to participate on Social works, events
and meetings. 10.8% of the respondents answered that females take part on such
activities whereas 29.1% of households were found to have equal participation of both
male and female.
C. Economic transaction control
Table 9: Economic transaction control
Number
Percent
Male
142
69.0
Female
17
8.4
Both
46
22.7
Total
207
100
When we asked which member of the family performs economic transaction in the
house, 69% of the respondents answered male; while females also perform economic
transaction in 8.4% of households. However, 22.7% households had both the genders
involved in economic transaction.
D. Ownership of property
Table 10: Ownership of property
Number
Percent
Male
143
69.5
Female
40
19.7
Both
24
10.8
Total
207
100
When asked which member of the family owns the family property, 69.5% of the
owners were found to be males; while 19.7% of the females owned their property.
Remaining 10.8% households had both the genders involved in economic activity and
property ownership.
E. Decision making
Table 11: Decision making
Number
Percent
Male
99
48.3
Female
16
7.9
Both
92
43.8
Total
207
100
When asked about the gender of the person taking the important decision in the
family, it was evident that the patriarchial family system was still rooted in their
minds as 48.3% respondents answered the decision makers in their family as male.
7.9% of the respondents answered female and 43.8% replied that there was equal
participation of male and female in decision making in the family.
4.3 Common Health Seeking Behaviour

4.3.1Main source of health related information.
Table 12:Main source of health related Information
Health Related Information
Number
Percent
Radio/TV
154
74.5%
Health workers
117
56.3%
FCHVs
19
9.4%
Educational institution
9
4.2%
Poster/Pamphlets
3
1.6%
internet/mobile
30
14.6%
Most of the people received health related information through tv and radio. Internet
and Smartphones also have started becoming an important source of health related
information.
4.3.2First choice of health service
Table 13: First Choice for Health Services
First choice for health services
Number
Percent
Public health centre
193
93.0%
FCHVs
0
0.0%
Dhami/Jhakri
1
0.5%
Clinic/Nursing home
13
6.5%
For almost all the people the first choice of health services was public health
centre ie local health post (swaasthya chauki) since the hospitals or private
practices were far from immediate access.
4.3.3Health insurance
• Information on health insurance
Table 14:Information on Health Insurance
Info about Health Insurance
Number
Percent
No
86
41.4%
Yes
121
58.6%
58.6% people had information about health insurance while 41.4% had no idea about
it. Those who knew about insurance also knew that insurance is implemented in their
gaupalika.
• Family Insurance
Table 15 : family insurance (N=121)

People with
Number
Percent
No
19
15.6%
Yes
102
84.4%
Of the 121 respondents who knew about insurance, 84.4% had medical insurance
done of their family members.
• Reason for not having Family Insurance
Table 16: Reason for not having family insurance (N=19)
Reasons Of Not Doing Family Insurance
Number
Percent
Not Necessary
5
26.3%
Lack Of Money
14
73.7%
Of the remaining 19 people, 73.7% reported financial difficulty as reason for not
doing the insurance even though they had knowledge about it.
4.4Diseases Related Knowledge

The respondents had been asked about different aspects of three communicable
diseases, namely HIV/AIDS, tuberculosis, and COVID-19-19.
For each of these diseases, it was first asked where they had heard about the diseases.
Only those respondents who had heard about the respective diseases were asked the
remaining questions related to the same disease.
Table 17: People who had heard about the communicable diseases:
SN
Name of Disease
Number
Percentage
1
HIV/AIDS
121
58.4
2
Tuberculosis
128
61.8
3
COVID-19
204
98.5
4.4.1 Knowledge, Attitude and Practice on HIV/AIDS
HIV/AIDS is a sexually transmitted infection caused by Human Immunodeficiency
Virus (HIV). AIDS is the final stage of HIV infection. Not every person with HIV
advances to the AIDS stage. People with AIDS have severely crippled immune
system, which puts the individual at risk of opportunistic infections. It is not AIDS
itself which kills the diseased person, but it is the opportunistic infections. It transmits
not only through unsafe sexual contact, but also through unsafe transfer of blood or
tissues, and mother-to-child transmission. It is a major public health problem
worldwide.
58.4% of the respondents had acknowledged that they heard about HIV/AIDS. People
did not want to talk about HIV/AIDS as openly, which also accounts for the low
percentage.
A. Knowledge on the mode of transmission of HIV/AIDS

Table 18: Knowledge on the mode of transmission of HIV/AIDS
SN
Mode of Transmission
Number
Percentage
1
Unsafe sex
105
50.7
2
Blood/Organ Transplantation
88
42.5
3
Unsterilized Syringes
81
39.1
4
Transplacental Transmission
87
42.0
5
Do not know
86
41.6
Most of the respondents (50.7%) knew that HIV/AIDS is transmitted through unsafe
sexual contact. 42.5% knew about Blood transfusion and organ transplantation
whereas 39.1% knew unsterilized syringes as possible modes of transmission. Also,
42% answered vertical transmission. 41.6% had no exact idea.
B. Knowledge on Treatment of HIV/AIDS

Table 19: Knowledge on the treatment of HIV/AIDS (n=121)
SN
Availability of treatment
Number
Percentage
1
Yes
43
35.5
2
No
53
43.9
3
No idea
25
20.6
35.5% of the respondents were aware about the existence of treatment of HIV/AIDS.
C. Knowledge on prevention of HIV/AIDS
Of those who had heard of the condition, when asked about the preventive aspect of
the disease, 74.3% said that avoiding unsafe sex was a preventive measure. Almost
three quarters of the respondents (72.7%) knew that avoiding contaminated blood
transfusion played a role in preventing the disease. 70.2% agreed that avoiding
contaminated syringe is a preventive measure.23.1% of those who had heard abot the
disease had not idea about its prevention.
Table 20: Knowledge on Prevention of HIV/AIDS (n=121)
SN
Preventive measures
Number
Percentage
1
Avoid unsafe sex
90
74.3
2
Avoid contaminated blood transfusion
88
72.7
3
Avoid exchange of contaminated syringe
85
70.2
4
No idea
28
23.1
4.4.2 Behaviour shown to HIV infected individuals
Table 21: Behaviour shown to HIV infected individuals
SN
Behaviour
Number
Percentage
1
Stay away
50
24.5
2
Stop normal conversation
6
2.8
3
Normal behavior as usual
23
11.3
4
Help the victim
126
61.3
11.3% of the respondents answered that they would behave normal as usual with the
HIV infected patients whereas 61.3% responded that they would help the victim.
24.5% people would have stayed away from the infected person.
4.4.3 Knowledge, Attitude and Practice on Tuberculosis
Tuberculosis is a chronic communicable disease caused by the bacterium
Mycobacterium tuberculosis. It primarily affects lungs and causes pulmonary
tuberculosis, but can also affect the intestine, lymph glands, skin, etc. In spite of the
availability of highly effective drugs and vaccine which make tuberculosis a
preventable and curable disease, it continues to pose concern as a very common health
problem.
The survey showed that 61.8% of the total respondents had heard about tuberculosis.
A. Knowledge on transmission of tuberculosis
The mode of transmission was correctly mentioned by majority of the respondents
(70.3%) i.e. through coughing and sneezing. 35.1% answered blood, 41.4% answered
excreta and 74.2% answered contact with infected person as the mode of
transmission.
Table 22: Knowledge on transmission of tuberculosis(n=128)
SN
Mode of transmission
Number
Percentage
1
Droplet infection
90
70.3
2
Blood
45
35.1
3
Excreta
53
41.4
4
Contact with the victim
95
74.2
B. Knowledge on treatment of tuberculosis

Table 23: Knowledge on treatment of tuberculosis
SN
Number
Percentage
1
Yes
104
81.2
2
No
14
10.9
3
Do not know
10
7.8
Among the respondents who had heard about tuberculosis, 81.2 % knew about the
availability of its treatment.
C. Center for TB treatment
Most people who knew about the disease also knew that the treatment facility are
available in local as well as private facility. 65.4% people knew treatment facilities
are available at local governmental health institution, 31.7 said private clinic is the
treatment centre.
Table 24: Center for TB treatment
SN
Center for treatment
Number
Percentage
1
Local Government Health Institution
84
65.4
2
Private clinic
41
31.7
3
Other
3
3.3
D. Fees for TB treatment in government health institution

Table 25: Fees for TB treatment in government health institution
SN
Fee of treatment
Number
Percentage
1
Yes
68
53.8
2
No
60
46.2
E. Information on DOTS treatment system
Table 26: Information on DOTS treatment system
SN
Information on DOTS
Number
Percentage
1
Yes
8
6.3
2
No
120
93.7
93.7% of the respondents didn’t know about the treatment plan of tuberculosis or ever
heard about DOTS.
4.5Knowledge on Covid-19
4.5.1Information About Covid-19
Table 27:information about COVID-19
COVID-1919 info
Number
Percent
No
3
1.5%
Yes
204
98.5%
4.5.2Mode Of Transmission Of Covid-19

Table 28: MODE OF TRANSMISSION OF COVID-19
MOT of COVID-19
Number
Percent
Contact with the victim
165
79.5%
Droplet Infection
177
85.5%
By Touching
156
75.5%
By Food
137
66.5%
No Idea
36
17.5%
4.5.3Information about Vaccine
Table 29: information about vaccine
COVID-19 Vaccine info
Number
Percent
No
4
2.0%
Yes
203
98.0%
Almost all of the respondents had information about the existence and importance of
vaccination.
4.5.4Vaccination Status
Table 30: vaccination status of people
Vaccination Status
Number
Percent
No
0
0.0%
Yes
207
100.0%
The residents of Fujel ward no. 3 were vaccinated with at least one dose.
Table 31: Number of doses taken
No. of Doses
Number
percent
1 dose
4
2.0%
2 doses
43
20.7%
3 doses
160
77.3%
77.3% of the respondents were fully vaccinated, with the administration of an extra
booster dose as well.
4.5.5history Of Covid-19 Infection
Table 32: covid-19 infection history
COVID-1919 infection History
Number
percent
No
161
77.8%
Yes
46
22.2%
The whole ward of Fujel didn’t have any eruptive cases of severe covid-19 pandemic
as seen in other parts of country or world. Those few who were infected were
immediately taken to Kathmandu or Gorkha. None of the respondents reported any
deaths in their family due to covid-19.
4.6Knowledge, Attitude and Practice on Heart Disease
4.6.1 Knowledge on the causes of heart disease
Table 33: Knowledge on the causes of heart disease
SN
Causative factors
Number
Percentage
1
Unhealthy food habit
96
46.3
2
Lack of physical exercise
34
16.4
3
High blood pressure
45
21.7
4
Tobacco/Alcohol Consumption
43
20.8
5
No idea
6
2.9
96 of the respondents answered unhealthy diet (46.3%) of those who heard of heart
disease) and/or inadequate physical exercise (16.4%) as the cause of heart disease,
20.8% named alcohol as the cause, 21.7% answered high blood pressure and 2.9%
stated other reasons, such as asthma, diabetes.
4.6.2 Knowledge on prevention of heart disease

Table 34: Knowledge on the prevention of heart disease
SN
Preventive measures
Number
Percentage
1
Avoid tobacco/alcohol consumption
53
25.6
2
Regular Physical exercise
43
20.8
3
Healthy food habit
96
46.4
4
Regular blood check up
32
15.5
5
No idea
2
0.9
25.6% respondents believed that avoiding tobacco/alcohol consumption prevented
heart diseases, while 20.8% people believed that regular physical exercise helped
prevent heart disease. Also, 46.4% respondents believed in healthy food habit as a
preventive measure.
4.7 Knowledge, Attitude and Practice on Diabetes
Of the total 207 participants, 134(64.7%) had heard about diabetes.
4.7.1 Knowledge on causes of diabetes
Table 35: Knowledge on the causes of diabetes(N=134)
SN
Causative factors
Number
Percentage
1
Hereditary
125
93.3
2
Obesity
116
86.3
3
Unhealthy food
121
90
4
Less exercise
104
77.6
5
Excess consumption of Sugar
114
84.8
90% of the respondents answered unhealthy food and 86.3% answered obesity as the
cause of Diabetes, 93.3% named heredity as the cause, 84.3% gave answer that
diabetes is caused by excess consumption of sugar, and 77.6% stated less exercise as
one of the cause.
4.7.2 Knowledge on prevention of diabetes

More than half of the participants (80.5%) believed that less consumption of sugar
prevented one from diabetes while 76.1% and 85.5% of the people believed that more
exercise and healthy food habits also contributed to preventing diabetes.
Table 36: Knowledge on the prevention of diabetes (n=134)
SN
Preventive measures
Number
Percentage
1
Less consumption of Sugar
108
80.5
2
More exercise
102
76.1
3
Healthy food habit
115
85.5
3
Regular blood test
43
32
4
No idea
22
16.4
C.Incidence in the family
18 people among the family of the 207 respondents (8.7%) are found to suffer from
Diabetes Mellitus.
D.Regular blood Check up
50 out of 207 respondents (23.9%) answered us that they have habit of regular blood
checkup.
4.8 Knowledge, Attitude and Practice on Mental illnesss

Of the total respondents, 41.1%(85) had heard about mental illnesss.
4.8.1 Knowledge on symptoms of mental illnesss

Table 37: Knowledge on symptom mental illnesss(n=85)
SN
Symptoms
Number
Percentage
1
Mental tension
74
87.5
2
Psychosis
69
81.1
3
Irrational thought
57
67
4
Thought of suicide
46
54.1
5
Lack of social participation
39
45
Mental tension was stated to be a symptom of mental disease by majority of the
respondents (87.5%). Psychosis was also stated by 81.1% respondents, while half of
the believed other symptoms as indicative of mental illness.
B. Cause of mental illnesses
Table 38: Cause of mental illnesses (n=85)
SN
Cause
Number
Percentage
1
Hereditary cause
41
48.2
2
Family affair
74
87
3
Social affair
53
62.3
4
Drug addiction
26
30.6
5
Witchery
32
37.6
Other includes mental tension, feeling alone etc.
The major cause of mental illnesss was stated to be family affair and social affair by
87% and 62.3% respectively. 48.2% of the respondents believed the cause was
hereditary and 30.6% believed it to be due to drug addiction.
4.8.2 Prevalence of mental illnesss
Of the total 85 participants who had heard about mental illnesss 2 of them either
themselves had mental illnesss or had family member with mental illnesss among
which one was taking medication for depression.
4.8.3 Knowledge on treatment of mental illnesss
Table 39: Knowledge on treatment of mental illnesss
SN
Number
Percentage
1
Available
73
85.8
2
Not available
5
5.9
3
No idea
7
8.2
Maximum of the people (85.8%) believe that mental illnesss have treatments.
D. Behaviour towards people with mental illness
Table 40: Behavior towards people with mental illness
SN
Symptoms
Number
Percentage
1
Stay away
16
18.8
2
Boycotting from society
14
16.4
3
Advice for medical treatment
76
89.4
4
Do normal behavior
34
40
89.4% of the participants stated that they would advice a mentally ill person for
medical treatment while 40% stated that they would behave normally.
4.9Environmental status
4.9.1 Water
A. Main source of drinking water
Table 41: Main source of drinking water
Source
Number
Percentage
Tap water/ Pipeline
38
18.4
River
1
0.5
Spring/ Dhunge Taps
167
81.1
Wells
0
0
Total
207
100
It was observed that majority of the respondents (81.1%) used water coming through
spring, of Fujel ward-03, 18.4% relied on tap water.
B. Time taken to fetch water from the source
Table 42: Time taken to fetch water from the source
Time
Number
%
Source at house
40
19.3
Less than 15 minutes
119
57.4
15- 30 minutes
30
14.4
More than 30 minutes
18
8.6
Total
207
100
19.3% of the respondents reported that they had water source at house to use for their
daily household purposes and 57.4% of the respondents said that they had to walk for
less than 15 minutes.
C. Water purification practices
Table 43: Method adopted for purification of water
Practices
Number
Percentage
Boiling
26
12.6
Chlorination
2
0.9
Filtration
15
7.27
Direct use/ No purification
164
79
Total
207
100
The study showed that 79% of the participants did not implement any method for
purification of drinking water. Like wise (12.6%) said that they drank boiled water.
7.27% of respondents said that they used candle filter in their home.
D. Reasons for not purifying water
It was found that the major reason of not purifying water was that the community
people don’t consider the purification of water necessary. Although a few groups of
people tend to purify water by various method. Purification, boiling mainly was done
when sickness like fever, cough, cold prevailed in the family.
4.9.2 Latrine
Table 44: Presence of toilet/latrine for defecation
Know
Number
Percentage
Yes
207
100
No
0
0.0
Total
207
100
All of the surveyed households were recorded to have latrines.
Type of latrine
Table 45: Types of toilets
Types
Number
Percentage
Sanitary
190
91.7
Insanitary
17
8.3
Total
207
100
Almost all of the households surveyed (91.7%) had sanitary latrine.
4.9.3 Waste
A. Separation of wastes
Table 46: separation of wastes at home
Separation of degradable and non-degradable wastes
Number
Percent
No
85
41.10%
Yes
122
58.90%
Only 58.9 percent of the household separated degradable and non degradable wastes.
B. Mode of separated waste management

Table 47: Techniques followed for the management of waste
Degradable Waste management
Method of degradable waste management
Number
Percent
Burying
40
32.8%
Organic manure
36
29.5%
Use in kitchen garden
46
37.7%
Non degradable waste management

Method of non degradable waste manegement
Number
Percent
Burning
86
70.5%
Burying
28
23.0%
Throwing in sewage
6
4.9%
Littering
2
1.6%
Around 70.5% of the sample practiced burning the solid wastes generated.55.6 % of
respondents said that they disposed the waste by composting method in ditches,
whereas 38.1% used organic waste in kitchen garden.
C. Mode of waste management
Table 48: management of waste not separated.
Management of both wastes
Number
Percent
Burying
67
66.9%
Burning
26
30.2%
Throwing in forest/river
2
2.9%
D. Mode of waste water management
Table 49: Management of waste water
Management of waste water
Number
Percent
Latrine
10
5.1%
Kitchen garden
108
55.4%
In a pit
16
8.2%
sewage/pipeline
61
31.3%
Waste water from domestic household activities was managed by mainly using in
kitchen garden(55.4%), throwing in the sewage presence by the roadside(31.3%),
throwing in pit or latrine.
` 4.10Maternal and Child Health

4.10.1 Family planning
A. Appropriate number of children
Table 50: Appropriate number of children (N=53)
SN
Number of children
Frequency
Percentage
1
2
28
52.8
2
3
17
32.1
3
4
8
15.1
52.8% couples desired for 2 children while 32.1% people wanted 3 children, 15.1%
even said 4 was the right number.
B. Birth spacing between two children

Table 51: Birth spacing (N=53)
SN
Year
Number
Percentage
1
3
14
27.2
2
4
12
22.7
3
5
24
45.5
4
6
3
4.5
27.2% women replied of having a birth spacing of 3 years was appropriate while
majority (45.5%) replied that 5 years birth spacing is appropriate
C. Knowledge about family planning

Table 52: Knowledge about family planning(N=53)
SN
Knowledge
Number
Percentage
1
Yes
50
86.4
2
No
3
13.6
86.4% of the women seem to have knowledge on family planning.
F. Use of family planning
Table 53: Use of family planning
SN
Number
Percentage
1
Yes
45
71.4
2
No
5
28.6
71.4% houses use methods of family planning.
D. Methods of family planning used
Table 54: Methods of family planning used(N=45)
SN
Method
Number
Percentage
1
Condom
0
0.0
2
Pills
27
51.0
3
Depo provera
23
44.4
4
Norplant
2
3.7
5
IUD
3
5.6
6
Minilap
0
0.0
7
Vesectomy
0
0.0
83.30% people seem to have convenience in using Depo-Provera while 12.50% and
10.90% prefer to use pills and condom respectively.
E. Problem when using family planning devices

Table 55: Problems when using family planning devices
SN
Number
Percentage
1
Yes
3
6.7
2
No
42
93.3
14% people have reported to be facing problems using family planning devices.
J. Reason for not using family planning devices
Table 56: Reasons for not using family planning devices
SN
Source
Number
1
Lack of availability
0
2
Financial Problems
2
3
Family Pressure
3
4.10.2 Maternal Health
Maternal health refers to the health of women during pregnancy, childbirth and the
postpartum period, as defined by World Health Organization (WHO). Care of women
during these three phases of maternity is crucial, especially considering the direct
effect that the health of a mother can have upon her child's health. With proper care of
women during maternity, several complications potentially leading to morbidity and
mortality of both mother and newborn can be largely avoided. Family planning also
comes under the scope of maternal health.
In Nepal, maternal mortality has been recognized as a public health problem and
several programmes have been launched to address this. As a result, Nepal is noted for
its remarkable achievement in bringing down the number of maternal deaths from 539
per 100,000 in 1996 to 281 per 100,000 in 2006. In 2013, the MMR value descended
to 190 per 100,000 (Source: Trends in Maternal Mortality: 1990 to 2013),
symbolizing the achievement of the fifth Millennium Development Goal (MDG) of
reducing maternal mortality by three quarters of its value in 1990 (850 per 100,000).
Factors determining maternal health situation are influenced by the socio-economic
background including health practices of the community.
Age at first marriage
The age at first marriage can be considered one of the demographic indicators.
Women who marry at early age are at higher risk of having their first child at young
age, hence making contribution to higher fertility rate highly probable.
Table 57: Age at first marriage
Age at marriage
Number
Percentage
LESS THAN 15 YEARS
6
11.3
15-19 YEARS
14
26.4
20-24 YEARS
25
47.1
25 YEARS and above
8
15.0
Total
53
100.0
As shown in the table, 26.4% of women of reproductive age group were married
within 15 to 19 years of age while 47.1% were married in 20-24 years of age. 11.3%
of women were married within 15 years of age while 15 % were married after 25
years of age.
Age at first child birth

Table 58: Age at first child birth
Age at first child birth
Number
Percentage
15-19 YEARS
7
13.2
20-24 YEARS
33
62.3
25 YEARS and above
13
24.5
Total
53
100.0
62.3% of the women gave birth to their first child in 20-25 years of age while 13.2%
of the women gave birth to their first child within 15-19 years of age. 24.5% gave
birth after 25 years of age. The birth occurred mostly within one year of marriage.
4.10.3 Antenatal care

Antenatal care, care of the mother during pregnancy period, has its primary objective
to secure good health of both the mother and the child until delivery. As part of
antenatal care, pregnant women make antenatal visits to have updates on her own and
child's condition and to take necessary preventive, promotive and maintenance steps
depending on the condition figured out. Pregnant woman is also given iron and folic
acid tablets, deworming tablets, administered TT vaccine and informed about birth
preparedness and newborn care as well as the danger signs in pregnancy, postpartum
period and in newborn in her visits.
Information on ANC coverage was obtained from mothers of infants.
A. ANC checkup
Pregnant women should have at least four antenatal visits as recommended by WHO.
Each visit should be made at four, six, eight and nine months of pregnancy even in the
absence of complications since it is possible during these visits to detect health
problems associated with pregnancy. Frequent visits have to be made in case any
complications appear.
Out of 53 mothers, all answered that they had their pregnancy checkups. Among
them, we asked how many times they have checked and their answer was:
Table 59: ANC visits

SN
Times
Number
Percentage
1
One time
8
15.2
Two times
13
25.2
Three times
9
18.8
2
Four times
23
43.8
Only 43.8% of the mothers had had all 4 ANC visits while rest of the mothers had
only had three or less ANC visits.
f. Use of abusive
Most of women (50 out of 53) answered they had not used any abusives (Alcohol,
cigarette, tobacco) during pregnancy. Absence of their consumption during pregnancy
was noted in the ward as the women seemed aware of the harmful impacts that
smoking and consuming alcohol can impose on the growth, development and overall
health of the newborn. Those who used abusive usually consumed tobacco during to
addiction and habit.
g. Perceived information regarding danger signs in pregnancy
Various complications such as bleeding from vagina, convulsions and fits, excessive
vomiting, severe headache or giddiness, fever, loss of fetal movements and swelling
of feet may develop in pregnant women. Occurrence of any of these complications is
a danger sign and should immediately be addressed to health personnel.
We asked if they know what the dangerous sign are during pregnancy and their
response is as
Table 60: Danger signs

SN
Sign
Number
Percentage
1
Onset of fever
3
5.6
2
Bleeding
24
45.3
3
Impaired Vision
15
28.3
4
Swelling of legs
6
11.3
5
Foul smelling secretion
4
7.5
6
Eclampsia/ pre- ecclamsia
1
1.8
46.4% women responded bleeding as a major dangerous sign during pregnancy
whereas 40.7% replied onset of fever as another major dangerous sign. 31% and
21.4% replied swelling of legs and foul smelling secretion respectively.
Some women answered other signs like headache, vertigo, vomiting, white water flow
etc.
h. Problems observed in last Pregnancy
7 out of 53 women answered that they had encountered some problems in last
pregnancy.
The problems includes Fetus turned opposite side, Pain in womb, Fever, weakness,
swelling of legs. But the problems weren’t so prominent ones as stated by them.
i. Preplanning before delivery

31 out of 35(88.6%) answered that they had preplanned before the delivery.
Table 61: Preplanning before delivery
SN
Sign
Number
Percentage
1
Money
28
54.5
2
Blood donor
6
11.3
3
Transport
19
36.4
4
Other
0
0.0
Most of the families (54.5%) had preplanned money before delivery to ensure safety
of mother and child. A significant number (36.4%) had preplanned Transport.
Other includes clothes, food, caretaker, Blood donor etc.
j. Median age at first child birth
The median age at first child birth of women of reproductive age group in Fujel ward-
03 was found to be 22 years of age.
k. Maternal mortality rate
Maternal mortality rate in Fujel ward-03 was found out to be nil, which is an
incredible achievement considering the aforementioned national data.
4.10.4 Delivery care/ Intra-natal care
Delivery has to take place in an aseptic environment, preferably with assistance of
trained personnel. Several life-threatening complications such as obstructed labor and
postpartum hemorrhage may arise during delivery that can endanger the life of
mother, baby or both. Management of such complications demands a high degree of
skill and knowledge, and is usually not possible in home based deliveries. Also,
constant medical supervision is required which is only available at health institutions.
Hence it is always better to prioritize institutional delivery compared toa home based
one.
Information related to these various aspects of delivery care was obtained from the 4
mothers of infants in Fujel ward-03.
A. Place of delivery
The data shows high incidence of home based deliveries due to rather small number
of total delivery cases, hence maximizing the chances of error. The table below shows
the common places of delivery in Fujel ward-03.
Table 62: Place of Delivery (n=53)

S.N.
Place of delivery
Number
1.
House
3
2.
Government health facility
47
3.
Private health facility
3
Out of 53 respondents, 47 delivered at Government health facility, 3 had delivered at
home. To women who delivered at house, assistance was provided by neighbors and
FCHV. This has to be reduced to zero as soon as possible because deliveries ought to
be done at hospital so that nothing risky happens.
B. Reasons for not going to health institutions for delivery
The health post has been spreading awareness about institutional delivery. Yet, this
cases of home delivery was seen because of the absence of family members during
that particular time of labor , labor being started on night and not feasible for going
health institution and the assistance was proved my neighbors.
C. Cord cutting practice
New sterilized blades were used for cutting cord in the case of home based delivery.
Table 63: Cord cutting practice
SN
Tools
1
Sterilized blade
3
4.5
2
Reused blade
0
0.0
3
Sickel/knife/khukuri
0
0.0
4
Scissors
50
95.5
69% of the umbilical cords were cut with sterilized blades while a substantial number
of cases (17.2%) were cut by scissors.
D. Substances applied after cord cutting
Navi malam or chlorhexidine was applied to the cord stump 47 of out of 53 newborns
after cutting the cord. Navi malam prevents neonatal sepsis.
The awareness generated on the importance of using Navimalam as well as its
increased accessibility is the ground for its use in all deliveries, irrespective of the
place of delivery.
E. Problems during delivery
No major problem were seen during the delivery as stated by the mothers. Any
medical abnormality might have been directly dealt with by the consulting doctor and
medical staffs.
4.10.5 Postnatal care

The postpartum period is particularly important for women as they may develop
serious, life-threatening complications after delivery. Evidence has shown that a large
proportion of deaths occur during this period, with postpartum hemorrhage being an
important cause. A postnatal care visit is an ideal time to educate a new mother on
how to care for herself and her newborn Therefore, it is highly recommended that
women receive at least three postnatal checkups, the first within 24 hours of delivery,
the second on the third day following delivery, and the third on the seventh day after
delivery (MOHP, 2011).
A. PNC checkup
Out of 53 respondents, 50 received PNC while the other 3 did not. The latter did not
receive it because of the cases of home delivery. And most women do not make it to
the health posts on 3rd and 7th day because they were relatively far from the health post
and women do not travel such long distances in the post-natal period.
B. Post partum checkup
Table 64: Post partum checkup(n=50)
SN
Time
Number
Percent
1
Within 24 hrs
12
24.5
2
2-3 days
22
44.4
3
4-7 days
16
33.1
Out of 50 respondents, 24.5 % had post-partum check-up after 24 hours , 44.4% had
check-ups done within 2-3 days and 33.1% had check-ups done within 4-7 days.
C. Knowledge about post partum complication

Table 65: Knowledge about post partum complication
SN
Complication
Number
Percent
1
Swelling of hands and face
17
40.8
2
Shivering/Panic
10
20.6
3
Heavy bleeding
16
31.4
4
Placenta not coming out
3
5.8
5
No idea
7
1.4
Out of 53 respondents, 40.8% women knew that heavy bleeding and swelling of
hands and face were postpartum complication while heavy bleeding and shivering
was seen in greater proportion.
D. Health complications faced by mother during postpartum period
Mothers may have to encounter severe and potentially fatal health complications like
puerperal sepsis, postpartum hemorrhage, fever and many more after delivery.
The study showed that out of 53 respondents, 4 answered early labor and prolonged
labor. Other complications were constipation, fever, white watery flow, piles and
severe pain.
4.6.5.3 Knowledge on legalization of abortion
In September 2002, abortion was declared legal in Nepal. The government began
providing comprehensive abortion care services in March 2004. The abortion law
allows women to terminate their pregnancy under the following conditions:
pregnancies of 12 weeks gestation or less for any woman on her own decision,
pregnancies of 18 weeks gestation if the pregnancy is a result of rape or incest, and
pregnancies of any duration with the recommendation of an authorized medical
practitioner if the life of the mother is at risk, if her physical or mental health is at
risk, or if the fetus is deformed. Abortion services are provided at service delivery
points with surgical facilities and medicines located at district hospitals, some primary
health care centers, health posts, and private hospitals.
Upon further questioning we got to know that only 45 out of 53 respondents had idea
about the Law of safe abortion in Nepal, who were asked about the conditions for
legal abortion
Table 66: Conditions for Approval of Abortion in Nepal

SN
Condition
Number
Percent
1
Within 12 weeks of pregnancy
20
43.4
2
Rape, within 18 weeks of pregnancy
6
13.2
3
Pregnancy leading to effect the health of mother and child
9
20.8
4
No idea
10
22.6
85.2% women said that safe abortion was allowed within 12 weeks of pregnancy
while 26.9% women said that in cases of rape, safe abortion was allowed within 18
weeks and 44% women said that abortion was allowed anytime in pregnancy leading
to effect the health of mother and child.
Place of abortion
Table 67: Place of abortion
SN
Place
Number
Percent
1
Health institute
24
45.5
2
Clinic
0
0.0
3
Trained Health worker
29
54.5
45.5% women stated that abortion should be done at health institute while 54.5%
stated that they should go to a certified trained Health Worker.
4.10.6 Child Health

A. Time of first bath
Newborns are at a high risk of developing hypothermia if they are not kept wrapped
with warm and dry clothes immediately after birth, preferably with skin-to-skin
contact with the mother. One of the various ways of protecting the baby from
hypothermia is avoiding bathing within 24 hours of birth.
When women were asked about the time period after which they gave their newborns
the first bath, following statistics were obtained.
Table 68: Time of first bath (n=53)
S.N.
Time of first bath
Number
Proportion (%)
1.
Before 24 hours
10
18.7
2.
After 24 hours
43
81.3
81.3% of babies were bathed after 24 hours and not within 24 hours because they
seemed to have been spread awareness by the medical workers of health institution .
The mothers replied that they wiped their babies instead. 18.7% had no idea regarding
appropriate time of first bath.
B. Colostrum feeding status
Breastfeeding should be initiated within an hour of birth. It is essential to feed the
baby colostrum as it provides gastrointestinal defense and protection from diarrhea.
All 53 mothers (100%) had fed their babies with colostrum. Relatively common
practice of pre-lacteal feeding with food items like honey was not found in any case
recorded in our study.
C. Time at which colostrum was given
49 out of 53 mothers gave her colostrum milk to baby within the first hour of birth.
D. Times of feeding milk
47 out of 53 mothers (88.7%) fed their breastmilk more than 8 times including day
and night.
4.10.7Complementary Feeding Practices
Among the 18 mothers with children 6 month -2 years surveyed,
Table 69: Complementary foods
S.N.
Other food item given
Number
Proportion (%)
1.
Soon after birth
0
0.0
2.
Before 6 months
2
7.8
3.
After 6 months
16
92.2
92.2% children were given complementary foods after 6 months while 7.8% children
were provided complementary foods before 6 months.
The reason behind the feeding of other food item before 6 month was due to the
insufficient breast milk as answered by the mother.
F. Knowledge about sarbottam pitho
Table 70 : Knowledge about Sarbottam Pitho
Information on sarbottam pitho
Number
Percent
No
23
42.9%
Yes
30
57.1%
G. Knowledge on correct method for Sarbottam pitho preparation
Table 71: Knowledge about correct method of Sarbottam Pitho

preparation
Method for sarbottam pitho preparation
Number
Percent
Right method
27
90.9%
wrong method
3
9.1%
Only 27 mothers know about the correct method of preparing sarbottam pitho.
4.10.8Information about Basic Diseases Common to Child
Out of 53 respondents, only 3 (4.2%) does not seem to have information about basic
child disease.
Those who did know information gave following problems.
Table 72: Information about basic diseases to child
S.N.
Health problems
Number
Proportion of children(%)
1.
Pneumonia
5
9.4
2.
Cough
49
92.5
3.
Diarrhoea
51
96.2
4
Fever
48
90.6
5
Respiratory problem
4
7.5
6
Malaria
4
7.5
Pneumonia, cough, Malaria and Respiratory problem were provided as option in
questionnaire. Diarrhoea and fever were the problems they mentioned as others and
thus the data seems less for those problem. Our observation found that they had ample
information and experience about diarrhoea and fever, it is just they didn’t recall at
the time of survey.
85.29% respondent had information about cough and 73.53% had information about
pneumonia. Despite of being cold there, the case of pneumonia were rare.
4.10.8.1 Knowledge on cause of Diarrhoea

Table 73 : Knowledge on cause of diarrhoea
SN
Cause of Diarrhoea
Number
Percentage
1
Stale food and dirty water
52
98.7
2
Packaged food
6
11.3
4
Superstition
4
9.1
5
Overconsumption
2
4.5
6
Others
1
1.8
98.7% Mothers attributed stale food and dirty water as the prime cause of diarrhoea in
children.
4.10.8.2Place of preference for treatment of Diarrhoea
Table 74 : Preferred place for diarrhoea treatment
SN
Place
Number
Percentage
1
Home
0
0
2
Health institute
50
95.5
3
Dhami/Jhankri
0
0
4
Private health clinic
2
4.5
For all the mothers, the preferred place to go in case of diarrhoea in their children
is a proper health institution, either government or private.
4.10.8.3 Correct Treatment for Child suffering from diarrhoea
Table 75: Correct Treatment for Child suffering from diarrhoea
. SN
Treatment
Number
Percentage
1
Home remedies
5
9.5
2
ORS
51
97.2
4
Zinc tablet
5
9.5
5
Nutritious diet
7
14.3
6
Jholyukt khaana
25
47.6
Almost all mothers(97.2%) knew about Oral Rehydration Solution(Jeevan jal),

and knew what to feed in case of diarrhoea.
4.10.9Respiratory Problems
All of the 53 respondent mothers said that there was no respiratory problems seen till
date with their child.
4.10.10Immunization Status
All of the children were vaccinated/being vaccinated according to their age.
Table 76: Immunization status of children
Vaccination Type
Number
Percent
BCG
53
100.0%
Rotavirus1
48
90.5%
Rotavirus2
40
76.2%
DPT1
48
90.5%
DPT2
40
76.2%
DPT3
33
61.9%
Polio1
35
66.7%
Polio2
30
57.1%
Polio3
25
47.6%
IPV1
43
81.0%
IPV2
28
52.4%
PCV1
45
85.7%
PCV2
38
71.4%
PCV3
25
47.6%
mrv1
23
42.9%
mrv2
15
28.6%
JE
15
28.6%
K. Body weight of newborn
A baby is considered to be born with normal weight if the measurement lies within the
range of 2,500 grams to 3,500 grams when taken within the first hour of life, before
significant postnatal weight loss occurs. Low-birth weight babies are newborns
weighing less than 2,500 grams under the same condition.
Table 81 shows the proportion of children who were born with weight belonging to
one of the following categories
Table 77: Birth weights (According to the mothers surveyed)
S.N.
Weight at birth
Number
Proportion of children(%)
1.
Less than 2,500 grams
4
20
2.
2,500-3000 grams
7
35
3.
3,000-4,000 grams
9
45
Birth weight of 45% children was between 3 to 4kgs while birth weight of 35%
children was between 2.5 to 3 kgs. Rest of the children were born with weight less
than 2.5 kgs.
N. Nutritional status of children
Maintaining proper nutrition of U5 children has long remained a challenge for
countries like Nepal. Low dietary intake, worm infestations and infectious diseases,
lack of appropriate health care, inequitable distribution of food and ignorance of
children has led to increase in malnutrition among those children. The role of
nutritional assessment is of paramount importance in reducing this proportion.
The following anthropometric measurements were used to assess the nutritional status
of U2 children of FujelMunicipality, Ward no. 2:
• Weight for Age
• Height for Age
• Weight for Height
• Mid-Upper Arm Circumference (MUAC)
A total of 32 readings were taken. Measurements such as recumbent length were taken
for children below 2 years, height for children of 2 or more than 2 years by
stadiometer, weight was measured by bathroom scale, and MUAC was measured by
Shakir’s tape.
WHO provides a standard reference table which classifies nutritional levels of
children of various age groups based on standard deviations from the median value,
which was used in classification of survey data as follows :
Table 78: Classification of malnutrition

Weight Interval
Classification
Median Weight +1 SD
Normal
Weight -1SD to -2SD
Mildly - under nourished
Weight -2SD to -3SD
Moderately - under nourished
Weight below -3SD
Severely - under nourished
-
Table 79: Nutritional status of U5 children (n=53,31 males, 22

females)
Indicators
Degree of Malnutrition
%Male
%Female
Normal
Mild
Moderate
Severe
Normal
Mild
Moderate
Severe
Weight
83.7
16.3
-
-
84.2
15.8
-
-
for age
Height
89.6
10.4
-
-
87.1
12.9
-
-
for age
Weight
for
87.3
12.7
-
-
86.2
13.8
-
-
height
a. Underweight (Weight/Age):
Weight for age is an indicator that addresses both chronic and acute forms of
malnutrition. It shows whether a significant difference exists in weight of a child
compared to the median weight of children of that age group, and thereby assists
classification of nutritional status.
Of the 20 children observed, 8 were males and 12 were females. A total of 7 males
and 10 females, accounting for 85% of the children surveyed, were found to be in the
normal range. Likewise, 1 males and 2 females were seen in the mildly underweight
category.
b. Stunting (Height/Age):
The height of a child usually does not change owing to recent changes in dietary
habits. Instead, height is affected by long term nutritional pattern, making height for
age a useful indicator of chronic form of malnutrition.
We observed 20 children in which 17(85%) were seen in the normal range. 2 boys and
1 girl each were found to be mildly stunted (15%).
c. Wasting (Weight/Height):
In contrast to stunting, wasting appears in response to recent dietary deprivation as
well, making it an appropriate indicator of acute malnutrition. Of the 20 children
observed, 18 (90%) were in the normal range, while 1 boys and 1 girls were seen to
be mildly wasted (10%).
d. Mid-Upper Arm Circumference (MUAC):
The Mid-Upper Arm Circumference is measured in the left arm in relaxed position at
the mid-point of the imaginary line from Acromion process to Olecranon process of
children above 6 months up to five years of age.
We observed MUAC of 20 children, out of which 16 were found to be in the green
Zone, 3 in the yellow zone and 1 in the red zone.
Table 80: MUAC readings (n=53)

Zone
Number
Percentage
Green (>13.5 cm)
43
81.8
Yellow(12.5-13.5 cm)
7
13.6
Red(<12.5 cm)
3
4.5
Chapter V: Qualitative Findings

5.1 Focus Group Discussion
5.1.1 Focus Group Discussion with local residents
Objectives:
• To recognize their “Felt needs”
• To know the first hand POV of community with regards to
health and living.
Details:
• Date :3 September
• Venue : Kabita Kanchan Hotel and Khaja Ghar,
Aamdada
• Time : 8 am to 9:30 am
• Participants :Ward chairperson, ward members, principal,
local stakeholders
• Facilitator : Abhishek Shah
• Recorder : Pramath Kapoor, Priya Mahato
• Informant : Sadmarg Thakur
• Observer : Neha kafle, Tabassum thakurai, Amit Yadav,
Abhay kumar, Asutosh sah, Aditya giri.
Theme of the discussion: Our question for the focused group discussion with
local residents was “what is the health status of your community and in which aspects
do you expect improvements?”
Major findings:
The major points extracted from the discussion with the members are listed:
• Lack of proper health post building and Health workers in the
ward after restructuring the VDC to a municipality.
• Lack of knowledge on communicable and non communicable
diseases like Heart diseases, Dengue, Tuberculosis, HIV/AIDS etc.
• Smoking, alcohol consumption and tobacco usage high.
• Rabies outbreak is commonly and occurs frequently. However,
vaccines were not available due to lack of storage facility.
• Plastics and non biodegradable waste has started becoming a
problem.
• Child marriage not much of a problem.
• 1st choice of health services being Local Health Post, but dhami
and jhankri were also preferred.
Thus, the discussion led to the conclusion that the aforementioned problems were
mostly seen in Fujel ward-03. We decided to conduct the MHP programme on one of
these very topics and found our real needs from the felt and observed needs we
mentioned.
5.1.2 Focus Group Discussion with Female Community Health

Volunteers (FCHV)
Objectives:
• To understand the commonly existing women and child health
problem
• To know the works of FCHVs and their contributions in
community health uplifting
Details:
• Date :4 September
• Venue : Health Post, Arkhaley
• Time : 10 am to 10:30 am
• Participants :8(Ward chairperson, ward members, principals,
local stakeholders)
• Facilitator : Priya Mahato
• Recorder : Abhishek Shah
• Informant : Tabassum Thakurai, Neha kafle
• Observer : Pramath kapoor, Sadmarg thakur, Amit Yadav,
Abhay kumar, Asutosh sah, Aditya giri.
Theme of the discussion: Our question for focused group discussion with FCHV
was “what are the problems that females of your community usually come asking for
help and assistance?”
Major findings:
The major points extracted from the discussion with the members are listed:
• FCHVs not being empowered at other times and only working
for their own “Vatta”
• Mostly women and young girls ask for help if something is
wrong with their menstrual cycle like vaginal discharge, bleeding and pain.
• They don’t provide complete assistance during pregnancy and
child birth and they just assist in minor health problems.
• Lack of training in terms of prevalent epidemics or diseases.
5.2 Key Informant Interview

A key informant interview was conducted after the first community presentation in
which we tried to find some more knowledge on a few of our major problems in the
ward.
Objectives
• To know the cause behind the lack of health workers
• To know why people don’t purify water in most households.
• To know the pattern of health care choice of people.
• To know the commonly followed hygiene and sanitation habits.
Details
• Key informant: Subhash Panta, ward chairperson.
• Date : 3rd September
• Time : 9:30 am to 10:10 am
• Place : Ward Office
Major Findings
• The lack of health post was due to political reconstruction of
Fujel after being divided in two wards (ie. 3 and 4). The temporary health post
was made after the earthquake and has been in working since then.
• The water source was mostly spring water in the ward whose
water was claimed to be pure enough for drinking. The people thus don’t rely
on any sort of purification measures mostly. The water tested positive for
coliform as per our test kit. Methods of purification are necessary to be applied
in every household.
• For minor insignificant diseases local health post or self
prescription of medicine was done by the people;for major symptoms of
diseases like diarrhoea, people tend to visit modern health centres, or cities
directly. Dhami jhankris were consulted as per their beliefs.
• Extreme prevalence of marijuana usage, tobacco usage was
seen among the younger generations, for which the adults were highly
concerned.
The interview led to the major conclusion that the lack of health workers and the
issue of lack of purification methods into practice was addressed. Moreover, the
health seeking behavior of the people now accommodates both tradition and
modern knowledge- and the common coordination between the two healing
methods is proving to be beneficial to the health status of the community rather
than being detrimental.
Chapter VI: Micro Health Project

Micro health project is a miniature health project conductible within limited time and
resources and designed to develop health related skills and self-reliance among the
community people on the prioritized health needs of their community. A micro health
project should be feasible and sustainable with its results being measurable and visible
within a short period of time. Use of locally available resources and public
participation are also important aspects of an MHP.
We carried out the Micro health projects (MHP) in three phases:
1. Planning
2. Implementation
3. Evaluation
6.1 Planning of MHP
Planning of an MHP involves various processes and tasks undertaken before the
actual implementation of the project including goal and objective setting, deciding the
activities to be performed and identification of the resources to be used. Correct
planning acts as a foundation for robust implementation leading to achievement of the
set objectives, and is thus of great significance for any project.
The MHP was planned with intent to allow optimum time, resources and efforts in
addressing the root issues based on which the problems seen on the surface stood. For
the planning of MHP, the classical health educational model was followed, which
includes nine steps.
• Collection of baseline information
• Identification of observed needs and felt needs
• Identification and prioritization of real Needs
• Establishing goals and objectives
• Deciding the target group
• Deciding the content for MHP implementation
• Choosing appropriate methods and materials
• Identification and utilization of local resources
• Deciding technique of evaluation
I. Collection of baseline information
Techniques that had been used previously during the data collection phase, including
the household survey, FGDs, interviews and various other formal and informal
discussions acted as the sources for the baseline information that was needed to
proceed with our MHP.
II. Identification of observed needs and felt needs
Once the necessary baseline information was collected, the phase of analysis began.
Various problems that had been noticed were listed out and designated as ‘Observed
Needs’. The problems that were felt by the local residents, health workers and other
stakeholders, as told to us during our various informal and formal meetings and
interviews and in the first community presentation, were listed out as the ‘felt needs’
of the community. The problems that fell onto both the lists were finally taken as the
real needs, with which we moved ahead to the next stage in the conduction of our
MHP.
Felt Needs
Observed Needs
Real Needs
Felt Needs
Observed Needs
Real Needs
Felt needs
Felt needs are the changes deemed necessary by the people themselves in order to
correct the deficiencies that they perceive in their community. During the phase of
data collection, various interviews, discussions and talks with the community people
had helped us identify the felt needs of the community. Further, following the first
community presentation, an FGD session was conducted with the ward chairperson,
ward members, principals and other participants of the programme to assess the
feasibility of the programmes under MHP.
Felt needs of the community people of Fujel ward-03 were:
1. KAP on Non communicable diseases
2. Steps of proper hand washing
3. FCHVs not being available
4. Awareness on Adverse Effects of Smoking and Drinking
5. First choice of health service not being hospital
6. Environmental Sanitation
7. Lack of own health post of the ward
Observed needs
Observed needs are those health and/or developmental needs which can be
scientifically shown to be needs in order to state a community health or health related
problem and so, to improve health status. Based on the results of the household survey
and observations, observed needs of the community people of Fujel ward-03 were
determined to be:
1. KAP on Non Communicable diseases
2. Steps of proper hand washing
3. Knowledge on safe abortion
4. Lack of own health post of the ward
5. Early marriage
6. FCHVs not being available
7. First choice of health service not being hospital
8. KAP on Tobacco, alcohol and drugs
Real needs
The health/developmental needs that are felt by the target population as well as
observed by concerned observers come under 'real needs'. Micro health projects are
carried out on real needs as they provide a common ground of motivation and interest
for the target population as well as the project conductors.
Following needs were identified as real needs:
P1 KAP on NCD, including Rabies
P2 Environmental Sanitation and Hand washing
P3 KAP on Tobacco, alcohol drugs
P4 Rabies outbreak
P5 Menstrual hygiene
Need prioritization
Various criteria like magnitude, feasibility, available resources, cost effectiveness and
local cultural acceptability may not permit all problems to be addressed. In order to
make a wise use of resources and ensure effectiveness, prioritization was carried out.
Prioritization means using a systematic method of assigning greater or lesser
significance to various needs, problems and related interventions. The matrix ranking
method was used to prioritize top needs which would be addressed by the MHP. Each
problem was allotted a certain score out of 6 as the total number of real needs were
also 6 with a score entered not being used again, i.e. from the highest value to the
lowest value on ordinal basis.
Based on this ranking, it was decided that MHP programmes would be conducted on
the problems ranking 1st KAP on NCDs including Rabies, and subsequent needs
would be further addressed in other Health Projects.
Table 81: Prioritization Table
III. Establishing goals and objectives
For KAP on NCDs including Rabies Outbreak
General Objective
To develop KAP on Non Communicable Diseases like Hypertension, joint
problem, Gastritis, Mental health; and also Rabies, among the community
people of Fujel ward no.3.
Specific Objectives
• To appraise the people about the causes, symptoms,
consequences and treatment of Hypertension, Joint problem, Gastritis, Mental
health.
• To appraise the people about the causes, mode of transmission,
symptoms, consequences and treatment of rabies.
• To develop knowledge in the community people about healthy
lifestyle and to promote measures to safeguard oneself from these diseases
For KAP on Tobacco, Alcohol and Drugs usage
General Objective
• To teach students of Grade 7, 8, 9 and 10 about harmful effects
of Tobacco, Alcohol and Drugs usage
Specific Objectives
• To explain the need and requirement of knowledge of SRHR to
Fujel ward-03 students
• To highlight the problems of addiction that adolescents and
teenagers are vulnerable to.
For steps of proper hand washing
General Objective
• To teach students about accurate hand washing process
Specific Objectives
• To explain the essence of proper way of washing hands in
relation to healthy living
• To appraise the younger population about the diseases that
occur due to unclean hygienic practices
For Awareness on Environmental Sanitation
General Objective
• To teach students of Grade 7, 8, 9 and 10 about importance of
Environmental Sanitation and Hygiene
Specific Objectives
• To explain the need and requirement of knowledge of
Environmental Sanitation and Hygiene to Fujel ward-03 students
• To appraise the younger population about the diseases that
occur due to unclean hygienic practices
• To inform about healthy and environmental friendly practices
like reduce, reuse, recycle.
For Awareness on Menstrual Hygiene
General Objective
• To teach students of Grade 7, 8, 9 and 10 about menstruation.
Specific Objectives
• To explain the need and requirement of knowledge of
menstruation
• To eliminate the stigma surrounding menstruation
• To show the use of menstrual product and its proper disposal
• To highlight the problems during menstruation and its solution.
IV.Determining the target groups

• For KAP on NCDs including Rabies Outbreak, the community
people were chosen to be the direct target groups since they would be able to
instruct other villagers as well as their own families about these diseases.
• For hand washing, environmental sanitation and menstrual
hygiene, the students of schools were chosen, so that they can forward these
teachings to their homes and community.
V. Deciding the content for MHP implementation

The contents for the MHP would have to be informative while digestible to the
novice mind at the same time. Furthermore, they would have to induce not a sense
of fear or obligation but sincere necessity to implement necessary changes in one's
lifestyle for the purpose of remaining healthy. With great attention being paid to
the target groups as well as the set objectives, the contents were set as follows:
For KAP on NCDs including Rabies Outbreak
• Basic introduction to Non Communicable Disease including
Rabies Outbreak
• Information on causative factors, source of infection and the
chain of transmission for rabies
• Information regarding preventive measures for both Non
Communicable disease and rabies
• Information about risks factors and ways to eliminate to lead a
healthy and active lifestyle
• Information on availability of treatment options
For KAP on menstruation
• Basic introduction to menstruation and reproductive health
• Demonstration of use of menstrual product and its proper
disposal
• Information regarding the problems during menstruation and its
solution
For KAP on steps of proper hand washing
• Information on proper method of hand washing
• Information on various communicable water borne diseases and
due to lack of proper hand washing and hygiene
• Information on soap water emphasis for hand wash
For Awareness on Environmental Sanitation
• Information about the potential diseases that could occur in
their community
• Information about waste management by the 3R principle-
reduce, reuse and recycle
• Sanitary habits to be followed in daily life activities
I. Choosing the appropriate methods and media
Use of appropriate methods and media allows better learning, cognition and
retaining of knowledge and skills for adopting desire
d behavior. For all three of the MHPs we conducted, there were the major methods
and media used:
• Methods
• Group discussion
• Mini lecture/ lectures
• Demonstration
• Counseling
• Media
• Chart papers
• Marker and whiteboard
• Flash cards
• Sticky notes
VII. Identification of available resources

For all three MHPs, chart papers, sticky notes, flash cards and local writing
materials like school whiteboards were used.
VIII. Development of detailed plan of action
After completion of previous planning steps, a detailed plan of action was
outlined. It is to be noted that the activities are listed as per a chronological order.
6.2 Implementation of MHP
Once the plan came into a solid shape, the core of the MHPs finally commenced- its
implementation. Planned activities were implemented with the help of local leaders,
teachers, key personnel and community people. Local participation was the key
approach for implementation of MHP.
Implementation of MHP on KAP on Non Communicable Diseases and rabies:
• Group discussion programme:

The main issues of the community were discussed among the ward members, ward
chairperson, local stakeholders and school principal, we figured out the real needs,
ways to assess them and covered topics of communicable (rabies) and non-
communicable disease awareness among the community people. Since heart disease,
hypertension, joint problem and Gastritis were the major diseases prevailing in the
community, we explained measures and methods of preventing risk factors such
diseases.
The community based education programme was held on 13th september to the local
people of community at Sabha Hall, Aamdada. People from all over the community
had come there to attend the program. As discussed in the FGD, we explained to our
best efforts about the causes, mode of transmission, preventive measures and
treatment options about Rabies and Risk factors of non-communicable diseases such
as Hypertension, Joint problem, diabetes, Gastritis, mental illness.
Our resource person and the information about our program was disseminated by the
ward chairperson Mr. Subhash Pant.
6.3 Implementation of School Health Project
School based education programme

Once you teach a child, the child can teach the family. Following this basic principle,
the field team delivered interactive lectures to the students of Shree Bhiravashram
Madhyamik Vidhyalaya on 9th september. Students of grades 8, 9, and 10 were the
major targets. The lectures lasted two periods (each lasting 40 minutes). Colorful
charts prepared previously were displayed to maintain interest. Acting as the resource
persons, the principal of the school greatly assisted us in conducting the classes. In the
end, a separate feedback session was also held to check the student’s views on the
program and its effectiveness.
Handwashing program was conducted on the same day Shree Bhiravashram

Madhyamik Vidhyalaya. The lectures lasted two periods (each lasting 40 minutes).
Colorful charts prepared previously were displayed to maintain interest. Acting as the
resource person again, the principal of the school provided us the platform to conduct
the classes.
6.4 Evaluation
An important feature of micro-health projects is the fact that they can be evaluated
within a short period of time. The results were compared with our original objectives
thereby giving us a picture of the degree of success of our MHPs.
MHP on KAP on Non communicable diseases and Rabies
• The education programme as well as the education-material
prepared was highly appreciated by all the teachers and students of the school,
the principal and the community people being focused on.
• Informal discussion was conducted after the community health
education programme, in which majority of the people provided correct
answers and rational opinions regarding both the discussed diseases.
MHP on Environmental sanitation
• Informal discussion was conducted after the school health
education programme, in which majority of the students provided correct
answers and rational opinions regarding both the discussed diseases.
• Feedback session was also conducted to ask the students about
what they felt about the program.
MHP on steps of proper hand washing
• At the end of the session, we asked all the students to show us
the steps along with us and also randomly asked a few of them to answer our
questions.
6.5 Sustainability of MHP
While an MHP should be possible to complete and evaluate within a short time frame,
its results are expected to have a long-term impact on the health of the community
people. To ensure the sustainability of the programmes we launched, following steps
were taken.
MHP on KAP on Non Communicable Diseases, Rabies and steps of proper
handwashing:
The students involved in the programme had committed to keep on disseminating the
knowledge on the STIs. Further, the locals counseled individually in communicable
and non-communicable diseases had also been sensitized and will certainly play roles
to help spread awareness on these diseases in Fujel ward-03. All students and locals
would also continue to adapt and disseminate the contents explained to them. During
the second community presentation, the local people and the school teachers and
students expressed their commitment to keep working further to improve the status of
their knowledge on diseases and lead a healthy and happy life.
Chapter VII: Community Presentations

7.1 First community presentation
Date : 7 September, 2022
Time : 1:00 PM to 2:00 PM
Venue : Conference Room, Shree Bhairavashram Madhyamik Vidhyalaya.
Participants
The programme was attended by

• School principal of Shree Bhairavashram Madhyamik
Vidhyalaya.
• School Development Board Chairperson of the same school
• Representatives from ward office
• Local people
• Teachers and staff members of the school
Main objectives of the programme
• To formally introduce ourselves with the community people

• To explain the objectives of our CHD programme
• To present the findings of our household survey
• To discuss the observed needs and felt needs of the community
• To identify the real needs and prioritize them
• To discuss about the topics for MHP
• To plan for implementation of MHP
Detail plan of programme
• Programme chaired by: School Principal
• Programme conducted by: Abhishek Shah
• Welcome speech by: Abhishek Shah
• Objectives of the program by: Sadmarg Thakur
• Presentation of the findings by: Asutosh Sah, Priya

Mahato,Neha Kafle
• Open floor discussion: The attendants were requested to put

forth their views regarding the programme and the presentation, to which we
received active interaction and helpful suggestions, especially from teachers.
• Thanks giving, addressing comments, future plan of MHP

according to discussion by: Sadmarg Thakur
• Closing speech by: School Principal
The subject matters of discussion were

• Discussion on findings of household survey
• Geographic profile and social mapping
• Demographic profile
• Socio-economic and cultural status
• Gender concept and situation
• KAP on communicable and non-communicable diseases
• Health service utilization
• Environmental health
• Maternal and Child Health (MCH)

• Family planning
• Discussion on findings of FGD and key informant interviews
• Discussion on observed and felt needs and their prioritization to

find out the real needs
• Planning of MHP according to prioritized real needs utilizing

locally available resources
7.2 Final Community Presentation

Date : 16 September, 2022
Time : 2:00 PM to 3:00 PM
Venue : Conference Room, Shree Bhairavashram Madhyamik Vidhyalaya.
Participants
The programme was attended by

• School principal of Shree Bhairavashram Madhyamik
Vidhyalaya.
• School Development Board Chairperson of the same school
• Representatives from ward office
• Local people
• Teachers and staff members of the school
Objectives
• To share our experiences regarding our activities during the

field stay
• To evaluate the outcome of MHPs
• To get feedback about MHPs
• To provide them suggestions to sustain the learnings from MHP
• To receive their comments about our one-month residential

field programme
• To formally bid farewell to Fujel and mark an end to our

residential field stay.
Detail plan of programme
• Programme conducted by: Sadmarg thakur
• Presentation of the findings along with details of MHP and their

handover to the community by: Tabassum Thakurai and Abhishek Shah
• Speech and recommendations by:
• Thakur Panta (A teacher Shree Bhairavashram Madhyamik

Vidhyalaya)
• Tanka Prasad Devkota (School principal of Shree

Bhairavashram Madhyamik Vidhyalaya)
• Farewell speech and thanksgiving by: Sadmarg Thakur
Activities
• All the activities performed by the team during their 30 day stay
in Fujel ward-03 were briefly summarized.
• The overall process involved in conduction of MHPs along with

the rationale was reiterated.
• Major health issues discovered during our study which still

need to be worked on were highlighted.
• Speeches circling around our 30 day stay and the activities we

conducted were delivered by several of the invited personnel. The team was
immensely touched with the positive feedbacks and regards about the MHP,
community programmes conducted by us and about the data collection.
• The team acknowledged community people, representatives

from various offices, community-based organizations and schools, social
mobilizer, FCHVs for their hospitality, supportive nature as well as keen
participation in all our programs and making our community health diagnosis
a grand success.
Chapter VIII: Conclusion, Recommendations and

Learning Reflections
8.1 Conclusion
Fujel, Gandaki gaupalika ward no. 03 was found to be a village in its early stages of
transition into a suburb. Facilities of drinking water, transportation, education and
health to a certain extent were all present. Not just the facilities, but the people,
culture, language, ethnicity and even climate were found to be entirely overwhelming
and better compared to what we are used to in cities. Despite the availability of the
various services mentioned, these are still rudimentary and need a lot more
improvement comparing it to overall Fujel and the nation itself.
The sample of 207 houses- taken after much physical, mental and psychological
ordeal from all of the team members- revealed adequate information regarding
various determinants of health in Fujel ward no. 03. A village composed almost
entirely of Brahmins and Newars. Hinduism dominates as the religion being most
followed. Demographically, males were found to be less in number than females with
the sex ratio at 94 ……..males per 100 females which is just the same being in
national figure.
Like one would usually expect in a stereotypical rural setting, almost all of Fujel
residents were involved in some form of agricultural aspect. Yet economic
sustainability and food sufficiency was found to be markedly low in the village,
raising some serious questions about the nature of agriculture in the ward. An equally
disheartening trend was of buying fruits, vegetables and other general grocery from
Benighat or Gorkha bazar, while using most of the farmland for production of food
grains (which didn't even suffice a year for almost half of the households.)
Gender status was seen to be rather dismal, with males dominating fields of decision
making, social involvement, economic activity, property ownership as well as
education. We are hopeful that the situation will improve by leaps and bounds in the
days to come as the mentality for preference to child seems to be equal for both male
and female and that the females in the ward are not bound to just kitchen and
household works.
Knowledge, attitude and practices on communicable diseases was found to be
dissatisfactory with almost half of the general population having absolutely no idea
about most communicable and non communicable diseases and their current trends.
Considerable lack of information and misconceptions were seen even in those who
claimed to have heard of the disease, acting as key points for another one of our micro
health projects.
The health facilities were accessible to most locals but after long hour's walk, owing
to its non-strategic position. Hopefully the completion of new health post building
will solve the health situation of the ward. The ward has a medical shop run privately
by a local resident but it just fulfills the self medication needs of the locals. Morever,
people didn’t admit to seeking the faith healers during illness which could be
worrysome in severe health conditions.
In terms of environmental health, it was again found to have an excellent
performance. The water supply in most houses was from pipelines through “EK
GHAR EK DHAARO” PROGRAMME which was really a great matter of
achievement. The water quality was good in some toles and not suitable for drinking
in others, as per the coliform test kit and the local stakeholders. That being said, only
21% of the households using methods of purification of water, even that during the
times of sickness and winter, was thought to be a problem. Since we didn’t observe
any water borne disease in the community, we had not further basis of questioning.
Almost all houses had a latrine and home garden and the people mostly had a good
method of waste management. The biodegradable ones were thrown in pits to create
compost manure while the non bio-degradable ones were incinerated in fire to get rid
of it. Burning of non degradable wastes was a serious concern for us and the
environment.
The maternal and child health status of Fujel ward no. 03 was quite impressive. Our
study showed that all of the households possessing U5 children that we questioned
had immunized their children completely as per their age (if incomplete was the
vaccination, it was due to the child not coming of age). In the study done for mothers
of U5 children, the delivery practices and ANC visit system as well as iron tablet
supplementation with antihelminthic drug use was found to be appreciable, credit
going to the health post and its programmes at ward 03, the active participation of the
health staffs, FCHVs there in conducting routine monthly health checkups,
vaccination programs etc. There was no maternal, infant and neonatal mortality found
in our study.
On major issues and problems of adolescence, and teenagers including physical
changes, menstruation, and the adverse effects of Tobacco consumption, smoking and
drinking, we provided an even clearer information as a real need by conducting a
School Health Project as well.
The people of Fujel ward no. 03 are really very cooperative, helpful and hardworking.
We believe, if they keep working hard to develop the village addressing the problems
we highlighted and what we taught them, they can surely make Fujel ward no. 03 an
even better place and rightfully, both in terms of natural beauty and facilities.
8.2 Recommendations to people of Fujel, Gandaki-03,Gorkha

• Spring Water of the village, although being the highlight of the
rural stay of Fujel has definite room for improvement in terms of drinking
purpose since purifying water once at home is always better than just drinking
it directly.
• The knowledge on communicable and non communicable
diseases was not as much as we thought when they said they had heard about
the diseases we asked about. The programs related to such diseases must be
carried out timely and in different toles so as to ensure 100% coverage and
make people lead more healthy and happy lives.
• The lack of a centrally located health post is a problem that
goes beyond our range of abilities to address. The over reliance on the ward 1
health post or Fujel hospital must be reduced as it is too far and as hospitals
are for the ill people who aren’t always capable of walking long distances for
checkups, the ward needs to have a central health post of its own placed by
looking feasibility, funds and ease for the locals.
• The FCHVs of the ward should be increased by launching more

such trainings to young energetic women and also the prevalent FCHVs must
be mobilized and empowered.
• With proper application of the 2nd , 3rd and 4th points, we believe
that the problem of visiting shaman healers will decrease by itself as the
people have a habit of adjusting with the available, affordable and easily
accessible which for now the shaman healers might fit best into. This will
change when the health post will be there, FCHVs will be working hard,
health programs disseminating information on many diseases will be regularly
organized making people tend to visit health posts more.
8.3 Learning Reflections

The 30 days we spent in Fujel ward no. 03 were not as easy as expected but not even
as harsh as life could throw. Only being either in late teenagers and early twenties
phase, the sudden transition from a luxurious life in the warm cradle of cities into a
rural environment was indeed at the beginning a very uncomfortable situation. What
followed in the rest of the 30 days unfolded a journey of such fun and real life
scenario that we forgot that we were here for just a month. Today, as this report is
being typed, all of us stand transformed, having been enriched with knowledge and
experience that can never quite be put into words. A learning experience in every
manner, we learned the following in the CHD field stay, and much, much more that
has been engraved into our hearts and minds:
• We understood how rural people think and behave.
• We learned how to stay in rural area and adapt to the rural life.
• We learned the practical use of various tools and techniques in
CHD that we had only learnt in theory classes.
• We learned the ways to actually build rapport and perform tasks
in collaboration with the local people, authorities, schools and also with local
limited resources.
• We learned the ways to create maximum support and help from
people and also earn their faith.
• We developed ideas on how to make people adhere to the
knowledge we shared them and practice entire life realizing the importance of
it.
• We learnt how it is difficult to implement any program or
incorporate any new idea in the community.
The specific academic skills we learnt are listed here:
• We learned the practical use of various tools and techniques in
CHD that we had only learnt in theory classes. This made the knowledge
permanent and solid, as it was a memory now rather than just a definition or a
theory.
• We learned the rationale and techniques involved in obtaining
qualitative data, including conduction of FGDs, key informant interviews and
informal discussions.
• We learned to select and utilize various methods and media for
conducting health education programmes.
.
References
• Park K.K. Park’s Textbook of Preventive and Social medicine.
23rd edition. Prem Nagar: M/s Banarsida’s Bhanot. 2015.
• Hale C, Shrestha IB, Bhattacharya A. Community Diagnosis
Manual. TU. Institute of Medicine. Nepal. 1996.
• Debus M. Methodological review: A Handbook for Excellence

in Focus Group Research. 1st edition. Washington DC: Porter Novelli. 2007.
• Sanyal P. Community Medicine- A Student's Manual. 1 st

edition. New Delhi: Jaypee Brothers Medical Publishers. 2015.
• Ministry of Health and Population (MOHP) [Nepal], New ERA,

and ICF International Inc. 2012. Nepal Demographic and Health Survey
2011.Kathmandu, Nepal: Ministry of Health and Population, New ERA, and
ICF International, Calverton, Maryland.
• US Agency for Development. Maternal and Child Health. NYC:

USAID [updated 2016 April 15; cited 2016 November 29]. Available from:
https://www.usaid.gov.
• Ward profile book of Fujel, Gandaki ward no.3 published by
Thakur Panta, local resident and teacher at Shree Vairavashram Madhyamik
Vidhyalaya.
•
Annex- I: Plan of Action
Annex-II: Questionnaire for household head
Annex-III: Questionnaire for mother with U5 child

Annex- IV: Formulae Used
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Annex-V: Appreciation letters and other documents:
Annex-VI: Pictures Gallery:

DATA COLLECTION AND ANTHROPOMETERY
FOCUS GROUP DISCUSSION

KEY INFORMANT INTERVIEW
FIRST COMMUNITY PRESENTATION
SCHOOL HEALTH PROJECTMICRO HEALTH PROJECT
INSPECTION AND VISIT FROM CM DEPARTMENT
FINAL COMMUNITY PRESENTATION
CHD GROUP B
FUJEL-03,GANDAKI GAUPALIKA, GORKHA

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A Report Of

Community Health Diagnosis Field Program

MATERNAL HEALTH / FAMILY PLANNING

CHILD HEALTH SITUATION

KNOWLEDGE, ATTITUDE AND PRACTICE (KAP) ON

FOCUSED GROUP DISCUSSION

1.5 Sources of data collection

Interview schedule: Tool 2

Informal question answer session

1.6 Indicators in data analysis

• Contraceptive Prevalence Rate

• Orientation classes were attended before the CHD program.

• There was regular supervision and guidance from the teachers

1.9 Inclusion and Exclusion Criteria

• For more than one mother of under-5 child in the same

1.10 Ethical Consideration

• We were unable to meet several mothers of U5 children in the

• Furthermore, entire families would often be absent from their

• The anthropometric devices provided by the campus proved to

• Sudden outbreak of Rabies and frequent attacks of rabid dogs

1.12 Logistic management

Tools for anthropometric measurement

Financial support and transportation

Lodging and fooding

Chapter II- Overview of the ward

Chapter III: Methods and approaches

Chapter IV: Findings

4.1.2 Population Pyramid of Fujel ward-03

4.1.3 Major Demographic findings

• Crude Birth Rate (CBR):

• General Fertility Rate (GFR):

• Total fertility rate (TFR)

• Crude Death Rate (CDR):

Disability is defined as a physical or mental impairment that substantially limits one

Source: Field Survey, 2022

Table 5: Alcohol consumption

4.3 Common Health Seeking Behaviour

Table 15 : family insurance (N=121)

4.4Diseases Related Knowledge

A. Knowledge on the mode of transmission of HIV/AIDS

B. Knowledge on Treatment of HIV/AIDS

B. Knowledge on treatment of tuberculosis

D. Fees for TB treatment in government health institution

4.5.2Mode Of Transmission Of Covid-19

4.6.2 Knowledge on prevention of heart disease

4.7.2 Knowledge on prevention of diabetes

4.8 Knowledge, Attitude and Practice on Mental illnesss

4.8.1 Knowledge on symptoms of mental illnesss

B. Mode of separated waste management

Non degradable waste management

` 4.10Maternal and Child Health

B. Birth spacing between two children

C. Knowledge about family planning

E. Problem when using family planning devices

Age at first child birth

4.10.3 Antenatal care

Table 59: ANC visits

Table 60: Danger signs

i. Preplanning before delivery