Community health diagnosis report Chitlang VDC, Makwanpur.

Thesis Report.

SUMMARY:

This community health diagnosis report presents the findings and the analysis of the findings of one-month long community health diagnosis of Chitlang VDC, Makwanpur carried out by the 21st batch of students of Bachelors in Public Health (BPH), Maharahgunj Campus, Institute of Medicine (IOM). The main purpose of this report is to illustrate and elucidate how the health status of the community including the factors associated with them was diagnosed and the prioritized health problems solved with maximum utilization of local resources through community participation by conducting micro health project. The community health diagnosis was conducted as per the need of the curriculum of BPH 2nd year, IOM.
The study was designed as descriptive cross-sectional study to be carried out on sample population of Chitlang VDC. The technique of stratified proportionate systematic random sampling was used and the total sample of 284 households, i.e. 25.94% of the total households was taken, the unit of analysis being the individuals and households. Primary data were collected from the interview with the household heads or any other family member of age more than eighteen years, and through observation, focus group discussion (FGD), anthropometric measurements and self administered questionnaire. Secondary data were collected by reviewing the records. The tools used in the study were semi-structured and open-ended questionnaires, observation check list, anthropometric table and instruments, FGD guidelines and the format for secondary data review.
Demography and Vital Statistics
The study indicates that Chitlang had a total population of 6086 with 1095 households. Majority of the people were Hindus and the major ethnic group was Newar which comprised 61.86% of the total population. The average size of household was 7.15 and joint families were most common. The sex ratio was 94 males per 100 females and the total dependency ratio was 53% both of which are higher than the national figures. The Crude Birth Rate was 30 per thousand and the Total Fertility Rate was 3.04 per woman, both of which are similar to the national figures. The Crude Death Rate was 1.96 per thousand which is far below the national figure of 8.7 per thousand (2006 NDHS) whereas no any case of infant, under-five and maternal mortality was found in our sample study. Similarly, the population growth rate was found to be 1.38−lower than the national data.
The median age of the population was found to be 23.48 years. The females in the Chitlang VDC married later compared to females in whole Nepal as the median age at first marriage of females was 19.12 years which is higher than the national figure of 17.2 years (2006 NDHS) but the age at first pregnancy was 19.58 years, similar to national figure of 19.6 years(2006 NDHS). The contraceptive prevalence rate was found to be 53.84%.
Socio-economic status
The socio-economic conditions of the people varied greatly according to the ethnicity whereas the educational status varied by gender too. The overall literacy rate was 77.8% while the literacy rate of males and females differed as much as by 20%. The female literacy rate was only 68.1% whereas the male literacy rate was 88%. The difference in literacy rates was also significant on ethnicity basis as Dalits were found to be educated only up to lower secondary level. This had direct impact upon their major source of income as well. Agriculture remained the major source of income for 83.4% of people and labour for 2.5% of the people but the involvement of Dalits in labour was higher (33.3%) than other ethnic groups. Despite agriculture being the major source of income for majority of people, only 22% of households had food sufficient for one year or more. Most of the people with higher secondary level education or above were Brahmins and Chhetris and accordingly, they out-numbered the other ethnic groups in holding jobs. Like in the country itself, majority of people depended upon radio to obtain health information. Health services
The major institution providing health services in Chitlang VDC was the governmental sub-health post. The hilly landscape of Chitlang was found to cause only 37% of the households to reach there within 30 minutes. Most of the households, i.e. 63.5% used stretcher or “doko” to take patients to the health facility. Although 74% of households were aware of the free health services in governmental health facilities, only 66% chose to go there first. Around 81% population had heard about tuberculosis but only 69% knew about free DOTS program available in the health facility.
Nutrition
Crystal phoda salt was found to be in use in 43% of the households. Only 49% of the respondents had heard about night blindness and only 38.8% of them knew that it is caused by Vitamin A deficiency. Fifty percent of respondents hadn’t heard about malnutrition. Among those who have heard of it, only 60.56% knew that it is caused by lack of nutritious food.
Gender
Gender plays a significant role in the lives of women and in our survey, women were evidently found to be prejudiced. Only 10.5% of the households had women involved in income generating activities and only 11% of the women had property in their name. Moreover, only 19% of females had sole right to decide on their own health and 18% on financial activities.
The low priority given to females was obvious as only 17% of the respondents desired a girl child as their first child. The participation of females in social activities was found only from 22% of the households while from 41% of households both the male and female members participated in such activities. Maternal health
Our study indicated that 70% of the respondent mothers had made at least four antenatal care visits during their entire pregnancy. Most of those who did not make any visits considered it to be unnecessary or hadn’t any idea about it. Three in four pregnant women were found to have received tetanus toxoid injections. Though 89% of the respondent mothers had taken iron tablets, only 35% among them took the complete dose as majority of them reported to have discontinued the intake owing to its adverse effects. Similarly, about 80% of pregnant women had taken the deworming tablets during last pregnancy. Although 58% of women responded positively towards birth preparedness, 41% of the women didn’t know about the danger signs during pregnancy.
It was found that three in four women had given birth at home with the same proportion of family members assisting the birth. Though the percentage of use of safe delivery kit (SDK) was relatively better than the national figure, 58% of the deliveries were conducted without SDK. Majority of women (61.82%) believed that it is not necessary to deliver at health facility, while few of them attributed high cost and inaccessibility to their not delivering at health facility. Only 64% of the mothers knew about the free delivery service in governmental health facility, 62% knew about the travel allowance and only 52% had knowledge that abortion is legal in Nepal.
The postnatal care coverage was only 30%. Only 4.5% of the mothers had visited within 24 hours after delivery. A total of 79% of women had taken vitamin A capsule after delivery. However, 64% of the women didn’t have knowledge on the danger signs during postnatal period.
While 34% of respondent mothers had initiated to feed breast milk within first hour to their newborns, 80% had fed colostrums to their babies. Almost 40% of mothers reported that their babies were bathed after 24 hrs which is high in comparison to national data, 9.3% (2006 NDHS). Child health
On the basis of weight for age, only 24% of children below 5 years were found to be normal while under-five female children accounted for only 6% of total normal children. Our survey found the nutritional status of under-five children considerably low, mainly the girls than the boys.
It was found that 3% of total under-five children were wasted as well as stunted and this included only girl children whereas 3% of total under-five children had chronic form of malnutrition. By measuring the mid upper arm circumference, it was found that almost 24% of children aged 13-59 months had mild/moderate form of malnutrition. Majority of mothers avoided pre-lacteal feeding whereas 54% exclusively breast fed their children for six months or more.
The correct way of super-flour preparation was known to 41% of the respondents. There was cent per cent coverage of immunization and vitamin A supplementation.
Family planning
Majority of respondents, i.e. 85% desired to have only two children whereas 46% of respondents preferred a spacing of 4 to 5 years. The use of modern family planning methods was 54% which is higher compared to national data. Depo-Provera injection was found to be most widely used contraceptive device, i.e. 76% as a means of temporary family planning whereas 14% of the respondents had chosen a permanent family planning method.
Environmental status
The main source of drinking water for the Chitlang VDC was water piped from the “mool”. The vast majority of respondents, i.e. 87% did not treat water for the drinking purposes while those who did, relied on boiling for purification. The latrine coverage was found to be 63% whereas 23% of those who hadn’t constructed latrine considered it unnecessary. Cow-sheds were found to be within the houses in as much as 92% of households Almost 94% of total households used wood as fuel while only 5% of them had an improved cooking stove. Kitchen garden was found in 86% of total households. Kitchen garden was the most preferred site for liquid waste disposal among the households (38%), followed by manure pit (35%). Manure pit was mostly preferred for solid waste disposal.
Micro health project
The health-related aspects were not only collected but also presented to the community. With the help of these findings and through discussion of the needs observed by us and those felt by the community, the real needs were identified and prioritized accordingly. Finally, micro health project was conducted specifically on topics of safe motherhood, water purification, nutrition and indoor air pollution.