1.

Introduction

1.1 Background

A community, functioning as a collective social entity, serves as a reflection of a nation's

socio-economic and overall health dynamics, grounded in shared values. Community
Health Diagnosis (CHD) stands as a deliberate strategy, prioritizing the systematic
planning, execution, and assessment of health interventions within the community.

In alignment with the World Health Organization (WHO), CHD is delineated as "a
thorough quantitative and qualitative depiction of citizens' health and the determinants
impacting it. This process identifies prevailing health issues, proposes avenues for
improvement, and triggers targeted, impactful actions."

Community health diagnosis operationalizes fundamental methodologies of community

medicine, integrating epidemiology, biostatistics, demography, family health, nutrition,
environmental health, health promotion, education, medical sociology, and anthropology
in practical field situations. This comprehensive approach facilitates a swift yet
comprehensive understanding of a community and its health challenges, allowing for the
identification of priority areas for intervention and viable solutions. CHD involves a
systematic process, encompassing exploration and community interaction, pre-testing of
methods, survey planning and execution, and thorough result analysis. The final step
entails communicating these findings to the community and stakeholders, catalyzing the
initiation of strategic planning for essential changes in health services and activities.

The major purposes of Community Health Diagnosis are:

 To analyze the health status of the community.

 To determine available resources.
 To identify and prioritize problems for planning.
 To implement and evaluate health action by and for the community.
 To identify community perceptions and attitude towards health issues.
 To assisting the community to become conscious of its problems and to initiate
steps towards their solution.

1.2 Rationale

 Community diagnosis centers on pinpointing the fundamental health needs and

concealed health issues within a community through a thorough assessment of
health determinants and available resources.

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  The data acquired through community diagnosis serves as a foundational reference
for relevant sectors, guiding planning, resource allocation, and the development of
health policies tailored to the specific needs of the community.
 The information gathered from community diagnosis serves as a foundational
reference for pertinent sectors, informing strategic planning, resource allocation,
and the crafting of health policies tailored to the specific needs of the community.

1.3 Objective

1.3.1 General Objective

 To assess the existing health status and needs of the community, determine
the available resources, prioritize needs, and implement a feasible and cost-
effective micro health program that actively involves local resources and
community members.

1.3.2 Specific Objective

Program Objective
 To gather information about the geographical features, demographic
characters, environmental and socio-economic condition as determinants of
health status of the community.
 To study the common health seeking behaviors among people.
 To determine the delivery, accessibility and utilization patterns of health
services in the community.
 To analyze the data regarding the acceptance of family planning devices, Ante
Natal Care (ANC) and Post Natal Care (PNC) practices, and knowledge about
laws of safe abortion.
 To summarize the immunization records and assess nutritional status of
under-five children by anthropometric measurements.
 To make an observation of the physical setting of the households,
environmental sanitation, hygiene and waste management.
 To prioritize the real health needs drawn through the analysis of felt needs and
observed needs.
 To organize (Plan, Implement and Evaluate) appropriate Micro Health Project
(MHP) addressing the real health needs of the community.
 To present major findings of CHD to the community people and give practical
suggestions and recommendations regarding behavior to adopt for health of
individual and the whole community.

Learning Objective
 Acquiring proficiency in crafting a social map necessitates actively
coordinating with the community for skill development.
 To familiarize oneself with the geographical and social intricacies of the
community and create a comprehensive ward profile.

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  To identify the resources and utilize logistics for collection of secondary data.
 To acquire knowledge and skills for establishing baseline information
regarding the significant health status, problems, and needs of the community.
Subsequently, prioritizing these issues based on various constraints is a key
aspect of this development.
 To develop knowledge and skills to plan, design, execute and evaluate micro
health project in the community.
 Developing the skills to work in close coordination and partnership with
various stakeholders at the ward level is a crucial aspect of professional
growth.
 To immerse oneself in the community and cultivate effective communication
skills for engaging with community members.

1.4 Methodology

1.4.1 Study Design

The study design for the field was a descriptive cross-sectional study that involved both
qualitative and quantitative study methods.

Quantitative data was obtained through primary and secondary data. Household survey
was conducted for primary data with the help of interview with a semi-structured set of
questions, observation checklists and anthropometric measurements. Secondary data was
collected from the Ward Office and the Urban Health Centre at Nursery.

Qualitative data was obtained from Female Community Health Volunteers (FCHVs), ward
representatives and health workers.
1.4.2 Study Area
Our study area was Ward 1 of Bidur Municipality located in Nuwakot District of Bagmati
Province, located to the north west of Kathmandu, the capital of country Nepal. This ward
was formed by merging three wards (1, 10 and 11) formerly of Bidur Municipal in 2072 B.S.
We conducted the survey in 8 settlements namely Trishuli Bazar, Dhunge Bazar, Bandre,
Pandegaau, Bogatigaau, Keurini, Ratmate and Rimal Daada . Trishuli Bazar, Dhunge
Bazar and Bandre were connected to the main highway while the other settlements were
dispersed across the hill.

1.4.3 Study Population

The study population was heterogenous, consisting of different ethnicity, religion and age
group. The major ethnicity group of the ward was Brahmin followed by Chhetri followed by
Tamang and Newar. Hinduism was the major religion followed by Buddhism and
Christianity.

1.4.4 Unit of Analysis

Each household was a sampling unit. The respondents were

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  Head of household or other eligible member of the family
 Mother of children under 5 years of age
 Under-five aged children

1.4.5 Sampling Technique

As the data collection of the ward was still in process, a list of households was not
available. So, a proper sampling frame couldn’t be made. Hence, non-probability sampling
technique was chosen.

Quota sampling method was used for selection of households. We divided the ward into 2
sub-groups based on geographical distribution of population. Trishuli Bazar, Dhunge
Bazar and Bandre were considered as one sub-group connected to the Pasang Lhamu
Highway. Pandegau, Bogatigau, Ratmate and Keurini were considered as another sub-
group which were scattered in the hillside.

The ward had approximately 670 households out of which 203 households (30.3%
approximately) were covered. Number of households for survey from each sub-group was
decided proportionately according to approximate population size of the sub-group.
Households from each sub-group was chosen according to our convenience.

1.4.6 Survey Technique and Tools

Both primary and secondary sources were used to collect the necessary data.
• Primary Source: It refers to the data collected specifically for the purpose of the
task being done.
• Secondary Source: Secondary data refers to the data already collected by another
person for another purpose used for the purpose of the task.

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S. Techniques Tools Respondents
N.
Quantitative
1 Interview Set of Questions  Head of household
 Mothers of children under 5
years of age
2 Observation Observation checklist
3 Anthropometry  Weighing machine Children under 5 years
 Tailor’s tape
 Shakir’s tape
Qualitative
4 Examination Coliform P/A (H2S )
Test Vial
5 Social Mapping Local Resource Locals
6 Key Informants  Health Professional
Interview  School Nurse
 Ward chairperson of Ward
1, Bidur

Table 1: Techniques and Tools of Data Collection

1.4.7 Data Analysis
The data collected from survey was categorized into different variables. The data was
entered into Apple’s Numbers and Kobo Toolbox. Most of the data analysis was done in
Kobo Toolbox. Chart and diagram were prepared from Apple’s Number. Anthropometry
data was entered in Number and analyzed in WHO Anthro Survey.

1.5 Variable Used

a. Demographic Details
 Age
 Sex
 Birth Details
 Death Details
 Disability Details
 Family Size
 Family Type

b. Socio-economic Details
 Source of Income

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 Religion
 Ethnicity
 Occupation
 Education level
 Gender Perception
 Smoking , Alcohol and Tobacco Consumption
 Social Security

c. Common Health Care Status

 Major Health Problem
 Common Health Care Seeking Behavior

d. Household Environment
 Water Source
 Water Purification

e. Household Observation Checklist

 House Type
 Lighting Status
 Ventilation
 Presence of Shed
 Sanitation of Toilet
 Iodine Intake Status
 Cooking Fuel Status
 Waste Management Status

f. Family Planning Details

 Family Planning Methods

g. Antenatal Care (ANC) Practices

 Age at First Child
 ANC Visits

h. Delivery Services
i. Postnatal Care (PNC) Practices
 PNC visits

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 j. Information on Abortion
k. Child Health and Nutrition
 Breastfeeding practice
 Complementary Feeding Practice
 Child Diseases

l. Immunization Details
m. Anthropometric Details
 Weight-for-age
 Weight-for-height
 Height-for-age
 Mid Upper Arm Circumference (MUAC)

1.6 Credibility of Information

To make sure that the information was valid and reliable, following activities have been
performed:
 Orientation classes were attended before the CHD for proper guidelines needed for
the field.
 The tools were pre-tested before the field in Kathmandu and confirmed to be
reliable.
 Anthropometric tools were properly calibrated to ensure accurate measurement.
 Data entry was done in accordance to the answers given by the respondents without
any changes.

1.7 Ethical Considerations

 Proper introduction and purpose of data collection was explained to all

respondents before the interview.
 Verbal consent was taken from every respondent before asking the questions
 The information obtained was kept completely confidential to maintain the
respondent’s privacy.
 Respondents were free to skip any question or even end the interview if they felt
uncomfortable at any point.
 Our status as students was clarified and no false assurances were made to any
respondent.

1.8 Limitations

Despite the efforts, there were a few imitations to the study.

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  The settlements were widely dispersed, and the absence of adequate
transportation measures resulted in certain areas within the ward being
challenging to access.
 Respondents from a few sampled households were not available during the
survey period.
 Anthropometric measurements for numerous under-five children were not
captured, as they were not present in the ward during the designated time.
 A subset of respondents exhibited reluctance in responding to inquiries
concerning smoking habits, family planning measures, and contraceptives.

1.9 Logistic

1.9.1 Transportation
Transportation arrangements from Kathmandu to Ward No. 1 were coordinated by the
campus, utilizing a reserved vehicle up to the ward office. Further, the ward chairperson
facilitated transportation from the ward office to our respective residences. The return to
Kathmandu was organized by the campus itself.

1.9.2 Lodging and Food

Our residence during the CHD program was the Trishuli Clinic Quarter, under the
management of the ward chairperson. Meals were arranged at a nearby restaurant.

1.9.3 Financial Support

The campus allocated a stipend of Rs. 19,500 per student to cover essential expenses
during the stay.

1.9.4 Tools
The campus supplied interview tools, anthropometric equipment (1 weighing machine, 1
Shakir’s tape, and 2 Tailor’s tapes), 3 water testing Coliform kits, and essential stationery
items (chart papers, markers, etc.) for the fieldwork.

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 2. Ward Profile

2.1 Overview of Ward No. 1, Bidur Municipality

Ward no. 1 Bidur Municipality is situated in Nuwakot District, Bagmati Province of Nepal.
It lies north-west from Kathmandu District

It is bordered by Ward 10 to the north, Ward 9 to the west, Ward 2 to the south, and Likhu
Gaupalika to the east. The total area of the ward no 1 is 4.69 sq. km. There are
approximately 670 households in this ward.

The climatic conditions in the region are temperate, characterized by warmth in summer
and cold in winter. Substantial rainfall occurs from Ashar to Bhadra. The predominant
vegetation consists of expansive deciduous forests, with major tree species including pine,
sal, and chilaune. Settlements are dispersed across various areas within the ward.

In the total sample population, 48.27% are males, with the remaining 51.73% being
females. The religious distribution shows that 79% adhere to Hinduism, and approximately
4% each follow Buddhism and Islam. The predominant ethnic groups in the ward are
Brahmin, followed by Chhetri and Tamang. Nepali is the primary language spoken in this
community. Agriculture is the prevailing occupation, with crops such as wheat, maize,
paddy, and mustard being cultivated.

The educational landscape comprises 2 government schools, 1 private school,1 multiple

campus and a CTEVT college within the ward. Additionally, there are two markets, with
Dhunge Bazar being the larger of the two.

2.2 Transect Walk

A transect walk conducted on the 5th of Poush, 2080, in Ward 1 served as a valuable tool to
delineate the location and distribution of resources, features, landscape, and major land
uses along the transect. This exploration aimed to understand environmental and social
resources, population distribution, and infrastructure.

The findings revealed scattered settlements with pockets of high population density. Ward
No 1 contains three schools and an urban health center. Dhunge Bazar emerged as the
principal market, housing both the ward office and the Trishuli Hydropower Canal. The
Urban Health Center was situated in Nursery, approximately an hour away from any point
in Ward No 1. Pasang Lhamu Highway interconnected all areas in the ward, with
inaccessible road conditions and a lack of transportation facilities in the hilly core area .

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2.3 Social Mapping

The collaborative creation of the social map for Ward 1 involved school teachers and local
residents. Utilizing accessible local resources like pebbles, clay, mud, leaves, plastics,
sticks, coal, ash, and stationery, the map was meticulously crafted. It accentuated key
features such as settlements, roads, rivers, forested areas, schools, health posts, temples,
and the ward office.
Ward no 1 has geographical boundaries with Ward 10 to the north, Ward 9 to the west,
Ward 2 to the south, and Likhu Gaupalika to the east. Keurini Khola serves as the northern
border. The Tishuli River plays a crucial role in providing drinking water to Trishuli Bazar
and Dhunge Bazar, constituting 75% of the total households in the urban area, while the
remaining 25% lies in the rural area encompassing Pandegaau, Bogatigaau, Ratmate, and
Keurini.

The Rural area is predominantly covered by forests, with scattered settlements.

Connectivity differs, as Trishuli Bazar and Dhunge Bazar are linked by a highway, while the
other rural areas are connected by un-pitched roads. Each settlement has at least one
school, reflecting a decent education infrastructure. The presence of an Urban Health
centre in Nursery addresses healthcare needs in the rural area. However, transportation
remains a challenge for areas lacking highway access..

Fig 1: Social Map of Ward 1 Bidur Municipality, Nuwakot along with Index

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 3. Method and Approaches

To have a good understanding about the health and socioeconomic status a number of
quantitative and qualitative methods were used.

3.1 Quantitative Methods

The primary quantitative data source was a comprehensive household survey conducted
over a period of 9 days. The subsequent data entry and analysis phase was efficiently
completed within 6 days. In addition to the survey, secondary sources from the Urban
Health Center and the ward office substantially contributed to the quantitative dataset.
The observation checklist embedded in the questionnaire tool also facilitated the
acquisition of essential data.

3.1.1 Sampling Techniques

The sampled households constitute approximately 30.3% of the total households in the
ward. To address the absence of a sampling frame, a non-probability quota sampling
method was employed. Sub-groups were delineated based on the geographical distribution
of the population, and households from each sub-group were selected proportionately
according to the estimated size of the respective sub-group.

3.1.2 Tools for Quantitative Data Collection

Structured questionnaires, observation checklist and anthropometric tools (weighing
machine, measuring tape, and Shakir’s tape) were used for interview in household survey.

3.2 Qualitative Methods

The coliform kits supplied by the campus were employed to assess the water quality at
various sources and storage points for drinking water. Testing was conducted at three
distinct sources, providing valuable information on the quality of drinking water. Social
mapping, carried out with the assistance of locals, aimed to comprehend the ward profile
and approximate population distribution. Interviews were systematically conducted with
Female Community Health Volunteers (FCHVs), health personnel, and local residents to
gain insights into the ward's health condition, health-seeking behaviors, and drinking
water situation.

3.2.1 Tools for Qualitative Data Collection

Key Informant Interview (KII) and informal interviews were conducted to obtain necessary
qualitative data.

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3.3 Approaches to Different Activities

3.3.1 Key Informant Interviews

Key Informant Interviews (KIIs) were carried out to gain insights into specific aspects. The
findings from the key informant interviews reveal several pertinent issues concerning
community health and well-being. The interview with the Ward Chairperson highlighted
forthcoming initiatives such as the drinking water project, indicative of efforts to enhance
access to clean water—a fundamental determinant of public health. Furthermore, the
Chairperson's suggestion to conduct a micro health project focusing on mental illness
underscores a recognition of the importance of addressing mental health concerns within
the community, signaling a comprehensive approach to health promotion. In discussions
with the In charge of the Urban Health Centre, the emergence of suicide cases in the
Keurini village was noted, indicating a pressing need for mental health support and
intervention services. Lastly, insights gleaned from the Female Community Health
Volunteers emphasized the significance of postnatal care, reflecting a commitment to
maternal and child health promotion. These findings collectively underscore the complex
landscape of health challenges faced by the community, necessitating a multi-faceted and
collaborative approach to address these issues effectively.

3.3.2 Micro Health Project

Following the collection of felt needs from the initial community presentation, a
comparative analysis was conducted against observed needs obtained through the
household survey. Real needs were discerned, and a prioritization process ensued,
considering factors such as magnitude, feasibility, resources, and time constraints.
Subsequently, the Micro Health Project (MHP) was planned to address a prioritized need
and executed on the 26th of Poush in school as School Health Program (SHP) in Tribhuvan
Trishuli Secondary School and on the 27th of Poush, 2080, at Keurini Chautara. The
implementation involved the presence of health workers, school teachers, ward
representatives, students, and local residents. The MHP's effectiveness was evaluated
based on feedback received from the attendees.

3.3.3 Final Community Presentation

The final community presentation was conducted on 2nd of Magh, 2080 at the premise of
Ward Chairperson, ward office staff, head of veterinary office and local people.The
program was done to share our recommendations to improve the health status of the
community and to thank the residents, leaders, ward officials, health personnel and
everyone who cooperated with us in all the programs conducted. This presentation was our
formal farewell to this month-long CHD field and to this beautiful ward no. 1, Bidur
Municipality and its residents.

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 4. Findings

4.1 Demographic Findings

Demography, in its literal sense, refers to the 'study of people.' As per the United Nations
(UN) definition, demography is "the scientific study of human populations, primarily
focusing on their size, structure, and development." In the context of the ward, a
comprehensive survey was conducted, covering a total of 203 households and
documenting information on 1012 individuals.

4.1.1 Population Pyramid

The population pyramid serves as a graphical representation of population composition by

age and sex. In the context of the surveyed population of 1012 individuals, comprising 488
males (48.2%) and 524 females (51.78%), a classification into different age groups was
undertaken with a 5-year interval. The resulting pyramid illustrates the distribution across
various age and distinguishes between male and female demographics.
Fig 2: Population Pyramid Depicting Constrictive Age-Sex Distribution in Ward 1, Bidur
(n=1012)

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The pyramid is of constrictive type with a spindle shape. Maximum percentage of the
population pyramid is constructed by the age group (40-44) which includes 4.74% female
population and 5.23% that of male. Majority of female are within the age category of 20-24
which is 5.13%. The age category 40-44 is having maximum 5.23% of males. The size of
population in the subsequent age group above the category 40-44 is tapering for both male
and female which show the ward has a sparsely distributed elderly and geriatric
population. As per the Nepal census report 2078, 61.96% of the country’s population is
shaped by people under the broad age group of 15-59. Similarly, children of age 14 and
below comprises 27.83% and those with age 60 and above makes 10.21% of the population.
These results are seen consistent with the inferences that can be drawn from the
population pyramid of Ward 1 while classifying the whole population under 3 broad
categories.

Table 2: Major Demographic Characteristics of the Respondents Residing in

Ward 1, Bidur Municipality, Nuwakot (n=1012)
S.N. Demographic Indicators Findings National Unit of
Figures measurement

1 Sex ratio 93.3 95.59 * Males per 100 females

2 Average family size 5.09 4.37* Person per household

3 Literacy rate (>5) 83.5 76.2* Per 100 population

4 Crude Birth Rate(CBR) 18.75 20** Per 1000 population

5 General Fertility rate (GFR) 58.64 78** Per 100 women

6 Crude Death Rate (CDR) 5.92 6.8* Per 1000 population

7 Disability Ratio 4.4 2.2* Per 100 population

8 Total Dependency Ratio 44.92 Per 100 independent

population

9 Child Dependency Ratio 28.75 Per 100 independent

population

10 Elderly Dependency Ratio 16.16 Per 100 independent

population
*National Population and Housing Census (NPHC), 2021
**National Demographic and Health Survey (NDHS), 2022

4.1.2 Sex Ratio

The sex ratio, denoting the total number of males per 100 females in a population, serves
as a crucial demographic indicator. Findings from the survey reveal a sex ratio of 93.3,
slightly below the national average of 95.59 males per 100 females reported by the Central

14
Bureau of Statistics (CBS) in the 2078 BS Census. These results underscore a noteworthy
variation from the broader demographic pattern observed at the national level.

4.1.3 Literacy Rate

In the determination of the literacy rate, individuals aged five years and above possessing
the ability to read and write were classified as literate. The survey reveals that 83.4 percent
of Ward 1 residents fall within this literate category. Within this cohort, the male literacy
rate is recorded at 96.9 percent, while the female literacy rate stands at 86.51 percent.

In contrast to the national averages, where the overall literacy rate is 76.2 percent, male
literacy is 83.6 percent, and female literacy is 69.4 percent, our sample population
demonstrates an impressive literacy rate. This observation signifies a noteworthy positive
deviation from the prevailing national literacy trends.

4.1.4 Crude Birth Rate (CBR)

The Crude Birth Rate (CBR) is characterized by the total number of live births per 1000
mid-year population within a given year. In Ward 1, the computed CBR stands at 18.75 per
thousand. Notably, this figure closely aligns with the corresponding data derived from the
National Demographic and Health Survey (NDHS) report, which reports a CBR of 20 per
1000 population. This congruence underscores the reliability and consistency of the
obtained CBR statistics in relation to national demographic trends.

4.1.5 General Fertility Rate (GFR)

The General Fertility Rate (GFR) is delineated as the total live births per 1000 women in
the reproductive age group of 15-49 years within a given year. Within this demographic
segment, the surveyed population of females totaled 324. The computed GFR for Ward 1
stands at 58.64 per thousand women of reproductive age, indicating a rate lower than the
national average of 78 per thousand women. This disparity emphasizes a noteworthy
distinction in fertility patterns between Ward 1 and the broader national context.

4.1.6 Crude Death Rate (CDR)

The Crude Death Rate (CDR) is defined as the total number of deaths per 1000 mid-year
population within a specified area for a given year. In Ward 1, the computed CDR stands at
5.92 per thousand, presenting a figure lower than the corresponding national value of 6.8
per thousand. This observation underscores a comparatively lower mortality rate within
Ward 1 in relation to the broader national context.

4.1.7 Disability Ratio (DR)

Disability is defined as the encounter with any condition that impedes an individual's
ability to engage in specific activities or attain equitable access within a given societal
context. This encompasses various forms of conditions, be they physical, mental, or

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cognitive, acquired after birth or present since birth. The disability ratio in our surveyed
population was determined to be 4.4 per hundred, marginally surpassing the national
census figure of 2.2 percent reported in the Nepal 2078 census.

Remarkably, our survey identified physical disability as the predominant form within our
sampled population. This finding underscores the prevalence of physical impairments and
emphasizes the need for targeted interventions to address this specific aspect of disability
within the community.

4.1.8 Dependency Ratio

The dependency ratio, a key demographic metric, is derived from the proportion of
individuals above 65 years of age and children below 15 years of age in relation to the
economically productive age group of 15-64 years. The overall dependency ratio in our
study was calculated at 44.92 per 100 independents. Breaking it down further, the child
dependency ratio stands at 28.75 per 100 independent population, while the old
dependency ratio is found to be 16.16 per 100 independents. These figures provide a
nuanced understanding of the demographic dynamics, highlighting the respective burdens
associated with child and elderly dependence on the economically productive age group.

4.1.9 Family Size and Type

The average family size within the ward was determined to be 5.09, indicating a marginal
increase compared to the national average of 4.37. Predominantly, families exhibited a
nuclear structure, constituting 58.13%, followed by joint families at 37.44%. A smaller
percentage, 3.94%, comprised compound families, while a minimal 0.49% fell under the
category of special families. This detailed breakdown provides insight into the diverse
family structures within the surveyed ward, contributing to a comprehensive
understanding of familial demographics.

Table 3: Percentage Distribution of Types of Family in Ward 1, Bidur

Municipality (n = 203)
Family type Percentage (%)

Nuclear 58.13%

Joint 37.44%

Compound 3.94%

Special 0.49%

4.2 Socio-Economic Findings

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4.2.1 Population Distribution by Religion, Ethnicity, Occupation
and Education
Table 4: Percentage Distribution of Population by Religion in Ward 1, Bidur
Municipality (n = 1012)
Religion Percentage (%)

Hindu 79.3%

Buddhist 17.4%

Christian 2.8%

Muslims 0.4%

This Ward is inhabited in majority by Hindus, followed by Buddhists and Christians and
few Muslims.

Table 5: Percentage Distribution of Population by Ethnicity in Ward 1, Bidur

Municipality (n = 1012)
Ethnicity Percentage (%)

Brahmin 24.9%%

Chhetri 22.4%

Tamang 18.5%

Newar 15.7%

Damai/Kami/Sarki 10.8%

Magar 2.7%

Others 5.0%

Out of the total 203 households we visited, majority of the respondents were Brahmins,
followed by Chhetris and Tamangs. Due to the variation in terrain, the settlement areas are
dispersed at distance from one another. These settlement areas/ toles are homogeneous
with respect to the culture and practices they share and the major ethnicity that inhabits.

Table 6: Percentage Distribution of Population by Occupation in Ward 1,

Bidur Municipality (n = 1012)
Occupation Male Female

Agriculture 7.25% 11.45%

Homemaker 0.13% 16.16%

Occupation Male Female

Job 6.74% 5.09%

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 Labor 5.6%% 0.38%

Student 7.76% 8.27%

Foreign employment 4.96% 2.54%

Business 8.91% 6.23%

Unemployed 4.71% 3.82%

Among 203 households surveyed, Majority of the people(18.7%) were involved in

agriculture. 11.83% of people were engaged in jobs while 5.98% were in labor. 7.5% left the
country for foreign employment. 15.14% pursue business as their profession. Majority of
females were housewives. The national status of agriculture in the country is 75 percent
and we got very little data in Bidur Municipality-1. The reason might be the fact that most
of the people do not solely rely on agriculture and are engaged secondarily in other
occupation.16.03% of the people were currently students while the remaining were the
dependent population.

Educational Status
The literacy rate within the Ward has been determined to be 83.9%. Notably, 10.2% of the
population possesses basic reading and writing skills.

Table 7: Percentage Distribution of Population by Educational Status (n =

1012)
Level of education Male (%) Female (%)

Illiterate 3.05% 13.5%

Can read and write 4.57% 5.99%

Pre school 4.67% 4.06%

Basic 14.11% 9.75%

Secondary 16.65% 13.3%

Bachelors and above 5.08% 5.28%

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Fig 3: Line Graph Showing Education level of Males and Females in Ward 1, Bidur
Municipality

4.2.2 Gender Equity and Social Inclusion Status of the

Respondents
Table 8: Percentage Distribution of the Respondents based on the Status of
Gender Equity and Social Inclusion in Ward 1, Bidur Municipality (n = 203)
GESI Characteristics Male (%) Female (%) Either of any
(%)

Sex preference of first child 21.67% 8.37% 69.96%

Male (%) Female (%) Both (%)

Participation in major decision 48.3% 21.3% 30.4%

making

Participation in social activities 39.9% 29.5% 30.6%

Land ownership 55.1% 30.0% 14.9%

Financial transaction/ decision 42.9% 19.2% 37.9%

Preferred Gender of the First Child

Among the surveyed households, 21.67% expressed a preference for their first child to be
male, while 8.37% indicated a preference for a female child. Notably, a significant majority,
comprising 69.96% of respondents, conveyed contentment with either gender for their first
child. This underscores a prevailing inclination towards openness and flexibility in gender
preferences within the surveyed population.

19
Role in Decision Making and Social Participation
In the surveyed households, 48.3% exhibited males taking a lead in making major
decisions, contrasting with a lower incidence of 21.3% where females held this
responsibility. Furthermore, an observable trend emerged in social engagement, with
39.9% of males actively participating compared to 29.5% of females. These findings
suggest notable gender differentials in both decision-making roles and social involvement
within the studied demographic.

Land Ownership and Financial Transaction

Upon surveying family property ownership, a notable majority of proprietors, constituting
55.1%, were identified as males, with a comparatively lower ownership incidence of 30%
among females. Additionally, 14.9% of households exhibited joint property ownership by
both genders. In financial transactions, 42.9% of households witnessed men taking charge,
while 19.2% featured women in the role of financial transaction initiators. Furthermore, a
significant portion, encompassing 37.9% of households, saw collaborative involvement of
both genders in financial decision-making processes. These findings illuminate distinct
patterns in property ownership and financial transactions within the surveyed
demographic.

4.2.3 Social Security

In Bidur Municipality-1, the Nepal government extends security allowances to various
segments of the population, including senior citizens, single women, and individuals with
disabilities, incapacitated and helpless persons, among others. Notably, approximately
35.9% of the population in this municipality receives social security allowances. A
significant portion, comprising 72.6%, benefits from old age allowances, while 20.5%
receive allowances designated for helpless single women. Additionally, 6.9% of the
populace in this region receives disability allowances. These statistics delineate the
distribution and prevalence of different security allowances within Bidur Municipality-1,
shedding light on the social support mechanisms in place.

Table 9: Percentage of Social Security Allowance Received by People in Ward

1, Bidur Municipality (n = 203)
Social Security Allowance Percentage (%)

Old age 72.6%

Single woman 20.5%

Disability 6.9%

4.2.4 Major Source of Income

20
In a comprehensive survey encompassing 203 respondents, the primary sources of income
were diverse, with 33.9% deriving income from agriculture, 28.0% from business, and
14.2% each from labor and job-related activities. Notably, 9.7% of respondents reported
foreign employment as their source of income.

Examining the overall survey results among 203 households, a significant majority,
accounting for 81.7%, expressed satisfaction with their total income, deeming it sufficient
to sustain their livelihood. However, for those families unable to meet their basic needs
with regular income, recourse to loans and cooperatives emerged as a prevalent strategy to
ensure the adequacy of their livelihood. This data provides valuable insights into the
income sources and coping mechanisms within the surveyed population.

4.2.5 Status of Smoking, Alcohol and Tobacco Consumption

Table 10: Percentage Distribution Showing Status of Smoking, Alcohol and
Tobacco Consumption (n = 1012)
Smoking Alcohol Tobacco

Regular Sometimes Regular Sometimes Regular Sometimes

8.6% 1.3% 3.9% 3.2% 6.1% 0.6%

Based on our surveyed sample population, 8.6% of respondents were identified as regular
smokers, while an additional 1.3% reported occasional smoking. The prevalence of regular
tobacco consumption was found to be 6.1% within the total population, and 3.9% of
respondents acknowledged regular alcohol consumption. Notably, these behaviors were
more pronounced among individuals aged 15-69.

In comparison, the Nepal Health Research Council (NHRC) 2019 report indicated higher
rates, with 28.9% of adults being regular tobacco users and 17.1% reporting regular
smoking habits. It is noteworthy that a significant majority of our sample population
refrained from any use of these intoxicants, highlighting variations in behaviors across
different demographic groups.

21
Fig 4: Stacked Bar Diagram Showing Percentage Distribution of Smoking, Alcohol and
Tobacco Consumption in Ward 1, Bidur Municipality Municipality (n = 1012)
4.3 Environmental Sanitation

4.3.1 Drinking Water

Source of Drinking Water
Water is an essential part of life, hence its safety and availability in adequate amount is
important. The cleanliness of source and purification methods of drinking water is a major
indicator of the health status of the community.

Table 11: Percentage of Major Drinking Water Source of Ward 1, Bidur

Municipality (n = 203)
Water source Percentage (%)

Natural Source 44.3%

Pipeline 32%

River 20.1%

Well 0.4%

In this ward, a predominant 44.3% of residents rely on natural sources as their primary
water supply, while 20.1% obtain drinking water from the river, and 32% utilize water from
the pipeline. Additionally, a singular household was identified obtaining water from a well.

It is noteworthy that nearly all households have sufficient access to water from their
primary source. However, a minor fraction (0.98%) expressed inadequacy in the quantity
of water available for drinking purposes from their primary source.

Table 12: Percentage of Cleanliness of Drinking Water Source of Ward 1,

Bidur Municipality (n = 203)
Cleanliness around Source Percentage(%)

Clean 96%

Dirty 4%

Water sources of almost all households (96%) were observed to be hygienic while the
remaining 4% were unhygienic.

Purification of Drinking Water

Access to pure drinking water is an important aspect of good health. Contaminated water
is the major reason for numerous water-borne diseases that affect the entire health of the
community.

22
Table 13: Percentage of Respondents using Methods of Purification of
Drinking Water in Ward 1, Bidur Municipality (n= 203)
Method of purification Percentage (%)

Filtration 48.7%

Boiling 39.9%

Chemical treatment 0.98%

SODIS 0.49%

No purification 24.1%
*Multiple Response Table

In a comprehensive survey of 203 households, it was found that a significant majority,

75.8%, implemented various purification measures for their water consumption.
Noteworthy practices included boiling, with 39.9% opting for this method, while a smaller
percentage, 0.49%, relied on solar disinfection (SODIS), and 0.98% employed chemical
treatment. A substantial 48.7% of respondents preferred the filtration of water at the
source before consumption. However, it is noteworthy that 24.1% of households reported
consuming water directly from the source without employing any purification methods.
These findings shed light on the diverse approaches taken by households in ensuring the
safety and quality of their water supply.

Storage of Drinking Water

63% of households stored drinking water, whereas 36.9% directly drank from the source.
Out of 63% of households, 98% properly covered the stored water while 2% didn’t cover
the stored water.

Coliform Test of Drinking Water Sources

Coliform Presence/Absence (P/A) Test Vials, sourced from the campus, were employed to
assess the potability of drinking water across three distinct locations within the ward.
These kits provide qualitative insights into the condition of the drinking water. The
detection of fecal contamination is indicated by a discernible black coloration within the
test vials.

A water quality assessment was conducted at various locations, including Trishuli Bazar,
Keurini (a natural source), and Dhunge Bazar (jar water). The analysis revealed that the
water from the pipeline in Trishuli Bazar exhibited fecal contamination, as indicated by a
black coloration in the testing kit.

23
Fig 5: Coliform Test of Different Water Sources in Ward 1, Bidur Municipality

4.3.2 House Type and Condition

Conditions of the house such as lighting and ventilation are one of the determinants of
health of the family. Proper lighting and ventilation is necessary for a healthy lifestyle.

Table 14: Percentage of Different Types of Houses in Ward 1, Bidur

Municipality (n = 203)
Type of House Percentage (%)

Pakki 52.7%

Semi-pakki 35.9%

Kacchi 11.4%

Table 15: Percentage of Ventilation Condition of Households in Ward 1, Bidur

Municipality (n = 203)
No. Of Windows per Room Percentage (%)

More than two 59.1%

Less than two 40.9%

52.7% houses in the ward were Pakki, 35.9%% were Semi-Pakki and 11.4% of the houses
were Kacchi. After the earthquake in 2072 BS, the number of Pakki houses has increasd in
the ward.
59.1% of the houses had more than two windows in each room allowing proper exchange of
air in and out of the room whereas 40.9% had less than two windows.

4.3.3 Status of Cattle Shed

As agriculture is the major occupation in this area, a lot of families are involved in animal
husbandry and thus have cattle sheds. But cattle sheds, if unmanaged, can be a source of

24
many zoonotic diseases. Proper distancing of sheds from houses is necessary to check the
spread of such diseases.

Table 16: Percentage of Presence or Absence cattle sheds in Ward 1, Bidur

Municipality (n=203)
Presence or Absence Percentage (%)

Present 37.4%

Absent 62.6%

Table 17: Percentage of shed attached or separated from houses in ward 1 ,

Bidur Municipality (n =76)
Distance of shed from houses Percentage (%)

Attached to house 14.5%

Separated from house 85.5%

37.4% of the households had a cattle shed out of which 14.5% of the sheds were adjacent of
the dwelling house while 85.5% had their sheds at a certain distance from their houses.

4.3.4 Type of Toilet

Table 18: Percentage of Condition of Toilets of Households in Ward 1, Bidur
Municipality (n = 203)
Sanitation of toilet Percentage (%)

Sanitary 94.5%

Insanitary 5.5%

All households had a latrine inside or outside their homes. 94.5% of the households were
found to be sanitary. The toilets in the remaining 5.5% households were found to be
insanitary with either soil around the latrine or with a bad odour and flies roaming around
the latrine.

Table 19: Distance of Toilets from Households in Ward 1, Bidur Municipality

(n=203)
Distance between toilet and water Percentage (%)
resources

More than 15 meters 96.05%

Less than 15 meters 3.95%

25
96.05% of households have their toilets more than 15 meters away from water sources
while the remaining 3.95% have their toilets less than 15 meters away from water sources
making them prone to water-borne diseases.

4.3.5 Use of Salt

Iodine is an essential micronutrient in the human body. It is necessary for the formation of
thyroxin hormone which regulates body metabolism. Iodine is also needed for proper
development of the nervous system during fetal life. Deficiency of iodine causes swelling of
the thyroid gland known as goiter. The Nepal Government has implemented Universal Salt
Iodization to ensure that people receive adequate amounts of iodine in their diet.
All households were found to consume iodized salt.

4.3.6 Fuels Used for Cooking

Table 20: Percentage Distribution of Major Cooking Fuels in Households in
Ward 1, Bidur Municipality (n = 203)
Cooking fuel Percentage (%)

L.P.G. 59.11%

Traditional Chulo 37.43%

Biogas 2.48%

Electricity 0.98%

Most of the households used more than one type of cooking fuel. Most of the houses
(59.11%) had used L.P.G. as a major cooking fuel. 37.43% households used traditional
chulo. A few households (2.48%) were found to be using biogas to cook food while 0.98%
even used electricity as cooking fuel.

4.3.7 Surrounding Environment

Table 21: Percentage Distribution of Cleanliness around Households in Ward
1, Bidur Municipality (n = 203)
Cleanliness around House Percentage (%)

Satisfactory 94.08%

Unsatisfactory 5.92%

94.08% of the households had a satisfactory environment around the house. The
remaining 5.92% were found to have an unsatisfactory environment with wastes and
garbage around. It was mostly due to lack of proper waste management system in rural
inaccessible areas of the ward.

26
4.3.8 Waste Management
Effective household waste management is essential for maintaining a clean and healthy
environment. According to the survey results, 78.3% of the 203 households surveyed ,
actively practice waste separation, distinguishing between biodegradable and non-
biodegradable materials. However, 21.7% of households still dispose of both types of waste
collectively. Addressing this aspect of waste management is crucial for fostering a more
sustainable and environmentally responsible community.

Table 22: Percentage Distribution of Management of Decomposable Wastes in

Ward 1, Bidur Municipality (n = 143)
Methods Percentage

Compost manure 53.8%

Dumping 22.3%

Municipality 18.2%

Kitchen garden 5.7%

Table 23: Percentage Distribution of Management of Non-decomposable

Wastes in Ward 1, Bidur Municipality (n = 143)
Methods Percentage (%)

Municipality 44.0%

Burning 43.3%

Dumping 9.7%

River 1.5%

Throwing away 1.5%

Among those who separate wastes into the two groups, 53.8% use biodegradable wastes to
make compost manure. Few of them dump the waste or throw the waste in the kitchen
garden and others give it to the municipality truck. 44% of the households give non-
biodegradable wastes to municipality trucks while 43.3 % burn them. Others either dump
the wastes or throw them away.

Table 24: Percentage Distribution of Management of Unseparated Wastes in

Households in Ward 1, Bidur Municipality (n = 60)
Methods Percentage (%)

Municipality 75%

Dumping 16.6%

Methods Percentage (%)

27
 Burning 6.6%

River 1.8%

60 households don’t separate their wastes as biodegradable and non-biodegradable. They

primarily give their waste to Municipality trucks. Few (16.6%) dump their waste while
others either burn or throw it in the river.

4.3.9 Wastewater Management

Table 25: Percentage Distribution of Waste Water Management in Ward 1,
Bidur Municipality (n = 203)
Methods Percentage (%)

Drainage/river 50.2%

Kitchen garden 33.5%

Pits 14.7%

Toilets 1.6%

50.2% of the households throw waste water from their homes in drainage. 33.5% of houses
dispose the wastewater in their kitchen gardens. 14.7% dispose it in the pit while 1.6% use
it in toilets.

28
4.4 Knowledge on Common Health Problems

Table 26: Population Distribution of Respondents based on Knowledge on

Common Health Problems (n=203)
Disease Awareness (%)
Cancer 68.90%
HIV/AIDS 70.90%
Tuberculosis 71.40%
Mental Problem 74.80%
COPD 80.20%
Diabetes 83.25%
High Blood Pressure 86.70%
Dengue 90.14%

*Multiple Response Table

The distribution of respondents' awareness levels regarding common health problems,

based on a sample size of 203 individuals, reveals noteworthy insights into community
health knowledge. Across the surveyed diseases, awareness levels vary, reflecting distinct
patterns of understanding within the population. Notably, diseases such as cancer,
HIV/AIDS, and tuberculosis demonstrate moderate awareness levels, with percentages
ranging from 68.90% to 71.40%. Mental health problems exhibit a relatively higher
awareness level at 74.80%, suggesting a growing recognition of mental health issues within
the community. Moreover, chronic conditions like Chronic Obstructive Pulmonary Disease
(COPD) and diabetes garner considerable attention, with awareness rates of 80.20% and
83.25%, respectively. High Blood Pressure emerges as a well-recognized health concern,
with a notable awareness level of 86.70% among respondents. Remarkably, Dengue
awareness stands out with the highest percentage at 90.14%, indicating a robust
understanding of this infectious disease within the community. These findings underscore
the heterogeneous nature of health knowledge among the population and highlight areas
where targeted educational efforts could further enhance public health literacy and disease
prevention initiatives.

29
4.5 Common Illness and Healthcare Seeking Behavior

4.5.1 Major Health Problems

The major health problems in the ward were assessed based on what illness the people had
in the past few months and the regular medications they were taking. Common cold and
fever were the major illnesses seen within the past months. The prevalence of major non
communicable diseases (NCDs) which are mostly lifestyle and age related is shown in the
table. It was seen that the prevalence of those NCDs was getting higher as the age groups
gets older.

Table 27: Distribution of People Taking Regular Medications for Major Non-
Communicable Diseases and other Chronic Diseases (n = 1012)
Age Hypertension DM Gastritis COPD Thyroid CVS Psychological
Grou related related disorders
p
5-9 0 0 0 0 1 1 0
10-14 0 0 0 0 0 0 1
15-19 0 0 0 0 0 0 0
20-24 0 0 0 0 0 0 0
25-29 1 0 0 0 1 0 0
30-34 2 0 3 0 0 0 0
35-39 6 0 5 0 2 1 4
40-44 7 9 6 1 0 1 0
45-49 6 4 3 1 0 0 0
50-54 12 4 4 0 3 1 2
55-59 3 2 0 0 0 2 0
60-64 10 3 3 0 3 1 0
65-69 11 4 2 2 1 1 0
70-74 11 5 3 5 0 1 1
75-79 7 2 2 3 1 1 0
80-84 5 2 1 1 0 0 0
85-89 0 0 0 0 0 0 0
90-94 2 0 3 1 0 0 0
95-99 2 0 0 0 0 0 0
Total 86 35 35 14 12 10 8

30
Fig 6: Bar Diagram Showing Major NCDs and other Chronic Diseases in Ward 1, Bidur
Municipality (n=260)

40%

33%

30%

20%

13% 13%

10%

5%
5%
4%
3%

0%
Hypertension DM Gastritis COPD Thyroid related CVS related Psychological
disorders

The bar diagram presents the prevalence of major chronic medical conditions requiring
regular medication, expressed as a percentage of the total such NCDs and other chronic
diseases. The leading condition is hypertension at 33.07%, followed by diabetes (DM) and
gastritis, both at 13.46%. Chronic Obstructive Pulmonary Disease (COPD) accounts for
5.38%, while thyroid-related issues and cardiovascular system (CVS) concerns are at
4.62% and 3.85%, respectively. Psychological disorders represent 3.07% of the cases.

4.5.2 Common Health Care Seeking Behavior of the Respondents

Health seeking behavior has been defined as any activity undertaken by individuals who
perceive themselves to have a health problem or to be ill for the purpose of finding an
appropriate remedy.

Source of Health-Related Information

The table illustrates the percentage distribution of sources of health information among
the respondents, totaling 203 individuals. The primary source is health workers,
accounting for 59.11% of the responses, highlighting the significant reliance on
professionals within the healthcare sector. Following closely is radio/TV, contributing to
49.75% of the information dissemination. Social media emerges as a substantial source,
with 37.44% of respondents obtaining health information through these platforms.
Furthermore, Female Community Health Volunteers (FCHV) play a role, albeit to a lesser
extent, with a percentage of 10.84. It's essential to note that this data reflects a multiple
response table, indicating that respondents could select more than one source of health
information, capturing the multifaceted nature of information acquisition in this context.

31
Table 28: Percentage Distribution of Sources of Health Information among
Respondents (n=203)
Sources Percentage (%)
Health workers 59.11
Radio/TV 49.75
Social media 37.44
FCHV 10.84
*Multiple Response Table

First Place to go for Treatment when Sick

Table 29: Percentage Distribution of Different Places to go for Treatment in
Ward 1 (n=203)
Place Percentage (%)
Government Health Institutions 78.82
Private Clinics/ Hospitals 21.18

The predominant choice for seeking treatment is government institutes, constituting a

significant majority at 78.82%. In contrast, private clinics/hospitals represent a smaller
but noteworthy proportion, accounting for 21.18% of the respondents’ preferences. This
data indicates a prevalent reliance on government healthcare facilities within Ward 1,
underscoring the role of public institutions in providing medical services to the local
population.

Reason for Not Going to Government Health Institutions

Table 30: Percentage distribution of Reasons of Respondents for not going to
Government Health Institutions in Ward 1 (n=43)
Reason Percentage (%)
Lack of good service 48.84
Insufficient medicine 18.60
Being far 16.28
Lack of belief 13.95
Slow response 11.63
Unavailability of health workers 6.98%
*Multiple Response Table

The table outlines the percentage distribution of reasons why respondents in Ward 1,
totaling 43 individuals, choose not to seek medical assistance from government health

32
institutions. The primary factor cited is the perceived lack of good service, accounting for
48.84% of the responses. Insufficient availability of medicine is another notable concern,
with 18.60% of respondents indicating this as a reason for not choosing government health
institutions. Distance is a factor for 16.28% of individuals, highlighting accessibility
challenges. Additionally, 13.95% cite a lack of belief, 11.63% point to slow response times,
and 6.98% identify unavailability of health workers as reasons influencing their decision.
This data sheds light on various factors contributing to the choice of alternative healthcare
options in Ward 1.

4.6 Family Planning, Maternal and Child Health

Maternal and Child Health (MCH) refers to the health status of mothers and children. It
includes women during pregnancy, childbirth and postpartum period and children,
especially those under five years of age. Maternal morbidity and mortality, child
malnutrition and child mortality remains a grave problem in the healthcare of Nepal.
Maternal Mortality Ratio (MMR) of Nepal as of the latest census is 151 per 100,000 live
births ((CBS), 2078 BS). Maternal and Child Health aims to promote reproductive health,
physical and psychological development of child and to reduce maternal and child
morbidity and mortality. Nepal’s targets for SDGs are to reduce maternal mortality ratio to
less than 70 per 100,000 live births.

Family planning refers to the practices adopted voluntarily by individuals or couples to

achieve a happy and healthy reproductive and family life. It helps couples to develop a
positive attitude and make responsible decisions to promote health and welfare of the
family. Family planning is necessary to prevent unwanted births, determine number of
children in the family and maintain proper birth spacing between children. The
government of Nepal’s target under SDG is to increase prevalence of modern
contraceptives by women of reproductive age group to 60% by 2030 (Ministry of Health
and Population, 2022).

4.6.1 Family Planning

Number of children and age difference between them is an important indicator of quality
of life. The respondents were married females within the reproductive age (15-49 years).

Desired Number of Children and Birth Spacing

Table 31: Desired Number of Children among Respondents in Ward 1 (n =27)
Desired Number of Children Percentage (%)
Up to 2 88.89
3 and above 11.11

33
A significant majority, 88.89%, express a preference for having up to two children. In
contrast, a smaller proportion, 11.11%, indicates a desire for three or more children. This
data offers insights into family planning preferences within Ward 1, highlighting a
predominant inclination towards smaller family sizes among the surveyed population.

Table 32: Desired Birth Spacing among Respondents in Ward 1 (n=27)

Birth Spacing Percentage (%)
Less than 4 years 14.81
4-5 years 66.67
More than 5 years 18.52

The majority, at 66.67%, express a preference for a birth spacing of 4-5 years. A smaller
proportion, 14.81%, indicates a preference for less than 4 years of spacing, while 18.52%
express a desire for a spacing of more than 5 years. These findings provide insights into the
family planning choices of the surveyed population, illustrating a prevalent preference for
a moderate birth spacing of 4-5 years among respondents in Ward 1.

Use of Contraceptive Devices

Contraceptive devices are essential for proper family planning as they allow couples to
decide the number of children they want and to have a safe sex life without having fear of
being pregnant.

In Nepal, 57.2% of the married women of reproductive age group use some methods of
contraception with 42.7% using modern methods (sterilization, injectable, Intra-Uterine
Devices (IUDs), oral pills, condoms, locational amenorrhea method) with the most popular
method being female sterilization (13%), injectable (9%) and implants (6%). (NDHS 2022)

Table 33: Distribution of Use of Different Methods of Contraceptive Devices of

Respondents (n = 27)
Contraceptive Devices Percentage (%)
Depo 29.63
Female sterilization 11.11
Pills 11.11
Condom 7.40
IUD 3.70
Not using any 44.44%
*Multiple Response Table

This table outlines the distribution of the use of various contraceptive devices among
respondents, totaling 27 individuals. The most prevalent method is Depo, utilized by

34
29.63% of respondents. Female sterilization and pills each account for 11.11%, while
condom usage stands at 7.40%, and IUD usage at 3.70%. Notably, 44.44% of respondents
indicate not using any contraceptive method because of the fear of side effects (mostly),
unavailability of their husbands and other reasons.

Among the 3 individuals using Depo as contraceptive device, problems such as irregular
menstruation and white water discharge were seen.

These findings provide a comprehensive view of contraceptive practices in the surveyed

population, highlighting the diversity of methods employed and a substantial portion
opting not to use any contraceptive device.

Fig 7: Bar diagram showing Usage Status of Contraceptive Devices among the 27
Respondents of ward 1

4.6.2 Median Age at First Marriage

The age at first marriage can be considered as one of the demographic indicators. Women
who get married at early age are at higher risk of having their first child at young age,
50%
44%

38%

30%

25%

13% 11% 11%

7%
4%

0%
Depo Female steril- Pills Condom IUD Not using
ization any
hence making contribution to higher fertility rate.

The respondents to this question were mothers with children below five years. The median
age at first marriage of woman in Ward 1, Bidur was found to be 20 years, higher than
national status which is 19 years overall and 18 years for females (CBS, 2078 BS). Of the
27 respondents interviewed, 13(48.15%) of them got married before the age of 20 which is
the minimum legal age for marriage. The earliest age of marriage was found to be at 16
years.

35
4.6.3 Median Age at First Child Birth
The median age at first child birth of women of reproductive age group was found to be 22.

4.6.4 Maternal Mortality Rate

No cases of maternal mortality were recorded in our survey which is an incredible
achievement.

4.6.5 Antenatal Practices

Antenatal Care (ANC) refers to the health care and facilities given to a woman during
pregnancy. The goal of antenatal care is to detect any potential complications of pregnancy
early, to prevent them if possible, and to direct the woman towards the maintenance of
their health. The recommended number of antenatal checkups according to the WHO are 8
visits (12 weeks, 16 weeks, 20-24 weeks, 28 weeks, 32 weeks, 34 weeks, 36 weeks and 38-
40 weeks), which the Nepal government has adopted since last Shrawan. Previously it was
4 visits during pregnancy.

ANC Checkup
To find the status of ANC visits, we asked the respondent about their ANC visit during
their last pregnancy. The antenatal coverage of the ward was found to be

Table 34: Percentage of Respondents Going for ANC Checkups (n = 27)

Number of ANC Visits Percentage (%)
Less than 4 times 7.41
4 and above 92.59

A significant majority, comprising 92.59% of respondents, have attended ANC checkups

four times or more, reflecting a high level of adherence to recommended prenatal care
guidelines. Conversely, a smaller proportion, 7.41%, reported attending ANC less than four
times. These findings underscore the overall positive trend of engagement with ANC
services among the surveyed population, with a majority demonstrating a commitment to
comprehensive maternal healthcare through regular and consistent antenatal visits.

Table 35: Percentage Distribution of Source of Information for ANC among

Respondents (n=27)
Source of Information Percentage (%)
Family members 37.04

36
 FCHVs 37.04
Health workers 11.11
Self-aware 11.11
Media 3.70

Family members and Female Community Health Volunteers (FCHVs) both play prominent
roles, each contributing to 37.04% of the information sources. Health workers and self-
awareness are cited by 11.11% of respondents each, highlighting additional channels for
ANC information. Media represents a smaller source, accounting for 3.70%. These findings
indicate a significant reliance on familial and community networks for ANC information,
emphasizing the importance of interpersonal channels in disseminating maternal
healthcare knowledge within the surveyed population.

Smoking and Drinking during Pregnancy

None of the respondents consumed tobacco or drank alcohol during her pregnancy.

Table 36: Knowledge about the Danger Signs during Pregnancy among
Respondents (n=27)
Danger Signs during Pregnancy Percentage (%)
Dizziness 51.85
Bleeding 48.15
Fever 29.63
Hypertension 18.52
Fainting 11.11
Seizures 7.40
Blurred vision 7.40
*Multiple Response Table

The table presents the respondents’ awareness of danger signs during pregnancy, with a
sample size of 27. Notably, the most recognized danger sign is dizziness, identified by
51.85% of participants, followed closely by bleeding at 48.15%. A substantial proportion
also acknowledged fever (29.63%), while a comparatively smaller percentage recognized
hypertension (18.52%), fainting (11.11%), seizures (7.40%), and blurred vision (7.40%) as
potential risks during pregnancy. However, 14.81% of respondents didn’t have any idea
about the potential danger signs during pregnancy. These findings emphasize the
importance of health education initiatives to enhance awareness regarding less commonly
recognized danger signs, such as hypertension and seizures, contributing to overall
maternal well-being and informed decision-making during pregnancy.

37
Among the 27 respondents surveyed, 10 reported encountering various challenges during
their respective pregnancy periods, demonstrating a diversity of issues. These
encompassed a spectrum of health concerns, including but not limited to bleeding,
swelling of the legs, hypertension, abdominal pain, kidney complications, thyroid-related
issues, fever, headaches, vomiting, allergies, and hypotension. The broad array of
identified problems underscores the complexity and multifaceted nature of maternal
health experiences, necessitating a comprehensive approach to prenatal care and support.

Table 37: Percentage Distribution of Birth Preparedness Practice among

Respondents (n=27)
Birth Preparedness Percentage (%)
Money 59.26
Transportation 59.26
Person to donate blood 37.04
Absence of preparation 22.22
*Multiple Response Table

This table outlines the percentage distribution of birth preparedness practices among 27
respondents. The most prioritized aspects include financial readiness, with 59.26% of
participants acknowledging its significance, followed by an equal percentage for
transportation preparedness. The consideration of a person to donate blood during
childbirth is recognized by 37.04% of respondents. Notably, a portion of the surveyed
individuals, comprising 22.22%, admitted to an absence of specific preparations. These
findings underscore the varied emphasis placed on different facets of birth preparedness,
emphasizing the need for comprehensive prenatal education and support programs to
address diverse needs and ensure optimal maternal and neonatal outcomes.

4.6.6 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 complication demands a high degree of knowledge and is 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 to a home based one.

Information related to these various aspects of delivery care was obtained from 27 mothers
of under-five children in Bidur-1.

Place of Delivery

38
The Auxiliary Nurse Midwife (ANMs) and FCHVs have been advocating institutional
delivery for years now, as a result of which home-based deliveries have been declined
drastically in recent years.

Remarkably, each mother among the respondents opted for childbirth at a Governmental
Health Institution, a noteworthy statistic given the context of Ward 1. Notably, this
achievement is particularly impressive considering that half of the area and a quarter of the
population in Ward 1 are situated in rural settings. This choice underscores the confidence
and reliance placed on governmental health facilities for maternal healthcare services,
potentially reflecting positive community perceptions and access to quality healthcare in
both urban and rural sectors of Ward 1.

However, 25.93% mothers didn’t receive cost free delivery service at the governmental
health institutions.

4.6.7 Post Natal Care

Postnatal care (PNC) encompasses the healthcare and attention provided to a mother and
her newborn following delivery. The initial 48 hours post-delivery represent a critical
period, as a significant proportion of maternal and neonatal fatalities occur during this
timeframe. Hence, prompt postnatal care is imperative to promptly address any
complications arising from childbirth and furnish the mother with essential information
for the optimal care of her child. This approach is instrumental in mitigating risks and
promoting the well-being of both the mother and newborn, reflecting the importance of
comprehensive postnatal healthcare interventions.

Table 38: Percentage Distribution of the Respondents as per the Place of Stay
during Postnatal Period (n=27)
Place of Stay after Delivery Percentage (%)
Home at well ventilated and bright room 81. 48
Hospital 18.52

An overwhelming majority, comprising 81.48%, opted for the comfort of their home,
specifically in well-ventilated and bright rooms. In contrast, 18.52% of respondents chose
to stay in the hospital after delivery. Notably, none of the participants reported residing in
a home with a dark room, indicative of a positive inclination towards conducive and well-
lit environments for postnatal recovery. These findings underscore the diverse preferences
in postnatal accommodation and highlight the importance of creating supportive and
suitable spaces for mothers during this critical period.

PNC Checkup

39
A postnatal care visit is an ideal time to educate a new mother on how to care for herself
and her new-born Therefore, it is highly recommended that women receive at least three
postnatal check-ups, the first within 24 hours of delivery, the second on the third day
following delivery, and the third on the seventh day after delivery.

Regrettably, a concerning observation emerges from the data, revealing that 25.93% of
mothers did not avail themselves of any postnatal care (PNC) checkups. This non-
utilization of PNC services represents a potential gap in accessing crucial healthcare
interventions during a critical period. It is imperative to delve into the reasons behind this
trend to address potential barriers or misconceptions hindering the uptake of postnatal
care. Such insights can inform targeted strategies to enhance awareness and encourage the
importance of postnatal health checkups, contributing to improved maternal and neonatal
outcomes. Addressing this aspect is pivotal for comprehensive healthcare initiatives and
ensuring the well-being of both mothers and newborns in the postnatal period.

Table 39: Percentage Distribution of the Respondents who Carried Out the
Postnatal Check-Ups (n=20)
Check-Ups Percentage (%)
Within 24 hours 95
At 3rd day (72 hours) 10
At 7th day 5
*Multiple Response Table

Out of the respondents, a significant majority (95%) underwent a postnatal check-up

within 24 hours following delivery. Only a smaller fraction (10%) opted for a check-up on
the 3rd day, and a mere 5% scheduled their check-up for the 7th day postpartum.
Alarmingly, an additional 5% of mothers delayed their postnatal care check-up until after
40 days from childbirth.
The presented data exhibits a noticeable declining pattern in successive postnatal care
visits. This decreasing trend suggests a potential concern regarding the adherence to
recommended postpartum care schedules, emphasizing the need for further exploration
and encouragement of timely post-delivery healthcare check-ups.

40
 100

87.5

75

62.5

50

37.5

25

12.5

0
Check-Ups (%) Within 24 hours At 3rd day (72 hours) At 7th day

Fig 8: Line Graph Showing Percentage Distribution of Mothers going for PNC Checkups on
Recommended Days in Ward no. 1

Table 40: Percentage Distribution of the Respondents According to their

Knowledge about the Danger Signs during Postnatal Period (n=20)
Danger Signs during Postnatal Period Percentage (%)
Heavy bleeding 70
Hands and feet swelling 55
Adherent placenta 40
Shivering and fainting 20
Weakness 5
Fever 5
Vomiting 5
*Multiple Response Table

According to the data provided, the predominant alarming signs following childbirth were
highlighted as heavy bleeding, which was reported by 70% of the respondents.
Subsequently, 55% identified experiencing swelling in their hands and feet as a concerning
postnatal symptom. Additionally, 40% noted complications related to an adherent
placenta, while 20% reported episodes of shivering or fainting.

Interestingly, a significant portion of the respondents, precisely 33.33%, lacked awareness

concerning the potential danger signs that might manifest after delivery. This data
underscores the importance of educating individuals about the varied and possible
postpartum complications to ensure timely recognition and appropriate intervention when
faced with such situations.

41
Table 41: Percentage Distribution of the Respondents who Faced Problems
during Postnatal Period (n=5)
Problems Faced during Postnatal Period Percentage (%)
Postpartum hemorrhage 40
Postpartum depression 20
After pains due to Caesarean Section 20
Hypotension 20
Hypertension 20
*Multiple Response Table

Among the total respondents, 18.51% encountered issues during the postnatal period.
Within this subset, 40% experienced postpartum depression, 20% reported postpartum
physical discomfort following a C-section, while an additional 20% dealt with hypotension
and 20% faced hypertension. The remaining respondents did not encounter any postnatal
problems.

Table 42: Percentage Distribution of Primary Caregiver for Children in

Maternal Absence (n=24)
Primary Caregiver in Absence of Mother Percentage (%)
Mother-in-law 70.83
Husband 20.83
Father-in-law 12.5
Sister-in-law 8.33
*Multiple Response Table

Based on the data presented in the table above, it's evident that the primary caregiver for
children in the absence of mothers varies among respondents. Notably, 70.83% of mothers
rely on their mother-in-law to take care of their children when they are not present. In
20.83% of cases, the responsibility falls upon their husbands, while in 12.5% of instances,
the children are cared for by their father-in-law. Moreover, for 8.33% of cases, the duty of
caring for the children in the mother's absence is undertaken by her sister-in-law. This
distribution illustrates the diverse roles assumed by family members in providing childcare
support when mothers are unavailable.

4.6.8 Knowledge Regarding Safe Abortion

In September 2002, Nepal implemented legislation legalizing abortion, subsequently
introducing abortion services in public hospitals across the country. The legalization aimed
to address the prevalent unsafe and clandestine abortion practices, which posed significant

42
health risks and led to maternal deaths. This legislative shift marked a pivotal moment in
advancing reproductive healthcare and women's rights in Nepal.

The abortion law in Nepal allows termination of pregnancies under specific conditions:

 Pregnancies of 12 weeks gestation or less: Any woman can terminate her

pregnancy based on her independent decision within the first 12 weeks of
gestation.
 Pregnancies of 18 weeks gestation: In cases resulting from rape or incest,
termination is allowed up to 18 weeks of gestation.
 Pregnancies of any duration under medical recommendation: Abortion is
permissible when an authorized medical practitioner deems it necessary.
These circumstances include when the mother's life is at risk, there's a threat
to her physical or mental health, or if the fetus is determined to be deformed.

Following the legalization, efforts were undertaken to expand access to abortion services,
particularly in rural and remote areas where healthcare facilities were limited.
Collaborations between the government, non-governmental organizations (NGOs), and
healthcare providers were instrumental in ensuring the availability of trained personnel,
essential equipment, and medication necessary for safe abortions.

Moreover, the implementation emphasized comprehensive counseling services, providing

information on contraceptive methods alongside abortion services. This holistic approach
aimed to educate women about their reproductive rights, contraceptive choices, and post-
abortion care, promoting a broader understanding of reproductive health beyond the act of
abortion itself.

The legislation also sought to address socio-cultural barriers and stigmas associated with
abortion by raising awareness, reducing societal stigma, and fostering a supportive
environment for women seeking abortion services, thereby promoting a respectful and
non-discriminatory approach in healthcare settings.

Overall, the legalization of abortion in Nepal not only focused on legal aspects but also
encompassed a broader spectrum of reproductive health measures, aiming to enhance
women's health, autonomy, and access to comprehensive reproductive healthcare services
in the country.
Table 43: Percentage Distribution of Awareness Regarding Abortion Services
and Laws Governing Safe Abortion in Nepal (n=27)
Awareness on Percentage (%)
Abortion services 88.89

43
 Laws governing safe abortion in Nepal 48.14

The data illustrates levels of awareness concerning abortion services and the
understanding of laws regulating safe abortion in Nepal. Specifically, the figures indicate a
noteworthy 88.89% awareness regarding abortion services, reflecting the extent to which
individuals are informed about the availability of such services. In contrast, the awareness
regarding laws governing safe abortion in Nepal is comparatively lower, standing at
48.14%. This statistic suggests that there is room for improvement in educating the
populace about the legal aspects surrounding safe abortion practices in the country. The
data underscores the importance of comprehensive awareness campaigns and educational
initiatives to enhance knowledge and compliance with existing legal frameworks related to
abortion in Nepal.

Table 44: Percentage Distribution of Knowledge about Legal Conditions for

Safe Abortion in Nepal among Married Women (n=13)
Laws Regarding Safe Abortion Percentage (%)
Within 12 weeks 15.38
Within 18 weeks in case of rape or incest 15.38
In case of risk mother or child 76.92
*Multiple Response Table

The tabulated data pertains to public awareness of laws governing safe abortion in Nepal,
revealing percentages associated with different scenarios. Firstly, 15.38% of respondents
are cognizant that safe abortion is legally permissible within the initial 12 weeks of
pregnancy. Similarly, an equivalent percentage reflects awareness that abortion is lawful
within 18 weeks, specifically in cases of rape or incest. Conversely, a substantial 76.92% of
participants are informed about the legality of abortion when there is a perceived risk to
either the mother or the child. However, 23.07% of mothers who knew about the existence
of law were not very aware on the legal conditions of it. This data signifies the nuanced
understanding of the legal frameworks surrounding safe abortion, emphasizing the
importance of tailored educational initiatives to enhance public awareness on these legal
nuances.

Table 45: Percentage Distribution of Preference of Places to Visit by a Women

for Safe Abortion (n=24)
Places to Visit Percentage (%)
Health institution 54.16

44
 Trained medical personnel 29.16

Medical 12.5
*Multiple Response Table

The data delineates the preferences of individuals seeking safe abortion services in Nepal,
elucidating the percentages associated with distinct categories. A predominant 54.16% of
respondents express a proclivity towards health institutions as their preferred choice for
obtaining safe abortion services. This underscores the pivotal role that formal healthcare
establishments play in catering to the reproductive health needs of the populace.
Concurrently, 29.16% of participants indicate a preference for seeking assistance from
trained medical personnel. This preference underscores the significance of skilled
healthcare professionals in the provision of safe and accessible abortion services.
Furthermore, a notable 12.5% of respondents consider medical facilities as their choice for
obtaining safe abortion services. This insight highlights the multifaceted nature of
preferences among individuals, emphasizing the need for diverse and accessible avenues
for safe abortion services. In conclusion, the nuanced data provides valuable insights into
the varied preferences within the Nepalese population regarding the venues for accessing
safe abortion services. This understanding is crucial for tailoring healthcare strategies and
initiatives to ensure comprehensive and accessible reproductive health services.

4.6.9 Child Health and Immunization

In order to comprehensively evaluate the child health status within the confines of Bidur
Municipality ward no. 1, a meticulously designed approach was employed. This involved
the administration of a structured questionnaire to mothers with children under the age of
5. The questionnaire delved into various dimensions encompassing neonatal care, infant
care, and child care.

The strategic utilization of a structured questionnaire facilitated the systematic collection

of data, allowing for an in-depth understanding of the nuances associated with neonatal,
infant, and child care practices. This methodological precision ensures that the assessment
is both thorough and accurate, providing valuable insights into the health status of
children in the specified locale.

Bathing Practice of the New-Born

Newborns are particularly vulnerable to the risk of hypothermia, underscoring the critical
importance of promptly wrapping them in warm, dry clothes immediately after birth. A
preferable practice involves initiating skin-to-skin contact with the mother, a measure

45
known to provide additional warmth and facilitate early bonding between the newborn and
the caregiver.

It is noteworthy that hypothermia poses a significant threat to the well-being of newborns,

given their limited ability to regulate body temperature effectively. Research consistently
supports the notion that maintaining appropriate thermal conditions during the early
postnatal period is paramount for the newborn's overall health and developmental
trajectory.

In the pursuit of safeguarding infants from hypothermia, a prudent strategy is to refrain

from bathing the newborn within the initial 24 hours of birth. This precautionary measure
aligns with established medical recommendations, emphasizing the significance of
preserving the newborn's body temperature during the critical neonatal period.

These evidence-based practices not only serve to mitigate the risk of hypothermia but also
contribute to fostering a conducive environment for the newborn's physiological
adaptation and maternal-infant bonding. As such, adhering to these guidelines reflects a
commitment to optimal newborn care, informed by the latest advancements in neonatal
health research and medical best practices.

Table 46: Percentage Distribution of Bathing Practice of Neonates after Birth

(n=27)
Bathing Practice Percentage (%)
Within 24 hours 14.81
After 24 hours 85.19

The data reveals distinct bathing practices for newborns, showcasing that 14.81% undergo
bathing within the initial 24 hours, while a substantial majority of 85.19% opt for delaying
the first bath until after this critical period.

Colostrum Feeding
In promoting the well-being of newborns, the initiation of breastfeeding within the first
hour of birth is a cherished practice. This crucial moment establishes a foundation for
health and fosters an enduring bond between mother and child. Remarkably, 96.3% of
mothers have embraced this vital aspect, providing their infants with the invaluable gift of
colostrum. Colostrum, known for its rich nutrients and passive immunity, serves as a
nourishing elixir, fortifying newborns against infections.

Delving further, among the nurturing mothers who prioritized colostrum feeding, 42.3%
ensured this within the inaugural hour post-birth, emphasizing the significance of timely
initiation. Regrettably, a modest 11.54% of mothers deviated from this practice,
introducing other foods before offering the enriching benefits of colostrum. This insight

46
accentuates the importance of continuous education and support to promote optimal
breastfeeding practices, ultimately contributing to the holistic well-being of both mothers
and their precious newborns.

Table 47: Percentage Distribution of Mothers Feeding their Infants with

Colostrum (n=26)
Colostrum Feeding Percentage (%)
Fed within 1 hour 42.30
Fed after 1 hour 57.70

The data reveals that 42.30% of infants were fed with colostrum within the first hour after
birth, underscoring the importance of timely initiation. In contrast, 57.70% received
colostrum after the initial hour. This information emphasizes the varied timing of
colostrum feeding practices, reflecting the need for ongoing education and support to
encourage optimal newborn nutrition.

Complementary Feeding
Complementary feeding, also known as weaning, becomes imperative when breast milk
alone ceases to fulfill the nutritional needs of infants. Beyond the sixth month of life, breast
milk alone may not suffice, necessitating the introduction of complementary foods and
liquids. It is noteworthy that initiating complementary feeding before the age of six months
becomes crucial in cases where mother's milk is insufficient for the child's nutritional
requirements.

This transition marks a pivotal phase in infant nutrition, as it ensures the provision of
essential nutrients for optimal growth and development. According to established
guidelines, exclusive breastfeeding for the first six months remains a cornerstone, after
which a gradual introduction of complementary foods complements ongoing breastfeeding
practices. This approach aligns with evidence-based recommendations, contributing to the
comprehensive care and nourishment of infants during this critical stage of their
development.

Table 48: Percentage Distribution of Infants Fed with Complementary Food

(n=27)
Time at Complementary Feeding Percentage (%)
Before 6 months 33.33
After 6 months 66.67

47
According to our study, we found that 33.33% of the total respondents introduced
complementary food before 6 months of age while 66.67% introduced only after 6 months.
The reasons for early weaning were insufficiency of breast milk (for 77.78% of respondents
who had fed before 6 months) and lack of time.

Super flour, also known as Sarbottam Pitho, stands as a modified traditional cereal grain-
pulse porridge, recognized for its exceptional nutritional benefits. This wholesome
complementary food is meticulously crafted by roasting a combination of legumes,
comprising two parts of various types, and one part of cereals, such as wheat or maize. The
legumes and cereals are individually crushed before being expertly blended and cooked to
create the nutrient-rich mixture.

This nutritionally dense Super flour is recommended as a complementary food for infants,
particularly after the first six months of exclusive breastfeeding. It serves as a vital source
of essential nutrients crucial for the continued growth and development of growing babies.
The careful selection and preparation of ingredients contribute to its high nutritional
value, making Super flour a valuable addition to the infant diet to ensure a well-rounded
and nourishing start to their early dietary experiences.

In our finding, only 3.7% respondent mothers didn’t know how to prepare the super flour.
Every respondent mother who could make the super flour was correct about the proper
way of preparation.

Immunization Practices
The universal immunization of children against prevalent vaccine-preventable diseases is a
pivotal strategy in mitigating infant and child morbidity and mortality. The National
Immunization Program (NIP), a paramount initiative in Nepal, prioritizes the provision of
equitable services to geographically and economically challenging areas, along with
marginalized communities. The overarching objective is to curtail child mortality,
morbidity, and disability associated with vaccine-preventable diseases, as outlined by the
Ministry of Health and Population in 2022.

Routine childhood vaccinations encompass essential immunizations such as Bacillus

Calmette Guérin (BCG), oral polio vaccine (OPV), fractional inactivated poliomyelitis
vaccine (fIPV), pentavalent vaccine DPT-HepB-HiB (diphtheria, pertussis, tetanus,
hepatitis B, and Haemophilus influenzae type B), pneumococcal conjugate vaccine (PCV),
rotavirus vaccine (RV), Japanese encephalitis (JE) vaccine, and measles-rubella (MR)
vaccine.

The National Demographic and Health Survey (NDHS) focuses on assessing the
vaccination status of children aged 12-23 months. This report, however, concentrates on a
sample of children aged 15 months to 5 years. By the age of 15 months, children are

48
expected to have received vaccinations covering all fundamental antigens in accordance
with the national immunization schedule. This approach underscores the commitment to
achieving comprehensive immunization coverage and ensuring the health and well-being
of the pediatric population.

Table 49: Percentage Distribution of Children Aged 15 months to 5 Years

showing Immunization Status in Ward 1 (n=18)
Vaccines Percentage (%)

BCG 100

Rota I 100
II 100

OPV I 100
II 100

PCV I 100
II 100

III 100

DPT-HepB-HiB I 100
II 100

III 100

IPV I 100
II 100

MR I 100
II 100

JE 100
*Multiple Response Table

The presented data underscores the commendable immunization status observed in Ward
1 of Bidur Municipality. All sampled children aged 15 or above have diligently adhered to
the national immunization schedule. Nevertheless, it is noteworthy that a child,
approximately 14 months old, is pending the administration of the initial dose of the MR
vaccine.

4.6.10 Childhood and Neonatal Illness

The Community-Based Integrated Management of Newborn and Childhood Illness (CB-
IMNCI) represents a comprehensive amalgamation of two pivotal programs: the
Community-Based Integrated Management of Childhood Illness (CB-IMCI) and the
Community-Based Newborn Care Program (CB-NCP). This integrated package of child

49
survival interventions strategically addresses critical issues afflicting newborns, including
but not limited to birth asphyxia, bacterial infections, jaundice, hypothermia, low birth
weight, pneumonia, diarrhea, malaria, measles, and malnutrition.

Formally initiated on the 28th of June, 2071, and currently operational in 30 districts as of
the fiscal year 2071/72, CB-IMNCI serves as a linchpin for enhancing newborn and child
health outcomes.

In tandem with CB-IMNCI, the Facility-Based Integrated Management of Childhood and

Neonatal Illness (FB-IMNCI) plays a pivotal role by addressing childhood cases referred
from peripheral-level health institutions to higher-tier facilities. The overarching objective
is to equip health workers with the requisite knowledge and skills for managing
complicated cases in children under five and neonates, ensuring the timely and effective
handling of referred cases.

As of the latest update, the CB-IMNCI initiative continues to make strides, with ongoing
implementation and adaptation in response to the evolving landscape of child healthcare.
The program's impact and effectiveness are continuously assessed and refined to meet the
dynamic challenges in the realm of newborn and childhood health.

Table 50: Percentage Distribution of Respondents with Knowledge regarding

Common Childhood Health Illness (n=27)
Common Childhood Illness Percentage (%)
Common cold 96.3
Fever 70.4
Pneumonia 59.3
Diarrhea 51.9
Worm infection 14.8
Didn’t know 3.7
*Multiple Response Table

These figures indicate a notable awareness among respondents, with a high recognition of
common childhood illnesses such as the common cold and fever. Pneumonia and diarrhea
also exhibit substantial awareness, while worm infection reflects a lower but present level
of recognition. The percentage of respondents indicating a lack of knowledge is minimal at
3.7%. This data underscores the varying degrees of awareness regarding different
childhood health conditions within the surveyed population.

Table 51: Percentage Distribution of Respondents based on Preference of

Place to Visit in Case of Child Illness (n=27)

50
 Place to Visit Percentage (%)
Health Institution 55.56
Pharmacy 44.44

The data indicates that a majority of respondents, constituting 55.56%, prefer seeking
assistance at health institutions when faced with child illness. Conversely, 44.44% express
a preference for pharmacies. This insight provides valuable information about the
healthcare-seeking behavior within the surveyed population, emphasizing a notable
inclination toward formal health institutions for addressing child health concerns.

Table 52: Percentage Distribution of Respondents on Knowledge about Causes

of Diarrhea (n=27)
Causes of Diarrhea Percentage (%)
Contaminated water 96.3
Junk food 3.7

The survey indicates that 96.3% of respondents attribute diarrhea to contaminated water,
while only 3.7% associate it with junk food.

Table 53: Preference of Places to Visit in case of Diarrhea among Children (n=27)
Place to Visit Percentage (%)
Pharmacy 59.3
Health Institution 40.7

Survey results reveal that 59.3% of respondents prefer visiting a pharmacy in the case of
diarrhea among children, while 40.7% opt for a health institution.

Table 54: Understanding among Respondents about the Remedies to Prevent

Dehydration among Children with Diarrhea (n=27)
Remedies Percentage (%)
ORS 81.5
Remedies Percentage (%)
Home remedies 22.2
Nutritious foods 22.2
Fluid rich foods 11.11
Zinc tablets 7.4
*Multiple Response Table

51
The survey results highlight the nuanced understanding among respondents (n=27)
regarding remedies to prevent dehydration in children experiencing diarrhea.
Predominantly, 81.5% of respondents recognize the significance of Oral Rehydration
Solution (ORS) in addressing dehydration. Additionally, 22.2% acknowledge the potential
of both home remedies and incorporating nutritious foods in managing this condition.
Moreover, 11.11% of respondents emphasize the importance of fluid-rich foods, while 7.4%
consider the role of zinc tablets in preventing dehydration. This nuanced perspective is
reflective of the diverse approaches and knowledge within the surveyed population.

Table 55: Percentage Composition of Children with Respiratory Problems

(n=27)
Respiratory Problems Percentage (%)
Absent 96.3
Present 3.7

In the surveyed group of 27 children, 96.3% were found to be free of respiratory problems,
while 3.7% were reported to exhibit such issues.

4.6.11 Child Anthropometry

Anthropometry serves as a critical tool for evaluating child nutritional status by comparing
height and weight distributions with the World Health Organization (WHO) growth
standard. Demographic health surveys rely on anthropometric indices, including height-
for-age (stunting), weight-for-height (wasting), and weight-for-age (underweight), to
gauge nutritional status in children under 5. Notably, in Nepal according to NDHS 2022,
25% are stunted, 8% wasted, 19% underweight, and 1% overweight.

Key Nutritional Status Measures:

1. Stunting (Height-for-Age): Reflects growth faltering.
2. Wasting (Weight-for-Height): Describes acute under nutrition.
3. Underweight (Weight-for-Age): Composite index considering both wasting and stunting.
4. Overweight (Weight-for-Height): Indicates excess weight.
5. Mid-Upper Arm Circumference (MUAC): Another relevant measure.

WHO's standard reference table categorizes nutritional levels using standard deviations.
For height-for-age, below -3 S.D. is severely stunted, between -3 and -2 S.D. is moderately
stunted, and above -2 S.D. is normal. Similar classifications exist for weight-for-height and
weight-for-age, aiding in the interpretation of survey data to address child malnutrition.

Table 56: WHO Standards of Child Malnutrition

Standard Cutoffs Classification
Height For age (Z-score)

52
Below -3 S.D. Severely Stunted
Between -3 and -2 S.D. Moderately Stunted
Above -2 S.D. Normal
Weight for Age (Z-score)
Below -3 S.D. Severely Underweight
Between -3 and -2 S.D. Moderately Underweight
Above -2 S.D. Normal
Weight for Height (Z-score)
Below -3 S.D. Severely wasted
Between -3 and -2 S.D. Moderately wasted
Above -2 S.D. Normal

Source: WHO, Child Growth Standards

Table 57: Frequency Distribution of Under-Five Children by their Calculated Z

Scores (HAZ, WAZ & WHZ) (n= 27; male=14 and female=13)
Frequency
Classification Normal Moderate Malnutrition Severe Malnutrition
Male Female Male Female Male Female
Height-for-age 13 12 1 1 0 0
Weight-for-age 10 12 3 1 1 0
Weight-for-height 11 11 2 0 1 2

The table analysis reveals concerning figures regarding child nutrition indicators within
the population. Out of the total children surveyed, 7.40% are classified as stunted,
indicating a failure to achieve expected height for their age. Additionally, 18.51% of
children fall under the category of underweight, suggesting insufficient weight relative to
their age. Similarly, another 18.51% of children are identified as wasted, indicating acute
malnutrition characterized by low weight for height. However, upon closer examination of
severe cases, the prevalence rates decrease significantly. Specifically, no children are
classified as severely stunted, highlighting potential variations in the severity of nutritional
deficiencies within the population. Likewise, only 3.70% of children are categorized as
severely underweight, indicating a lesser prevalence of extreme undernourishment.
Moreover, severe cases of wasting stand at 11.11%, suggesting a notable but reduced
prevalence of acute malnutrition when considering severe instances. These findings
underscore the importance of targeted interventions to address malnutrition among
children, especially focusing on severe cases to mitigate adverse health outcomes and
ensure proper growth and development.

53
Table 58: Frequency Distribution of Under-Five Children as per MUAC
Measurements (n=24; male=14 and female=11)
Nutritional Status as per Male Female
MUAC Measurements
Normal 12 10
Moderately malnourished 2 1
Severely malnourished 0 0

The frequency distribution of under-five children, based on Mid-Upper Arm

Circumference (MUAC) measurements, offers crucial insights into their nutritional well-
being. Among the 24 children surveyed, comprising 14 males and 11 females,
approximately half are classified within the normal nutritional range. Specifically, 12 male
children and 10 female children exhibit normal MUAC measurements, indicating
satisfactory nutritional status. Conversely, a smaller proportion of children, consisting of 2
males and 1 female, are categorized as moderately malnourished. This highlights the
presence of nutritional deficiencies among some children, albeit not severe. Importantly,
none of the surveyed children, irrespective of gender, fall under the category of severe
malnutrition based on MUAC measurements, signifying a positive aspect of the
community's nutritional landscape.

The data underscores the importance of continued monitoring and intervention strategies
to address malnutrition among under-five children, particularly those classified as
moderately malnourished. By identifying at-risk individuals and implementing targeted
nutritional interventions, such as supplementary feeding programs or nutrition education
initiatives, it's possible to mitigate the adverse effects of malnutrition and promote
healthier outcomes for children. Additionally, the absence of severe cases of malnutrition
signifies a potential window of opportunity for proactive intervention, emphasizing the
significance of early detection and intervention in addressing nutritional challenges among
vulnerable populations. Through concerted efforts focused on nutrition education, access
to nutritious food, and healthcare support, communities can work towards improving the
nutritional status and overall well-being of under-five children.

54
4.7 Key Informant Interview (KII)

Key informant interviews are qualitative interviews with people who have knowledge and
understanding on a specific issue or problem being addressed in a community. A key
informant interview is done in order to interpret quantitative data by interviewing key
informants about the how and why of the quantitative findings.

Three KIIs were conducted all together.

4.7.1 KII on “Awareness Level on Diseases among Ward Members”

During the data collection phase, it became apparent that a significant portion of the
population lacked accurate knowledge regarding the causes of common diseases, and the
effectiveness of available measures for illness prevention was deemed unsatisfactory.
Consequently, a key informant interview was conducted to ascertain the strategies and
measures envisioned by relevant authorities to address this issue.

Details:
Date: 2080/09/20
Venue: Ward Office
Interviewee: Mr. Lenin Ranjit, Ward Chairperson, Bidur-1
Major Findings:

The authority was providing the ward members with health facilities but
awareness programs and educational conductions were not as prevalent.
 Mental hea
Conclusion:
Irregular menstrual cycle was a side effect of the depo injection but it was in a large scale
in the ward. In some cases, the respondents didn’t have periods even up to 4 years. But
they weren’t ready to change to other means of contraception due to convenience and no
worry about forgetting to use contraception. Health workers have tried to persuade the
people but they were persistent on using depo.

55
56