Title: Author: Health Issues in Nepal Barbara J. Deslich Everett High School, Lansing School District Lansing, Michigan 10 – 12 Science, Health 3 – 4 class periods To examine how culture and environment affect the health of a nation. Grades: Subject Areas: Time Required: Objective: Science Benchmarks: III.5.HS.6 II.1.HS.5 III.2.HS.5 Explain the effects of agriculture and urban development on selected ecosystems. Explain the social and economic advantages and risks of new technology. Describe technology used in the prevention, diagnosis, and treatment of diseases and explain its function in terms of human body processes. Materials Required: Background information provided, library and/or internet for research. Procedure: Present background material giving information on health issues in Nepal. Ask students to address the Constructed Response Questions in the Assessment Section. Responses can be used to generate class discussions related to the topic. Students interested in pursuing further study of the topic can use Research Topics for Extended Study. and nutritional programs are heavily dependant on the education levels of a populace. it has .000 live births. which is an indication that health care for men has a higher priority than for women. (2) Nepal is one of the least developed countries in the world. estimated to be about 55 years. Nepal is one of three countries in the world where the life expectancy for women is lower than for men. In 2000. only 41% of households have access to a health facility within walking distance of 30 minutes or less. infectious disease. The health of a nation is generally determined by a number of indicators reflecting the major health concerns of its individuals. and nutritional disorders. and its physical geography. (3) The overall pattern of morbidity in Nepal is dominated by reproductive issues (both maternal and perinatal). Degenerative and noncommunicable diseases account for 23% of the burden. (1) Maternal and Child Morbidity The maternal morbidity rate is linked to services provided for in prenatal. The life expectancy rate for Nepal is low. maternal mortality. Nutritional deficiencies also exist with an estimated 75% of all mothers suffering from anemia caused by iron deficiency. sewage systems. These major indicators are life expectancy. It is estimated that 60% of its 23 million people live below poverty level. and the under 5 mortality. Early marriage and childbirth also contribute to maternal mortality along with weak infrastructure and health services. control of communicable diseases. delivery and post-natal care. questions can be asked concerning the causes of these numbers and solutions offered based on governmental services and primary health care offered to the citizens of Nepal. the morbidity rate was 539 per 100. water resource management. The mortality rate for young females is significantly higher than for males (by 24%). According to a 1996 Nepal Living Standard Survey.5 years in the twenty years between 1976 and 1996. (4) This number is especially high when compared to countries of similar socioeconomic status. Three main factors that impact state of health in Nepal are its high rate of poverty. The per capita income is around $200. Only about 37% of the population (34% of rural and 66% of urban) has access to safe drinking water and only 6% have access to proper sanitation facilities. illiteracy. There is a strong correlation between literacy and the health of a population. infant mortality. and health.Background: Health in Nepal Three of the major areas of development in Nepal focus on population. The number of births attended by a health care provider is a low 10.8% in 2001. Along with this is a traditionally high level of illiteracy. with accidents and injuries comprising the remaining 9%. (5) Culturally. Once these statistics have been compiled and analyzed. (4) Preventative health care measures. but remains the lowest in Southern Asia. These are responsible for approximately 68% of the disease burden. This number has increased by 13. (1) The highest risk group for poor health are children under five (particularly girls) and females of reproductive age. and safe drinking water which would create a more hygienic environment. Control of disease is also dependant on the availability of safe drinking water and proper sanitation procedures and facilities. Many of the diseases in Nepal are infectious and can be prevented by the development of service water.00 per year. kala-azar. the main health problems are dysentery. or solid food contaminated by feces of typhoid victims or of carriers. Officials stated that while some people may be getting enough to eat. Prevention of the disease is a matter of sanitation and proper hygiene practices. The large number of people below the poverty line. whether in a health care facility or attended by a trained health care professional. (2) According to public health officials in Pokhara. muscle cramps. In severe cholera. water. inadequate health services. lack of nutritional education. Infectious Diseases Some of the most common diseases of concern in Nepal are malaria.000 live births. The means by which a person can be infected is from food or water contaminated by bacteria from the stools of cholera patients. but cannot afford to or do not have the resources to do so.been a tradition for women to have their babies at home without any health care officials attending the birth. their diet is not nutritionally balanced. which results from lack of proper hygiene and sanitation. major problems are skin disease. an urban area 60 miles west of Kathmandu. The child mortality rate has decreased significantly in the past 30 years but remains at a high level of 91 per 200. The bacillus is transmitted by milk. The symptoms of cholera are diarrhea and the loss of water and salts in the stool. and sometimes circulatory collapse. eradication of small pox and a reduction in cholera due to education. Child malnutrition still exists at alarmingly high levels. Japanese encephalitis. that is. and other water borne diseases. thirst. Jeevan gel is a solution of sugar and salt that is distributed by health care officials. and lung disease that results from indoor cook fires. dysentery. Prevention of the disease is. There is also a marked lack of nutritional education among the population. tuberculosis. it was common to withhold water from patients with diarrhea. People have been taught to treat water borne diseases with jeevan gel. The mortality rate is more than 50 percent in untreated cases. Hepatitis A and HIV/AIDS. the patient develops violent diarrhea with vomiting. (4) Gains have been attributed to control of malaria. used specifically for the dehydration that is caused by diarrhea. acute respiratory infection. Health Care Issues Directly Linked to Water Quality Cholera is a severe infectious disease caused by the bacterium Vibrio cholerae. again a matter of . but falls to less than 1 percent with proper treatment. parasites. Typhoid Fever is an acute infectious disease caused by the typhoid bacillus Salmonella typhi. Some people know how to boil and filter their water for drinking. Previously. healthy people who harbor typhoid bacilli without presenting symptoms. or can be bought in stores. In the villages outside of Pokhara. and malnutrition. This cultural tradition will have to be overcome before women are comfortable seeking health care at delivery. lack of clean drinking water and proper sanitation all contribute to the child mortality rate. Estimates from the World Health Organization predict that conditions will not improve over the next 8 years. usually followed by extreme weakness. creating ongoing hazards. and trichina worm. and pathogenic bacteria. Health Issues Directly Linked to the Use of Human Waste in Agriculture Use of human waste as an agricultural fertilizer has been in practice since ancient times. The upper abdomen may be painful and tender. loss of appetite. If oxygen is present. Hepatitis A is an acute viral infection that causes inflammation of the liver. by other objects taken into the mouth. They are most common where sanitation is poor. and contains trace elements which naturally control plant parasites and disease. from person to person. round worm. . and muscle pains. a reduced food output. Composting encourages biological decomposition of solid organic matter and produces a humus substance which can then be used as fertilizer. vomiting. amoeba.sanitation and proper hygiene practices. pathogens can remain viable for extended periods of time on the crops and in the soil. At this temperature there is rapid decomposition of protozoa. burning lungs. or with unwashed crops. polio. Symptoms begin with fever. including enteric viruses will die if the temperature exceeds 46°C for one week. and therefore. The two most common causes of dysentery are infection with a bacillus of the Shigella group. The dangers exist for people who work with the fertilizer. and mucus or blood in the stool. giardia. or on plants for many months. Both bacillary and amoebic dysentery are passed from one person to another and spread by fecal contamination of food and water. severe abdominal pain and cramps. The process can be aerobic or anaerobic. nausea. carbon dioxide is produced. The excreta can be treated in various ways to eliminate disease-causing pathogens. and energy is released in the form of heat. It is transmitted by food or water contaminated by excreta. skin rashes and other symptoms of illness have been found in rural farmers and residents who use human waste as fertilizer. In Nepal. pin worm. Human excreta is a rich source of nitrogen and other nutrients required for plant growth. worm eggs. improves soil structure making it easier to cultivate. hook worm. bacteria will consume the organic matter. the water. All fecal microorganisms. Some of the same diseases found in unsanitary water can be spread through untreated human waste. Outbreaks often occur in refugee camps and in institutions where small children are crowded together. tape worm. Burning eyes. Parasitic eggs and cysts may exist in the soil. Dysentery is a severe inflammation of the intestine characterized by passage of loose feces. many farmers have no other alternative. The virus will usually run its course in about two weeks. Composting is an option as is the use of a double-pit latrine. There are health risks associated with this practice. and infestation by an amoeba. typhoid fever. Entamoeba histolytica. they have a choice of using human waste as fertilizer or nothing. diarrhea. it encourages the formation of humus. so in many countries chemical or other organic fertilizers have replaced the use of human excreta. the soil. Hepatitis A is caused mainly by poor sanitation and lack of hygiene. The temperature of a compost can reach temperatures of over 70°C. Health risks are associated with use of human waste as fertilizer. The roads that do exist are in poor condition. Shortages of medicines and instrumentation along with the uneven distribution of medicines and facilities. with very few roads. Nepal is a country of hills. This would prevent the use of an enclosed bathroom in the home. and low-lying regions. National Health Policy (1991) A National Health Policy (NHP) was developed in 1991 to address the health of the nation. there is a lack of distribution not only of medicine and medical supplies. The fundamental relationship among these factors will influence the future of improved health care in Nepal. encourages participation of the private sector. The 8th Health Plan (19921997). This results in malnutrition for babies. mountains. reducing the rate of population growth. Many infants are breast fed for up to two years with no food supplements. The people of Nepal realize that improvement in health care for its citizens is closely tied to reducing poverty. • • . and hill regions. This prevents the effective allocation of medical staff and medicine throughout the country.Geographic and Economic Challenges A major problem with treatment of health issues is the geography and lack of infrastructure in Nepal. The widespread poverty in Nepal prevents the country from large-scale expenditures on public sewer systems. improving literacy. It addresses delivery of health care services as well as information and administrative issues. all in keeping with the objectives of the National Health Plan. successful management of its water and natural resources. Obstacles to Success of a National Health Policy • • • A lack of funds to service and maintain health cares facilities. and national and international NGO’s. Infrastructure is weak. The physical geography of Nepal and lack of good roads prevent the availability of accessible services. but of food itself. officials and citizens will work together in all of these areas. A mitigating circumstance that must be considered is the culture and religious traditions of the Hindu people that believe human excreta should be kept away from the house. Also they do not believe that human excreta should be kept in one place. High level of illiteracy among the population. people eat only potatoes supplemented with small amounts of green vegetables. Its prime objective is to approach health care at the district level and below. the 9th Health Plan (1997-2002). In many rural areas. which would preclude the use of a bathroom inside and the use of a public latrine in a village setting. The policy emphasizes community involvement. and an improved infrastructure for delivery of services. using district health systems as a means of health care delivery. With 80% of the people living in agricultural areas. and the Long Term Health Plan (2002-2017) have since been developed. In planning for the development of Nepal. especially for those living in villages in the mountains. All plans focus on implementation and development at the community level. Andrea.org. 5 November 2003. Rithivi Raj.np/ 5. Library of Congress. Lin. Klaus and Aung. Vice Chairman. Wagner. Yagui.net/country/nepal/nep05.un.htm 3.org. “Country Health Profile: Nepal”. 11 November 2003. Deputy Regional Director: World Health Organization. Water resources management and solid waste management are two of the most critical issues that must be dealt with as Nepal plans to develop its vision of a society where all of its citizens have access to proper health care and education. Federal Research Division. 15 November 2003. http://lcweb2.• A lack of decision-making and implementation by the government with regard to training skilled health care workers. poverty. National Strategies for Sustainable Development. “Nepal: Country Studies”.gov . “Millennium Development Goals: The United Nations System in Nepal” United Nations.sg/nepalnet.org/drd/hlth_sit_nepal. “Status Review: Health. http://www. Ligal. Solutions to problems with health care in Nepal are closely linked to education. Savada. An Introduction to Health in Nepal: NepalNet an electronic networking for sustainable development in Nepal http://www. Karki.whosea. a governmental commitment to improved services. National Planning Commission.health/medicine/health. 11 November 2003. Population and Drinking Water & Sanitation Sectors”.panasia. Works Cited 1. http://www. the Hindu religion and its culture.htm 4.htm 2. and the infrastructure to support change. http://w3.nssd.loc. Why is this important? How could Nepal get this message to their people when at least half the population can’t read? Support your ideas with specific suggestions. Be sure to include economic considerations. Many restaurant and grocery store restrooms in the US have signs on the walls instructing employees to wash their hands before returning to work. Be sure to include economic considerations. 1. 4. 2. 5. What suggestions would you have for a very poor country such as Nepal (where at least half of the population can not read) to increase people’s understanding of the importance of sanitation and disease prevention? How would you measure the success of your suggestions? 2. In Nepal’s National Health Policy. Use methods that would be of minimal economic impact. Present a solution as a public health policy regarding solid waste disposal and treatment for the rural areas of Nepal. Keeping human waste contamination away from food and water is very important. Research Topics for Extended Study: Students interested in conducting further research on this topic can explore the following issues and present their findings to the class. The country of Nepal is divided into many districts. Be sure to include economic considerations. 6. Present a solution as a public health policy regarding water quality and treatment for the rural areas of Nepal. . the government has chosen to concentrate on the delivery of health care services at the district (local) level. Present a solution as a public health policy regarding solid waste disposal and treatment for the urban areas of Nepal.Assessment: Constructed Response Questions: Students (individually or in teams) can address these questions and then prepare and present their responses to the entire class. Describe measures that can be taken in rural villages to improve the quality of water and byproduct disposal. 3. Present a solution as a public health policy regarding water quality and treatment for the urban areas of Nepal. 1. Explain why you think the decision to implement and deliver health care support this way was made in Nepal? How can Nepal measure the impact of their health policies and ensure that their limited health care budget is spent efficiently? 3. Describe current technology used to diagnose and treat some of the most common diseases in Nepal. Nepal’s National Health Policy is focused on education of the people.