Nakasongola Community Diagnosis Report

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Nakasongola Community Diagnosis Report

  1. 1. 1MAKERERE UNIVERSITYCOLLEGE OF HEALTHSCIENCESCOMMUNITY DIAGNOSIS REPORTFOR NAKASONGOLASUBCOUNTY,NAKASONGOLA DISTRICT.APRIL/MAY 2013BYAKELLO FAITH 11/U/334BALUKU ANDREW 11/U/15559/PSKALUNGI JONATHAN 11/U/1021KUNIHIRA CATHERINE 11/U/1127MUGALU DENIS EDWARD 11/U/1007NABUKALU SSENTONGO ANGELA 11/U/1044NDAGIRE REGINA NABIKINDU 11/U/1137ORIBA DAN LANGOYA 11/U/1019TUMWESIGIRE SAMUEL 11/U/47A REPORTFOR COMMUNITY DIAGNOSIS SUBMITTED TOTHE COLLEGE OFHEALTH SCIENCES, MAKERERE UNIVERSITY.
  2. 2. iDECLARATIONWeherebydeclarethe originality and authenticity of this report. Theviews expressed hereinaremostly ours though other people’s works have been cited and referenced.
  3. 3. iiACKNOWLEDGEMENTWe are thankful to the Almightyfor the wisdom,courage and determination he has granted usthroughout our stay in Nakasongola and as we accomplished this piece of work.Our sincere thanks also go out to our site supervisor; Dr. Nakku Edith,site tutor; Dr. JohnKamulegeya,Mr. Kirunda Dan and the entire staff at Nakasongola Health Centre IV for theirever present guidance during our stay at the facility.Special thanks go to the local leaders in Nakasongola Sub County and the villages thereinfor their hospitality and assistance in our community work. It made this work a great success.Every slight effort rendered by every group member is highly appreciated too.We cannotgowithoutthankingDr.DhabangiAggrey, the course coordinator, fortheformal andinformal skills, and knowledgeweacquired fromhimbeforewewentto the community. We are verygrateful.
  4. 4. iiiLIST OFABBREVIATIONS.AIDS : Acquired Immunodeficiency Syndrome.HIV : Human immunevirus.MMR : Maternal Mortality Rate.TFR : Total Fertility Rate.UDHS : Uganda Demographic and Health Survey.WHO : World Health Organization.
  5. 5. ivTABLE OFCONTENTSDECLARATION.................................................................................................................................iACKNOWLEDGEMENT..................................................................................................................iiLIST OF ABBREVIATIONS. ..........................................................................................................iiiTABLE OFCONTENTS ...................................................................................................................ivABSTRACT. .....................................................................................................................................viCHAPTER ONE.................................................................................................................................11.0 INTRODUCTION........................................................................................................................11.1 BACKGROUND......................................................................................................................11.2 Statement of the problem..............................................................................................................21.3 Broad objective.........................................................................................................................31.4 Specific objectives....................................................................................................................31.5 Scope of the study.....................................................................................................................3CHAPTER TWO................................................................................................................................42.0 LITERATURE REVIEW.............................................................................................................42.1 Defining health .............................................................................................................................42.2 Health status of the people of .......................................................................................................4CHAPTER THREE............................................................................................................................83.0 METHODOLOGY. ......................................................................................................................83.1 STUDY AREA.............................................................................................................................83.2 STUDY DESIGN. ........................................................................................................................83.3 STUDY POPULATION...............................................................................................................83.4 Sample size...................................................................................................................................83.5 Sampling techniques.....................................................................................................................83.6 Data collection techniques............................................................................................................93.7 Data processing and analysis........................................................................................................93.8 Ethical consideration. ...................................................................................................................93.9 Quality assurance........................................................................................................................9
  6. 6. v3.10. The activities carried out at the site:..........................................................................................9CHAPTERFOUR. ............................................................................................................................134.0 RESULTS...................................................................................................................................134.3. Sanitation and Hygiene..............................................................................................................174.4. Healthseeking behavior .............................................................................................................204.5. DISEASE BURDEN .................................................................................................................214.6. IMMUNIZATION COVERAGE..............................................................................................244.7. CHECKLIST .............................................................................................................................26CHAPTER FIVE ..............................................................................................................................275.0 DISCUSSION.............................................................................................................................275.1 Socio-demographic characteristics.............................................................................................275.2 NUTRITION ..............................................................................................................................285.3 SANITATION AND HYGIENE................................................................................................284 HEALTH SEEKINGBEHAVIOUR..............................................................................................29CHAPTER SIX.................................................................................................................................306.0 CONCLUSION AND RECOMMENDATIONS.......................................................................306.1 CONCLUSION .....................................................................................................................306.2 RECOMMENDATIONS..........................................................................................................30REFERENCES.................................................................................................................................31ANNEX ............................................................................................................................................32Annex1. Questionnaire. ....................................................................................................................32
  7. 7. viABSTRACT.Communitydiagnosis isthe comprehensive assessment of the health state of an entire community inrelation to its social, physical and biological environment. It involves identificationandquantification ofhealth problems in a Communityaswhole.We study the morbidity,mortalityratesandidentify their causes for the purpose of identification of those at risk.Thestudywas carried out in Nakasongola Subcounty, Nakasongola District.During this community diagnosis,weused questionnaires and checklist to obtain information onthe socio-demographic factors, Nutrition, Hygiene, Health seekingbehavior,andmaternal andChild Health.The collected data was then analyzed to comeupwith this report.Thestudywas Non-intervention descriptive cross-section surveyresearch.It involved thecommunityand thelocal leaders in the villages of Kalubanga, Matuugo and Buruuli.Generally the biggest health challenges of Nakasongola Sub County were found to be malaria,upper respiratory infections especially cough and diarrheal diseases. these were mainly due tothe bushes around people’s homes, congestion within the homes, poor sanitation to someextent, and the way of life of these people especially in Buruuli where there is communalalcohol drinking.
  8. 8. 1CHAPTER ONE1.0 INTRODUCTIONCommunity diagnosis is aprocess by which the health management committeemembersandhealthstaffbegintolearnaboutthecommunity healthproblems,needsandconcernsas well as thedeterminants of these problems. Everyindividual needs a family and every family needs acommunity toclingto.Healthprofessionalsserveso astosatisfy theirneeds.Thegreatestresourceavailableforthisisthecommunity whichis considered tobethefoundationof the health system.Prevention has to bedonebythe people themselves with the help of health workerswho havetheknowledgeaboutpreventivemeasures.Thepresenceofahealthunitnearbydoesnotitself reduce theamountof preventable illnessuntilthe people have a positive attitude towards their own healthbothin their homes and the surroundingenvironment.Ourgoal in the communitywas to build ourcapacityandassess local concerns that determine thehealthstatusoflocalresidents,establishprioritiesofimproving theirhealth,usethedataforpublichealthprogramplanning andpolicy making,developeffectiveinterventionsandevaluate theimpactofpublichealth programs andpolicies.1.1 BACKGROUNDCommunity diagnosisinvolvescomprehensiveassessmentofsocial,physical,cultural, economic,psychological, environmental and biological status of community in order toidentifyproblemsregardinghealth and set priorities forprogramdevelopment.This report has the community diagnosis of Nakasongola Sub County. NakasongolaSubCountyisfoundinNakasongola County, Nakasongola district. The district has 2 counties; Budyebocounty and Nakasongola county. Nakasongola County in turn has many sub counties includingNakasongola, Wabinyonyi, Kakooge, Kalungi, Kalongo sub counties. Nakasongola Sub County,our catchment area has many villages but we covered only three: Matuugo, Kalubanga and Buruulivillages. There are 30 health centers in the district, 27 of which are government owned, and 3 areprivate.
  9. 9. 2Despitethegovernmentandministryofhealth’sinitiativeprogramtoincreasetheutilization ofhealthservices,thereisstillhighprevalence of diseaseslikeMalaria,diarrheaandnew HIV infectionsemerging.Most people arepeasantswith low-incomeand low standards ofliving.Community diagnosishasacquiredthreelevels;Descriptive,analyticalandhealthy action programs. Itis usually a slow and gradual process based on information continuouslycollectedintheclinicalsituation,supplementedfrom timetotimeby surveysperformedoutsidethissituation.Forsmallpopulations,itmay benecessary tocumulateseveralyears`experiencebeforesatisfactory data can be got.Thisshouldbedonetogetherwiththeinhabitantsofthecommunitytoevaluateanyvariations.1.2 Statement of the problem.There are bushes around many of the homes we visited. These become breeding places formosquitoes, which spread malaria, the most prevalent disease in our catchment area. Anothercontributing factor to this is the low income of most of the people in Nakasongola. Most are justpeasant farmers who can’t afford to buy mosquito nets. They therefore wait for the free packsgiven out in government facilities and these can never be enough for the entire community and as aresult, they are defenseless against malaria. There is also poor sanitation in homes and the biggestcontributing factor is the high population in the homes. Being crowded in a limited space makes ithard to clean up and as result, much community members report with diarrheal conditions. Beingcrowded in homes also contributes to the high number of people reporting with upper respiratorytract infections like cough and others, many of which are communicable.The following is the summary of the possible factors contributing to the health status and health ofthe people living in Nakasongola Sub County:Distancefromhealth unit:Longdistance fromthehealth unitmight affect theturn up.Cultural beliefs: Dueto the cultural beliefs, people maynot seekpreventive andcurativehealth services.
  10. 10. 3Level ofeducation:Theliterates will easilyperceive the importance of health services providedthan the illiterates.Attitudeof health workers:Theconduct of health workers whiledeliveringtheServicesmayencourageordiscouragethe clients’turn up.Inadequatehealth education:Peoplemaynot bewellversed with someof the providedhealth services.Economic status:Income ofthemayinfluencethetypeof health facilityhe/she will use.Poorhousing facilities.1.3 Broadobjective.Theaimof thestudyis to carryoutcommunitydiagnosisof Nakasongola SubCounty.1.4 Specific objectives.Thestudywasguided bythe followingobjectives:To determine thedemographic characteristics of the communityof Nakasongola.To assess the nutritional statusand hygieneof thecommunity.To assess the common diseasesand health seeking behavior.To assess the health service delivery system in this community1.5 Scopeofthestudy.Thestudy wascarriedoutin Nakasongola sub county, Nakasongola county, Nakasongola district.The researchers covered 3 villages in the subcounty; Kalubanga,Matuugo and buruuli villages. Itfocusedoncommunitydiagnosis.
  11. 11. 4CHAPTER TWO2.0 LITERATURE REVIEWThis chapter contains theliteratureon the definition of health, health statusofpeopleofNakasongola district, and determinants of their health.2.1 DefininghealthAccordingtotheConstitutionoftheWorldHealthOrganization1948,healthisdefinedas astateofcompletephysical,mental,emotional,intellectual,environmental,spiritualhealth,and socialwell-beingand notmerelythe absenceof diseaseor infirmity.(WHO,2004).2.2 Health status ofthepeople ofNakasongola district.The health status of the people of Nakasongola districtas a whole is indicated by many factors, afew of which are discussed below.As of 2008, their life expectancy was 48 years which is a bit low in comparison to the national lifeexpectancy of 52 years.A TotalFertilityRate (TFR) of6.7birth/womanand a contraceptiveprevalencerate of24% both contribute significantlyto theincreasein Nakasongola’s population. The maternalmortality rate was recorded to be 506 deaths per 100000 live births; the infant mortality rate was88 deaths per 1000 live births.Teenage pregnancy estimatedat 25%in2006significantlycontributesto overall maternalmortality rate (MMR)Malaria,respiratory tractinfections especially pneumonia, skin diseases, diarrhealdiseases, physical trauma/accidents,intestinal worms, STIs, AIDS, and maternalcomplications remain theleadingcauses ofmorbidityandmortality. Malaria is the diseaseaffecting people the most in Nakasongola, contributing 48% to the diseaseburden,pneumonia 30%,skin diseases 5.3%, diarrheal diseases 4.6%, physical trauma
  12. 12. 52.5%, intestinal worms 2.2%, STIs contributing 2.1%,maternal complications 1.6% therest of the percentage being contributed by AIDS.Non-CommunicableDiseases(NCDs) are anemerging problem dueto multiple factorssuch as adoption ofunhealthylifestyles, metabolicside effects resultingfromlifelongantiretroviral (ARV) treatment.Neglected Tropical Diseases (NTDs), includingthose targetedforeradication, areStilloccurringin Uganda.Gender inequalities includingsexual andgender-based violenceremain amajorhindranceto improvement of health outcomes (UBOS, 2007).Seventyfivepercent of thediseaseburden in Ugandahowever is still preventable throughhealth promotion and diseasepreventionAs recoded from DMO’s office.2.3 Determinants of healthDeterminantisdefinedasany factor, whetherevent, characteristic, orotherdefinableentity thatbringsabout changein ahealthconditionorother definedcharacteristic. These are thecausesandotherfactorsthatinfluencetheoccurrenceofdiseaseandotherhealth-relatedevents.(Olsen et al2000)Many factorscombinetogethertoaffectthehealthofindividualsandcommunities.Whetherpeoplearehealthy or not,isdeterminedby theircircumstancesandenvironment.Toalargeextent,factorssuchaswhere we live,thestateofourenvironment,genetics,ourincome andeducationlevel,andourrelationshipswithfriendsandfamily allhaveconsiderableimpactson health.AccordingtoWHO,the determinants of health include;Incomeandsocialstatus-Higherincomeandsocialstatusare linkedtobetterhealth.Thegreater thegapbetweentherichestandpoorest people, the greaterthe differencesinhealth.Employmentandworkingconditions–Peopleinemploymentare generally healthier,particularlythose who have more control over their
  13. 13. 6working conditions. A direct relationship exists betweenpovertyandprevalenceofdiseasessuchasmalaria,malnutritionand diarrhea asthey aremore prevalentamong the poor than the rich households (UBOS2007)Physicalenvironment–Safewaterandcleanair,healthy workplaces,safehouses,communitiesandroadsallcontributetogoodhealth. Peoplewholiveinenvironmentswithpollution,highratesofjoblessness,inadequateaccesstohealthy andaffordablefood,fewopportunitiesfor physicalactivity, or that are targeted by corporations pushing unhealthy products such asalcohol,cigarettesandfastfood, tend toexperience adversehealthoutcomes.Culture-Customs, traditions and thebeliefs of the family and community allaffecthealth. Theculturalandsocio-economic contextwithinwhichwomeninUganda live hasinherent limitingfactorsthathaveabearingontheirhealth.Theruralwomenhavebeenmost disadvantagedasthesocio-culturalenvironmentisstilltighteningitsprohibitionsonnutrition and otherhealth-seeking behavior(FPAU1998). .Behavioral factors-How andwhatpeople eat,their levelof alcoholconsumption,theirengagementinphysicalactivity,ortheirpropensityforviolenceareallaffected by theenvironmentaroundthem. The combination of environmentaland behavioral factorscontributestoanincreasednumberofpeoplegettingsickandinjuredwhothenrequiremedicalservices(MC Ginn1993)Foodsafety;Unsafefoodcausesmany acuteandlife-long diseases,ranging fromdiarrhealdiseasestovariousformsofcancer.WHO estimatesthatfoodborneandwaterbornediarrhealdiseasestakentogether killabout2.2millionpeople annually, 1.9millionof themchildren.Foodbornediseases and threats to food safety constitute a growing public health problemandWHOsmissionistoassistMemberStatestostrengthentheirprogrammesfor improvingthe safetyof
  14. 14. 7food allthe wayfromproduction to final consumption.Watersupply,sanitationandhygiene.Around1.1billionpeoplegloballydonothaveaccesstoimprovedwatersupplysourceswhereas2.4billionpeopledonothaveaccesstoany typeof improvedsanitationfacility.About2millionpeopledieeveryyeardue todiarrheal diseases; mostofthem arechildrenlessthan5yearsofage.Themostaffectedarethepopulationsin developingcountries,living inextremeconditionsofpoverty,normallyperi-urbandwellersor rural inhabitants. (WHO, 2004).Education–loweducationlevels arelinked with poor health, morestressandlowerself- confidence.Education hasprofound health effects.Moreeducation makesan individual more awareofhealthyand unhealthychoicesand makesiteasierto makehealthychoicesOther determinants of health as outlined by WHO are; Transport, Food and Agriculture, Housing,Waste, Energy, Industrial, Urbanization. Water, Radiation, Nutrition and health. Genetics-inheritanceplaysapartindetermining lifespan andthelikelihoodof developingcertainillnesses.Personal behavior andcoping skills–balanceddiet,keepingactive,smoking,drinking,andhowwe dealwithlife’sstressesandchallengesallaffect health services-accessanduseofservicesthatpreventandtreat disease influenceshealth.Gender: Menand womensufferfromdifferent types of diseases at different ages(WHO 2002)
  15. 15. 8CHAPTER THREE3.0 METHODOLOGY.3.1 STUDY AREA.Thestudywas conducted in Nakasongola sub county, Nakasongola County, Nakasongola district.The district covers an area of 3509 sq.km. It is occupied by swamps (wetlands) and part of theLake Kyoga the study was carried out in 3 of the villages in Nakasongola Sub County:kalubanga, Matuugo, buruuli.Mostofthe occupantsgo for lowincomegenerating activities like peasant farming whereby theyrear cattle and grow food especially root tubers, and selling food items in their localmarketplaces. The commonhealth problems encountered in the areainclude; malaria, HIV/AIDS,diarrheal diseases, upper respiratorytract infections. The RTIs are also prevalent among thedrunkards found in buruuli village.3.2 STUDY DESIGN.Thestudywas a Non-intervention descriptive cross-section survey research.Itinvolved thecommunityand theirlocal leaders in Nakasongola sub county.3.3 STUDY POPULATION.Thetargetgroupwas thecommunity, and local leaders.3.4 Sample sizeThestudyinvolved 120 participants sampled from allthe villages in Nakasongola sub county.3.5Sampling techniques.Inthis study, probability-samplingmethodusing simplerandomsampling was used. Thehouseholdsofthestudywerepicked randomlyby researchers.Since theareaissparsely populated, theresearchersagreedtointerviewthe households one by one, consecutively.
  16. 16. 93.6Data collection techniques.Primarydata was collected usingquestionnaire andchecklist.Secondarydatawascollected usingdocumentarysource [Records].3.7Data processing andanalysis.Datawasprocessedandanalyzedmanuallyby theresearcherswiththehelpofcalculatorsand computers.Data wastabulatedandthefinalfindings were presentedinfiguresandtables drawn from Microsoftexcel sheet.3.8 Ethical consideration.Permissionwas sought fromthesitesupervisor Dr. Nakku as well as the localleadersanditwasgranted. The community visits were done in company of some of the VHTmembers. Consentwasobtainedfromtherespondentspriorto interviews. Any information obtainedwas handled with high degreeof confidentiality; asthere was nomentioningof people’s names butusingtheirsignatures on thedata collection tools forthose who could write. For illiteratecorrespondents, a thumb print was used.3.9 Quality assurance.The researchers themselves collected theirdata.3.10. The activitiescarried out at thesite:A] Home/community based work.The communitiesofconcernwere the earliermentionedvillagestowhich Nakasongola healthcentreIV rendersmostofits services. At least 30 homes werevisited from each village.Theobjectives of thesevisits wereto;Find out common types of food eaten, food securityand hygiene,
  17. 17. 10Find outthe health problems of the community.Find out theessential needs of thehomes in the community.o TheLC1, Healthmanagement teamsand communitymobilizers ofallthementioned villages werevisited and assessmentcarried outpertaininghealth problems, environmental and individual sanitation,commondiseases andtheircausesplus food security.Theseleaderswouldalso describeto us their various roles in thehealth sector aswellasthe roles oftheothermembers oftheir healthmanagement teams.B] FACILITY BASED ACTIVITIES {FBA}These included allthe activities weused to do at thefacility, Nakasongola health centreIV in thedifferent departments. The objectives were;1. To do a diet history at the antenatal clinic and young child clinic to see what food is eaten andassess whether the diet provides the macro and micro nutrients.2. To conduct anthropometric measurements and report on the nutritional status of childrenand mothers.3. To provide nutrition education to parents/guardians of children and to pregnantwomen.4. To participate in the measurement of hemoglobin in the laboratory and to interpret theresults.The Facility based activities were:Immunization and child growth monitoring.Voluntarycounselingand testing [VCT].Laboratory work bleeding patients and carrying out tests to measure theirhemoglobin levels.Pharmacywork;packing and prescribingdrugs.Participation inconsultation.
  18. 18. 11Treatment;administering intravenous fluids/drugs,fixingcannularsand drips.Nutritionand psycho-social support activities.Tutorials, SDL andwritingweeklyreports.C] ACTIVITIES IN THE PHARMACY.Thepharmacyhasa store anda dispensary.In thestoredrugsarekeptonshelvesandtheheavyonesareplacedonthepalletssothattheydonotcomeincontactwiththe floor. The movementofthedrugsinthestoreistrucked bytheuseofstockcards.Onthe stockcards they indicate quantityreceivedfromthesupplier,quantity outofthestoretothedispensary andstock remainingin the store.Italso helps themto truckthedrugs that are about toexpire.Inthedispensary,drugsarekeptonthe shelves. They havearangeofdrugsincluding antibioticsMixtures [Antibiotics,cough expectorants, antimalarials, antifungal,Injectableandi.vfluidsandCreams). Atthe dispensary, prescriptions are received, interpretedanddispensed.Patientsareexplainedtoonhowtotakethedrugsandifthereisapotentialriskofinteractionwithfoods theyareadvisedaccording.Afterdispensingthedrugs, theyare recorded. Therecordsaremanual and theworkis tedious.D] TUTORIALSThese werealways3-hoursessionsheldonMondaysandThursdays. OnMondayswe wouldformulatelearningissuesfromtheproblemandbrainstormonthemandfinallyderive learningobjectivestoberesolvedon Thursday. These tutorialswerealwaysconductedbytheweeklychairpersons with their scribes.E] IMMUNIZATIONImmunizationandchildgrowth monitoringplusPreventionofmothertochildtransmission (PMTCT)servicesatNakasongola Health Centre IV.We foundout thatmost commonlygivenvaccines are;BCG.Polio vaccine,
  19. 19. 12Measles vaccineVitamin AcomplementThe turns up for the mothers are fairandthesemothersarealwaysgiven a session of healtheducationtalkbeforestartingimmunization everytime theycome.As part of the PMTCT services, health talks are given to mothers and all the HIV/AIDs victimsevery time they gather for nutrition and psycho- social support.The facility also offersfreecondomstoitsclients.G] REPORT WRITINGThesewere meant to besummarized descriptions of weeklyactivities, challenges and findings,which wesubmitted in to thetutor every Fridaywith thelogbooks.In accordancewith thetimetablewehad to write onepage reporton ;1. A problem statement and research objectives.2. Research study to solve problem (given as problem 66) using research methods.H] LOGBOOKWeusedto fill in ourdailylogof activities from MondaytoFridayandgiveapagesummaryof alltheweeklyactivities and objectives. The books were then handed in onFridayevenings together withthe weeklyreports to the site tutor for assessment.
  20. 20. 13CHAPTERFOUR.4.0 RESULTS.Thisstudywas carried out in Buluuli and Kalubanga villages of Nakasongola Town Council, inNakasongola district. A total of 120 respondents weredrawnfrom the two villages.4.1. Socio - DemographyTable 4.1: Summary of Socio – Demographic Data.CHARACTERISTICS Frequencies PercentageAge of respondentsBelow 5 years 0 0.0Between 6 - 18 years 0 0.0Above 18 years 120 100.0Sex of respondentMale 23 19.0Female 97 81.0Head of house holdMother 69 57.1Father 51 42.9Child headed 0 0.0Type of familyNuclear family 80 66.7Extended family 40 33.3Others 0 0.0Number of people thefamilyLess than 5 54 45.2Between 6 - 18 49 40.523 19.0Age ranges in the householdBelow 5 109 90.5Below 6 - 18 246 204.8Above 18 223 185.7Occupation of head offamilyCivil servant 14 11.9Business personnel 17 14.3Peasant 83 69.0Others 6 4.8Religion of the familyAnglican 57 47.6Catholic 26 21.4Moslem 17 14.3Others 20 16.7
  21. 21. 14Fig 4.1: Demography of study sample.Fig 4.1 Shows that 18.9% of household members were under 5 years of age, 42.6% were betweenages 6 to 18, and 38.7% were above 18 years old.Fig 4.2: Occupation of household heads
  22. 22. 15Fig 4.2: shows that 11.9% of household heads were civil servants, 14.3% were business personnel,while 69.0% were peasants.4.2. Nutritional statusTable 4.2: Food security and nutritionstatusFOOD SECURITY ANDNUTRITIONSource of foodOwn garden 74 61.9Bought from markets 46 38.1Shops 0 0.0Commonly eaten foodsMatooke 46 38.1Root tubers 97 81.0Maize and its products 69 57.1Animal products 37 31.0Others 0 0.0Number of meals taken perdayOne 9 7.1Two 31 26.2Three 77 64.3More than three61.9% of households sampled obtained food from the garden, while 38.1% bought food from the market.The most commonly eaten food is Root Tubers (81.0%), followed by Maize and its products at 57.1%.
  23. 23. 1638.1% of the households consumed matooke while 31% could afford animal products.Most households have 3 meals per day (64.3%), while 26.2% and 7.1% of households have two and onemeal per day respectively.Fig4.3: Commonly consumed foods.
  24. 24. 174.3. Sanitation and Hygiene.Table 4.3: Sanitation and Hygiene Status.Frequency Percentage17 Water sourceBorehole 49 40.5Tap 60 50.0Well 6 4.8Spring 0 0.0Others 6 4.818Distance of water sourcefrom homeLess than 1 km 80 66.71 - 2 Km 26 21.4Above 2Km 14 11.919 Safe drinking waterA. Who take safe drinkingwater 77 64.3B. Who don’t take safedrinking water 43 35.7If A,Boiled 66 54.8Filtered 0 0.0Treated with chemicals 11 9.550.0%of thesampled households usetap water for homeconsumption. 40.5%use water from a
  25. 25. 18borehole, while4.8% of households use other sources of water like rain water storage.66.7%of thesampled households draw water from less than a kilometer in terms of distance.21.4% have a water source with a kilometer or two, while 11.9% have to trek more than 2kilometers to access a water source.64.3 % of the households reported consumption of safe drinking water. Boiling was the majorway of water purification (54.8% of those who drunk safe water). The other way was use ofchemicals, like water guard (9.5%). Filtration, as a method of water purification was not usedamong the households sampled.35.7% of households didn’t consume safe water, that is, they either didn’t boil it or add waterpurification chemicals before use.Fig 4.4: Common water sources.
  26. 26. 19Fig 4.5: Distance of water source from home.
  27. 27. 204.4. Healthseeking behaviorFig 4.6:FacilitiesaccessedwhensickFig 4.7: Facilities accessed for health care.020406080100120Health Unit Herbs ChurchNo.ofrespondentsFig 6: Health seeking behaviourFig 6: Health seeking…020406080100120Health Unit TraditionalhealersHerbs ChurchNo.ofrespondents
  28. 28. 2185.7 % of the households sampled receive health care from health units.Significant to note is that 11.9% of the households reported use of herbs to treat illness, while 2.4% seekremedy from church.Only 19.0% of the sampled households go for regular medical checkup from health units.Of the 19%, 62.6% go for medical checkup every six months, 12.6 % go for the checkups between sixmonths and 1 year, 12.6% take 1 to 2 years to go for medical checkup, while as the other 12.6% spendover 2 years before going for checkup.The remaining 81.0 % do not go for medical checkups.4.5. DISEASE BURDENTable 4.4: Common diseases and their frequenciesDISEASE BURDENCommon diseasesMalaria 83 69.0RTIs 86 71.4Diarrheal diseases 11 9.5Others 6 4.8Frequency of diseasesEvery month 69 57.1Between 2 and 6 months 34 28.6Over 6 months to a Year 9 7.1Over 1 year 9 7.1Chronic diseasesPresent 49 40.5Absent 71 59.5If Present, ExampleWas treatment given?
  29. 29. 22Fig4.8: Common diseases affecting household members.
  30. 30. 23Fig 4.9: Disease occurrences.As indicated in the above figures (Fig 8 and Fig 9), Respiratory Tract Infections and Malaria are the mostcommon diseases affecting the households sampled, with 71.4 % and 69.0% respectively. Diarrheal diseasesaffect only 9.5% of households.The frequencies of illnesses, occurring in the households reported for; every month, between 2-6 months,over 6 months to 1 year, and over 1 year were 57.1%, 28.6%, 7.1% and 7.1% respectively.However, 40.5 % of the households reported cases of chronic illness such as Asthma, Hypertension, andSickle cell disease.
  31. 31. 244.6. IMMUNIZATION COVERAGEFig 4.10: Immunization statusAll households sampled considered immunization of relevance to their health.However, only about 70% of the households had all their members fully immunized, with 30%having partially immunized members.40% of the household respondents complained of poor customer care as a challenge faced duringthe immunization process.26.7% complained about limited stock of vaccines at the immunization centres.13.3% had long distance as their main challenge during the immunization process.70%30%0%immunisation statusFully immunised Partially immunised not immunised
  32. 32. 25Fig 4.11: Challenges faced during immunization.051015202530354045501No. of respondentsLong distancePoor customer careLimited stock of vaccinesPoor communicationOthers
  33. 33. 264.7. CHECKLISTFig4.12: Graph of Check List0510152025303540Latrine RubbishpitKitchen AeratedhouseCleancompoundUtensilrackFood store AnimalhouseFrequencyGraph for check listpresentAbsent
  34. 34. 27CHAPTER FIVE5.0 DISCUSSIONThe study involved 120 households and we managed to capture all our forecasted sample size.5.1 Socio-demographic characteristics.Most of the respondents were females, accounting for 81% of the total respondents, the rest beingmale(19%).This is because the men in the study areas were out for work at the times ofquestionnaire distribution.The age distribution of all the respondents was above 18years as shown in the data above. Thisconfirms the validity of the information we got as all these were considered reliable adults.Majority of the households sampled were headed by mothers (57.1%),others by fathers(42.9%0and none by children. This implies that the women in our study area are heavy laden, affectingtheir general health as depicted by their great turn ups at the health centre.Within the sampled households, most of the family members were below 5 years of ageyears(45.2%), a significant number of them lying between the ages of 6 and 18 years(40.5%).This accounts for the high morbidity rate in children recorded at the health centre.The study also cut across the different religious beliefs, and the majority of the residents werefound to be Anglicans (47.6%), the rest falling in other dominations; Catholics, Muslims,traditionalists. This also affected their health seeking behaviors as the traditionalists sought forhelp from the spirits, the Pentecostals from church and the rest from the health centre (majority).With regards to occupation, majority of the respondents were peasants (69%), others werebusiness personnel (14.3%) and civil servants (11.9%). This shows that most people are lowincome earners and this affects the quality of their health as regards their nutrition and the placesthey go to for treatment. This in turn explains the poor child and maternal health as recorded atthe health facility
  35. 35. 285.2 NUTRITIONThe study results show that most of the households sampled obtained food from their owngardens (61.9%) while only 38.1% bought it from the market.64.3% of the households could afford to have 3 meals a day, 26.2% had two a day and 7.1% hadonly one meal a day.Most of the meals were served with root tubers (81%), others were served maize and its products(57.1%), matooke (38.1%) and animal products (31%).These results depict that most of the families do not have a balanced diet in their nutrition. Theirmeals are majorly deficient in proteins as shown by the few animal products consumed. They arealso generally deficient in vitamins indicated by the absence of vegetables in their meals.They however has a strong food security as most of them grow their own food and even havefood stores for it. The people in Nakasongola preserve cassava and sweet potatoes by drying it inpreparation for the dry season, when they serve them as “kasedde”.5.3 SANITATION AND HYGIENE.Majority of the sampled households use tap water at home (about 50%), others obtain it form theboreholes (40.5%) and wells 4.8%) especially when there is shortage at the taps. This is a goodindicator of their water safety. They are however affected by the distances to these water sourcesas majority walk a distance of at least a kilometer to obtain it (66.7%), 21.4% of them walk adistance between 1 and 2 km, while 11.9% have to foot more than 2km. This water is mainlyboiled for consumption (54.8%) while 9.5% use chemicals like water guard. The rest do not treatit at all, with the belief that it is already treated from the sources pumping it to the taps.The water safety accounts for the very low prevalence of water borne diseases like bilharzias andtyphoid as recorded at the health facility.From the checklist graph above, about majority of the household disposed off their rubbish safelyin rubbish pits and in their gardens for manure, accounting for the high percentage of cleancompounds recorded. Human wastes were also observed to be disposed off in pit latrines,accounting for the low prevalence of diseases like cholera and ebola which would be spread by
  36. 36. 29poor waste disposal.4 HEALTH SEEKINGBEHAVIOURFrom figure 6, majority of the people in the study area seek for health attention from the healthfacility. A significant number, however seek for it from traditionalists while a few seek for healthattention from the spiritual healers and churches. Almost none of the respondents were found to evergo for routine medical checkups. Actually, majority of them were ignorant about them. This goodhealth seeking behavior is attributed to short distance of most of the respondents’ homes from thefacility, to the facility staff and VHT’s effort to publicize the services available for exampleimmunization, safe circumcision, weekly health education programs, cancer screening and the effortto attend to them fully when they come to the facility.The facility plays a big role in prevention and control of HIV/AIDS; free condoms are provided everysingle day and there are free counseling sessions on Tuesdays. Testing for HIV/AIDS is done free ofcharge at the facility.
  37. 37. 30CHAPTER SIX6.0 CONCLUSION AND RECOMMENDATIONS.6.1 CONCLUSIONThe study has revealed that the health and health status of people of Nakasongola sub county isstill below the expected level. The major factors that contribute to the health and health statusinclude;1. Low levels of income2. Lack of mosquito nets and thick bushes around homes.3. Poor housing facilities as most houses were found to be crowded.4. Long distances from reliable water sources.5. Ignorance about some essential factors like water treatment and importance of routinemedical checkups.6. Poor nutrition as it was observed that most of their meals are protein and vitamindeficient.6.2 RECOMMENDATIONSOn the basis of the findings of the study, the following recommendations are proposed:1. Carryout Health Promotion and preventive activities like community health education on:use of mosquito nets to prevent malaria and attending antenatal clinics to promote maternaland child health.2. The number of outreaches should also be increased to create more awareness on theimportance of clearing bushes from homes and give out mosquito nets to people whocannot afford.3. The overcrowding in the houses was caused by too many children within the same household.We therefore recommend that the health stake holders educate people about family planningand child spacing and their advantages, and encourage people to carry them out.4. Local leaders should ensure proper house construction to promote proper sanitation.5. Health stakeholders should encourage members to go for routine medical checkups by tellingthem the advantages of the act.6. More people should be trained to join the VHTs and these should be given allowance as anencouragement to be part of the awareness teams.
  38. 38. 31REFERENCES.1. WHO;Worldhealth report 2002,20041. Olsen SJ,MacKinonLC,Goulding JS, Bean NH,SlutskerL.Surveillancefor foodborne2. diseaseoutbreaks–United States, 1993-1997.In: Surveillance Summaries,March 27,2000.3. MMWR 2000; 49(No.SS-1):1–594. McGinnis,JMFoege;actual cases of death in the UnitedStates Journal of theAmericanMedical ASSOCIATION,270;2207-2217,1993
  39. 39. 32ANNEXAnnex1. Questionnaire.QUESTIONNAIRE FOR COMMUNITY DIAGNOSIS OF NAKASONGOLA SUB-COUNTY,NAKASONGOLA DISTRICT.Consent form: We are medical students from Makerere University College of Health sciences carryingout community diagnosis in Nakasongola Sub County. This is to achieve a comprehensive report onhealth status and factors affecting health in Nakasongola Sub County. We would like you to participatein this research and we promise that the information obtained will not be linked to you directly and weshall ensure strict confidentiality. You are free to withdraw at anytime during the course of theinterview.Signature…………………………………………1. Age of the respondentA. Below 5 yearsB. Between 6-17 yearsC. Above 18 years2. Sex of the respondentA. MaleB. female3. Who is the head of this household?A. motherB. fatherC. child headed4. What is the type of family?A. nuclear familyB. extendedC. others
  40. 40. 335. How many people stay within this household?A. less than 5B. between 6-10C. more than 106. How many people in this household lie within the age ranges of?A. below 5B. between 6-18C. above 187. What is the occupation of the head of the household?A. civil servantB. business personnelC. peasantD. others8. What is the religion of the family?A. protestantB. roman catholicC. moslemD. othersIMMUNISATION COVERAGE9. Do you think immunization of children is important?A. yesB. noC. have no idea10. What is the immunization status of the youngest member of the household?A. fully immunizedB. partially immunizedC. not immunizedi. If answer is A or B, why?11. What challenges do you find with immunization generally?A. long distance
  41. 41. 34B. poor customer careC. limited stock of vaccinesD. poor communicationE. othersDISEASE BURDEN12. Which disease(s) commonly affects members of the household?A. malaria/feverB. RTIs(cough)C. Diarrheal diseasesD. Others(identify)13. How often does sickness occur in this household?A. Every monthB. Between 2 to 6 monthsC. Over 6 months to 1 yearD. Over one year14. Does anyone in the household have a chronic disease?A. YesB. Noii. If yes which one………………………………………………..iii. Did they get treatment for this diseaseHEALTH SEEKING BEHAVIOUR15. Where do you seek health attention?A. From the health unitB. From traditional healersC. Use herbs from homeD. From churchE. Others16. Do you go for regular medical check upA. YesB. Noi. If yes ,how often
  42. 42. 35A. Within 6 monthsB. Between 6 months and 1 yearC. Between 1 and 2 yearsD. Over 2 yearsHYGIENE AND SANITATION17. What is the source of water for household use?A. BoreholeB. tap waterC. wellD. springE. others18. How far is the water source?A. less than 1 kmB. between 1-2kmC. above 2km19. Do you treat your water?A. yesB. noIf yes, how do you treat the water?A. boilingB. filteringC. use water guard or other chemicalsD. othersFOOD SECURITY AND NUTRITION STATUS20. What is the source of food for this household?A. own gardensB. buy from markets and shopsC. others21. What are the commonly eaten foods in this household?A. matookeB. root tubersC. maize and its productsD. animal productsE. others
  43. 43. 3622. How many meals are prepared in this household per day?A. one mealB. two mealsC. three mealsD. more than three mealsCHECK LISTITEM PRESENT ABSENTLatrineRubbish pitKitchenAerated houseClean compoundUtensil rackFood storeAnimal houseKEY INFORMAT GUIDE1. What work do u do in this community2. What are the health services available to the people?3. What is the participation like in the health programs?4. what are the issues affecting health in the community5. What do the people do about these issues?6. What in your opinion needs to be done about these issues?

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