Health and Physical Education Book 8_2077 Editioin

General Considerations in Immunization ^ DPT, Polio and Hepatitis ‘B’ vaccines should be given in three doses, otherwise they may not work. ^ All vaccines should be given on scheduled time. ^ They can be found free of cost. ^ After BCG vaccination, a small wound may appear. It will heal after few days. ^ B.C.G. and Measles vaccines should be given for only one dose. ^ Vaccination can be given even if the child has mild fever. [Activity] Prepare a neat and clean immunization table for newly born babies on a chart paper and discuss the relation between immunization and child health with friends in the class. v. Proper use of Latrine and Control of Open Defecation Everybody knows that human feaces is the main source of many communicable diseases. Open defecation pollutes the air, soil and water resources. As a result, it spreads many faecal borne diseases in the surroundings. Therefore, people should develop the habit of proper use and management of the latrine to maintain sound health. B. Some Communicable Diseases i. Meningitis Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. There are mainly two kinds of meningitis i.e. viral meningitis and bacterial meningitis. In which, bacterial meningitis can cause serious complications such as brain damage, hearing loss or learning disabilities. Causes ^ Viruses such as enterovirus, herpes simplex virus , varicella zoster virus or mumps virus ^ Meningitis may also be caused by bacterial infection (tuberculous meningitis) ^ Can also be caused by physical injury (skull fracture) ^ Inflammation by protozoa (cerebral malaria) ^ Drug reaction and allergies Mode of Transmission ^ Droplets of respiratory secretions during close contact (i.e. kissing, sneezing or coughing) with a person who has viral meningitis 51

^ Sharing of personal possessions and utensils such as toothbrush, glasses, cups, food, or towels Signs and symptoms ^ Lack of appetite ^ Fever, nausea, and vomiting ^ Severe, persistent headache ^ Drowsiness and neck stiffness ^ Inability to tolerate light (photophobia) ^ Discomfort in loud noise (phonophobia) ^ Fast heart beat and rapid breathing ^ Later symptoms can include rash, seizure and coma Complications ^ Memory or concentration problems ^ Long-term consequences like deafness, epilepsy, hydrocephalus (obstruction of the normal flow of CSF) if not treated quickly ^ Loss of vision or brain damage (rare case) Preventive Measures ^ Some forms of meningitis associated with meningococci, haemophilus influenza type B, pneumococci may be prevented by immunization ^ Administration of antibiotics who comes in close contact with the infected person ^ Complete the recommended vaccine schedule ^ Good hygiene, such as regular hand washing with soap and water ^ Not sharing food, drinks, or utensils with the infected persons ^ Avoid bites from mosquitoes ii. Encephalitis Encephalitis is inflammation of the brain Herpes virus tissue, most often due to infection. The A causative agent of Encephalitis brain tissue swells which may destroy nerve cells; cause bleeding in the brain and brain damage. Most cases are caused by viral infections. In rare cases, bacteria can also cause this disease. Causes i. The diseases like measles and rubella may lead to encephalitis ii. Parasites such as roundworms, cysticercosis, and toxoplasmosis iii. Different viruses including Herpes simplex virus, arbovirus, etc. iv. Syphilis and tuberculosis causing bacteria may also cause this disease 52

Mode of Transmission i. Respiratory droplets from an infected person ii. Mosquito, tick, and other insect bites iii. Contaminated food or drink Severe symptoms Mild symptoms ^ very high fever ^ vomiting ^ confusion ^ fever and headache ^ drowsiness ^ neck stiffness, lethargy ^ hallucinations ^ general feeling of being unwell ^ light sensitivity ^ unconsciousness ^ Coma Possible Complications i. Problems of vision hearing ii. language and speech problem iii. paralysis, speech impairment iv. loss of memory v. coma vi. death Prevention and Control Measures ^ Children and adults should avoid contact with anyone who has encephalitis. ^ Controlling mosquitoes may reduce the chance of some infections that can lead to encephalitis. ^ Remove any sources of standing water (such as old tires, cans, gutters, and wading pools). ^ Wear long-sleeved shirts and pants when you are outside home, particularly at dusk. ^ Vaccination to prevent a form of viral encephalitis that often affects people living in dorms or in the military. ^ Wearing long sleeved shirts and pants in areas with mosquito populations prone area. ^ Keeping standing water away from house. [Activity] What measures are undertaken by the people to get protection from mosquito bite in your neighborhood? Collect information about it by visiting any ten house holds of that place and discuss it in your class. 53

iii. Hepatitis-‘B’ The word hepatitis is derived from the greek word ‘hepato’ meaning liver and the latin word 'itis’ meaning inflammation. Hepatitis is an inflammatory condition of the liver. Hepatitis B is the disease of liver and is caused by hepatitis ‘B’ virus. The hepatitis ‘B’ virus is a DNA virus that is about 42 nanometer long. In its most chronic stage, hepatitis ‘B’ can become a fatal disease. In this stage, the virus causes cirrhosis in the liver. Cirrhosis is that condition in which the liver is so badly damaged that it may cause liver cancer to the patient. The incubation period of this disease ranges between 30 to 180 days. Mode of Transmission Hepatitis B Virus Liver damaged ^ Sharing of contaminated needles and razor blades by Hepatitis ‘B’ ^ Transplantation of infected organs, etc. ^ Exposure to body fluids containing virus ^ Unprotected sexual intercourse ^ Transfusion of infected blood ^ Transmission from mother to child ^ Shared personal care items Signs and Symptoms ^ Manifestation of jaundice ^ Headache and mild fever ^ Fatigue and tiredness ^ Loss of appetite ^ Muscle or joint ache ^ Slight abdominal pain ^ Light coloured stool ^ Nausea and vomiting ^ Weight loss ^ Itchy skin Preventive Measures ^ Only allow well-sterilized skin perforating equipment while doing tattoo or acupuncture ^ Do not share brush, razors, and needles with other ^ Avoiding alcohol, smoking and drug abuse ^ Avoided unprotected sexual relationship ^ Avoid unscreened blood transfusion ^ Take vaccine against hepatitis B 54

iv. HIV and AIDS MHC Proteins gp41 Transmembrane HIV stands for human Lipid immunodeficiency virus. It is Envelope Glycoprotein also known as Retrovirus. It Protease, gp120 Docking is a virus that affects specific Peptides, Glycoprotein white blood cells called CD4-T Host Proteins RNA Genoma lymphocytes. Having HIV does p17 Matrix not mean that the person has Protein AIDS. It can take many years Capsid Nucleocapsid for the HIV infected person to enter into AIDS stage. Over Integrase time, HIV can destroy so many Reverse Transcriptase CD4-T lymphocytes so that the body cannot fight against diseases. This condition is called AIDS. AIDS cannot be cured. However, with the anti-retro viral drugs available today; it is possible to have a normal life for many years. The first case of HIV was found in the USA in 1981 AD. Similarly, the first HIV case in Nepal was identified in 1988 AD. According to UNAIDS 2017 AD), there are about 36.5 million HIV infected people in the world. The National Centre for AIDS and STD control (NCASC), has estimated 40,000 HIV population in 2016 AD in Nepal. HIV and AIDS moves through some specific stages which are mentioned below: Window Period The window period is the interval of time between infection and production of anti- HIV antibodies in the blood. The antibodies are produced by the body’s defense system in response to HIV. The window period varies slightly from person to person. Thus, this period lasts for as short as three months to as long as twelve months. During this period, the individual is already infected and may unknowingly transmit the virus to other persons. HIV/AIDS LADDER S HIV- Infection T Window Period (3-12 months) A HIV Positive G Healthy Carrier Stage E (Some months to many years) S AIDS (Attack by multiple opportunistic diseases like PneumoniaC,aDnciaerrr,heotce.a), Tuberculosis, 55

Healthy Carrier Stage (Clinical latency) This period is also called asymptomatic HIV infection period. People may not have any symptoms during this period. People who are on anti-retroviral therapy (ART) may live for several decades. It is important to remember that they are still able to transmit HIV to others during this phase even if they are treated with ART. AIDS Stage AIDS is the final stage of HIV infection. In this stage; immune system is badly damaged. When the number of CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3), then people living with HIV are considered to have progressed to AIDS. After AIDS, opportunistic diseases like tuberculosis, syphilis, diarrhea, pneumonia or cancer attack the AIDS patient. People with AIDS cannot survive more than six months to two years. Mode of Transmission M Sharing needles, syringes and other injecting equipment M From mother to baby before or during birth or by breast feeding M Unsafe sexual contact M Transfusion of infected blood M Sharing of infected needles Minor Symptoms M Mild to moderate swelling of the lymph nodes in the neck, armpits and groin M Persistent cough for more than one month M Recurrent upper respiratory tract infection M Frequent or unusual skin rashes M Night sweats and sore throat M Skin rashes and nail infection M General feeling of tiredness M Occasional fever Major Symptoms M Loss of weight for more than ten percent of the body weight M Continuous fever for more than one month M Continuous diarrhoea for more than one month M Opportunistic diseases of various kinds M Abnormal discomfort, headache M Being tired all the time 56

Preventive Measures M Public awareness about reproductive and sexual health should be increased M Have anti-retroviral therapy by infected mother if she is pregnant M Proper use of condom can control HIV infection M Do not involve in the unsafe sexual activities M Blood should not be used without screening M Use sterilized or disposable syringe M Avoid body piercing and tattooing M Be away from prostitution [Activity] Conduct a talk programme in your school on the topic “HIV and AIDS as a health and social problem” inviting social activist in the field of HIV and AIDS, police representative, local leaders and health workers working in epidemiology. C. Some Major Non-communicable Diseases i. Asthma Asthma is a disease in which patient becomes breathless in need of air and has cough with excessive sputum production. It affects the bronchi and bronchioles of the lungs. In this disease, patient becomes breathless in need of air and has cough with excessive sputum production. There is no complete treatment of this disease but it can be prevented and controlled. People with Asthma are at increased risk of developing heart disease, lung cancer, and a variety of other conditions. It is said that people who lack a protein called alpha 1 antitrypsin may be more likely to develop this disease. People living with Asthma are more likely to get colds, pneumonia, enlarged heart, and high blood pressure. The WHO has estimated that nearly about 80 million-world population is suffering from Asthma. Causes ^ Smoking ^ Indoor smoke ^ Genetic problems ^ Dust and chemical fumes ^ Outdoor air pollution ^ Frequent upper respiratory tract infections Signs and Symptoms ^ An ongoing cough ^ Chest tightness 57

^ Frequent respiratory infections ^ Respiratory distress ^ Shortness of breath, especially with activity ^ Wheezing (a whistling or abnormal lung sounds) ^ Shortness of breath, especially with physical activity Preventive Measures ^ Avoid air pollution ^ Eat healthy foods ^ Learn breathing exercises ^ Walk or do other light exercises ^ Not start smoking or to quit smoking ^ Stay away from smoke, chemical fumes and dust ii. Stones Stone is a hard, crystalline mineral material formed within the gall bladder, kidney, or urinary tract. Stone disease is a painful condition of a patient due to the formation of crystalline mineral material in the gall bladder or kidney. A kidney stone is a hard mass that forms in the kidney. When we do not drink enough water, waste chemicals such as calcium and phosphorous in the urine can stick together and form kidney stones. Small stones may pass down the urinary tract and be excreted without causing symptoms. Larger stones may get stuck in the urinary track and block the flow of urine, which can cause severe pain or bleeding. Gallstones are pebble like deposits of bile inside the gallbladder. They can be as small as a grain of sand or as big as a TT ball and can occur as a single stone or as a collection of many stones. There are two types of gallstones: cholesterol stones, which account for 80 percent of gallstones, and pigment stones, which are composed of bilirubin. KIDNEY (cut) Causes Minor Renal calyx column ^ Heredity Renal Major pelvis calyx ^ Medicine like guaifenesin, topiramate, etc. Kidney Renal stone Ureter pyramid ^ High blood pressure, diabetes, osteoporosis ^ Obesity is also a major risk factor of Renal calculi can cause stone blockage of the ureter at 3 millimeters ^ Too much calcium or too much oxalate 0 1 2 3 4 5 6 7 8 9 10mm ^ Drinking water in less quantity 58

Symptoms i. Kidney stone M Sharp pain that start at the back and move towards the groin M Inability to find a comfortable position M Cloudy or unpleasant smelling urine M The frequent urge to urinate M Blood in the urine is seen M Fever and chills M Painful urination ii. Gallstone M Pain in the upper abdomen, around the back or right shoulder blade M Nausea and vomiting with ongoing pain Preventive Measures ^ Drink plenty of water every day ^ If you have had a calcium stone in the past, reduce eating chocolate, grapes, beans, strawberries, spinach, black tea, etc. ^ If you have had a uric acid stone, reduce eating liver, kidney, fish and the skin of poultry ^ Reduce your salt intake to no more than three grams a day ^ Reduce refined sugar intake because it can increase the risk of kidney stones ^ Take healthy diet and stick to regular meal times iii. Cancer Pancreatic cancer Cancer is a disease in which abnormal cells are grown without control and are able to destroy other normal tissues. Cancer cells can spread to other parts of the body through the blood and lymphatic system. There are around 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start. For example, cancer that begins in the colon is called colon cancer and the cancer that begins in the skin is called skin cancer (melanoma). Similarly, breast cancer, rectal cancer, endometrial cancer, blood cancer (leukemia), lungs cancer, pancreatic cancer, prostate cancer, thyroid cancer are named according to their location. According to WHO, nearly 7.6 million people are dying annually in the world due to cancer, and it is projected that this number will increase to more than 10 million by 2030 AD. 59

Causes ^ Radiation produced from X-ray, UV ray, radium, etc are considered as the major causes of cancer ^ Excessive consumption of tobacco products, alcohol, non-edible colours, etc. ^ Polluted environment, food adulteration and eating spicy and oily food ^ Hepatitis-B Virus has been accepted to be one of the causes of liver cancer ^ Human papilloma virus is believed to be the main cause of cervical cancer ^ The bacteria called, Helicobacter pylori is believed to be the main cause of stomach cancer ^ Cuts and wounds not healing for a long time Signs and Symptoms ^ Bleeding from any natural orifice (i.e. nose, mouth, anus, vagina, etc.) ^ Persistent cough and change in voice (hoarsness) ^ Growth of lumps in breast which might be painless ^ Unexplained loss of body weight ^ Change in digestive and bowel habits ^ Any sore that does not get better ^ Change in wart or mole Preventive Measures ^ More than 40 percent of cancer can be controlled by avoiding tobacco and doing daily physical exercise. ^ Random use of chemical fertilizer and pesticides in agriculture must be controlled. ^ Use of inedible colours and preservatives in the food substances must be controlled. ^ Many cancers are found to be caused by other chronic infections like Hepatitis B, Human Papiloma Virus and HIV. So, controlling of them can prevent some cancer. ^ Cancer awareness campaign need to be conducted in massive scale. ^ Unhealthy food habits should be controlled. ^ Control of environmental pollution. iv. Diabetes Mellitus (Sugar) Diabetes is a non-communicable disease resulted by high concentration of sugar in the blood. Diabetes is also known as sugar disease. It is the medical condition in which either the pancreas cannot secrete insulin at all or body cannot respond to the secreted insulin. Untreated diabetes can cause many long-term complications like heart disease, kidney failure, damage to the eyes, nerve damage to the feet and other parts of the body. There are two types of diabetes mellitus. 60

Diabetes Mellitus (Type I) It is also called insulin STROKE HEART ATTACK dependent diabetes or juvenile diabetes. It is characterized by PERIPHERAL NEUROPAT HY PER IPHERAL ARTERY DISEASE loss of the insulin producing cells in the pancreas, leading DIABETIC NEPHROPATHY DIABETES “COTTON WOOL” SOTS DIABETIC RETINOPATHY to insulin deficiency. It is traditionally termed as COMPLICATIONS ANEURYSM “juvenile diabetes” because ABNORMAL GROWTH a majority of these diabetes OF BLOOD VESSELS cases are among the children. General characteristics HEMORRHAGES HARD EXUDATES M Occurs when the body’s immune system destroys LENS WITH CATARACTS its insulin-producing cells in the pancreas. M People with type I diabetes DIABE TIC FOOT CTS need daily injections of HIGH PRESSURE DAMAGES CATARA insulin to live a normal life. OPTIC NERVE DRAINAGE CANAL BLOCKED TOO MUCH FLUID STAYS IN THE EYE THIS INCREASES PRESSURE GLAUCOMA M Occurs most often in children or young adults. Diabetes Mellitus (Type II) It is also called insulin non-dependent diabetes General characteristics M More common among older; obese people who have a family history of diabetes. M Occurs when the pancreas makes enough insulin but body cannot respond to it effectively. M Usually develops in adults over the age of forty. Causes M Lack of secretion of insulin by pancreas M Sitting idly and eating more food M Too much carbohydrates in diet M Too much worry and idleness M Lack of physical exercise M Obesity Signs and Symptoms M Itching and skin infection, particularly around the genitals M Frequent urination and loss of water in the body 61

M Tingling or numbness in legs, feet or fingers M Weight loss in spite of increased appetite M Presence of more sugar in urine M Feeling tired and lethargic M Slow healing of wounds M Increased thirst M Extreme hunger M Tongue looks dry M Blurred vision M Fatigue Preventive Measures Insulin Taking by a Diabetic Patient M Periodic test for the presence of sugar level in urine and blood M Do regular physical activities and exercise Block in Coronary Artery M Have a healthy food habit M Avoid alcohol and tobacco substances M Weight management M Follow healthy lifestyle M Avoid obesity v. Heart Diseases Among non-communicable diseases, Cardio Vascular Diseases-(CVDs) are one of the major causes of death. CVDs alone cause more than (30%) death out of total deaths by non-communicable diseases in the world. Cardiovascular diseases include coronary heart disease, cerebrovascular disease (stroke), peripheral arterial disease, rheumatic heart disease, congenital heart disease, and heart failure. Risk factors of Cardiovascular Disease Muscle Damage i. Age The risk of stroke and heart attack increases with age. Coronary Heart Attack ii. Heredity People with a family history of these diseases are at greater risk. iii. Diseases Risk is increased for people with diabetes, heart disease, high blood pressure, etc. 62

iv. Other medical conditions Risk increases with obesity, high blood cholesterol level, or high red blood cell count. v. Lifestyle Risk increases with cigarette smoking especially if combined with the use of oral contraceptives, low level of physical activity, alcohol consumption, or consumption of cocaine or intravenous drugs. a. Heart Attack Heart attack is a disease in which the supply of blood to the heart is suddenly blocked or stopped. In other words, heart attack refers to the damage of heart muscle due to the lack of blood flow. Various research studies have revealed that heart attack most often occurs because of coronary heart disease. Every year, more than seventeen million people in the world are dying due to heart diseases. WHO has estimated that this number will increase to near about 25 million by 2020 AD. Signs and Symptoms M The chest can feel like a heavy object is pressing it. M Discomfort in the centre or left side of the chest. M Pain spreads to the back, throat, and left arm from the middle of the chest. M Sweating, nausea, vomiting, or dizziness occurs. M Extreme weakness, anxiety, or shortness of breath occurs. M Rapid irregular heartbeat occurs. M However, in some condition people may have heart attack without having any symptom. A silent heart attack may occur in any one but it is more common among the people with diabetes. Preventive Measures M Eat a healthy diet M Take regular physical activity M Quit smoking M Maintain a healthy blood pressure M Monitor your cholesterol (blood lipids) M Limit your calories M Reduce your stress M Maintain a healthy weight M Limit alcohol consumption M Eat a lot of fruits and vegetables 63

b. High Blood Pressure The systolic pressure represents the pressure exerted when the heart is beating. The lower diastolic pressure represents the pressure exerted when the heart is at rest between beats. The blood pressure reading of 120/80 would mean that our systolic pressure is 120 mm Hg and diastolic pressure is 80 mm Hg. High blood pressure is defined as an adult having a systolic pressure of 140 mm Hg or higher and a diastolic pressure of 90 mm Hg or higher. High blood pressure is also called hypertension. Hypertension increases the risk of heart attack, stroke and kidney failure. Obesity, alcoholism, smoking, and heredity are the major risk factors of hypertension. Different levels of blood pressure are mentioned below: Blood Pressure Optimal Normal High Normal Hypertension Less than 130 130-139 140 or higher Systolic Less than 120 Less than 85 85-89 90 or higher Diastolic Less than 80 Causes of High Blood Pressure and Heart Attack M Stress M High blood pressure M Obesity M High cholesterol M Smoking M Diabetes M Heredity M Sedentary lifestyle M Diabetes M Stress M High-fat diet M High fat diet M High cholesterol M Heredity M Sedentary lifestyle M Inhalation of carbon monoxide M Eating too much salt M Misuse of drug called cocaine M Heavy alcohol consumption Preventive Measures M Maintain healthy body weight M Healthy lifestyle M Quit smoking M Consumption of low fat diet M Lows salt consumption M Reducing alcohol intake M Getting regular physical exercise M Eating enough fruits and vegetables c. Rheumatic Heart Disease Rheumatic heart disease is a chronic condition caused by rheumatic fever. This disease occurs due to the infection caused by ‘Group A’ Streptococcus bacteria. 64

It is the most common acquired heart disease in children in many countries in the world including Nepal. Untreated tonsillitis can later results into Rheumatic Heart Disease. This disease damages the heart valves. This disease mostly attack the children in the age group 3-15 years. Symptoms of Rheumatic Fever and Rheumatic Heart Disease M Fever and chest pain M Heart problem, which may result in shortness of breath or chest pain M Joint pain mainly in the knees, elbows, ankles and wrists M Joint swelling with redness and warmth M Painless skin nodules appear M Rashes in body parts is seen M Rapid jerky movement due to muscle weakness Preventive Measures M Protect yourself from frequent tonsillitis M In the case of frequent tonsillitis, remove the tonsil M Take complete dose of antibiotics if tonsillitis occurs due to streptococcal bacteria. M Avoide sharing personal items with the persons infected by tonsillits Word Meaning Antibodies : substances produced by the body and giving immunity against specific antigens Cerebral malaria : falciparum malaria in which the brain is affected and often produces coma, shock, or sudden death Coma : a state of deep and often prolonged unconsciousness; usually the result of disease or injury Cysticercosis : disease caused by larvae of some tapeworms (e.g., Taenia solium or T. saginata) in subcutaneous, muscle, or central nervous system tissue; Enterovirus : any of a genus of picornaviruses, including poliovirus,that infect the gastrointestinal tract and often spread to the nervous system. Inflammation : a response of body tissues to injury; characterized by pain, swelling, redness and heat Lymph node : any of numerous bean-shaped masses of tissue, situated along the course of lymphatic vessels, that help to protect against infection by killing bacteria Seizure : a sudden attack, or convulsion, as in epilepsy or another disorder Skin nodule : small nodes on skin Toxoplasmosis : a disease caused by the protozoan Toxoplasma gondii that can cause blindness and brain damage 65

Recap S A disease, which tends to transmit from an infected to a healthy person is called communicable disease. S Air, water, food, soil, dust particles, insects and animals, are the different medium through which the pathogenic germs are transmitted from the infected person to a healthy person. S Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. There are mainly two kinds of meningitis i.e. viral meningitis and bacterial meningitis. S Encephalitis is inflammation of the brain tissue, most often due to infections. S Sanitation refers to the control of all those factors in man’s physical environment which exercise or may exercise for adverse effect on his/her health and survival. S Immunization refers to the production of immunity by artificial means against particular diseases. S Immunization can prevent the children from many infectious diseases like measles, whooping cough, tuberculosis, pneumonia, tetanus, poliomyelitis, etc. S Meningitis is an acute inflammation of the protective membrane of the brain and spinal cord which may cause serious complications in the brain, hearing loss, learning disabilities, etc. S Encephalitis is an inflammation of the brain tissue, most often due to infections. The brain tissue swells which may destroy nerve cells; cause bleeding in the brain and brain damage. S Hepatitis B is the disease of liver and is caused by hepatitis ‘B’ virus. The incubation period of this disease ranges between 30 to 180 days. S Cirrhosis is that condition in which the liver is so badly damaged that it may cause liver. S Asthma is a disease in which patient becomes breathless in need of air and has cough with excessive sputum production. S Stone is a hard, crystalline mineral material formed within the gall bladder, kidney, or urinary tract. S A kidney stone is a hard mass that forms in the kidney. S Gallstones are pebble like deposits of bile inside the gallbladder. S Cancer is a disease in which abnormal cells are divided without control and are able to destroy other normal tissues. S According to WHO, around 7.6 million people are dying by cancer annually in the world due to cancer. S The medical condition in which either the pancreas cannot secrete insulin at all or body cannot respond to the secreted insulin is called diabetes. S Rheumatic heart disease is a chronic disease caused by Group A Streptococcus bacteria. It is the most common acquired heart disease in children in many countries in the world including Nepal. 66

EXERCISE A. Answer the following questions. 1. What is communicable disease? 2. Mention any two preventive measures of communicable disease. 3. What is balanced diet? 4. What is environmental sanitation? 5. Mention any two points to be considered in immunization. 6. Write the difference between BCG vaccine and IPV vaccine. 7. Write any two importance of proper use of latrine. 8. Mention any two preventive measures of Meningitis. 9. Mention any two symptoms of Encephalitis. 10. Explain briefly about Hepatitis ‘B’. 11. Write the difference between HIV and AIDS. 12. What is Asthma? Mention any two symptoms of it. 13. What is cancer? Mention any two major causes of it. 14. What is Diabetes Mellitus (Type-I). Mention its two characteristics. B. Choose correct option from the bracket. 1. Heart attack occurs due to the...............................blood supply to the heart. (lack of/adequate/normal/) 2. ...............................causes Rheumatic heart disease. (Gram bacteria/ Coliform bacteria/Streptococcus bacteria) 3. Diabetes Mellitus Type - I is also known as.............................. (Diabetes Insipidus/Gestational Diabetes/Juvenile Diabetes) 4. Skin cancer is also known as..............................(Melanoma/Leukemia/ Sarcoma) 5. Anti-retroviral Drugs are provided to the HIV infected persons just before the ................................(AIDS/healthy career stage/window period) C. Write short notes on: a. Immunization b. Healthy carrier stage c. Kidney stone d. Signs and symptoms of cancer e. Heart attack 67

Unit Adolescence, Sexual and Reproductive Health 5 Learning Achievement After completing this unit, students will be able to: M Give introduction to adolescence, sexual and reproductive health. M Tell the responsibilities of adolescents towards themselves, family, society and nation. M Mention some safer sexual behaviour to maintain good reproductive health and healthy sexual life. M Tell the different natural and artificial methods of contraception along with their advantages and disadvantages. M Explain about comprehensive sexuality education. Adolescence, Sexual and Reproductive Health Adolescence is the most important stage of human life. Adolescence is a period of life in which boys and girls move from childhood to adulthood mentally, physically, emotionally, spiritually and socially. Adolescence is the stage ‘to grow to maturity’. This period is a transitional period of human life, when a boy or girl is no more a child nor is considered as an adult by others. Indeed, it is the most crucial stage of the total life span of human life. In this period, great changes occur in all developmental dimensions of the individuals. Different Stages of Human Life 68

According to WHO, “adolescence is the age between 10 to 19 years”. It is called a transitional period of life since rapid change in physical, social, mental, emotional and spiritual aspects take place during this period. So, this period of life is also called as the period of storm and stress. A. Responsibilities of Adolescents I. Personal Responsibilities M Be sincere and pay attention in study and learning activities M Taking care of personal health and hygiene M Not to be indulge in bad habit M Not to make bad company M Engage in creative activities M Start any kind of activity with the consultation of the guardian II. Responsibilities towards the Family M Always carry out activities under the guidance and suggestion of the family M Pay attention on the health and hygiene of the family members M Pay effort to create peaceful and prosperous environment in the family M Motivate the family to adopt healthy life style by avoiding superstitions M Helping guardians at their domestic work M Respect elders and love the junior members in the family M Make good foundation in social, emotional and spiritual behaviour so that guardians can feel pride for you III. Responsibilities towards the Nation M Develop healthy habits and motivate others too M Pay respect to social norms and values M Involve in social and cultural activities M Conduct mass awareness campaign against superstition in the society M Take leadership role in eradicating social problems M Pay contribution in shaping healthy and peaceful society M Involve in social work as a volunteer M Conduct such benevolent works so that society feel proud of you B. Safe Sexual Behaviour Safer sexual behavior encompasses masturbation, abstinence, sexual relationship between husband and wife only, proper use of condom and marriage at appropriate age. Adolescents have strong sexual desires in this stage of life. So, they may involve in unsafe sexual activities which results into different problems and complexities like unwanted pregnancy, STIs, HIV and AIDS, etc. Some Measures of safe sexual behavior are as follows: 69

Adoption of self-control and mutual understanding Having sexual relation only between faithful couples Proper use of condom during the intercourse period No sexual intercourse with the person infected by STIs Timely treatment if infected by STIs To accept the natural changes in the sexual organs Not to establish sexual relation incompatible with the social norms and values Some of the methods of safer sexual behaviour are explained below: I. Masturbation Masturbation is the self-stimulation of one’s genitals with one’s hand for sexual pleasure. Due to lack of proper education about masturbation, adolescents feel guilty for sickness in such activity. However, masturbation does not harm an individual physically or mentally and does not reduce sexual potency. It gives sexual pleasure without harming anybody and it serves to fill up the gaps in the absence of sexual intercourse. II. Abstinence Abstinence is a practice of not involving oneself in sexual intercourse. Abstinence is a way to keep adolescents safe from sexually transmitted infections (STIs) and unwanted pregnancy. There is no doubt that abstinence is safe but in practice, it is hard to follow. In this matter, adolescents should develop strong determination and self-control over abstinence before marriage. III. Faithful with Sexual Partner Sexual relation with only one partner is also considered as an important approach of safer sexual behavior. The multiple sexual relationship may spread STIs including HIV/AIDS. In addition, it also decreases trust and faith between partners and leads to conflict and mental tension. Therefore, sexual relation must be limited only between husband and wife. IV. Proper Use of Condom Effective use of condom prevents unwanted pregnancy, STIs, and HIV /AIDS. Therefore, the couples should be encouraged for consistent use of condoms if necessary. C. Reproductive Health The concept of reproductive health as an integral part of total health. According to WHO, reproductive health is “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system, its functions and process”. 70

D. Concept of Safe Abortion Safe abortion can be considered as the termination of immature fetus before 24 weeks of pregnancy at authorized hospitals or abortion centers by the authorized doctors. A conditional abortion has come to practice in Nepal since the enactment of “Safe Abortion Service Procedure”, 2060 BS. It helps to reduce the complication and maternal deaths. The new abortion service provision of 2060 BS legalizes abortion under the following conditions: Condition of Safe Abortion M Up to 12 weeks gestation for any indication, by request M Up to 18 weeks gestation in the case of rape or incest M At any time during pregnancy if mental/physical health or life of the pregnant woman is at risk (approval from a medical practitioner required) M At any time during pregnancy if the fetus is deformed and incompatible with life (approval from a medical practitioner required) M The pregnancy up to 9 weeks (63 days) can be safely aborted by using medicines (medical abortion). Safe Abortion Considerations M The pregnancy up to 12 weeks (84 days) can be safely aborted by using equipments (mechanical abortion). M Only certified health personnel in safe abortion care are eligible to provide induced abortion services M The pregnant woman alone has the right to choose to continue or discontinue pregnancy M In the case of minors (< 16 yrs of age) or mental incompetence, a legal guardian must give consent Pregnancy termination is voidable under these conditions: M The law prohibits termination of pregnancy for the sole purpose of sex selection M If anybody is found doing abortion or forcing for abortion by giving threat, temptation, mislead or coercion s/he has to go to jail for one year M Abortion is not eligible if the legal abortion conditions are not fulfilled E. Problems of Unsafe Abortion Unsafe abortion increases the rate of complication and maternal deaths. The government of Nepal has made the provision of safe abortion. A large number of women are facing many complications due to their engagement in unsafe abortion. In order to have a good reproductive health, adequate health care is necessary even after the incidence of abortion. Otherwise, they will suffer from reproductive health problems throughout the life. Unsafe abortion may create the following health problems: 71

Unsafe abortion may cause heavy bleeding and increases complication Uterus and its associated organs may get infection It may cause infertility It may cause pelvic inflammatory disease (PID) It may compel to remove uterus due to injury and infection It may also cause death of the women F. Concept, Uses and Methods of Contraception Proper use of contraception helps to maintain birth spacing and limits the family size. Contraception plays an important role for happy and prosperous family life. There are two types of contraception such as permanent and temporary. Temporary contraception again can be divided into natural and artificial methods. Natural contraception is the processes of avoiding unwanted pregnancy through fertility awareness based methods. Artificial method of contraception is of two types like permanent and temporary contraception. The contraceptive devices like condoms, pills, Norplants, IUDs, Depo-Provera can be used for temporary control of birth. Permanent contraception like vasectomy for male as well as minilap and laparoscopy for female can be widely practiced if the couples have already had desired number of children. I. Temporary Contraception The use of temporary contraceptive devices delays the birth and help to maintain birth spacing too. They help to widen the gap between the first and the second child. There are different devices for female and male. They are described below: a. Natural Methods of Contraception Natural contraception method is the process of avoiding unwanted pregnancy without using any artificial means of contraceptive. This method is also known as fertility awareness based method. They are explained below: i. Calendar Method It is one of the important female natural contraception method. It is the fertility awareness based contraception because its main objective is to know the fertile period (i.e. unsafe or ovulation time period) and not to involve in sexual intercourse during that unsafe period. For relying on this method, firstly, the woman should record the number of days in each menstrual cycle for at least 6 consecutive months. Here, the first day of menstrual bleeding always should be counted as day 1. Then secondly, she has to record the period of the shortest menstrual cycle and the longest menstrual cycle from among the six-recorded menstrual cycles. Then, she has to subtract 18 from the shortest menstruation cycle. This tells her 1st day of unsafe period. Similarly, she has to subtract 11 from her longest menstrual cycle. This tells her the last day of her unsafe period. After confirmation of the total number of days of her unsafe period, either the couple should avoid sexual intercourse or male partner has to follow withdrawal method during this period. 72

Step I: Woman’s recorded length of 6 menstrual cycles Menses Cycles 1st 2nd 3rd 4th 5th 6th Months Jan Feb March April May June 33 29 29 30 34 30 Step II: Confirmation of the length of the shortest and the longest menstrual cycles Length of the longest cycle = 34 Length of the shortest cycle = 29 Step III: Subtraction of 18 days from the shortest menses cycle 29 - 18=11 ( i.e. 11th day is the first day of unsafe period) Step IV: Subtraction of 11 days from the longest menses cycle 34 - 11=23 ( i.e. 23rd day is the last day of unsafe period) Step V: Confirmation of fertile (unsafe) period Different Steps in Calender Method ii. Withdrawal Method Withdrawal method is the oldest method. In this method, male has to take his penis out from the vagina and semen needs to be ejaculated outside. It is not (100%) effective because sometimes sperms can enter into the vagina before ejaculated outside. It is also called coitus interrupts method. iii. Lactation Amenorrhoea Method The lactation amenorrhea method (LMP) is the use of breast feeding as a temporary family planning method. During the time of breast feeding, there is less chance of conception because it suppresses production of oestrogen and progesterone hormone, which are essential hormone for ovulation. If breast feeding is practiced properly, (i.e. at least 8 times in a day and at least 2 times at night and for 20 minutes each time) it may delay ovulation at least for 6 months to as long as 18 months. In this way, LMP provides natural protection against pregnancy. On the other hand, the mothers who do not breast feed have resumed menstruation and ovulation as early as six weeks after delivery. iv. Basal Body Temperature Method It is also one of the important natural contraception methods. In this method, a woman should record her body temperature immediately after waking each morning. To get proper record of every change of body temperature, the thermometer should be kept in either the mouth or armpit. The process should continue throughout the month. During the early part of the menstrual cycle body temperature remains at lower level. At the time of ovulation, the temperature rises by 0.4° to 10°F and then maintains higher level for 3 to 4 days. The shift of temperature from a lower to a higher level indicates for ovulation. Sexual 73

intercourse should be avoided for three consecutive days in which the temperature has been recorded at the higher level. Then the woman can start sexual intercourse with a very little risk of conception. NAME: .................................................................. MONTH: ......................... DATA oC 37.6 37.5 37.4 37.3 1 23 37.2 6 5 4 32 1 37.1 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 32 32 33 37.0 P 36.9 36.8 36.7 36.6 36.5 36.4 36.3 36.2 36.1 36.0 DAY of CYCLE 1 2 3 4 5 6 7 PERIOD and P P PP P P MUCUS P = Period (bleeding) v. Cervical Mucus Test Method It is also an important natural female contraception method. In this method, the texture, colour and thickness of the cervical mucus is examined for the confirmation of unsafe and safe period. Normally, in the beginning days right after completing menstrual bleeding, vagina remains dry. During this time the cervical mucus consists of a thick plug at the cervix. After few days; the cervix releases the thick, translucent and non-slippery mucous. However; during the ovulation time, cervix produces thin, transparent, slippery and non- breakable mucous. If the mucous is transparent, slippery, and stretchable, it can be confirmed as a unsafe period. In this condition, couples should avoid sexual intercourse. Safe period Unsafe period • Thick • Thin • Translucent • Transparent • Non-stretchable • Stretchable • Non-slippery • Slippery vi. Abstinence Method Abstinence is a practice of not involving oneself in sexual intercourse. Abstinence is the solution to keep adolescents safe from sexually transmitted infections (STIs) and 74

unwanted pregnancy. Adolescents should develop strong determination and self- control over abstinence before marriage. b. Artificial Contraception Method Artificial contraception method includes both temporary and permanent contraception. They are of different types. Some of them are described below: i. Condom A condom is a sheath made up of thin latex rubber. It is elastic and oily which makes sexual intercourse comfortable. It is worn in an erected penis just before the sexual intercourse. It is found in average size in different colours and textures. It prevents the sperms to spill over the vagina. It keeps the sex partner safe from different sexually transmitted infections (STIs) and pregnancy. The user should handle it properly because there may be chance of tearing. Advantages It prevents STIs including HIV and AIDS as well as pregnancy when used correctly. It can be used without medical advice. It is safe, no hormonal side effects. Can be used by men of any age. Can be stopped at any time. Disadvantages It can be used only once. May cause itching for a few people. There is small possibility of tearing or slip off during sex. There is problem of place to dispose. ii. Femidom Femidom is a woman’s artificial contraceptive device to protect against STIs and unwanted pregnancy. It is made up of thin, transparent, soft latex rubber. It is bigger in size compared to the male condom. Before sex, a woman needs to place the closed end in her vagina. During sexual intercourse, the man’s penis goes inside the femidom. Then it does not let the sperm enter into the uterus. 75

Advantages There isn’t any side effect It can be used without medical advice It prevents from STIs and unwanted pregnancy Can be handled by woman Disadvantages There is problem of place to dispose it after use It is expensive at this time Difficult to maintain privacy It can be used only once High failure rate iii. Diaphragm The Diaphragm is a soft hemispherical dome shaped rubber cap that covers the cervix. It should be kept on the cervix before sexual intercourse. It is available in different sizes in the market. Diaphragms block sperms from entering into the uterus. Advantages It prevents pregnancy effectively if used correctly with every act of sexual intercourse It can be stopped at any time Easy to use with a little practice No hormonal side effects Disadvantages Requires fitting by a family planning provider It cannot be used without training May be difficult to remove iv. Contraceptive Pills A substance or a combination of substances usually steroids administered orally which prevents pregnancy is called contraceptive pills. There are altogether 28 pills. Among them, 21 pills are called active pills which contain oestrogen and progestogen. The remaining 7 tablets are iron tablets which are brown in colour and called “remainder pills”. The 21 active pills suppress the development of ovum and stops ovulation. The users should start from active pills because they are for stopping conception. When active pills are finished then remainder pills should be taken. Women who use oral contraceptives should swallow a pill each day to 76

prevent pregnancy. At present day, combined oral contraceptives contain very low dose of hormones. They are often called low dose combined oral contraceptives. Similarly, progestin-only oral pills contain very small amounts of only one kind of hormone called progestin. It is better to take them in the evening. In case of missing, the users must take immediately when they remember. But these pills should not be taken by the women who are suffering from Diabetes , Cancer, Asthma, T. B. Hepatitis, etc. Advantages It is inexpensive It is (99.99%) effective, when used correctly It reduces abdominal pain during Combined Pills menstruation It helps to continue menstruation It is beneficial for the woman with low weight No need to use anything at the time of sexual intercourse Increase sexual enjoyment because no Progestin only Pills need to worry about pregnancy Can be used as long as a woman wants to prevent pregnancy Fertility returns soon after stopping Disadvantages It is not effective if not taken regularly It causes breast tenderness, slight weight gain, nausea and mild headache The amount of milk may decrease if woman is breast feeding (in the case of combined pills) Doctor’s advice should be taken before using it Problem of blood pressure might be seen in some females It can cause nausea, headache and acne In a few women, it may cause depression and less interest in sex Very rarely can cause stroke, blood clots in deep veins of the legs or heart attack Do not protect against STIs v. Foam Tablet Foam tablet is a kind of chemical contraceptive. It is a tablet which contains an active spermicide with foaming ingredients and are placed deep in the vagina close to the Cervix. It should be kept at the cervix at least 10 minutes before sexual 77

intercourse. It melts due to body temperature and converts into foam that makes thick layer and blocks sperm to enter into the Uterus. It also destroys the mobility of sperms and helps to inhibit conception. It is called ‘Kamal Chakki’ in Nepali market. Advantages It is useful for the female who has vaginal dryness It does not have any side effects It can be used without advice of medical personnel It does not need any training to use so that any interested female can use it It prevents against infection in the vagina No effect on breast milk production Easy to use with a little practice No hormonal side effect May increase vaginal lubrication Disadvantages It is ineffective after 1 to 2 hours of use The users should wait at least for 10 minutes so that it needs patience Irritation of vagina may occur in some females It may reduce sexual satisfaction It is burdensome to the user since it has to be used before each intercourse May cause warm sensation May cause irritation to woman or her partner, especially if used several times a day vi. Intra Uterine Contraceptive Device (IUCD) Intra-uterine device (IUD) is a very effective, reversible, long- term temporary female contraception. In Nepal, Copper T (TC u - 380 A) is most widely used. It is an English letter ‘T’ structured small plastic device wrapped by copper. So, it is also called Copper ‘T’. It is kept in the Uterus by the help of doctor or expert. It makes sperm inactive and works as barrier against sperms. It also does not allow conception in the Uterus. Once it is used, it works for 12 years. It is not recommended to use this device to female sex workers and the women who have already given birth to more than two children. A provider can remove the IUD easily with the help of the doctor. Advantages It is 99 percent effective No interference with sex 78

Long lasting, It works at least for 10 years Uterus Intrauterine Cervix device (IUD) It doesn’t disturb health of women Strings It is useful to mothers who are breast feeding Does not suppress the production of breast milk No interaction with any medicine No hormonal side effects Increases sexual enjoyment because no need to worry about pregnancy Disadvantages May come out of the Uterus, possibly without the woman’s knowledge Pain in waist and lower abdomen might be felt in some females Longer and heavier menstrual bleeding or bleeding between periods possibly contributing to anaemia Irregular menstrual bleeding is observed in the beginning Does not protect against STIs including HIV and AIDS Severe cramps and pain may occur to some women vii. Depo-Provera Injection (DMPA) Depo-Provera is a female contraceptive device. It contains progestin hormone which is released slowly and suppresses the development of ova. It also thickens mucus in the cervix, which does not allow the sperms to pass into the uterus. Normally, It works for three months. So, that it is also called quarterly injection. It should be taken within 7 days of menstruation, especially in thigh, buttock or arm. Advantages It is (99%) effective It doesn’t interfere with sex It lasts for three months after using once The female who has blood pressure problem can also use it Increase sexual enjoyment because no need to worry about pregnancy No tension of daily pill taking May help prevent uterine fibroid Helps prevents ectopic pregnancy 79

Disadvantages Change in menstruation bleeding is likely, including light spotting or heavy bleeding It may increase the weight of the body in some females It doesn’t prevent against STIs including HIV and AIDS Swelling, especially in leg is seen in some female It may cause headache, moodiness, breast tenderness, nausea, less sex drive and or acne are observed in some women viii. Nor plants The Nor plant implant system is a set of 6 small (3-4 cm long), white plastic capsules. It is also called subdermal implants. It is made up of soft and flexible white colour rubber capsule. Each capsule is about the size of a small matchstick. Each capsule contains Progestin hormone. They are placed under the skin of a woman’s upper arm within 7 days of menstruation. It should be inserted by a doctor or a trained health worker. It needs simple incision to insert them. When they are inserted in the arm they start to release the hormone gradually and mix up in the blood stream. Then it suppresses production of ova and thickens the mucus layer in the Cervix which doesn’t let the sperm pass into the Uterus. A set of Nor plant capsules can prevent pregnancy for at least 5 years. All six capsules should be taken out, if users want baby and after 5 years of insertion. Advantages It works for five years It doesn’t reduce sexual satisfaction It is not so expensive It makes woman free from using different devices every day Very effective even in heavier women No estrogen side effects Fertility returns almost immediately after capsules are removed Disadvantages Pain and tenderness in breasts might be felt in some females Menstruation becomes irregular in the beginning It doesn’t prevent against STIs including HIV/AIDS It may cause acne, headache, nausea, etc Change in menstrual bleeding, including: light spotting, prolong bleeding and or Amenorrhoea may occur Weight gain, hair loss, acne, dizziness and enlargement of ovarian cysts may occur 80

II. Permanent Methods of Contraception Vasectomy Site a. Vasectomy Vasectomy is a permanent method of family planning for male. It is the most effective method for them who decide they will not want more children. It is a safe, simple and quick surgical procedure. It is not castration. It does not affect the function of Testes and does not affect sexual ability. It is also called male sterilization or male surgical contraception. It needs simple incision on the upper part of Scrotum. It is done by cutting Vasdeferenses and tying them in both sides. So that sperms cannot pass to Seminal Vesicles. It is effective 6 to 10 weeks after surgery. Therefore, it is better to use condom during sexual intercourse for 20 times of ejaculation or should apply any other method of contraception at least for 10 weeks. Advantages M It is very much effective M There isn’t any problem in sexual satisfaction M There isn’t any side effect in the body M It doesn’t reduce sexual ability M It is lifelong, safe and effective family planning M No repeated clinic visit is required Disadvantages Laparoscopy M It does not prevent against STIs and HIV and Site AIDS M Sometimes, this operation is found unsuccessful M Pain in the Scrotum, swelling and bruising M Not immediately effective M Reversal surgery is difficult, expensive b. Laparoscopy Laparoscopy is a permanent contraception for female. It is also called female sterilization or female surgical contraception. In this sterilization a small incision (2 cm-5 cm ) is made just below the Navel. An instrument called Laparoscope is entered through the incision. With the help of Laparoscope, fallopian tubes are closed with a ring, a clip or by electro coagulation. Due to this, ova and sperms cannot meet together and fertilization becomes impossible. It should be done within 30- 42 days of delivery or within 5 to 8 days of menstruation. 81

Advantages M It is an effective measure of contraception M It makes couple’s life happy M It avoids burden from using contraception frequently M It avoids fear of conception during sexual intercourse M It does not reduce sexual satisfaction Disadvantages M It does not prevent against STIs and HIV and AIDS M It needs expert doctor or health worker to use it M It is complex and risky method M It cannot be used by the woman who has already have abdominal operation c. Minilap Minilap is also a permanent contraception for female. Small incision is made in lower abdomen just above the pubic hair. Then the Uterus is raised with an instrument (uterine elevator) to bring each of the 2 fallopian tubes under the incision. After that, the fallopian tubes tied and cut down or else closed with a clip or ring. It stops to pass ova through fallopian tubes and conception is not possible even though sperms are ejaculated inside the vagina during sexual intercourse. It must be done within 45 days of delivery or within 8 days of menstruation. Advantages Minilap Site M It is (100%) successful M It is not so complicated like Laparoscopy M It helps to limit the family size M It does not reduce sexual satisfaction M No need to admit in hospital for operation Disadvantages M It is difficult to reverse, if anyone wants M The service is not available everywhere M It cannot prevent STIs including HIV/AIDS [Activity] Draw the diagram of all kinds of artificial contraceptive devices in a chart paper and cling it on your classroom wall. d. Reproductive Health and Services The concept of reproductive health as an integral part of total health was introduced in 1994 AD at Cairo Conference (International Conference on Population and 82

Development). After the Conference, reproductive health has been recognized as the most important aspect of health of the people. WHO has defined reproductive health as, “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and process.” In the modern concept of health, reproductive health has become an important and inseparable part of the health of human being. In Nepal, the government and NGOs are providing the following reproductive health services: S Prenatal care during the pregnancy period S Counselling about contraception and family planning S Distribution of contraceptive devices S Prevention and treatment of STIs S Provision of safe abortion services S Maternal child health care and delivery service S Safe delivery services and MCH care S Provision of emergency contraception e. Comprehensive Sexuality Education Comprehensive Sexuality education is an educational instruction all about human sexuality, relationships, responsibilities, human sexual anatomy, sexual reproduction, reproductive health, reproductive rights, safe sex, birth control and sexual abstinence. It helps to bring positive change in knowledge, attitude and practice of youth on sexuality and sexual behaviour. In fact, sex education is a means by which individuals are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases including HIV and AIDS. Importance of Comprehensive Sexuality Education M Helps to avoid high-risk sexual behaviour M Helps to create public awareness against gender violence M Provides necessary information about the reproductive rights M Encourages family communication about sexuality between parents and children M Provides correct information about human sexuality and promotes sexual hygiene M Provides young people with the tools to make informed decisions and build healthy relationships M Helps adolescents to demonstrate responsible sexual behaviour at home, school and community M Encourages adolescents to consult appropriate health personnel to get service on sexual health M Teaches young people the skills to make responsible decisions about sexuality, including how to avoid unwanted verbal, physical, and sexual abuses 83

M Provides medically accurate information about the health benefits and side effects of all contraceptives, including condoms, as a means to prevent pregnancy and reduce the risk of contracting STIs including HIV and AIDS Scope of Comprehensive Sex Education a. Sexual and Reproductive Health Sexual and reproductive health is a major area of comprehensive sex education. It provides information about abstinence, proper age at marriage, proper birth spacing, reproductive rights, safe sex, birth control measures, sexual abstinence and responsible sexual behaviour. b. Gender Gender refers to those characteristics of males and females that are shaped by social factors. In short, we may say that gender roles are a set of behaviour which is determined by the society for men and women. Gender discrimination is the systemic deep rooted social problem in Nepal. Women cannot enjoy equal share in the productive works. Being the patriarchal social and cultural system there is injustice to the women in various areas including right to property in our country. Therefore, appropriate gender role should be developed among young people so that there will be transformation of traditional models of gender role in the society. In this context, gender equity plays an important role to create a decent society where men and women can live a meaningful life with dignity. c. Gender Violence The term “violence against women” means any act of gender based violence that results in or likely to result in physical, sexual or psychological harm to women. It includes threats of acts such as coercion, deprivation of liberty, battering, dowry related violence, marital rape, rape, sexual abuse, sexual harassment and intimidation at work, forced sterilization, forced abortion, trafficking and so on. Violence against women is an obstacle to the achievement of the objectives of equality, development, peace and quality of life. In all societies, to a greater or lesser degree, women and girls are subjected to physical, sexual and psychological violence. The violence against women can be classified into two categories like domestic violence and social violence. The ill treatment against women like exploitation of labour, battering, beating, polygamy, deprivation from education, marital rape, etc come under the domestic violence. Similarly, in social violence category there are female trafficking, rape, dowry related violence, sexual slavery, sexual abuse, sexual harassment and intimidation at work place and so on. d. Sexual Rights of Citizen Every individual should enjoy right to get sexual identity without coercion. The constitution of Nepal has provided that the state shall not discriminate among citizens on grounds of origin, religion, race and sex. It means everybody should hold 84

right to introduce explicitly whether the person is male, female or third gender. Each person shall have the right to live with dignity. In this ground, everybody has right to be free from sexual and reproductive health related abuse, violence and sex trade. In addition, a person is free to receive services on sexual and reproductive health without any kind of discrimination. e. Entertainment Every person has the right to get sexual satisfaction and entertainment. To get pleasure and satisfaction through various other means other than the sexual intercourse fall under the scope of comprehensive sexual education. f. Diversity We can observe every individuals deserving diverse identity in the society. Each individual is living with diverse cultural, economic, biological, sexual, religious and gender based unique identity. For instance, we can see the individuals with unique sexual identity like male, female; third gender, transgender, etc in the society. g. Relation Everybody has right to establish relation with family, friend, relatives, neighbours and nation. To some extent, peer group relationships help teenagers learn to interact with people in a healthy manner. Studies indicate that most people who indulge in drugs, alcohol and teenage sex do so under peer group pressure or orientation. Therefore, an appropriate sexual health education is required for young people which will enable them to maintain healthy relation with family, friend, relatives, neighbours and nation. [Activity] What are the using methods, advantages and disadvantages of various types of natural contraception? Discuss in your class under the supervision of your teacher. Word Meaning Abstinence : abstaining from sexual relations Coercion : exercise of power to do something forcefully Deprivation : take away possessions or opportunities from someone Incest : sexual relations between persons so closely related that they are forbidden by law or religion to marry Intimidation : being made to feel afraid or timid PID : inflammation of the female pelvic organs caused by STIs which shows the symptoms like abdominal pain, fever and foul-smelling vaginal discharge 85

Recap S Adolescence is the most important stage of human life. Adolescence is a period of life in which boys and girls move from childhood to adulthood mentally, physically, emotionally, spiritually and socially. S According to WHO, “adolescence is the age between 10 to 19 years”. S Adolescence is called a transitional period of life since rapid change in physical, social, mental, emotional and spiritual aspects takes place during this period. S Safer sexual behavior encompasses masturbation, abstinence, sexual relationship between husband and wife only, proper use of condom and marriage at appropriate age. S Masturbation is the self-stimulation of one’s genitals with one’s hand for sexual pleasure. S Due to the lack of proper education about masturbation, adolescents feel guilty and develop the doubt of sickness of such activity. S Abstinence is a practice of not involving oneself in sexual intercourse. Abstinence is a way to keep adolescents safe from sexually transmitted infections (STIs) and unwanted pregnancy. S According to WHO, reproductive health is “a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity in all matters relating to the reproductive system should be free from disease and okay in its functions and process”. S Safe abortion can be considered as the termination of immature fetus before 24 weeks of pregnancy at authorized hospitals and abortion centers and by the authorized doctors. S Safe abortion helps to reduce the complication and maternal deaths. S Comprehensive Sexuality education is an educational instruction all about human sexuality, relationships, responsibilities, human sexual anatomy, sexual reproduction, reproductive health, reproductive rights, safe sex, birth control and sexual abstinence. S Sex education is a means by which individuals are helped to protect themselves against abuse, exploitation, unintended pregnancies, sexually transmitted diseases including HIV and AIDS. S Gender refers to those characteristics of males and females that are shaped by social factors. In Short we may say that gender roles are a set of behaviour which is determined by the society for men and women. S It is necessary to promote appropriate gender role development among young people so that there will be transformation of traditional models of gender role in the society. S The term “violence against women” means any act of gender based violence that results in physical, sexual or psychological harm to women including threats of acts such as coercion, deprivation of liberty, battering, dowry related violence, marital rape, rape, sexual abuse, sexual harassment and intimidation at work, forced sterilization, forced abortion, trafficking and so on. 86

EXERCISE A. Answer the following questions. 1. What is adolescence? 2. Why is adolescence period also known as transitional period of life? 3. Make a list of adolescent’s responsibilities towards the family. 4. What is masturbation? 5. What is abortion? Mention any two methods of safe abortion. 6. Mention the consequences of unsafe abortion. 7. Mention the voidable conditions of pregnancy termination. 8. What are the advantages of contraceptive pills? 9. Explain briefly about cervical mucus method. 10. What is femidom? Mention its two advantages. B. Fill in the blanks. 1. ................................sexual pleasure without harming anybody and it ................................gaps in the absence of sexual intercourse. 2. Abstinence is a way................................from sexually transmitted infections and................................. 3. Laparoscopy is also known as.......................or female surgical contraception. 4. According to the constitution of Nepal 2015 AD, State shall not ...............................citizens on grounds................................. 5. Depo-Provera is a................................which................................cervix and prevents conception. C. Write short notes: a. Basal body Temperature Method b. Gender Violence c. Comprehensive Sexuality Education d. Vasectomy e. Unsafe Abortion Community Work Invite a nurse in your locality and ask her to mention about the using method, functions, advantages and disadvantages of various types of natural and artificial contraception methods and devices. 87

Unit 6 Drugs, Alcohol and Tobacco Learning Achievement After completing this unit, students will be able to: M Introduce drugs and mention the effects and control measures of drugs abuse and addiction. M Introduce alcohol and mention the effects and control measures of alcoholism. M Introduce tobacco and mention the effects and control measures of smoking. A. Drugs A drug is a substance which may have medicinal and intoxicating performance when taken into a human body and is not considered as food. According to WHO, “A drug is any substance that when taken into the living organism may modify one or more of its functions.” In other words, drug is a substance that affects the structure and functioning of a living organism. The term medicine is sometimes preferred for therapeutic drugs in order to distinguish them from narcotics and other addictive drugs, which are used illegally. While talking about the narcotic drugs, some drugs stimulates the body, some of them are proved depressant, while some of them hallucinate the user. Cocaine, Brown Sugar, Heroin, Opium and Hasis are the example of some common narcotic drugs. Such drugs can cause addiction. Narcotic or illicit drugs can damage the brain, heart, and other important organs. Addiction of these illicit drugs may even ruin the precious life. A. Types of Drugs i. Stimulants (Uppers) The stimulant drugs include cocaine, nicotine and amphetamines like Benzedrine, Dexedrine and Methedrine, which increase the activities of the brain. They produce mood elevation, feeling of well-being and increased alertness, and sense of heightened awareness. The possible effects of abuse of these drugs are euphoria, high blood pressure, insomnia, and 88

loss of appetite. Overdose of these drugs cause, increase in body temperature, hallucinations, convulsions and death also. ii. Depressants (Downers) Sleeping pills Depressant drugs slow down the activity of the brain. Sleeping pills (Amytal, Numbutal and Seconal), heroin and codeine are some examples of depressants. Slurred speech, disorientation, and drunken behaviour, confusion, sluggishness, drowsiness and dilated pupils are the possible effects of these drugs. Overdose of these substances results in shallow respiration, clammy skin, dilated pupils, weak pulse, coma and even death. iii. Hallucinogens The hallucinogen drugs distort perception, hearing, and feeling. LSD (lysergic acid diethylamide), phencyclidine, and mescaline are the examples of hallucinogen drugs. These drugs may distort the hearing, body image, and visual illusion. Its physical effects are tingling of hands, feeling of numbness, nausea, chilliness and dilation of the pupils. Overdose of this kind of drug are coma, and even death. Reasons of Indulgement in Drugs Drugs are taken to forget discomfort and frustrations of life. The addicted friends usually influence their friends to this habit. In Nepal, some people use drugs to worship and please Lord Shiva. Drift towards western culture, sense of pseudo freedom and urbanization. Personality problem also makes a person more prone to drug addiction. The smugglers may trap the persons in drug abuse. Imitating elders and celebrities. Effects of Drugs Memory power becomes weak. There is disharmony between thinking and activities. Change in facial appearance and looking intoxicated all the time. Increase in heart beat and blood pressure. Loss of appetite and the body becomes exhausted. Vomiting and the feeling of nausea. Social reputation of an individual gets degraded. 89

Injecting drug with an unsterilized syringe may cause STIs like AIDS, Hepatitis ‘B’ and ‘C’. Reduction in reproductive performance. Drug addiction leads to social disorder and criminal activities. Immunity power weakens, which leads to ill health. Prevention and Control Measures We must aware the people of the harmful effects of drug addiction through community participation. There must be effective control mechanism against smuggling of narcotic drugs in the society. There should be management of sports and other recreational programs so that in leisure time, young people will involve themselves in such activities. There should be discussion on the adverse effects of drug addiction among family members and neighbours. There must be a good relationship among the family members. Law against smuggling of illicit drugs must be implemented strictly. Encouraging the child to believe in himself. Advising addicts to seek treatment from hospitals and counselling from rehabilitation centers. B. Smoking Tobacco is the dry leaves of the plants of Nicotiana Tobaccum. The tobacco smoke includes vaporized chemicals, gases, particles of tar, nicotine and many more of cancer causing substances. Smoking directly affects the lungs, heart and brain. Causes of Smoking Sometimes as a matter of entertainment and fun and under the pressure of their bad company. If all senior members at home have the habit of smoking, the children also imitate such habit. Some people begin to smoke by the influence of smokers in their society and working places. They fall under the false impression that smoking increases their memory power and it also stops their worries and anxieties. Being curious about its taste start smoking. Some young persons begin to smoke as a fashion. 90

Immediate Effects Healthy Lungs Smoker’s Lungs Smoking causes headache, vomiting and stomach pain Coughing is often the result of smoking It causes heart beating faster Giddiness and nausea Bad breathing Long-term Effects Pregnant women are much affected. Miscarriage and still birth may happen. Blood-pressure increase. Teeth, skin and fingers become pale due to nicotine. Wounds may appear in the gums and in the mouth. There is a possibility of chronic bronchitis, heart attack and lungs-cancer. Women may become sterile. Prevention and Control Measures At present, Government of Nepal has banned the advertisement of smoking and other intoxicating things from radio, T.V. and other electronic means. The advertisement of smoking from other sources too should be restricted. Parents should practise healthy habits. If they have smoking habit it should not be in front of the children. Family members must be aware about the bad effects of smoking. Efforts should be made to declare certain areas as smoke prohibited areas. Youngsters should be encouraged for other recreational activities. Avoid the company of bad friends and smokers. Increment in the tax of tobacco. C. Alcohol An alcoholic beverage is a drink that contains a chemical called ethanol. The distilled beverages like whiskey, brandy and vodka contain more than (40%) of alcohol. Wine contains around (9-16%) and beer contains (5-7%) of alcohol in average. In the context of Nepal the local alcohol like Jad, Raksi, Chhyang, Aaila, Nigar and Tongba are commonly available in the market. Alcohol is legally consumed in most of the countries around the world. However, alcohol consumption is injurious to our health. 91

Reasons for Taking Alcohol In some ethnic communities, alcohol is used in social rites and rituals. Young people are curious towards its taste and start drinking. In getting together with friends as a recreational purpose. Some use alcohol under the pressure of their friend circle. Due to the assumption of reducing tension. Some people have tradition to drink. Due to lack of proper guidance. Broken environment at home. Effects of Alcohol Normal Cirrhosis Hepatocellular carcinoma i. Immediate Effects After Alcoholism e It reduces the eye muscle’s ability and causes poor focus, double vision and reduction in night vision. e Family life and personal relationship are disturbed. e Body becomes imbalance and passive. e Impairs memory and judgment. ii. Long-term Effects Condition of Liver e Overuse makes the drinker vulnerable to peptic ulcers, cirrhosis, pancreatitis, gastritis and heart disease. e The gastrointestinal tract is usually affected and digestion becomes worse. e Liver is adversely affected by alcohol. e It adversely affects the social prestige of the individual. e Increases the risk of heart failure and stroke. e It leads to infertility. Prevention of Alcoholism One must avoid the company who have formed the habit of drinking alcohol. If there is a culture to drink alcohol, it must gradually be reduced. Health education must be extended against alcoholism. Drinking alcohol should be prohibited in public places. Advertisement of alcohol must be banned. Word Meaning Amphetamines : a group of nervous system stimulating drugs that are subject to abuse because of their ability to produce wakefulness, euphoria and weight loss Cirrhosis : a liver disease in which normal liver cells are damaged and causing the organ to shrink, harden, and lose its function because of alcoholism 92

Recap S According to WHO, “A drug is any substance that when taken into the living organism may modify one or more of its functions.” S Narcotic drugs are of different ; for instance some drugs stimulates the body, some of them are depressant, while some of them hallucinate the user. Cocaine, Brown Sugar, Heroin, Opium and Hasis are the example of some common narcotic drugs. S Lysergic acid diethylamide (LSD), is an illegal recreational drug derived from a parasitic fungus. LSD is the most well known hallucinogenic drug. S Narcotic drugs can damage the brain, heart, and other important organs eventually. Cocaine for instance can cause heart diseases. S The stimulant drugs include cocaine, nicotine and amphetamines like Benzedrine, Dexedrine and Methedrine, which increase the activities of the brain. S The possible effects of abuse of cocaine, nicotine and amphetamines cocaine are euphoria, blood pressure, insomnia, and loss of appetite. The effects of overdose of these drugs are manifested in agitation, increase in body temperature, hallucinations, convulsions and ultimately leading to death. S The barbiturates like Rembutal and Gardenol including the tranquillizers like Valium and Librium are the examples of depressant drugs. S Depressant drugs slow down the activity of the brain. Slurred speech, disorientation, and drunken behaviour are the effects of these drugs. Overdose of these substances results in shallow respiration, clammy skin, dilated pupils, weak and rapid pulse, coma and even death. S LSD (lysergic acid diethylamide), phencyclidine, and mescaline are the examples of hallucinogen drugs. These drugs may distort or alters the auditory acuity, body image, and visual illusion. Overdose effects of this kind of drug are psychosis, coma, and even death. S The tobacco smoke includes vaporized chemicals, gases, particles of tar, nicotine and many more of cancer causing substances. Smoking increases the risk of heart disease, chronic bronchitis, respiratory disorders and retarded fetal development. S At present, the government has banned the advertisement of smoking and other intoxicating substances from radio, T.V. and other electronic means. The advertisement of smoking from other sources too should be restricted. S An alcoholic beverage is a drink that contains a chemical called ethanol. Alcoholic beverages are divided into three general classes such as beer, wine, and distilled beverages (liquors). S Alcohol is legally consumed in most of the countries around the world. However, alcohol consumption is injurious to our health. It is said that a glass of pure alcohol once at a time is a fatal dose to human body. S Alcoholism makes the drinker vulnerable to peptic ulcers, cirrhosis, pancreatitis, gastritis and heart disease in the long run. 93

EXERCISE A. Answer the following questions. 1. What is narcotic drugs? Give two examples. 2. What is LSD? Mention one effect of this substance. 3. What are depressant drugs? Give any two examples. 4. Name any two stimulant drugs. Mention any two effects of stimulant drugs. 5. How do youngsters start smoking? 6. Mention any two effects of depressant drugs. 7. Write down any two difference between downers and uppers. 8. Write any two characteristics of Hallucinogens. 9. Mention any two long term effects of smoking. 10. Mention any two long term effects of alcoholism. B. Write True or False. 1. Alcohol is also known as recreational drugs................................... 2. Medicine is also known as recreational drugs in order to distinguish them from narcotics................................... 3. The articles such as plastic glue, paint thinners and cocaine are considered as therapeutic................................... 4. Cigarette smoking contains tar and carbon monoxide................................... 5. Euphoria, elevated blood pressure, insomnia and loss of appetite are the effect of cocaine................................... C. Write short notes on: a. Drugs b. Stimulants c. LSD d. Alcoholism 94

Unit Environmental Health 7 Learning Achievement After completing this unit, students will be able to: M Give introduction to environmental health. M Explain about causes, prevention and control of water borne diseases. M Mention various types of water purification methods. M Explain various ways of solid wastes management methods. M Explain causes, prevention and control measures of air and noise pollution. Introduction to Environmental Health The concern of environmental health is the promotion of human health by maintaining environmental components in proper order. It includes the activities like conservation, management, and proper utilization of environmental resources to uplift human health. According to WHO; “Environmental Health is the field of science that studies how the environment influences human health and disease. ‘Environment,’ in this context, means things in the natural environment like air, water and soil, and also all the physical, chemical, biological and social features of our surroundings”. The ultimate goal of environmental health is to control possible negative impact and maintain healthy environment for quality and productive life. For the sound 95

human health, environment should be clean and free from hazards. In this regard, environmental sanitation is the most essential component for healthy human life. Environmental sanitation and human health are inseparable aspects. Some major areas of environmental health are: M Proper disposal of waste materials, sewage, human excreta, etc. M Safe distribution of food materials. M Protection from insects and rodents. M Supply of clean and safe drinking water. M Personal hygiene. M Proper housing. A. Waterborne Diseases The diseases caused by drinking or ingesting water contaminated by human or animal faeces and urine containing pathogenic bacteria or viruses are called waterborne diseases. The diseases like typhoid, hepatitis ‘E’, giardiasis, diarrhea, dysentery, and cholera are common water borne diseases. Water borne diseases cause around 3.4 million deaths each year in the world. Similarly, around 12 thousand individuals are killed every year by the diarrhoeal diseases in Nepal. Causes of Waterborne Diseases ^ Mixing of discharge from the hospitals, labs and industries without treatment into the water sources. ^ Direct disposal of solid and liquid waste materials into the water sources. ^ Washing clothes and utensils, swimming, in the water resources. ^ Direct disposal of solid and liquid waste materials into the water sources. ^ Improper water storage system, corrosion of water pipes, leakage in water pipes. ^ Natural causes like flood, landslide, heavy rain, etc. Prevention and Control ^ Wastewater from industries, hospitals, etc should be treated before discharging outside ^ Regular supervision and maintenance of water supply pipes and storage system ^ Establishment of water treatment plants in industries, hotels, and laboratories ^ Awareness campaign about water pollution should be carried out ^ Water should be boiled and filtered before using for drinking ^ Habit should be formed to use toilet for defecation and urination 96

B. Water Purification Methods In Nepal, people get water from various sources like tap, tube-well, stone spout, river, pond, well, etc. About half of the total population of the country is not getting piped water. Water supplied to the public is also not safe for drinking. Mixing of harmful elements in water causes water pollution and affects human health. It is essential to purify water for good health. Some of the methods of purifying water are mentioned below: i. Boiling It is one of the safest but expensive methods of purifying drinking water. In the domestic filtration method, water should be kept boiling at least for five minutes after it reaches the boiling point. Boiling helps to kill the germs and pass off dissolved gases in the water. ii. Filtration It is also one of the safe water purifying methods. In this method, we can filter water using different layers of pebbles, charcoal and sand. In quick services, we can use clean cloth to filter water. There are different kinds of candle containing readymade filters also available in the market. But ordinary filtration method cannot purify chemical and biological contamination in water. iii. Chemical Method It is one of the popular and easy methods of purifying water from contamination. In this method, the water can be made safe to drink by adding chemicals like Chlorine or Potassium Paramagnet to kill the germs in prescribed quantity 2 drops or one tablet in one litre. But it is difficult to purify if the water is contaminated by dust and other solid particles, colour and odour. iv. Solar Water Disinfection (SODIS) It is the cheapest and easiest method of purifying drinking water. In this method, about (70%) part of the transparent bottle should be shaken for more than 20 times. After that, the empty portion of the bottle also should be filled up with water and lid should be closed tightly. Then, the water filled bottles should be kept in the direct sunlight is startling position at 450 continuously for more than 6 hours. 97

[Activity] Prepare a traditional domestic filter with the help of locally available materials and use it in your school. C. Management of Solid Wastes i. Reduction of waste in its Production This principle gives emphasis on less use of things and generating less quantity of wastes. For this, we can develop our habits like using jute and paper bags while buying goods from the market to replace polythene bags, by not cooking more food than our requirement. Similarly, we can buy milk from the dairy in our own pot or utensils rather than using polythene. It can preserve the natural resources in one hand and be able to control environmental pollution in other hand. ii. Reuse In this method, the same thing can be used time and again in its original form. For instance; glass, beverage bottles, cans, horlicks bottles, etc can be reused time and again. It helps to save our resources and helps for the management of solid wastes. iii. Recycle Recycle refers to the reuse of things time and again after adopting certain measures of recycling process. The already used papers, torn out plastics, polythene, broken metal pots and utensils can be recycled in the factories. It helps to keep the environment clean and save the resources for the future generation. D. Air Air is a precious natural resource. Air supplies us with oxygen, which is essential for our bodies to live. Without it, we would die within minutes. Air is needed by living organisms to breathe. Air is composed primarily of nitrogen, oxygen, argon including other gases like neon, helium and hydrogen. Need and Importance of Air e It is essential for respiration e It can also be used as the source of energy e It is essential for the operation of machineries e Carbon dioxide is utilized by the plants during photosynthesis process e It helps to separate unwanted things from the food grains 98

Causes of Air Pollution COPD e Use of automobiles, aircraft, etc. Damaged e Dust particles from ontopped roads Alveoli e Smoke from forest fire Mucus e Volcanic eruption e Harmful gases emitted from industries and vehicles e The use of firewood, dried dung and agricultural residues for cooking e Burning of plastics and rubber during strikes e Improper disposal of solid waste and sewage Airborne Disease An airborne disease is a pathogenic disease that can be transmitted from an infected person to another through the air. The pathogens of airborne disease travel through dust particles, and respiratory droplets during coughing, sneezing, laughing, talking and close personal contact. Common ways to prevent these diseases include receiving vaccines and avoiding contact with an infected person. The diseases like influenza, chickenpox, anthrax, tuberculosis, smallpox; flu, measles, bronchitis, pneumonia, common cold, mumps, whooping cough, diphtheria, etc are the examples of airborne diseases. Prevention and Control Measures of Air Pollution e Education and awareness campaign about the ill effects of air pollution should be conducted in massive scale. e Exploration and utilization of alternative sources of energy instead of traditional sources like animal dropping, firewood, kerosene, etc should be done in time e Old automobiles should be replaced by the new eco-friendly vehicles. e Tree plantation on the road side as well as afforestation programme should be done through community participation. e There should be proper management of industries. e There should be proper management of solid wastage and sewage in the urban areas. e The government should enforce the environment protection law and regulation for the protection of environment. E. Noise Pollution The wrong sound in the wrong place at the wrong time is known as noise pollution. We are living in an increasingly noisy environment. Crowd of people, loudspeaker, means of transportation and machines are the sources of sound. It can be defined 99

as “an unwanted and unpleasant sound that is harmful to health and productivity of human health”. Causes of Noise Pollution e Unmanaged urbanization and industrialization e Automobiles and aircrafts e Crowd of the people e Sound produced from cement factories, rice mills, grill factories, saw mills, etc. e Construction of road, buildings, etc. e Musical instrument played in the concerts Effect of Noise Pollution e Loud noise may cause deafness e Sound pollution adversely affects digestive system e Blood pressure increases e It also causes sleeplessness problem (Insomnia) e It interferes with speech communication e It may cause anxiety and frustration to people e It also causes irritation and lack of concentration Prevention and Control Measures of Noise Pollution e Education and awareness campaign about noise pollution issues e Proper management of urbanization, industrialization and transportation system e Establishment of bus parks, railway stations and airports far away from the residential areas e Plantation of trees on the road sides and surrounding the houses and factories e The workers who work in the noisy places should be given earplugs and ear muffs e Silence zone must be maintained nearby school, hospitals, college, etc. e Unnecessary volume of loud speaker at public places should be controlled e Vehicles should be prohibited to use unnecessary horns Word Meaning Anthrax : an animal disease that can be transmitted to humans and causes infection to lungs Bronchitis : inflammation of the air passages in the lungs, causing difficulty in breathing Hazard : something causing danger, peril, risk, or difficulty 100