HPE Book 10_2076 Edition

golden champ). It spreads in a large canopy shape and is useful for men and animal for shade in summer and useful for birds to make nest. The height of big species goes approximately 30 meter high whereas the height of the small species grows up to 8 meter. These trees are useful for making furniture and firewood which are the main causes of depletion. Oil can be extracted from its flower which can be used for the treatment of eye disease and gout. Similarly, the bark and fruits can be used as medicine for leprosy, skin disease, cough, rheumatism and ulcer. Its cutting, exploitation and export are banned and kept by the government Golden Michelia (Champ) under the category of endangered and protected status. Regeneration of this plant can be made through seed and branch but difficult and time consuming. Monograph of Golden Michelia Scientific name : Michelia Champaca Distribution : Hilly region (Between the altitude of 600-1,500 meter) Type : Evergreen Tree Species : Two species (small and large) Flower : Golden Yellow Height : Between the range of 8-30 meter. Useful parts : Timber, bark and flower Importance: M Oil extracted from its flower is used for the treatment of the eye disease and gout. M Bark is used as medicine for the treatment of leprosy, cough, rheumatism and ulcer. M Timber of this tree can be used for furniture. 2. Jatamasi (Spikenard) This is another rare plant found in Nepal. It is also known as Jatamasi. Its scientific name is Nardostachys grandiflora. It grows upto the height of 60 cm and leaves divided into three heart shaped parts. It is found in the northern part of high Mountain region at the elevation of 3,000 to 5,000 meter. It is a small perennial herb with thick aromatic rhizome covered with fibres of old leaves, lower leaves larger than the upper ones. Its roots look reddish brown. Its flowers are pinkish white in colour. Health, Population and Environment Education-10 151

Its rhizomes can be used to extract oil which can be used in preparing Ayurvedic medicine. The oil of this plant is used to prepare the medicine of cholera, epilepsy, cough, cold, spleen disease, intestinal worms and haemorrhoids and altitude sickness, high blood pressure, insomnia and heart disease. It oil also can be used in perfume. Its dust is used to make Spikenard (Jatamasi) sweet incense. Its export outside the country is banned. It is protected in Shey Phoksundo National Park, Annapurna Conservation Area. Reproduction can be done either by seed or by bulb. Monograph of Spikenard Scientific name : Nardostachys grandiflora Distribution : Mountain region (Between the altitude of 3,000-5,000) Type : Herb with thick aromatic rhizome covered with fibres. Flower : Pinkish white Height : Around 60 cm Useful part : Rhizome Importance: M Medicine for the treatment of the cholera, cough, cold, haemorrhoids, altitude sickness, high blood pressure, epilepsy, insomnia and heart disease. M The oil of this plant also can be used to make perfume. M By-product (dust) of the rhizome can be used to make incense. 3. Sarpagandha (Serpentina) Serpentina is also known as Sarpagandha. It is also one of the endangered and protected medicinal plants of Nepal. Its scientific name is Rauwolfia Serpentina. It is a small erect perennial plant with the red and white flowers in bunches. It grows up to the height of 1 meter tall. It is found in the Terai and Hilly region in the forest of Sal at the altitude up to 1,200 meter. It is scattered in the Sal forest. Its stem is dry and white. Its leaves are wide and long. It produces white and red bunches of flowers during summer. It bears pea like fruit which is green in the early stage. The fruit gradually Serpentina (Sarpagandha) becomes red and black when ripped. Its rhizomes are very much beneficial for the treatment of blood pressure, pain relief, insomnia, insanity, dysentery cholera, etc. It 152 Health, Population and Environment Education-10

is completely prohibited to export crude drug but processed extracts may be exported after the permission from the department of forest. It can be reproduced through seeds and stems. Monograph of Serpentina Scientific name : Rauwolfia Serpentina Distribution : Sal forest in the Terai and hilly region (Up to 1,200 meter altitude) Type : Small erect perennial plant Flower : Reddish white blossom during summer Fruit : Pea like fruit in the early stage; turns into black when it is ripped Height : Around 1 meter Useful parts : Rhizome Importance: M For the treatment of the blood pressure, pain relief, insomnia, insanity, dysentery and cholera. 4. Launth Salla (The Himalayan Yew) The scientific name of Himalayan Yew is Taxus baccata wallichana. It is also called Lauth Salla. The Himalayan Yew is not so tall. It grows up to 8 meter. This is a plant of pine species. In Nepal, It is distributed at the altitude ranging between 1,700 to 3,400 meters from the sea level especially in the central and western region of the country. It is a slow growing tree. For instance, it gradually grows for 100 years. Its leaves get shaded during the month of Jestha and Ashad and flowers blossom during the month of Chaitra to Jestha. It bears small round shaped seeds, which turns into red colour when it is riped. It can be cultivated through its seeds and stem cutting. In Nepal, the Dabar Nepal Pvt. Ltd. has Himalayan Yew (Launth Salla) produced its saplings from its nursery in Banepa and the Taxol is extracted from the factory established at Rampur Tokani of Bara district. The Taxol extracted from its leaves is used to cure cancer of earlier stage specially for cervical cancer. In addition, Ayurvedic medicine can be made using Taxol of its leaves. For instance, it can be used as medicine for intestinal diseases, headache, respiratory infection, diarrhoea, high blood pressure and dry cough. It is banned to cut down and export outside the country. Health, Population and Environment Education-10 153

Monograph of Himalayan yew Scientific name : Taxus baccata wallichana Distribution : Hilly region (At the altitude from 1,700-3,400 meter) Type : Soft wood small tree Leaves : Shed during the month of Jestha and Ashad Seed : Bears small round shaped turns into red colour when it is ripped Height : Up to 8 meter tall Useful parts : Leaves Importance: M Medicine for the treatment of the early stage cancer in general and cervical cancer in particular. M The taxol also can be used for the treatment of the diseases like headache, respiratory infection, diarrhoea, high blood pressure and dry cough. 5. Panch Aunle (Aterrestrial Orchid) The scientific name of Panch Aunle is doctylorhiza hatagirea. Panch Aunle is also called Aterrestrial orchid. It is distributed at the altitude of 2,300 to 3,600 meters. Its rhizome is divided into three or five finger like lobes and looks like our palm with fingers. It produces attractive flower like rose. The structure of its leaves resembles the weapon, ‘sword’. The colour of its flower is purple. This plant’s height grows up to 90 cm. Its rhizomes are pulled out and sold illegally. The rhizomes of Aterrestrial Orchid three or four years old can be taken out without uprooting (Panch Aunle) the plants. It falls in the endangered category. Its rhizomes can be used for the treatment of cough, stomach troubles, heal wound cuts. Asthma, anaemia, burns as well as energy booster and tonic in homeopathy. Monograph of Panch Aunle Scientific name : doctylorhiza Distribution : Hilly region (At the altitude of 2,300-3,600 meter) Type : Herbal erect perennial plant Flower : Bears small purple coloured flowers Rhizome structure : Palm shaped Height : Up to 90 cm Useful parts : Rhizome 154 Health, Population and Environment Education-10

Importance: M For the treatment of the diseases like cough, stomach trouble, wound cuts, asthma and anemia. M It also can be used as energy booster and tonic in homeopathy. 6. Yarsagumba (Cordyceps Sinesis) Yarsagumba is a vegetation under the mould group. It is found in the form of insect in winter and in the form of vegetation in summer after the snow melts. Literal meaning of Yarsagumba in Tibetan language is summer plant and winter insect. It is a rare and unique plant that grows on the moist alpine meadow of himalaya region at the altitude of 3,000 to 5,000 meter. It is reproduced through the spores of cordyceps mushroom. During the winter season, the fungal spores of old cordyceps settle on the body of the larvae and attack through their breathing pores. Thereafter, the infected and hibernating larvae are Cordyceps Sinesis (Yarsagumba) slowly eaten away. Eventually, the fungus gets so much in to the body of the infected larva that it grows out through its head and eats away all the body cavity of the insect. Later on, when snow melts, the fungus develops a mushroom (a long stalk of fruiting body) from the forehead of the dead larvae. The size of a mature mushroom reaches up to 5 to 8 cm above the ground and releases its spores and the life cycle repeats by infesting large number of larvae. In contrast the non-infected larvae would mature into caterpillars and grow into Thitarodes moths. The Yarsagumba is believed to be important for the treatment of the lungs and kidney problem, pulmonary tuberculosis, chronic coughs, night sweating, shortness of breath, tiredness, weakness, dizziness, anaemia, weakness after illness, sexual impotence and so on. It is banned for export in crude form. Processed products may be exported after permission from the department of forest. In 2013 AD, its price had jumped over 1.5 million rupees per kilogram. Monograph of Yarsagumba Scientific name : Cordyceps sinensis Distribution : Himalayan region (At the altitude of 3,000-5,000 meter) Family : Clavicipitaceae (Ascomycetes) Characteristics : Parasitic fungus, comes out from the anterior end of the caterpillar during monsoon, grows on moist alpine meadow Health, Population and Environment Education-10 155

Size : Around 5-8 cm long Color : Fruitification (mushroom) dark brown and stalk (dead larva) Market value Yellowish white. Useful parts : Above 1.5 million per kg : Whole part Importance: M For the treatment of kidney problem, pulmonary tuberculosis, chronic cough, night sweating, tiredness, shortness of breathing, dizziness, anaemia, weakness and sexual impotence. M In addition, it also can be used as tonic and cardiac tonics. E. Conservation Measures of Rare Plants Plants and vegetation are very essential for the livelihood of human beings. They provide us various useful materials like; vegetables, fruits, fodders, fibres, medicines, etc. Moreover, they supply us oxygen and help to maintain ecological balance as well. Since the beginning, people are using plant resources for their survival. But their over exploitation have made them rare. Hence, the conservation measures is very urgent. Some of the measures for the conservation of rare plants are described below: 1. Control of Forest Fire Haphazard forest fire is also considered as one of the main causes of rareness of the plant resources. Forest fire destroys a vast quantity of forest resources in Nepal specially during the dry season. Hence, forest fire needs to be controlled effectively for the preservation of forest resources from being rare. 2. Control of Indiscriminate Grazing Overgrazing hinders the regeneration capacity of the grass and the saplings of growing plants. Therefore, indiscriminate grazing of the animals should be controlled in time. And afforestation and plantation of sapling should be done in the open area. Moreover, there must be proper management of those areas. 3. Execution of Law Effective execution of laws is a must to conserve the biodiversity. The laws should be equally enforced to all the people. It certainly helps to control smuggling of the rare and endangered plants and their genetic resources and contribute to preserve those invaluable natural resources from extinction. 4. Awareness Program Awareness programs need to be conducted to educate the local people for proper utilization of resources. For this, individuals, community and local agencies should be mobilized in an integrated manner. 156 Health, Population and Environment Education-10

5. Establishment of Nursery Saplings can be grown in the nursery to increase the population of rare plants. For this, the number of nurseries need to be increased to protect the plants from being rare and endangered. This campaign need to be conducted in community level. 6. Proper Collection of Forest Products People in remote area use forest resources as the major source of fuel. They consume the forest resources traditionally. It causes destruction of plants and vegetation. That is why forest products should be collected wisely. In this condition, relative conservation principles need to be followed by all the concerned stake holders while utilizing the forest products. 6.4 Adverse Effects of Human Activities on Biodiversity and Conservation Methods Relative to its size, Nepal is blessed with rich diversity of flora. Nepal’s biodiversity is now under threat. Human activities like construction of road, drainage, canal, buildings, tunnels, unplanned urbanization, unorganized industrialization, unsustainable farming and over exploitation of natural resources result into adverse effect on biodiversity. Similarly, the environmental problems like global warming, climate change, desertification, acid rain, landslide which are induced by human activities also have adverse impact on biodiversity. So, we need to carry out their mitigating measures on time. Some of the effects are explained below: A. Degradation of Ecosystem Rapid population growth gives more pressure on natural resources. Rapid growth of population results into more population which means more pressure on existing resources. Overpopulation needs more land for settlement and other activities. Which poses deforestation, soil erosion, environmental pollution and many more ecological problems. Similarly, improper management of solid wastes and drainage also degrades the ecosystem of those places. Eventually it causes loss of biodiversity. B. Loss of Habitat The primary cause of the loss of biodiversity is known as habitat destruction. In many cases, the factors causing habitat loss are the activities like cattle farming, agriculture, manufacturing, dam construction with the goal of making profit. In addition, jhum cultivation (shifting cultivation) and deforestation also cause loss in habitats. After all, loss of habitats is also a primary cause of loss for biodiversity loss. C. Loss of Mobility of Animals and Birds Various human activities may cause loss of mobility of animals and birds. For instance, deforestation in the name of human settlement, road construction, canals, buildings and other so called development works eventually cause fragmentation of the habitats of the wild animals. As a result, they cannot get adequate food to eat and adequate space to survive and grow. Then eventually they move to the endangered stage. Health, Population and Environment Education-10 157

D. Limitation of Expansion of Vegetation Human activities gives more pressure on the regeneration process of vegetation. The human activities for different purposes such as deforestation for cultivation, industrialization, urbanization and human settlement make encroachment in the forest, grassland and vegetation. It ultimately creates adverse impact on the total ecological processes. 6.5 National and Local Level Biodiversity Conservation Programs The main programs and efforts to conserve biodiversity are described below: A. Establishment of In-situs (National Parks, Wildlife Reserves and Conservation Areas) To address the threats of biodiversity loss in the country, the government of Nepal has established In-situs in the various parts of the country. Here, In-situ conservation means the protection of species and ecosystems in their place of origin as the primary approach to biodiversity conservation. In other words, In-situ conservation encompasses “on-site conservation”. It is the process of protecting endangered plant and animal species in their own natural habitats. One benefit of In-situ conservation is that it maintains population in the surrounding where they have developed their distinctive properties. Moreover, this conservation strategy helps ensure the ongoing process of evolution and adaptation within their natural environment. The conservation areas like national parks, wildlife reserves and conservation areas are the examples of the In-situs. At present, there are 10 national parks, 6 conservation areas, 4 wildlife reserves and 12 buffer zones in our country. Altogether about 18.5% of the total land area of the country is covered by such conservation areas. They have made great contribution for the conservation of biodiversity and ecosystems. Table 6.3: Status of National Parks in Nepal Name of Districts Area Speciality Specific Plants/Animals National Park sq.km. (Year estd.) Shey Mugu, 3,555 Ghoral, blue • Pine, Walnut, Oak, Phoksundo Dolpa km2 sheep, musk Cyprus, Blue Pine, National Park deer, and Spruce, Juniper, Birds 1984 AD the Shey- Phoksundo • Blue Sheep, Ghoral, (2041 BS) lake. Musk Deer, Leopard, Wild Dog, Hare, Monkey, Langur, etc. 158 Health, Population and Environment Education-10

Chitwan Chitwan 932 The Park • Sal Forest, Khar, Sisoo, National Park km2 houses over Simal Forests 1973 AD 1,148 50 species of (2030 BS) km2 mammals • Rhinoceros, Tiger, Gaur, Bison, Crocodile, 1,710 Dolphin, Gharial, 450 km2 species of birds and 106 pythons km2 Sagarmatha Solukhumbu 225 The Park is • Fir, Birch, Juniper and National Park km2 famous for Rhododendron 1976 AD the scenic • Thar, Ghoral, Serrow, (2033 BS) beauty of the Musk Dear, Wolf, Red Himalayas Panda, and Snow including Mount Leopard Everest. • Impeyan Pheasant, Pigeon Langtang Rasuwa, Gosaikunda • Oak, Chir Pine, Maple, National Park Nuwakot, and Langtang Blue Pine, Hemlock, 1976 AD Sindhupalchok Valley Spruce, Rhododendron (2032 BS) • Leopard, Wild Dog, Red Panda, Black Bear, Langur, Blood Monal, Kaliz Rara National Karnali, Jumla Smallest • Coniferous Forest Park 1976 AD National (2032 BS) Park, Rara • Bear, Thar, Serow, Ghoral, Musk Deer, Lake 3,000 m Red Panda, Snow high Leopard Khaptad Bajhang, Famous for • Chir Pine, Maple, National Park Bhajura, Doti, medicinal Spruc, Birch, 1984 AD Achham plants. Over Rhododendron, (2041 BS) 220 species Yarsagumba, Orchids, of medicinal etc. plants are recorded. • Barking Deer, Leopard, Serrow, Ghoral, Musk Deer, Danphe, Monal, Kalij, Wild Boars, etc. Health, Population and Environment Education-10 159

Bardiya Bardia 968 Karnali River • Langur, Hyana, Wild National Park km2 dog, Jakal, Porcupine 1988 AD (2045 BS) • Dolphin (30 species of mammal, 250 species of birds) Makalu Barun Sankhuwasabha, 1,500 Makalu • Snow and Clouded National Park Solukhumbu km2 Barun River Leopard, Thar, Wild 1991 AD Boar, Musk Deer, Red Panda (2048 BS) Shivapuri Kathmandu, 159 Shivapuri • Rhododendron and Nagarjun Nuwakot, km2 watersheds other various valuable National Park Sindhupalchowk plant resources 2002 AD • Clouded Leopard, Wild Cat, Leopard Cat, Black (2058 BS) Bear, 177 species of birds, 102 species of butterflies and 102 species of mushrooms Banke Banke, Salyan, 550 Famous for • Sal forest National Park Dang km2 bengal tiger • Bengal tiger 2010 AD 305 and Youngest km2 national park (2067 BS) Shuklaphanta Kanchanpur Prime habitat • Bengal Tiger, One- National Park of around horned Rhino, Swamp 2,000 swamp Deer, Slowth Beer, 2017 AD deers including 48 species (2073 BS) mammals, 423 species of birds, 28 species of fish Source: Ministry of Forest and Land Conservation, Nepal National Biodiversity Strategy and Action Plan, 2014-2020 (Pg:191/192) Table 6.4: Status of Wildlife Reserves in Nepal Name of Year estd. Area District and Specific Animal Wildlife Reserve (sq. km.) Speciality Koshi Tappu 1976 AD 175 km2 (Sunsari, • Wild buffalo, Dolphin. Wildlife Reserve (2032 BS) Saptari and Crocodile Udayapur) Wild buffalo 160 Health, Population and Environment Education-10

Parsa Wildlife 1984 AD 499 km2 (Parsa, • Wild elephant, Bengal Reserve (2041 BS) Bara and tiger, Leopard, Sloth Makwanpur) beer, One-horned Dhorpatan 1987 AD 1,325 One-Horned Rhino,Blue bull, Hunting Reserve (2044 BS) km2 Rhino Barking deer and 300 (Baglung, species of birds Myagdi, Rukum) Ghoral • Leopard cat, Ghoral, Wild boar, Monkey and Barking deer Source: Ministry of Forest and Land Conservation, Nepal National Biodiversity Strategy and Action Plan, 2014-2020 (Pg:192) Table 6.5: Status of Conservation Areas in Nepal Name of Conservation Area Area (sq. km.) Estd. date District Annapurna Conservation 7,629 km2 1992 AD Kaski,Lamjung, Manang, Area 2,035 km2 (2049 BS) Mustang, Myagdi Kanchanjunga Conservation 1,663 km2 1997 AD Taplejung Area 15.95 km2 (2054 BS) Manaslu Conservation Area 2,179 km2 1998 AD Gorkha 1,903 km2 (2055 BS) Krishnasar Conservation 2009 AD Bardia Area (2065 BS) Gaurishankar Conservation 2010 AD Ramechhap, Dolakha, Area (2067 BS) Sindhupalchok Api Nampa Conservation 2010 AD Darchula Area (2067 BS) Source: Ministry of Forest and Land Conservation, Nepal National Biodiversity Strategy and Action Plan, 2014-2020 (Pg:193) Table 6.6: Status of Buffer Zone in Nepal S.N. Name of the Buffer Zone Date of estd. Area (sq. km) 1. Buffer Zone of Chitwan National Park 1996 AD 7506 km2 2. Buffer Zone of Bardia National Park 1996 AD 327 km2 3. Buffer Zone of Langtang National Park 1998 AD 420 km2 4. Buffer Zone of Shey-phoksundo National Park 1998 AD 1,349 km2 5. Buffer Zone of Makalu Barun National Park 1999 AD 830 km2 6. Buffer Zone of Sagarmatha National Park 2000 AD 275 km2 7. Buffer Zone of Suklaphanta Wildlife Reserve 2004 AD 243.5 km2 Health, Population and Environment Education-10 161

8. Buffer Zone of Koshi Tappu Wildlife Reserve 2004 AD 173 km2 9. Buffer Zone of Parsa Wildlife Reserve 2005 AD 298.17 km2 10. Buffer Zone of Rara National Park 2006 AD 11. Buffer Zone of Khaptad National Park 2006 AD 198 km2 12. Buffer Zone of Banke National Park 2010 AD 216 km2 343 km2 Source: Ministry of Forest and Land Conservation, Nepal National Biodiversity Strategy and Action Plan, 2014-2020 (Pg:193) B. Establishment of Ex-situs/Man-made Conservation Areas (Zoo, Sanctuary, Nursery, Botanical Garden, etc) The thousands of varieties of species have already been vanished from the Earth due to unfavourable natural environment. Therefore, people should create artificial controlled favourable environment for the conservation of endangered species of plants and animals. It is possible to protect biological resources that are on the verge of extinction through Ex-situ. Here, Ex-situ conservation means off-site conservation. In other words, it is the conservation of genetic resources outside their natural habitat. This conservation approach can be considered as the process of protecting the endangered species of plants or animals by removing part of the population from a threatened habitat and placing it in a new human controlled conservation site. Protected Areas (National Parks, Wildlife Reserves and Conservation Areas) of Nepal 162 Health, Population and Environment Education-10

Nepal botanical garden and central zoo are providing the examples of Ex Situs. In general practice, Ex-situ helps to provide favourable environment to the animals and plants in those places for their growth, reproduction, breeding regeneration. The differences between In-situ and Ex-situ are as follows: In-situ Ex-situ Ü In-situ is the conservation of biological Ü Ex-situ is the conservation of resources within their natural habitat. biological resources outside their natural habitat. Ü It is the conservation of animals, and Ü It is the conservation of animals plants in its parental site. and plants in the human controlled environment. Ü It is also called on site conservation. Ü It is also called off site conservation. Ü National parks, Wildlife reserves and Ü Zoo, Botanical garden and gene conservation areas are the examples bank are the examples of Ex-situ of In-situ conservation. conservation. Ü It is effective for the conservation of Ü It is effective for the conservation rare species of biological resources. of endangered species of biological resources. C. Local Programs for Raising Awareness Various local level awareness campaigns should be conducted to aware the people for the conservation and proper management of biodiversity. Government and non- government organizations can conduct these programs jointly at local or community level. Such programs should ensure the participation of the community members. It helps them to realize their responsibility for the conservation of plants and animals and their habitats. The Ministry of Soil and Forest Conservation is conducting various programs at different levels for the preservation of biodiversity as well as soil and forest resources. Other various ministries like Ministry of Agriculture, Ministry of Industry, Ministry of Science Technology and Environment are also launching various conservation awareness programs. Such activities certainly contribute for the conservation of biodiversity. D. Conservation Programs at National Level Various organizations are conducting different programs at national and local level for the conservation of the biodiversity. For instance, National Trust for Natural Conservation (NTNC) has been conducting different programs for biodiversity conservation through the participation of community members. Some international organizations such as The World Conservation Union (IUCN), The World Wildlife Fund (WWF), the International Centre for Integrated Mountain Development (ICIMOD), are also conducting different programs for the conservation of biodiversity and management of habitats and ecology. Health, Population and Environment Education-10 163

Summary Ü Biodiversity is the richness in variety and variability of species of all living organisms in a given region. It can be classified into three levels such as: species diversity, genetic diversity and ecosystem diversity. Ü Species diversity: Species diversity refers to the range of frequency and variability among living organisms by species variation in a given geographical area. Ü Genetic diversity: The genetic variation among the population of a single species and between the various species is called genetic diversity. Ü Ecosystem diversity: The frequency and variation of distinct ecosystems in a given area is called ecosystem diversity. Ü The total number of species in the world has been estimated around 5-30 million. In which, about 1.7 million species of all kinds of living beings have been already recorded. Ü Nepal is quite rich in biodiversity due to its sharp variation in its topography, climate and altitude. Ü Nepal occupies 0.03 % of the total area of the world but it harbours 2.2% of flowering plants, 9.3% of the world’s birds, 2.6% of algae, and 4.5 % of the world’s mammal. Moreover, over 700 species of medicinal plants have been recorded in the country. Ü In-Situ: In-situ refers to the conservation of the living beings or biological resources inside their natural habitat. It is also called in-site conservation. Ü Ex-Situ: Ex-situ refers to the conservation of the living beings or biological resources outside their natural habitat. It is also called off-site conservation. Ü Buffer zone: The area surrounding the national parks and conservation areas managed for the human settlement is called buffer zone. Ü Endangered (E): A taxa (biological resource) in danger of extinction due to the reduction of its population in a critical level is called endangered. Ü Vulnerable (V): A taxa (biological resource) believed likely to move into the “Endangered” category in the near future if the causal factors continue operating is called vulnerable. Ü Rare(R): A taxa (biological resource) with small world population that is not at present “Endangered” or “Vulnerable” is called rare. Ü Insufficiently known (K): A taxa (biological resource) suspected but definitely not known to belong any of the above categories because of lack of information. Ü Yarshagumba is said to be important for the treatment of kidney problem, pulmonary tuberculosis, chronic cough, night sweating, tiredness, anaemia, weakness, and sexual impotence. Ü Panch Aunle is useful for the treatment of cough, stomach trouble, asthma, and anaemia. 164 Health, Population and Environment Education-10

EXERCISE A. Very short answer questions. 1. Define biodiversity. 2. What is Ex-situ conservation? 3. Write any two importance of Himalayan yew. 4. Mention any two medicinal value of Sarphagandha. 5. Write any two causes of rareness of Asiatic Rock Python. 6. What is Buffer zone? 7. Write any two adverse effect on biodiversity due to human activity. 8. Write down any two conservation measures of biodiversity in your locality. 9. How many species of birds and mammals of Nepal have been included in the protected list? 10. Write the name of any one endemic fish of Nepal. B. Short answer questions. 1. What is biodiversity? Classify it and explain briefly. 2. What is agricultural biodiversity? Differentiate between species and genetic diversity. 3. The hilly region of Nepal is rich in biodiversity in comparison to other regions. Why? 4. List down the measures to preserve endangered plants and animals. 5. “Change in consumption pattern of resources is the best policy to conserve biodiversity”. Elaborate it. 6. What is climate change? List down any four implications of climate change on biodiversity. 7. Explain the role of In-situ and Ex-situ for the preservation of biodiversity. 8. What are the challenges for biodiversity conservation? Mention the mitigating measures. 9. Mention the role of biodiversity in socioeconomic development of the nation. 10. Proper conservation of habitats is necessary for the promotion of species richness of biodiversity. Why? C. Write differences between: 1. Ecosystem diversity and species diversity 2. In-situ and Ex-situ 3. Conservation and preservation of biodiversity 4. Natural biodiversity and agricultural biodiversity Health, Population and Environment Education-10 165

D. Write short notes on: 1. Asiatic Elephant 2. Panch Aunle 3. Giant Pied Hornbill 4. Ecosystem diversity 5. Ex-Situ E. Long answer questions. 1. Critically examine the efficiency of various national and local level programs for the conservation and management of the biodiversity with reference to Nepal. 2. Give light on rare species of animals and plants and explain the different legal status of rare species of biological resources according to IUCN category. 3. Analyses the biodiversity of Nepal by ecological regions. 4. What is rare plant? Demonstrate the medicinal uses of the following rare plants of Nepal: a. Golden Michelia b. Spikenard c. Serpentina d. Himalayan Yew e. Panch Aunle f. Yarshagumba Project Work Visit any one of the places that mentioned below in your convenience (i.e. Zoo, National park, Local forest, Wetland, Botanical garden). Prepare monograph or profile of any 10 species of plants and animals of that place on the basis of the following criteria: a. Local name: b. Scientific name: c. Family: d. Kingdom: e. Natural habitat: f. Distribution: g. Status according to, IUCN Red Data Book: h. Importance: i. Possible causes of rareness: j. Conservation measures: 166 Health, Population and Environment Education-10

UNIT ENVIRONMENTAL HEALTH AND DISEASES 7 Learning Achievement After completing this unit, students will be able to: Give introduction to disease. Differentiate between communicable and non-communicable diseases. Tell the causes, mode of transmission, symptoms and preventive measures of some major communicable diseases. Tell the causes, symptoms, prevention and control measures of some major non- communicable diseases. 7.1 Introduction to Communicable and Non-communicable Disease 7.1.1 Concept of Disease The term disease is derived from two words ‘dis’ and ‘ease’. It means lack of ease or comfort. We do not feel ease or comfort when we get diseased. So, we can say that disease is a negative condition of the body. In other words, disease is a harmful departure from the normal state of health. A disease is an abnormal condition that affects the body of an organism. In general understanding disease refers to any condition that causes pain, dysfunction, distress, disabilities and infection in the body. In other words disease can be considered as; A pathological condition of an organ or system of an organism resulting from various causes, such as infection, genetic defect or environmental stress and characterized by identifiable signs and symptoms. According to the Webster dictionary: “Disease is a condition in which bodily health is seriously attacked, deranged or impaired and departure from a state of health interrupting the performance of vital functions.” The Oxford English Dictionary defines “Disease is a condition of the body or some organs of the body in which its functions are disturbed.” Furthermore, from the ecological point of view, disease can be defined as: “A mal- adjustment of the human organism to the environment.” Hence, disease can be considered as a disorder with a specific cause and recognizable signs and symptoms; any bodily abnormality or failure to function properly except that resulting directly from physical injury. The concern of environmental health is the promotion of human health by maintaining environmental components. It includes the activities like Health, Population and Environment Education-10 167

conservation, management and proper utilization of environmental resources to uplift human health. According to WHO; “environmental health refers to those aspects of human health and disease that are determined by the factors in the environment”. The ultimate goal of environmental health is to control possible negative impact and maintain healthy environment for qualitative and productive life. 7.1.2 Types of Diseases There are various types of diseases, but all of them can be classified mainly under two groups. They are explained below: A. Communicable Disease Communicable disease is an illness in the body due to specific infectious agent or its toxic products. It is directly or indirectly transmitted from an infected person or animal to a healthy person through various mediums. 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 susceptible host. The spread often happens via airborne viruses or bacteria and also through contaminated blood or other bodily fluid. Cholera, typhoid, common cold, tuberculosis, hepatitis, syphilis, etc are the examples of communicable diseases. According to American Public Health Association: “Communicable disease is an illness due to a specific infectious agent or its toxic products arising through transmission of that agent from reservoir to susceptible host either directly from an infected person or animal or directly through the intermediate host, or vector or the inanimate environment.” Therefore, we can say that: a disease which tends to spread or transmit among individuals from infected to healthy persons is called communicable disease. Though germs enter in to our body, the symptoms are not seen immediately. The period after the entrance of the germs to the appearance of symptoms of the disease is known as incubation period. The duration of incubation period varies according to the nature of the disease. A person generally seems healthy during the incubation period. We know that communicable disease spreads from one person to another or from an animal to a person. According to the nature, communicable disease can be classified into four groups such as: Nature by Types of Communicable Disease Example of Disease Prevalence Poliomyelitis, Leprosy, etc. Sporadic A disease is said to be sporadic when a few scattered cases occur now and then. 168 Health, Population and Environment Education-10

Endemic A disease is said to be endemic when it is Malaria, Typhoid, Epidemic constantly present to a greater or lesser degree etc. in any particular geographical area. Sudden outbreak of infectious disease that Bird Flu, Cholera, spreads rapidly through the population etc. affecting a large proportion of people. A disease is said to be pandemic when a large SARS, Swine Flu, Pandemic number of people in many countries are HIV/AIDS, etc. affecting at the same time. B. Non-communicable Disease Disease which is not transmitted from one person to another through any medium is called a non-communicable disease. Non-communicable diseases are caused due to various factors like mal-nutrition, heredity, physiological disturbances, lifestyle, negligence or unhealthy environment. Hypertension, heart disease, stroke, cancer, diabetes, asthma and osteoporosis are the examples of non-communicable diseases. The Concept Table of Communicable and Non-communicable Disease Communicable Disease Non-communicable Disease • Pathogenic germs and parasites: • Malnutrition Virus • Unhealthy life style Causes of Disease Bacteria • Lack of proper exercise Protozoa • Intake of tobacco Fungi products, narcotic drugs Tick and alcoholism Lice etc. • Mental tension and anxiety, fatigue and workload, heredity • Germs, etc. Mode of Transmission • Direct and indirect contact, with infected • Unhealthy life style such persons, as:- intake of unbalanced diet, lack of proper • Transfusion of contaminated blood and exercise, mental stress, blood products, heredity, etc. • Insect bite or animal bite, • Infected utensils, contaminated food and drinks, • Infected needles or syringes, • Sexual contact with infected persons, etc. Health, Population and Environment Education-10 169

Nature of Diseases • Acute (Short Term Nature) • Chronic (Long Term Nature) eg: Diarrhoea, cholera common cold, etc. • Can be prevented easily but difficult to cure • Chronic eg: Tuberculosis, Pneumonia, leprosy, etc. eg: Cancer, Diabetes, Heart disease, etc. • Incurable and life-threatening eg: HIV & AIDS. Causes and Preventive Measures of Communicable and Non-communicable Diseases: Disease Causes of Communicable Causes of Disease Non-communicable Disease Transfusion of Contaminated Blood Obesity Contaminated Food, Water and Droplets Mental Tension Insects and Animal Bite Tobacco and Alcohol Unsafe Sex Narcotic Drugs Contaminated Syringe Lack of Physical Exercise Contaminated Fomites Imbalanced Diet Direct contact Heredity Preventive Measures Communicable Disease Non-communicable Disease Safe Sexual Contact Balance Diet Improving Personal Hygiene Adequate Physical Exercise Immunization and Rest Use of Safe Drinking Water Avoid Tobacco Products, Balance Diet Alcohol and Narcotic Drugs Sanitation Control Obesity Avoid Mental Tension 7.2 Some Major Communicable Diseases 7.2.1 Food and Water Borne Diseases A. Roundworm Infestation Ascaris Lumbricoides is the giant species of round worm. It is responsible for the disease Ascariasis in humans. Roundworm lives usually in upper portion of the small intestine 170 Health, Population and Environment Education-10

like duodenum. It is cylindrical in shape and pink in colour. The male roundworm measures 15-25 cm and the female from 25-30 cm long. The dirty behaviour of the individual is the main cause of this disease. The eggs of this parasite released from the patient’s excreta enter into the healthy person’s body through faecal oral route. A female roundworm can lay about 1 lakh Round worm eggs in a day which come out with the faeces of patient. These eggs enter into our mouth by means of food, water or contaminated hands. After it enters into our body, it gradually develops into adult worms. The incubation period of this diseases lasts for around 2 months. Mode of Transmission M Contaminated food and water M Unhygienic habits M Feacal-oral route M Eating raw food like radish, carrot, green leaf or salads without cleaning thoroughly Symptoms Abdominal pain and disturbance in digestive system Swelling of the stomach Cough Irritation around the anus Loss of body weight due to malnutrition Sleeplessness Nausea and vomiting Loss of appetite Constipation Appearance of worm in stool Preventive Measures e Do not defecate near water sources e Develop the habit of disposing faeces in toilet e Wash hands before eating and after toilet (use soap for washing) e Eat well cooked food. The foods that are eaten raw should be well washed and cleaned e Protect food from flies and other disease carriers (vectors) Health, Population and Environment Education-10 171

e Spread knowledge about personal hygiene e If anyone is affected from roundworm infestation, make provision of medical treatment B. Diarrhoea The passing of loose, liquid or watery stool for more than three times a day is called diarrhoea. Particularly, children suffer from this disease. Diarrhoea is an intestinal disorder often accompanied by other clinical signs and symptoms including vomiting, fever, dehydration and electrolyte disturbances. The causative agents of diarrhoea are Gartner Bacillus, E.Coli, Rota virus, Shigella Shiga and Salmonella. In addition to this, a number of non-infectious medical conditions like; indigestion, food poisoning, surgery of intestine, inflammation in the intestine and cold also may cause diarrhoea. Diarrhoea that comes on suddenly and lasts for no longer than a couple of days is called ‘acute diarrhoea’ whereas the diarrhoea that lasts for more Diarrhoea infected child than one week is considered as ‘chronic diarrhoea’. This disease transmits from an infected to another person because of unsanitary practices. The infectious diarrhoea is transmitted through contaminated food, water and drinks. The incubation period of diarrhoea ranges from 2 to 4 days. Symptoms Abdominal pain and frequent passing of loose stool Contraction of muscles Dehydration occurs due to frequent passing of watery stool Patient feels physically weak, having sunken eyes and hollow cheeks Loss of appetite Gradual decrease in body temperature Less urination than usual Preventive Measures e Health Education e Provision of proper disposal of faeces e Protection of food and water supplies from contamination by the human excreta and flies e Avoiding uncooked food and unwashed vegetables e Development of hygienic habits e Eating well cooked food 172 Health, Population and Environment Education-10

e Dehydration can be mitigated by giving Oral Rehydration Solution (ORS) like Jeebanjal, Navajiban, etc. C. Dysentery Dysentery is the common infection of gastrointestinal tract. Simply speaking, dysentery is an intestinal inflammation, especially in the colon that can lead to severe diarrhoea with mucus or blood in the faeces marked by pain, fever, dehydration and a feeling of incomplete defecation. It may be caused by the chemical irritants, bacteria, protozoa or parasites. Dysentery is common in underdeveloped areas with poor sanitary living conditions. This disease transmits from an infected person to another because of our unhygienic practices. Dysentery can be classified under two types such as Amoebic Dysentery and Bacillary Dysentery. 1. Amoebic Dysentery Amoebic dysentery is also known as an infection of the intestine caused by an amoeba called Entamoeba Histolytica. If timely treatment is not done, these amoeba are able to spread through the blood stream to infect other organs such as the liver, lungs and brain. It is a protozoal disease. The incubation period of Amoebic dysentery is believed to be ranging between 30 to 90 days. Symptoms Abdominal pain and mucus is seen in stool The patient may feel weak The eyes seem sunken and the cheeks look hollow Dehydration occurs Indigestion occurs Weight loss Fatigue Headache Muscle cramps Loss of appetite In the chronic stage, manifestation of Amoebic hepatitis may occur 2. Bacillary Dysentery Bacillary dysentery, also known as Shigellosis is a potentially dangerous and extremely contagious bacterial infection of the colon (large intestine). It is caused by the bacterium called Shigella Shiga or Flexeneri. The incubation period of bacillary dysentery is ranging between 2 to 7 days. Symptoms Abdominal pain and body ache Health, Population and Environment Education-10 173

Gradually the blood content increases with the faeces Dehydration occurs and the tongue becomes dry The patient slightly suffers from fever and chill Frequent discharge of faeces Nausea, vomiting and fever Weakness Weight loss Loss of appetite Preventive Measures e Health education e Wash the hands before and after meal and after toilet use e Food and water should be clean e Provision of safe drinking water e Food must be protected from flies e Proper management of wastes e Proper disposal for human excreta e Attention should be given for personal hygiene and environmental sanitation D. Cholera Cholera is an acute infectious disease of small intestine that causes severe watery diarrhoea and effortless vomit which can lead to severe dehydration and even death if it is not treated on time. It is caused by the bacteria called ‘Vibrio Cholera’ and characterized by continuous profuse of effortless diarrhoea and vomiting. It is transmitted from the infected person to another very soon. This disease is most common in the places with poor sanitation, crowding and famine. This disease gets transmitted by means of contaminated food, drink and vectors. The incubation period of cholera is very short ranging from few hours to 5 days. Symptoms Evacuation of loose watery stool for more than 40 times a day The stool is soft at first, later it appears starchy fluid (semi-solid) The patient feels nausea and vomits. Sometimes vomiting and diarrhoea happen at the same time Rapid heart beat Loss of skin elasticity Urine is suppressed Dehydration occurs, the patient looks weak and inactive The patient has sunken eyes and hollow cheeks 174 Health, Population and Environment Education-10

Low blood pressure is observed and finally the patient collapses If the patient is not treated in time, he/she may die Muscle cramps due to dehydration Hypoglycemia may occur due to deficiency of glucose in the blood stream Preventive Measures e Health education especially in personal hygiene e Protect food from flies and contamination e Drink boiled water e Wash hands after toilet and before eating food e Wash vegetables and fruits with clean water thoroughly before using e Dispose excreta properly e Apply oral rehydration solution to protect from the problem of dehydration e Do not share the clothes used by the infected person e Immunization with cholera vaccine (Tetracycline vaccine) during cholera epidemic 7.2.2 Air-borne Disease A. Common Cold Common cold is a common disease. It is rapidly transmitted from one person to another. It is caused by Rhinu virus (filterable virus). This is the viral disease of the upper respiratory tract. Common cold is characterized by the inflammation of mucus membrane of nose, throat, irritated nasopharynx, and chilliness lasting for 2-7 days. Common cold is not a disease to treat; some precautions are enough for this. It is transmitted directly through air while sneezing as well as through droplets by exchange of personal belongings with the infected person. Symptoms Common cold infected person Irritation of the nose and sore throat The patient may feel difficulty while breathing because of the swollen sinuses The voice of the patient is changed Running nose and watery eyes Temperature of the body increases. Little fever is also observed Congestion and dryness of the nose and throat Coughing and sneezing Pain is felt at back, limbs and head Weakness and loss of weight Health, Population and Environment Education-10 175

Preventive Measures e Education in personal hygiene e Use personal handkerchief e Vitamin C consumption e Do not come in contact with the infected persons. e Nasal discharge and phlegm must be properly disposed e Balance your time for work and rest e Be careful while working in the dusty environment e Protect yourself from cold e Wear clothes according to season e Adequate sleep 7.2.3 Diseases Transmitted by Contaminated Needles A. Hepatitis The word hepatitis is derived from the ancient Greek word ‘hepato’ meaning liver and the Latin word ‘itis’ meaning inflammation. Hence, etymological meaning of hepatitis is injury to the liver with inflammation of the liver cells. Hence, Hepatitis is an inflammatory condition of the liver. There are five types of hepatitis that are caused by the various types of hepatitis virus A, B, C, D and E plus G. Among them, some are acute and others are chronic. Hepatitis is acute when it lasts for less than six months and chronic when it lasts longer than 6 months. Mostly liver damage is caused by three hepatitis virus called hepatitis A, B and C. Moreover, hepatitis can also be caused by alcohol and some other toxins and infections as well as from our own autoimmune process. About 250 million people globally are thought to be affected by hepatitis C, while 300 million people are thought to be carriers of hepatitis B. 1. Hepatitis - ‘B’ It is a sexually transmitted infection. It is the disease of liver and is caused by Hepatitis ‘B’ virus. It is a DNA virus, which is round in shape and it is about 42 nanometer long. Symptoms of the acute illness caused by the virus, includes liver inflammation, vomiting, jaundice, etc. The chronic form is one that develops slowly and remains in the body for a long time. In its most chronic stage, hepatitis ‘B’ can become a fatal disease. In this stage, the virus causes severe scarring of the liver. The scarring process of the liver called “Cirrhosis”. Cirrhosis damages the liver so badly that it may no longer be able to function normally, then eventually causes liver cancer which may results into death of the patient. The infection is preventable by vaccination. The incubation period of this disease varies from 30 to 180 days. 176 Health, Population and Environment Education-10

Mode of Transmission M Exposure to body fluids containing virus M Unprotected sexual intercourse M Transfusion of infected blood M Sharing of contaminated needles and razor blades M Transmission from mother to child M Shared personal care items M Transplantation of infected organs, etc Symptoms Fatigue and tiredness Diarrhoea Loss of appetite Headache and mild fever Muscle or joint ache Slight abdominal pain Light coloured stool Nausea and vomiting Itchy skin Enlarged spleen Weight loss Yellow skin, whites of eyes, tongue (jaundice) Preventive Measures e Personal hygiene and cleanliness e Avoiding alcohol, smoking and drug abuse e Do not share brush, razors, needles or manicure instruments e Unprotected sexual relationship should be avoided e Immunization with hepatitis B vaccine e Avoidance of unscreened blood transfusion e Proper medical diagnosis and treatment e Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.) 2. Hepatitis - ‘C’ Hepatitis-C is a liver disease. It is usually spread through direct contact with the blood of a person who has the disease. In this disease, the liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increase in people with cirrhosis and only 20% hepatitis C patient get cirrhosis. Faeces is never a route of transmission in hepatitis C. It is caused by the hepatitis-‘C’ virus (HCV). It is caused by Health, Population and Environment Education-10 177

RNA virus, which is round in shape and is 60 nanometer long. The high possibility of transmission of this disease is among the intravenous drug users. Hepatitis C usually does not demonstrate signs and symptoms in its acute condition but in the chronic stage this condition can progress to scarring of the liver and advanced scarring (cirrhosis). In the context of Nepal, this disease is mainly found among intravenous drug users. In the later stage of Hepatitis C, the infection becomes chronic and slowly damages the liver and finally it may results into liver cancer. The incubation period of this disease ranges between 2 weeks to 6 months. Mode of Transmission M Blood and blood product transfusion M Tattooing with contaminated needles M Sharing of syringes M Unsafe sexual exposure M Transplantation of infected organs M Infected mother to child Symptoms Loss of appetite Nausea and vomiting Fever and enlargement of liver Dark urine Yellowing of skin or eyes (called jaundice) in rare cases Fatigue or muscular pain Loss of weight Preventive Measures e Care should be given to personal hygiene e Avoid unsanitary tattoos e Avoid sharing personal items such as toothbrushes, razors, syringes, etc. e Avoid sharing of needles and razors e Avoid unsafe sex 7.3 Non-Communicable Disease At present, non-communicable diseases have become the leading cause of deaths in the world except Africa. Nepal is also not remained untouched by this fact, there is lack and unavailability of such program which may help to control the prevalence of non-communicable disease. Besides this, due to the unhealthy living style; the onset of non-communicable diseases is severely affecting the present world. Cancer, heart attack, stroke and diabetes are the example of non-communicable diseases. 178 Health, Population and Environment Education-10

7.3.1 Causes or Risk Factors of Non-communicable Diseases There are various risk factors of non-communicable diseases. They can be classified under two groups: A. Modifiable Risk Factors The risk factors which can be controlled and changed are called modifiable risk factors. They are as follows: Consumption of tobacco and tobacco products Consumption of alcohol Lack of physical exercise Obesity Increase of glucose and cholesterol level in blood Unhealthy diet Mental tension and anxiety Unhealthy life style B. Non-modifiable Risk Factors Non-modifiable risk factors means those risk factors which cannot be changed or altered by human efforts. They are unavoidable risk factors that lead people ultimately to non-communicable diseases. Age, Sex and heredity are considered as non-modifiable risk factors. 1. Age Age is one of the major non-modifiable risk factors of non-communicable diseases. Generally, people suffer from non-communicable diseases after the age of 40 years. The common diseases that occur among the people after the age of 40 are hypertension, diabetes and heart disease. 2. Sex Sex is also considered as a strong non-modifiable risk factor of non-communicable disease. Different researches have revealed that males are more vulnerable to non- communicable diseases in comparison to their female counterparts. The research reports show that it is because of challenging job and more stressful life of male than that of female’s life. Because of these reasons, males are vulnerable to the risk of non- communicable diseases. 3. Genetic or Heredity The disease which is genetically inherited through the gene is called genetic or hereditary disease. For example; diabetes and cancer have a greater possibility of passing through the parents to offspring. Health, Population and Environment Education-10 179

7.3.2 Some Non-communicable Diseases A. Cancer Cancer is a diseases in which abnormal cells get divided without control and are able to invade other normal tissues. Cancer cells can spread to other parts of the body through the blood and lymphatic system. There are more than 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 melanocytes of the skin is called melanoma. Similarly, bladder cancer, breast cancer, rectal cancer, endometrial cancer, leukemia, lungs cancer, pancreatic cancer, prostate cancer, thyroid cancer are named according to their location. WHO has revealed that nearly 7.6 million people are dying annually in the world due to cancer, and it is projected that this number will still increase and go beyond 10.14 million by 2030 AD. Cancer type can be grouped into broader categories. The main categories of cancer include • Carcinoma: cancer that begins in the skin or in tissues that line or cover internal organs. There are a number of subtypes of carcinoma, including adenocarcinoma, basal cell carcinoma and squamous cell carcinoma. • Sarcoma: cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective tissues. • Leukemia: cancer that occurs in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter into the blood. • Lymphoma and myeloma: cancers that begin in the cells of the immune system. • Central nervous system cancers: cancers that begin in the tissues of the brain and spinal cord. Causes of Cancer (i) Physical Factors: • X-ray, UV ray, radium, etc. (ii) Chemical Factors: • Tobacco products, alcohol, non-edible colours, etc. (iii) Biological Factors: • Viral infection • 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 • Bacterial Infection • The bacteria called, Helicobacter pylori is believed to be the main cause stomach cancer 180 Health, Population and Environment Education-10

Some Warning Signs of Cancer Change in wart or mole Persistent cough and change in voice (hoarsness) Blood loss from any natural orifice (nose, mouth, anus, vagina, etc.) Unexplained loss of body weight Change in digestive and bowel habits Lumps felt in breast which might be painless Any sore that does not get better Preventive Measure of Cancer e More than 40 percent of cancer can be controlled by avoiding tobacco and doing daily physical exercise e Use of inedible colours and preservatives in the food substances must be controlled e Many cancers are found to be caused by other chronic infections like Hepatitis B, Human Papiloma Virus and HIV. So, controlling them can be the control of cancer e Unhealthy food habits should be controlled e Cancer awareness campaign need to be conducted in massive scale e Control of environmental poll e Random use of chemical fertilizer and pesticides in agriculture must be controlled B. Diseases Related with Heart and Blood Vessels Among non-communicable diseases, Cardio Vascular Diseases-(CVDs) are one of the major causes of death. CVDs alone causes more than 30% death out of total deaths by non-communicable diseases in the world. According to the WHO, around 17 million people are dying because of cancer every year and it is projected that 25 million people will be killed by this disease by 2020 AD. Cardiovascular diseases include: coronary heart disease, cerebrovascular disease (stroke), peripheral arterial disease, rheumatic heart disease, congenital heart disease and heart failure which are briefly explained in the following table: Different form of Cardio Vascular Diseases Coronary Heart Disease (Heart attack) A disease related to blood vessels which Cerebrovascular Disease (Brain Stroke) supply blood to the muscles of the heart (coronary arteries) e.g. heart attack A disease related to blood vessels which supply blood to the brain (cerebral arteries) e.g. brain stroke Health, Population and Environment Education-10 181

Peripheral Arterial Disease A disease related to the blood vessels that supply blood to legs and arms Rheumatic Heart Disease (atherosclerosis). e.g Ischemia Congenital Heart Disease A disease related to the valve of the heart caused by streptococcal infection Inborn malformation in heart 1. Heart Attack and Brain Stroke Heart Attack and Brain Stroke are the most emergent and complex conditions among the cardio vascular diseases. Heart attack and stroke are mainly caused by the blockage that prevents blood supply to the heart or the brain. The most common cause is a buildup of fatty deposits or blood clots on the inner walls of the arteries that supply blood to the heart or brain. These life threatening conditions eventually results into cardio vascular accident (stroke) and heart attack. i. Heart Attack Heart attack is a serious medical emergency 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. In this sense, we know that lacking of blood flow to the heart can seriously damage the heart muscles. Various research studies revealed that heart attack most often occurs as a result of coronary heart disease. Every year, more than 17 million people in the world are dying due to heart diseases. WHO has estimated that this number will still increase and near about 25 million people will die by heart disease by 2020 AD. Symptoms Chest pain: The chest can feel like it is being pressed by a heavy object Shortness of breath Discomfort in the centre or left side of the heart Pain radiating to the back, jaw, throat and arm Fullness, indigestion or may feel like heartburn Sweating, nausea, vomiting or dizziness Extreme weakness, anxiety or shortness of breath Rapid irregular heart beat But 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. 182 Health, Population and Environment Education-10

Causes of Heart Attack M High blood pressure M Over weight M Development of fatty substance in the vein that supply blood to the heart M Heredity M Stress M Smoking and drinking M Coronary heart disease and rheumatic heart disease ii. Brain Stroke Stroke is the sudden death of brain cells in a localized area due to the inadequate blood flow. It occurs when blood flow is interrupted to a part or section of the brain either by blockage or a rupture of blood vessels. Depending on the effect in the brain a stroke may cause paralysis, speech impairment, loss of memory, coma or death. A stroke is called a brain attack or cerebrovascular accident (CVA). Much of the time, stroke affect only one side of the body. Symptoms Blurring or darkened vision in one or both of the eyes Severe headache Dizziness Difficulty in walking Loss of balance and coordination of body Difficulty in speaking or understanding others who are speaking Numbness or paralysis in the face, leg or arm, most likely just one side of the body Risk factors of Heart Attack and Brain Stroke Risk factors for stroke and heart attack involve age, sex, heredity, medical conditions, use of certain medications, and lifestyle choices: • Age: The risk of stroke and heart attack increases with age. • Heredity: People with a family history of these diseases are at greater risk. • Diseases: Risk is increased for people with diabetes, heart disease, high blood pressure, etc. • Other medical conditions: Risk increases with obesity, high blood cholesterol level, or high red blood cell count. • 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. Health, Population and Environment Education-10 183

Preventive Measures e Quit smoking and alcohol e Eat a diet rich in vegetables and fruits e Reduce the intake of sweet and salty diet e Control blood pressure and diabetes e Get into regular moderate physical exercise for 30 to 45 minutes include: walking, jogging, yoga, game, etc. e Maintain a healthy weight e Reduce mental tension e Keep life style healthy 2. Rheumatic Fever and Rheumatic Heart Disease i. Rheumatic Fever Rheumatic fever is an inflammatory disease that may develop after an infection with group A streptococcus bacteria. The disease can affect the heart, joints, skin and brain. Rheumatic fever is responsible for many cases of damaged heart valves. It mainly affects children between the ages of 3-15 years. ii. Rheumatic Heart Disease Rheumatic heart disease is a chronic condition caused by rheumatic fever. This disease occurs due to group A streptococcal infection. It is the most common acquired heart disease in children in many countries in the world, especially in developing countries including Nepal. It generally damages the heart valves. Untreated tonsillitis can later results in to Rheumatic Heart Disease. This disease mostly attack the children in the age group 3-15 years. At least 16 million people are estimated to be currently affected by this disease. Symptoms of Rheumatic Fever and Rheumatic Heart Disease Abdominal pain Heart problem, which may result in shortness of breath or chest pain Joint pain (mainly in the knees, elbows, ankles and wrists) Joint swelling with redness and warmth Skin nodules Rashes in body parts Fever Emotional instability Rapid jerky movement due to muscle weakness C. Diabetes Diabetes is a group of metabolic disease in which a person has high blood sugar. 184 Health, Population and Environment Education-10

The high concentration of sugar in the blood produces the symptoms of frequent urination, increased thirst and increased hunger. 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 use the secreted insulin. The pancreas may secrete insulin for all the cells of the body, but some cells may not respond to it. Consequently, it causes extremely high concentration of sugar in the blood. This condition is called diabetes. 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. Depending on the nature, diabetes can be grouped into three types such as Diabetes Insipidus, Diabetes Mellitus and Gestational Diabetes. 1. Diabetes Insipidus Diabetes insipidus is a disease characterized by extreme thirst and the passing of vast amounts of diluted urine. It is caused by insufficient vasopressin (a hormone produced by pituitary gland of the brain that instructs the kidneys to retain water). Without enough vasopressin, too much water is lost from the body through urination. Which urges the affected person to drink large amounts of fluids in an attempt to maintain their fluid level. In the severe case diabetes insipidus can cause dehydration and coma due to excessive concentration of salts in the blood, particularly sodium. Depending on the cause, diabetes insipidus can be treated with medications, vasopressin replacement and a low-salt diet. Symptoms Excessive thirst Excessive urine production (polyuria) Unexplained weakness Muscle pain Irritability Dehydration Presence of sugar in urine The colour of urine is crystal and smells nice 2. Diabetes Mellitus (Sugar) Diabetes Mellitus is one of the most common and serious chronic diseases in the world including Nepal. Diabetes is a metabolic disease in which the body can not produce insulin (insulin is a hormone produced by pancreas that is needed to convert sugar, starche and other food into energy needed for daily life). There are three types of diabetes mellitus, all of which are characterized by high levels of blood glucose (sugar). Health, Population and Environment Education-10 185

Diabetes Mellitus (Type I) It is also called insulin dependent diabetes mellitus or juvenile onset diabetes. It is characterized by loss of the insulin producing beta cells in the pancreas, leading to insulin deficiency. The Mellitus Type I diabetes can affect children or adults, but is traditionally termed as “juvenile diabetes” because a majority of these diabetes cases are among the children. Generally, the onset of type I diabetes is unrelated to lifestyle. General characteristics M Results when the body’s immune system attacks and destroys its own insulin- producing beta cells in the pancreas M People with type I diabetes need daily injections of insulin to live a normal life M Develops most often in children or young adults M Although risk factors are not well defined, autoimmune, genetic, and environmental factors are involved in the occurrence of this disease Diabetes Mellitus (Type II) It is also called noninsulin dependent diabetes: General characteristics M Occurs when the pancreas makes enough insulin but body cannot use it effectively. M Usually develops in adults over the age of 40 M More common among older; obese people who have a family history of diabetes and who have had gestational diabetes earlier Gestational Diabetes Mellitus Gestational diabetes mellitus resembles type II diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in 2–5 percent of the total pregnant women. It may disappear after delivery. Gestational diabetes is fully treatable, but requires careful medical supervision throughout the pregnancy period. About 20-25 percent affected women develop type II diabetes in future. General Characteristics M It occurs during pregnancy M Usually disappears when the pregnancy is over M Women who have had gestational diabetes have a greater risk of developing type II diabetes later in life Causes of Diabetes Health, Population and Environment Education-10 Ü Too much carbohydrates in diet Ü Lack of physical exercise Ü Obesity 186

Ü Sitting idly and eating more food Ü Lack of secretion of insulin by pancreas Ü Too much worry and idleness Symptoms of Diabetes Increased thirst Extreme hunger Fatigue Weight loss in spite of increased appetite Feeling tired and lethargic Tongue looks dry Blurred vision Slow healing of wounds Presence of more sugar in urine Frequent urination and loss of water in the body Itching and skin infection, particularly around the genitals Tingling or numbness in legs, feet or fingers Preventive Measures e Have a healthy eating plan e Do regular physical activities and exercise e Follow healthy lifestyle e Avoid obesity e Avoid alcohol and tobacco substances e Weight management e Periodic test for the presence of sugar level in urine and blood D. Chronic Obstructive Pulmonary Disease (COPD) “The disease which may develop wheezing, breathlessness and mucus due to the obstruction of bronchi and bronchioles is recognized as chronic obstructive pulmonary disease.” A chronic obstructive pulmonary disease affects the bronchi and bronchioles of the lungs. Patient becomes breathless in need of air and also has cough with excessive sputum production. There is no complete treatment of this disease but it can be prevented and controlled. This disease if not treated in time, it may develop into the chronic disease Asthma. The WHO has estimated that nearly about 80 million world population is suffering from COPD. A survey shows that about 3 million people died in 2005 AD due to this disease. Among them, 90 percent were from the developing countries. Health, Population and Environment Education-10 187

Causes Ü Dust and chemical substances Ü Smoking and frequent upper respiratory tract infections Ü Indoor air pollution (i.e. smoke produced by; domestic combustion of coal, wood, kerosene, etc), Ü Outdoor air pollution (i.e. harmful gases or smoke produced by the industry and vehicle) Symptoms Heaviness in the chest Restlessness Difficulty in respiration during the sleep Cough with sputum Wheezy breathing during the work, exercise and running Fast respiration and pulse rate In the case of severe COPD, patient may die if he/she does not get oxygen in time. Prevention and Control e Keep away from allergens e Stay in non-polluted environment e Wear warm clothes to prevent yourself from cold e Keep away from smoking e Take medicine according to the doctor’s prescription e Take oxygen immediately if there is difficulty for respiration 7.4 Environmentally Infectious Diseases A. Dengue Fever Dengue fever is a mosquito-borne tropical disease. It is caused by the dengue virus. Dengue virus is transmitted through Aedes aegypti female mosquitoes that breed in household water containers and unused materials on the roof and around the houses. Aedes Aegypti is the vector of Dengue fever. It is a small, black mosquito with white stripes and is approximately 5 mm in size. Aedes aegypti mosquito breeds in any type of manmade containers or storage containers having even a small quantity of water. Drums, jars, pots, buckets, flower vases, plant saucers, tanks, cisterns, bottles, tyres, roof gutters, cement blocks, bamboo stumps, coconut shells and many more places where rainwater is stored for long period become suitable breeding habitats for these mosquitoes. The incubation period of this disease usually lasts for 3-7 days. According to WHO, around 300 million people are infected and approximately 20,000 persons die due to this disease each year. In the context of Nepal, this disease infects around 188 Health, Population and Environment Education-10

300 persons every year (Department of Health, GoN). The vaccine against dengue fever was discovered in 2016 AD. Habitat of the Vector Ü Water retained ditch Ü Water retained flower vase Ü Water retained discarded sinks Ü Water holding discarded barrels, buckets, drums and jerrican Ü Water retained discarded tires and other vehicle parts Mode of Transmission M Mosquito bite M Blood transfusion by infected donour M Infected mother to her foetus Signs and Symptoms Sudden high fever and pain behind the eyes Intense headache and tiredness Cough and sore throat Nausea or vomiting Severe joint and muscle pain Bleeding from nose and gums Liver enlargement Skin rash (appearing between two and five days after the initial fever) Convulsion Preventive Measures e Avoid heavily populated residential areas e Use mosquito repellent indoors and outdoors e Wear long-sleeved shirts and pants tucked into socks e Ensure that window and door screens are secure, and any holes are repaired e Use mosquito nets if sleeping areas are not screened Activity Organize a talk program in your class on the role of school children for the prevention and control of communicable diseases in community with the epidemiologist and other stakeholders under the supervision of your subject teacher. Health, Population and Environment Education-10 189

B. Viral Influenza Influenza is a contagious respiratory disease. It is caused by influenza A virus. It is highly contagious and easily spread among people. Influenza is spread from person to person when the virus enters the body through the eyes, nose or mouth. Coughing and sneezing release the germs into the air, where they can be breathed in by others. The virus can also rest on hard surfaces like doorknobs, ATM buttons, and counters. A person who touches these surfaces with their hands and then touches their eyes, mouth, or nose can become infected with the virus. Influenza is generally not spread by eating food or drinking water. People who live in community housing such as college dorms, nursing homes or military barracks are at higher risk of influenza infection because they are in contact with more potentially infected people. The incubation period for flu is about one to four days. Mode of Transmission M Direct transmission through airborne droplets during sneezing or coughing M Indirect transmission through the germ contaminated telephone, computer board, etc. M Contaminated hanky, tissues or hands Signs and Symptoms Body aches Cough and sore throat Chills and fatigue Fever and headache Loss of appetite Diarrhea and vomiting (possible) Prevention and Control e Rest and drink plenty of fluids e Cover your mouth and nose with a surgical mask e Wash your hands regularly with soap and water e Avoid close contact with the infected person e Avoid close contact with sick people e Staying home from work or school if you are sick e Timely Influenza vaccination to the children e Use an alcohol-based hand sanitizer if available 190 Health, Population and Environment Education-10

Summary Ü Disease is a pathological condition of an organism resulting from various causes such as infection, genetic defect, or environmental stress and characterized by recognizable signs and symptoms. Ü Communicable disease is an illness in the body due to specific infectious agent or its toxic product. It is directly or indirectly transmitted from an infected person to a healthy person (susceptible host) through various medium via air, water, food, soil, dust particles, and vectors. Ü The time period between infection and the appearance of symptoms of the disease is called incubation period. Ü A disease that lasts for a short time comes on rapidly and is accompanied by distinct symptoms. Ü A disease that lasts for a long period is called chronic disease. A chronic condition, by contrast is a long-developing syndrome. Ü HIV is the virus (Retro virus) that causes AIDS. This virus attacks and destroys a type of white blood cells called CD4+ T cell (T lymphocyte). Ü The risk factors that can be controlled and modified are called modifiable risk factors (eg alcohol and tobacco consumption, unhealthy diet, obesity, etc). Ü The risk factors that cannot be altered and modified are called non-modifiable risk factors. They are also called unavoidable risk factors (eg age, sex, heredity, etc). Ü Among the non-communicable disease, cardio vascular disease (CVD) is one of the major causes of death. The CVD includes coronary heart disease, cerebro vascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, etc. Ü Diabetes Insipidus is a disease characterized by the extreme thirst and passing of large amount of diluted urine. The insufficient secretion of vasopressin hormone causes it from the pituitary gland, which causes dehydration and coma to the patient due to excessive concentration of sodium salt in the blood. Ü Narcotic drugs are the substances with addictive properties. It develops physical dependency, feeling of pleasure, reduces fear and panic associated with severe pain. In most countries the production, trade, and use of narcotics are ban because of their addictive properties. Example: opium, morphine, codeine, heroine, etc. Ü Dengue fever is a mosquito-borne tropical disease. It is transmitted through Aedes aegypti female mosquitoes that breed in household water containers and unused materials on the roof and around the houses. Ü Influenza is a contagious respiratory disease. It is caused by a influenza A virus. Coughing and sneezing release the germs into the air, where they can be breathed in by others. Health, Population and Environment Education-10 191

EXERCISE A. Very short answer questions. 1. Which type of communicable disease is cholera? 2. Which disease is known as silent killer? 3. Mention any two symptoms of dengue fever. 4. What is the causative agent of bacillary dysentery? 5. What can be the main cause of non-communicable disease? 6. Which bacteria causes stomach cancer? 7. Mention any two modifiable risk factors of non-communicable disease. 8. What is the main cause of Rheumatic heart disease? 9. Write any two symptoms of stroke. B. Short answer questions. 1. “Diarrhoea is a common disease of Nepali children”. Justify the statement. 2. What is cancer? What are the causes and preventive measures of cancer? 3. Mention the causative agent, signs/symptoms and preventive measures of Round Worm infestation. 4. Mention the causative agent, mode of transmissions and preventive measures of common cold. 5. What is disease? Explain the types of disease. 6. What is heart attack? Write its signs and symptoms. 7. What is Dengue fever? Mention its causative agent, signs/symptoms and mode of transmission. C. Write differences between: 1. Heart attack and stroke 2. Amoebic dysentery and bacillary dysentery 3. Diabetes insipidus and diabetes mellitus D. Write short notes on: 1. COPD 2. Gestational Diabetes 3. Rheumatic Fever 192 Health, Population and Environment Education-10

E. Long answer questions. 1. Give an introduction to Diabetes Mellitus Type-I and illustrate its causes, general signs/symptoms and prevention and control measures. 2. What is hepatitis ‘B’? Mention its causative agent, mode of transmission, signs/symptoms including prevention and control measures. 3. What is Influenza? Mention its causative agent, mode of transmission, signs/ symptoms including prevention and control measures. Project Work Conduct a sample survey on Knowledge, Attitude and Behaviour on any one communicable disease among the currently married couples from 12 sample population under the sub topics that is given below: I. Introduction a. Background of the Study b. Objective of the study c. Significance of the Study d. Limitation of the Study II. Methodology a. Study Area b. Sources of Data c. Method of Data Collection III. Data Analysis and Interpretation IV. Findings, Conclusion and Recommendation Health, Population and Environment Education-10 193

UNIT ADOLESCENCE, SEXUAL AND 8 REPRODUCTIVE HEALTH EDUCATION Learning Achievement After completing this unit, students will be able to: Give introduction to Sexually Transmitted Diseases. Introduce HIV and AIDS and identify causes, symptoms, and prevention and control measures. Introduce syphilis, gonorrhea and chanchroid and identify their causes, symptoms, and prevention and control measures. Give introduction to Safe Motherhood. Explain the education and health service for Safe Motherhood. Tell the signs and symptoms of pregnancy. Identify risky conditions of pregnancy. Identify the minor and major problems of pregnancy. Tell the need and importance of Maternal and Child Health Care. Illustrate the measures of Maternal and Child Health Care. Mention about proper breast feeding and supplementary food to the baby. Tell immunization schedule to the newborn baby. 8.1 Some Major Sexually Transmitted Infections (STIs) The infection transmitted from one individual to another through the unprotected sexual contact is called sexually transmitted infection. The sexual intercourse before marriage is illegal and is not acceptable in our society. Multiple partners for sexual intercourse leads to various sexually transmitted infections. The common sexually transmitted infections are Syphilis, Gonorrhea, HIV and AIDS, etc. 8.1.1 HIV and AIDS Human Immuno Deficiency Virus or ‘HIV’ is the virus that causes AIDS. HIV attacks and destroys a type of white blood cell called a CD4 cell, commonly called the T-cell. This cell’s main function is to fight against disease. When a person’s CD4 cell count gets low, s/he is more susceptible to illnesses. AIDS is a life threatening disease caused by the Retro virus known as (HIV). As soon as retrovirus gets into the body, HIV infection begins and it starts invading CD4 (T-lymphocytes). Then the immunity power of the 194 Health, Population and Environment Education-10

infected person starts decreasing. Following infection by HIV, within 3 weeks to 3 months, many patients develop some symptoms such as fever, sweats, fatigue, muscle and joint ache, sore throat, diarrhoea, skin rash and swollen lymph nodes. But within one to three weeks, these symptoms disappear as the immune system responds to the HIV by producing antibodies that kill HIV infected cells. Having HIV does not always mean that the person has AIDS. It can take many years for people with the virus to develop AIDS. Hence, HIV and AIDS is often called the “silent epidemic” due to its very long incubation period, meaning that a person can be infected for many years without showing any symptoms. AIDS cannot be cured however, with the Anti Retro Viral Drugs available today, it is possible to have a normal life span with little or minimal interruption in quality of life. There are ways to help people stay healthy and live longer. UNAIDS has estimated that there are about 35 million people who have been living with HIV in the world. Although the disease appeared late in Asia it has exceeded other continents in the number of AIDS patients. The first case of HIV and AIDS was found in the USA in 1981 AD. Similarly, the first case of AIDS in Nepal was identified in 1988 AD. According to the National Centre for AIDS and STD control (NCASC), the total number of people living with HIV for 2012 AD was estimated 50,000 in the country. In Nepal, HIV epidemic is largely concentrated among the intravenous drug users, sex workers, male labour migrants and Trans genders. Normally, approximately 1,200 CD4 cells are present per cubic millimeter of blood. An HIV-infected person is considered to have AIDS when one or more of the following conditions appear: such as the CD4+T cell count falls below 200 cells/mm3 and opportunistic infection like; T.B., Syphills, Persistent diarrhoea or Kaposis sarcoma (cancer of skin, lymph nodes) develops. Then, the AIDS patient dies within 6 months iTnrUafenncsstOaefufdFesTbisoRleonAxoNodSfMISSIONMODE Sharing of infected HIV- Infection needles S W(3i-n1d2omwoPnetrhios)d T A HIV Positive G E (SHomeae lmthoyntChsatrorimearnSytyaegaers) S (Attack with AIDS diseases) multiple opportunistic Different stages of HIV & AIDS Health, Population and Environment Education-10 195

to 2 years due to the attack of opportunistic diseases. Usually, there are three major stages in HIV and AIDS. They are explained below: 1. Window Period The window period refers to the time period it takes for the HIV blood test to give an accurate positive result after the invasion by the virus. During this period, the blood test produces HIV negative result but the infected person may transmit the disease to other persons, so this stage is also known carrier stage. Usually, the window period lasts for months but it varies from person to person. For instance, to some persons this period lasts for 3 weeks only and to some persons, this period lasts for 12 months also. 2. HIV Positive In this period, if the infected person goes through the blood test it gives HIV positive result. However, there is no remarkable signs and symptoms of HIV and AIDS. This stage may last for as short as 5 years to as long as more than 17 years without showing any symptoms. Hence, this stage is also known a healthy carrier stage. At the end of the HIV stage, the infected person can start Anti Retro Viral Drugs available today to delay AIDS stage and have a normal life span. 3. AIDS Generally, an HIV infected person enters into the AIDS stage after 7-10 years of infection by the virus. If the HIV infected person starts the Anti Retro Viral Drugs just before the AIDS stage he/she can live a normal life for many years. Mode of Transmission M Unsafe sexual contact with HIV infected person M Transfusion of infected blood or blood products M Reusing or sharing of infected needles M Mother-to-child transmission Minor Symptoms Night sweats and sore throat Recurrent upper respiratory tract infection Frequent appearance of herpes zoster Mild to moderate swelling of the lymph nodes in the neck, armpits and groin Occasional fever Skin rashes and nail infection General feeling of tiredness Persistent cough for more than one month 196 Health, Population and Environment Education-10

Major Symptoms Loss of weight for more than ten percent of the body weight Being tired all the time Continuous fever for more than one month Continuous diarrhoea for more than one month Abnormal discomfort, headache Opportunistic diseases of various kinds Preventive Measures e Be away from prostitution e Public awareness about reproductive and sexual health should be increased e Do not involve in the unsafe sexual activities e Use sterilized or disposable syringe e Blood should not be used without screening e Proper use of condom can control HIV infection e Have anti- retroviral therapy by infected mother if she is pregnant e Avoid body piercing and tattooing Reasons of Prevalence of HIV/AIDS in Nepal 1. Poverty and Unemployment A large number of Nepalese youths emigrated to different foreign countries including India. During the long time stay outside in those places some persons happen to establish promiscuities sexual relation with the sex workers over there. If they establish unsafe sexual relation, they get infected with HIV/AIDS and return back to the country. If they have sexual relation with their sexual partner again then this disease transmits to the partners also. 2. Human Trafficking from Nepal The smuggler’s groups are involved in human trafficking. They trap people in different name and traffic them to India and other countries. In those places, they are compelled to involve in sex work. Because of such work, they get HIV infection. When they return to the country, they cannot get support, protection and rehabilitation service. As a result, they become the medium of prevalence of this disease. 3. Sex Trade in Rural and Urban Area Sex trade is illegal in Nepal. However, some people are involved in this illegal activity. In this context, they can spread HIV/AIDS to a large population if they establish unsafe sex. Health, Population and Environment Education-10 197

4. Ignorance about Sex Education In our society, there are many social taboos against open discussion about the sexual issues. So, there is no open discussion about sexuality, sexually transmitted diseases and other sexual issues even between husband and wife. Eventually people become ignorant about sexual issues and responsibilities. Hence, they become totally ignorant about AIDS related issues. For instance, they do not know What is AIDS? How does it transmit? How can it be prevented? It is necessary to understand that there should be equal treatment to the HIV infected persons also and there should be rehabilitation services and facilities to the HIV/AIDS victims. 5. Social Taboos About Open Discussion on STDs The STD infected person should openly explain their problems to the doctor or authorized health worker at the health organization. In our society, we cannot openly discuss about sexual issues and STDs yet. It is still believed that to talk about the sexuality is to cross the limitation of moral and social ethics. This factor also becomes one reason of high prevalence of the STDs including HIV/AIDS. Activity Divide the class in different groups and conduct a sample survey on endemic diseases of your locality and examine the causes, mode of transmission, signs and symptoms including their preventive and control measures. Then present the report in your class for discussion. 8.1.2 Syphilis Syphilis is a sexually transmitted infection caused by the spirochete bacterium called Treponema Pallidum. The primary mode of transmission of this disease is unsafe sexual contact. It may also be transmitted from mother to foetus during pregnancy or birth resulting in congenital syphilis. If left untreated, syphilis typically progresses through three stages: Primary, Secondary and Tertiary stage. The primary stage normally begins with a single chancre (a firm, painless, non-itchy skin ulceration), secondary syphilis with a diffuse rash which frequently involves the palms of the hands and soles of the feet and tertiary syphilis with insanity, blindness or heart damage. Its diagnosis is usually made by using blood tests. Syphilis can be effectively treated with antibiotics. It is believed that this disease has infected about 12 million people in the world in 2013 AD, with greater than 90 percent of cases in the developing world. During 2010 AD, Syphilis alone caused about 130 thousand deaths in the world. The incubation period ranges from 10 to 90 days. 198 Health, Population and Environment Education-10

Mode of Transmission M Unprotected sexual contact M Transfusion of contaminated blood M Infected mother to the foetus M Use of contaminated syringes and needles Symptoms Primary Stage Primary stage of Syphilis develops approximately 10 to 90 days after the initial exposure. As the earliest sign of syphilis in its primary stage, a skin lesion called chancre appears in the genitals or tip of the finger in male and on vulva and anal area in female. The chancre is a single, painless, non-itchy skin ulceration but occasionally multiple chancres may be present. The lesion may appear for 3 to 6 weeks without treatment then it disappears leaving scars. Eventually, lymph node enlargement occurs around the area of infection, generally 7 to 10 days after the formation of chancre. Secondary Stage Secondary syphilis occurs approximately 4 to 10 weeks after the primary infection. In this stage, skin rashes appear. At the same time hair falls, swelling of joints and symptoms of common cold occur. There may be enlargement of liver, spleen and lymph glands. Other symptoms may include fever, sore throat, weight loss and headache. The acute symptoms usually resolve after three to six weeks. If the treatment is not done in time, the third stage begins after some years later. Third Stage (Tertiary Stage) Tertiary Syphilis may occur between 3 to 15 years after the initial infection and may develop the following health problems: Gummatous Syphilis: Formation of gummas occurs (tumour like masses), Neurosyphilis: typically affect the skin, bone, liver, etc. Cardiovascular Syphilis: Development of maningo vascular syphilis resulting in to blindness, general paralysis and insanity. The most common complications of cardiovascular syphilis are serious damage to heart and blood vessels. Preventive Measures 199 e Early diagnosis of the cases e Sexual health education at home, school and community e Unprotected sexual activities must be discouraged e Wash and sterilize clothes and pots before using them e Avoid personal belongings of infected persons Health, Population and Environment Education-10

8.1.3 Gonorrhoea Gonorrhoea is a contagious disease. It is transmitted through sexual contact with an infected person. It may also be spread by contact with body fluid so that mother can pass on the infection to her newly born. The infection is easily spread and occurs most often in people who have multiple sex partners. It is caused by the bacterium called Neisseria Gonorrhoeae that can grow and multiply easily in mucus membrane of the body. This bacteria can grow in the reproductive tract including the cervix, uterus, fallopian tube in women and in urethra in both men and women. The bacteria can also grow in the mouth, throats and anus. The germs come out with the pus from the genitals. The average incubation period of this disease ranges between 3 to 9 days. Symptoms Burning sensation and difficulties in urination, frequent occurrence of urination Thick greenish yellow or white discharge flows out form the vagina or penis Genitals and urethra are swollen Red spots appear around the genitals Bleeding may occur between periods in women Painful or swollen testicles appear in men Eyes are affected to the newly born baby Swelling of vulva Burning sensation when urinating In women, lower abdomen or pelvic pain Mode of Transmission M Unsafe sexual contact M Sharing clothes and handkerchief used by the patients M Transfusion of contaminated blood M Use of infected needles and syringe M Infected mother to child Preventive Measures e Sexual relation between husband and wife only e Girls’ trafficking and prostitution must be banned e If a husband or wife is infected from it, both of them should be treated in time e The patient’s clothes and other belongings should be washed properly e It is needed to keep the genitals neat and clean e Education on sexual hygiene e Early diagnosis and treatment 200 Health, Population and Environment Education-10