Oasis Health, Population & Environment Education Book 10

of a single or a few rare creatures without a common and wide- range conservation policy cannot be considered wise, because all the components in an ecosystem are interdependent and interrelated directly or indirectly with one another. That’s why there must be a broad policy of the conservation of whole ecosystem in aggregate for the conservation of any rare creature in the ecosystem. d) Restriction on hunting Hunting has been seen as a big problem in the conservation of rare animals and birds. Frequently poachers, hunters, and smugglers enter the restricted areas of conservation and destroy valuable living creatures for commercial purpose. There must be restriction for hunting rare birds and animals for their proper conservation. e) Formulation and implementation of laws There are some laws in Nepal for conservation of rare birds and animals. These laws are not sufficient, and new laws should be formulated. Implementation of those laws is also a big problem for the administrators and concerned authorities because of an efficient network of hunters. A serious problem is that the network of hunters can, sometimes, have easy access to authority for illegal collection of listed animal products. f) Participation of local people in conservation The role of local people around the habitat of rare birds and animals is very important in their conservation. If the local people are involved in conservation works, conservation becomes effective. g) Conservation of ex-situ and in-situ i. Ex-situ conservation of rare animals and birds: It is the conservation of man-made or artificial habitat of rare animals and birds. The ex-situ conservation method is followed especially in the conservation of very rare and endangered animals and birds. Establishment of zoos, promotion of breeding centres, etc. are included in this method. ii. In-situ conservation of rare animals and birds It is the conservation of the natural habitat of rare animals and birds. In such a habitat, animals and birds live and reproduce naturally. It includes protection of the natural habitat of rare animals and birds. Establishment of national parks and wildlife reserves, conservation of natural habitats like forests and watershed areas, conservation of water resources for conservation of aquatic animals, etc. are included in this method. Health, Population and Environment - 10 151

6.5.7 Protected Animals and Birds Nepal is a rich country in biodiversity because of its wide-ranging biotic aspects with a remarkable presence of living creatures. Some birds and animals are found to be rare because of their reduced number. Law has been made for their conservation and the following mammals, birds and reptiles are listed as rare creatures of Nepal: Table : Protected Animals, Birds and Reptiles of Nepal Local Name Common Scientific Local Name Common Scientific Name Name Name Name Mammals (English 14. Krishna- 1. Arna Name) Bubalus sar Black buck Antilope arnee 15. Nayan cervicapra 2. Assame Wild water Macaca as- Rato Bandar buffalo samensis 16. Pudke Great Tibetan Ovis ammon 3. Bagh Assamese Panthera Bandel sheep monkey tigris 17. Salak Bengal tiger Cervus du- Pigmy hog Sus salvanius vauceli 18. Salak 4. Barasingha Swamp deer Canis lupus Indian Pan- Manis crassi- 19. Silu golin caudata 5. Bwanso Tibetan wolf Prionailurus bengalensis 20. Suns Chinese pan- Manis penta- 6. Chari Bagh Leopard Tetracerus golin dactyla quadricornis 21. Hispid 7. Chauka Four-horned Bos mutus kharayo Spotted lin- Prionodon 8. Chaurigai antelope sang pardicolor Wild yak Gangetic Platanista dolphin gangetica Hispid hare Caprolagus hispidus 9. Durlav Jan- Lynx Felis Iynx 22. Hiun Snow leopard Panthera gali Biralo Chituwa uncia Pardofelis 23. Hundar 10. Dwanshe Clouded nebulosa Striped hy- Hyaena Rhinoceros 24. Kasturi aena hyaena Chituwa leopard unicornis Mriga 11. Ek Singe Asian one- Musk deer Moschus Gainda horned chrisogaster rhinoceros 12. Gaurigai Gaur Bos gaurus 25. Hatti Asiatic ele- Elephas max- phant imus 13. Habrey Red panda Ailurus ful- 26. Himali gens Rato Bhalu Brown bear Ursus arctos 152 Health, Population and Environment - 10

Birds Cheer pheas- Catreus wal- 6. Raj Giant horn- Buceros 1. Cheer bill bicornis ant lichii Dhanesh Sypheotides indica 2. Danfe Impeyan Lophophorus 7. Sano Khar Lesser flor- Grus grus (G. 3. Kalo Saras pheasant impejanus Mujur ican antigone) Ciconia Black stork Ciconia nigra 8. Saras Common ciconia crane 4. Khar Bengal flor- Eupodotis 9. Seto Saras White stork Gavialis Mujur ican bengalensis gangeticus 5. Munal Crim- son-horned Tragopan Reptiles pheasant satyra 1. Ajingar Asiatic rock Python 2. Ghadial Gharial python molurus Gohi 3. Sun Gohori Golden moni- Varanus tor lizard flavescens Source: MOFS, Nepal, 2002 AD 6.6 Adverse Effects on Biodiversity and Their Mitigating Measures There are several adverse effects of human activities on biodiversity. Human population is increasing in an alarming way. The natural resources are not adequate in all places of human settlement. Therefore, people are destroying the ecosystem and environment to obtain the life-requisites. When the rate of exploitation of natural resources crosses the normal and tolerable limit, the biodiversity is adversely affected. Some of the effects on biodiversity are described below: a) Degradation of ecosystem An ecosystem is composed of innumerable biotic and abiotic components. All of the components of an ecosystem are interrelated with each other through delicate and dynamic relationships. Depletion of one component of an ecosystem directly or indirectly affects all other components of the ecosystem. Due to excessive exploitation of natural resources like forests and wildlife, the ecosystem becomes imbalanced. Mitigating measures for such effects are: • Conservation of the ecosystem should be made effective by raising awareness making laws and acts, conservation of endangered plants and animals, etc. Health, Population and Environment - 10 153

• Inclusion of applicable environmental education in school and higher education curricula. b) Loss of mobility of living creatures Living things have specific characteristics of mobility. They move from one place to another in search of food, sex, a preferred climate and favorable habitat. The degree of mobility differs from species to species. Some birds of Siberia are found to visit Nepal’s wetland areas during the winter season. Many elephants and tigers come to Nepal’s forests from India every year. Such movements help the ecosystem to remain balanced. The haphazard developmental activities have disturbed the mobility of living creatures. Construction of roads across forests, settlement of people in the buffer zones and deforestation are the main causes of loss of mobility of the living creatures. Such effects can be controlled by the following mitigating measures: • Controlled development works like construction of roads across forests and ban on establishment of industries and other destructive works in the habitat of living things. • Conduction of study and research program to explore the knowledge about mobility of living things for food, habitat, climate and other seasonal mobility of creatures; create a suitable and favorable situation for them to assist in their mobility. • Conservation of buffer zones between two different habitats of living things. c) Loss of habitat A habitat is the natural place of living beings. Enumerable wild animals live in the forests, amphibians live in or near the water resources, birds live in trees, and some animals live in burrows. These places are the natural habitats for them. Uncontrolled human activities are responsible for unfavorable changes in the climate, disturbance in food chain , impinge on in the reproductive process, and destruction of the habitats of various living creatures. Such activities affect adversely on the ecosystem and human beings. Such effects on biodiversity can be controlled by the following mitigating measures: • Control of human encroachment on the habitat of wildlife • Afforestation on barren lands and naked hills • Protection of rivers, forests, watershed areas, ponds and grasslands, etc. 154 Health, Population and Environment - 10

• Control of fire in forests • Ban and restriction on use of poisonous substances (for example: use of poison in rivers and ponds to collect fish) and electrical ambush, over a large area, which destroys the habitat of all living things d) Limitation of expansion of vegetation Vegetation is regarded as the producer of food in an ecosystem. They grow and spread naturally in the environment through seeds, pollination and vegetative propagation. All the creatures ultimately depend upon the food prepared by plants in their respective food chain. Diversity of vegetation has helped the ecosystem to sustain in a balanced way. Unwanted human activities like encroachment of forests and grasslands, destruction of vegetation and degradation of ecosystem have created problems in the expansion of the vegetation. Such effects on biodiversity can be controlled by the following mitigating measures: • Expansion of habitat of living things • Proper town planning to accommodate the human population within a limited area • Study and research to find out the methods and processes of the reproductive phenomenon of living things • Execution of programmed activities for the expansion of vegetation e) Threat on living creatures Many living creatures have become rare in the world and many of them are on the verge of extinction. Biodiversity is maintained by the diversity of living creatures. If the number of living things declines from the environment, the biodiversity loses its natural status. People kill many rare animals for illegal benefits. They also collect rare plants and insects for the same purpose. The one-horned rhinoceros, Asiatic rock python, Cordyceps are a few examples under the brutal threat of human activities. Such threats and effects can be controlled by the following mitigating measures: • Formulation of strict laws and regulations against illegal hunters, poachers and smugglers • Awareness programs regarding the importance of biodiversity and ecosystem • Participation of local people in biodiversity conservation • Assistance to organizations working for biodiversity conservation Health, Population and Environment - 10 155

Notes • Biodiversity is the degree of vividness of living things, genes, ecosystems and micro-organisms in a unit square area of earth. Biodiversity can be classified into three categories. They are ecosystem diversity, genetic diversity and species diversity. • Ecosystem diversity is the degree of vividness of ecosystems in a unit area. • Genetic diversity is defined as the degree of vividness of genes and genetic characteristics in a unit area on the earth. • Species diversity means the degree of vividness of living species within a unit area of an ecosystem. • The total area of Nepal is 1, 47,181 sq. km. The total area of Nepal covers 0.3 percent of Asia and 0.003 percent area of the earth. It lies between latitude 26’22’and 30’27’ north and the longitude 80’4’ and 88’ 12’ east. The east-west length of the country is only about 880km. North-south breadth of Nepal varies from 145 km to 241 km. • Nepal is very rich in biodiversity due to the presence of vivid ecosystems and living organisms. • More varieties of species due to extended biodiversity can assure more probability of new breeds. • The study of biodiversity is done on the basis of the following three ecological belts in Nepal. They are biodiversities of mountain region, hilly region and Terai region. • Rare living beings are those living things which have less number comparatively in the existing ecosystem. • Ex-situ conservation of rare plants is the conservation of man-made or artificial habitat of rare plants. Ex-situ method is followed especially in the conservation of very rare and endangered plants. • In-situ conservation is the technique for conservation of natural habitat of rare plants. 156 Health, Population and Environment - 10

Exercise A. Give very short answers to the following questions. 1. What do you mean by biodiversity? 2. How many types of ecosystems exist in Nepal at present? 3. Define genetic diversity. 4. How many types of Golden Michelia are found in Nepal? 5. Name a tree which is used for the production of oil that cures gout arthritis. 6. What is the altitude range for availability of spike nard in Nepal? 7. Which species of plants does the Himalayan Yew belong to? 8. What does the clouded leopard prey upon? 9. What is the average weight of the red panda? 10. Which parts of the one-horned rhinoceros are sold illegally at expensive prices? 11. What is the average height of the Bengal Tiger? 12. How much does an elephant weigh? 13. Write any one method of conservation of biodiversity. B. Give short answers to the following questions. 1. How can we categorize biodiversity? Introduce each of them briefly. 2. What do you mean by rare living things? Explain any three causes of rareness of plants and animals. 3. Give a short introduction of the Golden Michelia with its habit, habitat, use and reproduction. 4. Write short notes on: a. Serpentina b. Spike Nard 5. What is Yarchagumba? How does it reproduce? Write briefly about its economic importance. 6. Differentiate between ex-situ and in -situ conservation of rare plants with examples. Health, Population and Environment - 10 157

7. What is the great-pied hornbill? Give an introduction in detail. 8. Explain any five conservation measures of rare animals and plants. 9. How does biodiversity help in the improvement of breeds? Give your answer with examples. 10. What is sustainable conservation of natural resources? How does biodiversity contribute to such conservation? Explain. 11. Explain any two adverse effects on biodiversity and their mitigating measures. 12. If there is need of preparation of biodiversity conservation policies, what kind of measures shou d be made? 13. Clarify the In situ and Ex. situ conservation with examples. 14. Human beings are both destroyers and conservers of bio diversity. Give reasons. 15. There is need of participation of all people in biodiversity conservation. Give reasons. 16. Deforestation spoils state of biodiversity. Give reasons. C. Give long answers to the following questions. 1. Suggest any five effective techniques for the conservation of rare animals and birds with examples. 2. Explain the different forms of adverse effects on biodiversity and their mitigating measures. 3. How do plants and animals become rare? Explain in detail. 158 Health, Population and Environment - 10

Environmental 7 Health and Diseases Contents 7.1 Concept of Communicable and Non-communicable Diseases 7.1.1 Differences between communicable and non-communicable diseases 7.1.2 Mode of Transmission of Communicable Diseases 7.1.3 Cycle of Communicable Disease 7.2 Some of the Major Communicable Diseases 7.2.1 Food and Waterborne Diseases 7.2.2 Airborne Disease 7.2.3 Diseases Transmitted by Contaminated Needles 7.2.4 Diseases from the Environment 7.3 Non-communicable Diseases 7.1 Concept of Communicable and Non-communicable Diseases The main characteristic of communicable disease is that it is transmitted from an infected living organism to other healthy living beings like humans, animals, microorganisms, etc. As it communicates among living things, it is termed as \"communicable disease.\" Diseases are carried by different living and non-living vectors. Air, water, soil, common clothes, utensils, Health, Population and Environment - 10 159

food, dust, etc. play the role of vectors. Illnesses are caused by a specific infectious agent or its toxic products. These agents may be living viruses, bacteria, amoeba, fungi, worms or insects. Non-communicable diseases do not spread from one person to other. They are basically caused due to the disturbance in the body functions, unhealthy life style, lack of nutrients and different types of disorders found in the body systems. There are different non-communicable diseases, e.g. high blood pressure (hypertension), low blood pressure (hypotension), cancer, tumors, diabetes, asthma and nutrition deficiency diseases like marasmus, night blindness, anemia, goiter, etc. The communicable diseases are basically caused by some other living organisms. Therefore, there are immunizations against those germs. But immunization cannot be made for non-communicable diseases. Parkinson’s disease, brain hemorrhage, brain tumor and cancer, etc. are major fatal non- communicable diseases. 7.1.1 Differences between Communicable and Non-communicable Diseases Base of Communicable diseases Non-Communicable diseases Differences Causes Virus, bacteria, amoeba, other Heredity, food habit, unhealthy micro organisms, fungi and life style, especially physical parasites. inactivity, alcoholism, drugs and tobacco use, and malnutrition Nature They can spread from an They do not transfer from an infected individual to healthy individual to others. people. Nutrition, heredity, life style, From one infected living climate and the environment. organism to other through different media like Mode of contaminated food, air or transmission water, insect bite, animal bite, sexual contact, physical contact, blood transfusion, poor sanitation, etc. 160 Health, Population and Environment - 10

Nature of communicable Duration of diseases is mostly severe and Most of the non-communicable onset. short–term (acute), but few are diseases are chronic in nature, chronic long-term (chronic), but few are acute, too. too. Probable forms These diseases may take forms Non-communicable diseases of epidemics and endemics. never manifest themselves as epidemics or endemics. Target victims Communicable diseases are Non-communicable diseases are found mostly among poor found mostly among rich people and uneducated people in with luxurious and physically developing countries. inactive people. Generally, a short course of Effects of medications alleviates the Generally, a longer course of medication disease. (except those with no medication to alleviate the medications discovered like disease symptoms is needed. HIV/AIDS) Regular exercise, balanced Methods of Immunization, sanitation, diet, avoiding mental tension, prevention safer sex, education, balanced weight maintenance, avoiding diet, etc. unhealthy habits like tobacco, alcohol, drugs, etc. Example Dysentery, cholera, AIDS, TB, Cancer, hypertension, diabetes, syphilis, gonorrhea, hepatitis, stroke, heart attack, etc. etc. 7.1.2 Mode of Transmission of Communicable Diseases Mode of transmission Diseases Direct touch or contact with the Leprosy, trachoma, scabies, roundworms infected person, and sharing of and other contagious diseases personal materials like towel, clothes, etc. Through germ-contaminated food and Typhoid, cholera, diarrhea, dysentery, water hepatitis E, roundworms, hookworms, etc. Health, Population and Environment - 10 161

Through the inhalation of germ-con- TB (Tuberculosis), flu (bird-flu, swine-flu, taminated air or droplets from an in- etc.) common cold, measles, pneumonia, fected person etc. Through flies Kala zaar, dysentery, etc. Through mosquito bite Malaria, Japanese encephalitis etc. Through mad dog bite Rabies Through mice Plague Through lice Typhus fever Through sexual intercourse HIV/AIDS, gonorrhea, syphilis, hepatitis B, hepatitis C, etc. Through accidental piercing, shar- ing or injecting germ-contaminated HIV/AIDS, Hepatitis B, etc. syringe 7.1.3 Cycle of Communicable Disease Communicable diseases transmit through the transmission of germs. Germs travel through certain medium while transmitting from one medium to another. Disease cycle determines the common mode of transmission of communicable diseases. Disease cycle is the path made by the causative agents of communicable disease that joins their reservoir and receiver through a certain medium. Reservoir of the disease: Infected man or animal Receiver of disease Medium of transmission Fig: Communicable disease cycle. 162 Health, Population and Environment - 10

7.2 Some of the Major Communicable Diseases Communicable diseases can be categorized into the following four groups. • Food and water-borne diseases • Airborne diseases • Diseases transmitted by contaminated needles • Diseases caused by the environment 7.2.1. Food and Water-borne Diseases Roundworm, diarrhea, dysentery (amoebic and bacillary) a) Roundworm (Ascaris lumbricoides) Round worms are a type of parasitic invertebrates that are mostly internal parasite of different mammals like human being. As its name, its body is round or cylindrical and long. Body length of an adult may range from 10 to 30 cm. It is infectious and lives in the intestine and sucks body fluids from its wall. It has remarkably high reproductive power. A female round worm can produce more than 2,00,000 eggs in a single day. The eggs are so small that we cannot see them with our naked eyes. If there is open defecation by an infected individual or any other means of spreading the eggs of the worm, the eggs can contaminate soil, vegetables, fruits, and water resources. Due to such contamination, there is high chance of entry of the eggs in our stomach with food or water. The eggs are hatched inside his alimentary canal due to favorable temperature and environment within the canal. They grow rapidly and reproduce abundantly. They suck blood and body fluids from the internal wall of the intestine. Such activity affects the host badly. Its transmission through the feco-oral route, i.e. the route that takes feces to the mouth can be controlled simply by adopting proper healthy habits like washing hands properly before food intake and washing vegetables properly with clean water before use. Symptoms of Roundworm • The children seem tired, and physical performance is declined. • The children feel sensation of vomiting, or nausea, and abdominal pain, especially in the morning. • Sour watery fluid is expelled from the esophagus in the morning. Health, Population and Environment - 10 163

• Indigestion and low appetite resulting ultimately in malnutrition. • Retarded growth and development of body. • Distinctly visible worms in the stool. The worms may come out with vomit in the severe stage. • Sometimes, the worms cross the intestinal wall and spread in other parts of the body, too. Presence of worms in the brain may result in brain impairment and even death. b) Diarrhea It is a condition of frequent discharge of watery stool. It attacks people in all age groups, though the main victims are children. Diarrhea is a normal and easily controllable disease, but it has been a major cause of child mortality in Nepal. Annual child death is about 45 thousand due to infectious diseases including diarrhea. Among them, about 30 thousand children die each year due to diarrhea only. This shows a severe problem of diarrhoea existing in Nepal. This disease is caused mainly by Garter Bacillus, Entireties and Ecoli. This is transmitted through faecal contamination of water and food items. Flies play the main role in contamination as they sit on contaminated stool and bring the above- mentioned micro organisms attached to their feet to our food item. In this way they act as mechanical carriers of diarrhea. Diarrhea is sometimes caused by indigestion of food. Symptoms of Diarrhea • Frequent and watery stool is the main symptom of diarrhea. • Due to heavy loss of water from the body, the patient feels intense thirst. • Muscle cramp occurs sometimes. • Mucus is discharged with stool. • The patient becomes thinner. Eyes look sunken and deep. • Patient may fall unconscious in severe cases. Dehydration: Dehydration is the lack of water in our body. The human body consists of about 70% water of the total volume of the body. Water plays a basic and vital role in regulating all the body functions. Dehydration: Gradual Decrease of Water Level in our Body 164 Health, Population and Environment - 10

The following symptoms are seen in dehydration. • Frequent and severe thirst • Decreased urination • Eyes look sunken and deep • Declined blood pressure • Weakness and fatigue • If any part of the body is pressed with the fingertip, a deep mark remains for several minutes c) Dysentery It is a condition, when the mucus is discharged from the body frequently with loose stool. It is an inflammatory disorder of the intestine, especially of colon1 . Like diarrhea, dysentery is also transmitted through the feco- oral route. Food, vegetables, hands, water and other things, which come in contact with the mouth may cause dysentery if they are contaminated with causative agents. Dysentery is Communication of Diarrhea categorized into two types: Amoebic dysentery and bacillary dysentery. Amoebic dysentery is caused by a species of amoeba, whereas bacillary dysentery is caused by a type of bacteria. Amoebic dysentery This disease is caused by a microscopic amoebic microorganism, Entamoeba Hystolytica. Symptoms of amoebic dysentery are: • The patient feels abdominal pain and cramps. • The pain becomes severe at times. • Mucus is discharged with stool • Sunken eyes and hollow cheeks are observed. • Due to frequent passage of body fluid, dehydration occurs. • The patient feels remarkable weakness, intense thirst and fatigue. 1. Colon: large intestine Health, Population and Environment - 10 165

Bacillary dysentery This disease is caused by the bacteria, Shigella Shiga. Symptoms of bacillary dysentery are: • Moderate to severe pain in the bowel • Sudden pain and cramps in the muscles • Mucus and blood are seen in the stool • Frequent passage of stool • The patients feels thirsty very frequently due to loss of water • Weakness and fatigue • Dehydration Many symptoms of amoebic and bacillary dysentery are similar. The following table Shows the differences between these two forms of dysentery. Difference between amoebic and bacillary dysentery. Amoebic Dysentery Bacillary Dysentery (a) It is caused by an amoebic (a) It is caused by a bacterial parasite called Entamoeba microorganism of the genus histolytica Shigella. Species may be dysenteriae, sonnei, flexineri, shiga, boydii, etc. (b) Blood is discharged in clumps. (b) Blood is discrete. Color of blood is Color of blood is dark red. bright red. (c) Its incubation period is more (c) Its incubation period is about one to variable than bacillary. seven days. It varies from a few days to several months. But the average period is 2-4 weeks. (d) It appears in sporadic forms in (d) It appears widely as a sudden a community. outbreak. (e) Amount of feces discharged is (e) Amount of feces is scanty . comparatively more. (f) Odor of the feces is more (f) The feces produce little or no offensive offensive. odor. (g) PH of feces is acidic. (g) PH of feces is less acidic or alkaline. (h) It is associated only with (h) It is mostly associated with fever. complications. 166 Health, Population and Environment - 10

(i) Pain and tenderness are (i) Pain and tenderness are felt in the localized, especially in the whole abdomen. lower abdomen. (j) It spreads more quickly than amoebic. (j) Amoebic dysentery spreads slower than bacillary. (k) The onset is acute (the symptoms appear and last for a shorter period (k) The onset is insidious (with of time.) the symptoms progressing gradually over a bit longer period of time). 7.2.2. Airborne Disease Common Cold The common cold is an infectious disease caused by a filterable common cold virus known as Rhino Virus. It is easily transmitted from one person to another by inhalation of droplets of exhaled air contaminated with infected materials, etc. Common cold viruses are abundantly found in the mucus and droplets sneezed or coughed by the infected person. Contamination of food or water with these droplets or their direct inhalation can easily infect another healthy person. Symptoms • Running nose or continuous watery discharge from the nose • Erythema (redness) and irritation of nose • Swollen sinuses • Difficulty in breathing • Sound becomes \"closed-nose\" type • Redness in eyes • Sometimes there may be slight fever too • Watery eyes due to continuous secretion of tear Preventive measures • Proper rest with restricted intake of hot and spicy food • Isolation of patient and his/her proper care • Stay safe from infected persons’ handkerchief, clothes, etc. • Cough and nasal discharge should not be disposed openly. • Yoga, physical exercise, and a balanced diet with inclusion of vitamin C should be taken to increase immunity power • Warm clothes should be worn in the winter season and in cold places • Cold drinks and excessive exposure to cold environment should be discouraged for prevention from common cold Health, Population and Environment - 10 167

CORONAVIRUS and COVID-19 (An Extra-Curricular Content on Coronavirus Pandemic) COVID-19 is the infectious disease caused by the most recently discovered coronavirus. This new virus and disease were found first in Wuhan city of China, in December 2019. Coronaviruses are a large family of RNA viruses which may cause respiratory illness. It’s name is given for its outer spikes of crown- like appearance. Several types of coronaviruses are known to cause acute respiratory infections in human being. The latest variants of coronaviruses are found to be highly communicable. WHO has given the name of these new variants circulating in Nepal during the beginning of year 2078 BS are Alpha (B.1.1.7), Delta (B.1.617.2) and Kappa (B.1.617.1). The predominant among them in Nepal was Delta (B.1.617.2) variant. The new varients of coronaviruses are developed due to mutation in the existing strains of viruses. Mucormycosis, a serious and rare infection caused due to 'black fungus', has been observed in a number of Covid-19 patients recently. This is creating another life-threatening challange among the victims of Covid-19. SYMPTOMS OF COVID-19 Common symptoms of COVID-19 are fever, fatigue, and dry cough. In more severe cases, there is lung infection that can cause pneumonia. In severe case there is panic shortness of breath and even death. There is sudden and urgent requirement of artificial oxygen supply and intensive medical care if the condition is worsen. MODE OF TRANSMISSION The virus is contained in saliva droplets and can be transmitted by breathing at close range, particularly when they cough, sneeze or have a fever. The viruses may enter into the body through nose and eyes if they are touched with virus-contaminated hands/fingers. PREVENTIVE MEASURES AGAINST COVID-19 a) Get vaccinated to promote the immune response against coronavirus. b) Do not room around and meet people unnecessarily. 168 Health, Population and Environment - 10

c) Avoid shaking hands and hugging with people. d) Keep a safe distance of at least 2 meters (6 feet) from suspicious people. e) Wash the hands with soap and water. Rub the hands and suspicious body parts at least for 20 seconds before rinsing because these actions can kill viruses. f) Apply an alcohol-based hand sanitizer containing at least 60% alcohol. g) Avoid touching eyes, nose and mouth, because hands touch many surfaces and can pick up viruses. Do not touch the surfaces at public and crowded places. h) Wear a safe and quality mask to cover nose and mouth properly. 7.2.3 Diseases Transmitted by Contaminated Needles Communicable Liver Diseases: Hepatitis B and Hepatitis C a) Hepatitis B In medical language, the prefix ‘Hepato-’ denotes liver. Hepatitis B is a liver disease, caused by type B Hepatitis Virus (HBV). It is a hundred times more infectious than HIV/AIDS. This disease is known as 'silent killer' because it kills the victim without remarkable effects on the body. Its effects increase gradually over a long period of time (its incubation period may range from six weeks to 26 weeks according to the health habits and immune system of the victim). The period from the exposure to the virus until the onset of disease is termed as the 'incubation period'. This may take acute chronic forms. Acute hepatitis heals itself within a few weeks by the immune power of host body. In most cases, it takes a chronic form when there are gradual deaths of hepatocyt. Hepatocytes are the cells of liver. The liver has the capacity to regenerate if some of its portion is lost. But, in case of hepatitis B, regeneration of the lost cells does not occur. The patient dies of liver failure, cirrhosis2 or ultimately liver cancer. b) Hepatitis C Hepatitis C is also a liver disease caused by type C Hepatitis Virus (HCV). It was termed as non-A-non-B hepatitis in the past. Its incubation period 2. Liver cirrhosis : damage of liver Health, Population and Environment - 10 169

is less in comparison to hepatitis B. It normally ranges from two weeks to 24 weeks. Like hepatitis B, the final and fatal effects of hepatitis C are also liver cirrhosis and liver cancer. Hepatitis C may be acute or chronic. Acute type of hepatitis C is healed by the immune system of our body. Most of the patients (299 out of 300) of acute hepatitis C fully recover after four to eight weeks. Only a few (1 out of 300) may experience liver failure with acute type of hepatitis C. Chronic infection of the liver may persist up to 20 years before the onset of cirrhosis. The patient dies of liver failure, cirrhosis and/or liver cancer. Modes of transmission of hepatitis B and hepatitis C i. It is transmitted through contact with an infected person's blood. ii. Such contact may include blood transfusion, use of a contaminated syringe, common razor, etc. iii. It is transmitted among injecting drug users, who use common syringe to take intravenous drugs. iv. The common instrument of tattooing, piercing the ear and nose, or any other sharp instrument shared may get contaminated with infected blood and transmitted to another healthy person. v. There is more risk of HBV contamination with the common use of toothbrush, handkerchief, towel, common food and drinks, etc. But the chance is less for HCV. vi. Through sexual contact. vi By accidental pricking with a contaminated needle (particularly of a health personnel). vii From a pregnant mother to the fetus. But the chance is rare for Hepatitis C. Common symptoms of hepatitis B and hepatitis C Hepatitis B and C show common chronic symptoms in the victim. In both the cases, there is infection of the liver and gradual damage to the liver cells. In some victims (almost 10%), hepatitis becomes acute and shows remarkable symptoms. But, the remaining 90% victims may show mild or no remarkable symptoms. However, some signs are slightly different from one another. There may be different incubation periods. The symptoms of jaundice (yellowish body) are sooner in hepatitis B. Common symptoms of hepatitis B and C 3. Icterus : jaundice 170 Health, Population and Environment - 10

i. Early symptoms • Poor appetite • Light fever • Loss of interest in food • Slight muscle aches and joint pains • Nausea, weakness and fatigue ii. Later symptoms • Yellowish skin and mucus • Yellowish sclera of eye showing the signs of icterus3 • Periodic pressure felt below the right rib due to enlargement of liver • Pale stool but dark urine • Increased fatigue and tiredness • Liver failure and liver cirrhosis Control and prevention of hepatitis • Immunize against hepatitis virus as required. • Avoid sharing syringes and needles. • Always use one's own towel, handkerchief, razor and other such personal things. • Be safe from drug misuse and from sharing needles in drug intake. • Be safe from contaminated blood transfusion. • Develop safe sex habits. • Avoid alcohol intake. Alcoholics are more vulnerable to seeing severe effects sooner than non-alcoholics. Difference between hepatitis B and hepatitis C Hepatitis B Hepatitis C i. It is caused by type B hepatitis i. It is caused by type C hepatitis virus, virus, HBV. HCV. ii. It is preventable with ii. Its immunization has not been immunization. developed. Health, Population and Environment - 10 171

iii. Hepatitis B viruses are abundantly iii. HCVs are rarely present in body present in vaginal fluids, semen, fluids other than the blood. breast milk, blood and other body fluids. iv. The degree of liver damage is iv. The degree of liver damage is comparatively slower and lesser. comparatively worse. v. Hepatitis B is commonly v. Hepatitis C is rarely transmitted transmitted from pregnant mother from pregnant mother to fetus. to fetus. vi. Hepatitis B is commonly vi. Hepatitis C is rarely transmitted transmitted by sharing common from sharing such things which personal things like a handkerchief, are not contaminated with infected towel, toothbrush, food, drinks, blood. etc. vii. Its incubation period is 6 – 26 vii. Its incubation period is 2 – 24 weeks. weeks. 7.2.4 Diseases from the Environment a) Cholera The digestive tract is infected by this disease. There is the acute infection due to presence of bacteria called Vibrio Cholera. If the feces of one infected person contaminate the food, water, or any other edible things, cholera is transmitted to healthy persons if they take such contaminated things. Cholera killed many people in the Kathmandu Valley in 1994 BS. Symptoms of cholera are given below: Symptoms of Cholera • The symptoms of cholera are seen suddenly with frequent diarrhea and thirst. • Excessive nausea and vomiting. • Stool like rice-water is passed. • Dehydration, hollow cheeks and sunken eyes are observed due to excessive loss of body fluid. Preventive measures of food and waterborne disease • Protect food from flies. • Cover the foods properly to prevent contamination. • Drinking water should be safe from disease germs. 172 Health, Population and Environment - 10

• Adopt methods of purifying water from susceptible germs. • Develop the habit of using a toilet properly. Make family members aware of it. • Discourage any sort of open defecation. • Hands, nails, spoons, utensils, etc. should be cleaned properly before meal. • Personal hygiene and its implementation should be given emphasis at home by all the family members. • Environmental sanitation prevents the germs from spreading. • Green vegetables should be washed with clean and safe water before use. b) Dengue Dengue is an acute mosquito-borne viral illness of sudden onset with a headache, fever, joint pain, muscle pain, swollen glands and rash. Among them, fever, headache and rash are collectively called ‘dengue triad’. Dengue fever is endemic in various tropical and subtropical areas. It is also called breakbone fever or dandy fever. Vector is the means of transmission of the causative agent of the disease. The mosquito carries the dengue virus from an infected person to healthy people. In this case, the mosquito plays the role of vector. Aedes aegipti mosquito that transfers dengue virus Transmission of dengue by mosquito The causative agent ‘Dengue Virus’ is easily transmitted by mosquitoes. Therefore, the prevalence of dengue is very often found in the Terai region of Nepal, especially during the summer season. Health, Population and Environment - 10 173

Symptoms of Dengue Fever i. High fever ii. Rashes throughout body iii. Severe headache iv. Joint pain v. Muscle pain Prevention and Control of Dengue Fever i. Remain safe from mosquito-bite ii. Don’t let water accumulate in pits or canals near residential areas iii. Use a mosquito net or mosquito repellent while sleeping iv. Seek medical treatment as soon as the susceptible symptoms appear c) Viral Influenza Influenza is an acute respiratory illness caused by Influenza Virus. Influenza viruses are of generally two types. They are Influenza A Virus and Influenza B Virus. These viruses are microscopic in size. They are transmitted through air or any other commodity used by a diseased person. Most of the victims Influenza Virus of viral influenza recover completely in one to two weeks. If it persists longer than that, the victims may develop serious and potentially life-threatening medical complications, such as pneumonia, shortness of breath, very high fever and even death. Symptoms of viral influenza i. Fever ii. Running nose iii. Headache iv. Muscle ache v. Redness of eyes and excessive lacrimal secretion 174 Health, Population and Environment - 10

Prevention and control of viral influenza i. Stay away from a diseased person ii. Avoid physical exposure to extreme cold iii. Get vaccinated against viral influenza in time iv. Isolate the diseased person and take care of him/her properly 7.3 Non-communicable Diseases Non communicable diseases do not transmit from one person to another. This type of disease does not have causative microorganisms but is caused by lack of nutrients, and dysfunction or malfunction of the body organs. Human beings have been continuously fighting with different forms of communicable and non-communicable diseases for long. Many communicable diseases are controlled by immunization and strong preventive measures. But most of the non-communicable diseases are chronic in nature and they affect the victim for a long time. There is need of proper awareness, change in the life-style, and even change in the way we see diseases. Such diseases have been a great problem especially in poor and developing countries like Nepal and Bhutan in South Asia. World Health Organization listed the top risk factors of death in 2002. Risk factors are defined as any attribute, habit or exposure of an individual, which increase the possibility of disease or injury. Risk factors of diseases can be classified into two groups, as modifiable and non-modifiable risk factors of non-communicable diseases. Modifiable risk factors of non-communicable diseases The factors which can be modified, changed or controlled are called modifiable risk factors. Most of the risk factors of non-communicable diseases are modifiable. They are directly related to our lifestyle. These are. i. Tobacco and alcohol intake ii. Obesity (excessive fatness) iii. Lack of physical activity and exercise iv. Unbalanced and unhealthy diet v. Mental tension and irritation vi. Hypertension and high cholesterol in the blood vii. Environmental pollution, noise pollution and unhealthy lifestyle Health, Population and Environment - 10 175

a) Tobacco Tobacco is an agricultural product processed from a herb plant of Genus Nicotiana. It contains a toxin called nicotine, which produces euphoric effect in human brain if taken. A tobacco plant is a small herb. Its leaves are dried, ground, and used in different forms. Tobacco is used for smoking, it is mixed with lime and kept in the corners of the gums as \"khaini' (chewing tobacco), it is mixed in beetle nuts and chewed as \"jarda paan\", it is chewed with nuts and lime as \"gutkha\", and used in different forms in different places. Tobacco contains more than 4,000 toxic (poisonous) substances. More than 43 carcinogens4 including nicotine, tar and corbonmonoxide are found to be present in tobacco. Tobacco intake may result in asthma5, oral thrush, ulcer, pneumonia, bronchitis, hypertension and many other diseases including different forms of cancer in our body. It reduces the mental capacity and memory power. It also decreases social dignity of its users. It is one of the widely-used modifiable factor causing diseases. Tobacco-addicted people can modify their habit of tobacco intake with strong willpower and following a healthy habit. b) Alcohol It is another modifiable risk-factor of non-communicable disease. Alcohol is widely used in almost all parts of the world. Alcohol use is seen in both rural and urban, developed and underdeveloped, remote and local areas, as well as in poor and rich families in Nepal. Alcohol has been growing as a social cancer everywhere. It can be controlled by education, awareness, social movements and legal provisions. c) Obesity It is the condition of excessive fatness of the body. It puts an unnecessary working load on the heart. It may cause hypertension and other cardiovascular diseases. It also promotes other chronic diseases like diabetes and asthma. It can be controlled by a proper food habit and physical exercises. d) Lack of physical activity and exercise Lack of physical activities and exercise is seen mostly in rich families. This may create problems of obesity, hypertension, diabetes, and inactivity of internal organs. e) Mental tension 4 Carcinogen : substances responsible for causing cancer 5 Asthma : a respiratory disease characterized by difficult and rapid breathing 176 Health, Population and Environment - 10

Brain is the controller of all the body functions. Therefore, it should be healthy to make other organs healthy. Mental tension creates some toxic substances in our body. They decline the performance of the different parts of the body. f) Hypertension and high cholesterol6 in the blood Hypertension is the increased blood pressure. Increment of pressure may cause damage of the arteries. A person may collapse if the coronary artery of the heart and vital arteries of the brain are ruptured. It is caused by many factors including accumulation of cholesterol in the blood. Therefore, cholesterol should be controlled in our food. g) Environmental pollution, noise pollution and unhealthy lifestyle Pollution is an external factor that affects the human health adversely and causes different diseases. Such a situation can be modified by awareness, legal provision and proper education. Modification of an unhealthy lifestyle and adoption of healthier behavior can save us from many non- communicable as well as communicable diseases. Non-modifiable risk factors and non-communicable diseases Unlike the modifiable risk-factors, the non-modifiable risk factors cannot be controlled by our effort. For example, everyone undergoes ageing with passage of time and age. No one can be younger after being old. Similarly, the hereditary characters, sex, body structure, etc. are designed by nature and cannot be modified. These factors cause different types of diseases. Some non-communicable diseases like cancer, diabetes and Parkinson’s disease are transmitted from one generation to another through heredity. This cannot be modified. However, if we are conscious about the risk factors and modify our lifestyle, we can reduce the harmful effects of such hereditary diseases to some extent. Some Major Non-communicable Diseases • Cancer • Heart disease and cardiovascular diseases – Heart attack (Myocardial Infarction, MI) – Stroke (Cerebral attack or cerebral ischemia) • Rheumatic fever and rheumatic heart disease • Diabetes • Chronic obstructive pulmonary diseases (COPD) 6 Cholesterol : a type of fatty substance in the body responsible for cardiovascular diseases Health, Population and Environment - 10 177

a) Cancer Cancer is a condition of over production of cells in our body. It develops from a tumor. If the tumor is not treated in time, it develops into cancer. Cancer can spread from one part of the body to another part in the later stage. It is the rapid formation of abnormal cells which grow beyond their usual limits and occupy Normal and Cancerous Cells adjoining parts of the body. Cancer occupies the biggest share among the diseases causing deaths all over the world. People mostly die of blood cancer, lung cancer stomach cancer, and liver cancer. Cervical cancer and breast cancer are more prevalent among females where as prostate cancer is more prevalent in males. Cancer can be treated in its initial stage. If it is not diagnosed and treated in time, it cannot be treated. Due to lack of knowledge, education and health service centres, more than 70 percent of cancer deaths occur in underdeveloped and poor countries. It is estimated that the trend of cancer deaths will go on increasing and reach 9 million and 11.4 million in the years 2015 and 2030 respectively. There are many causes of cancer. Some are known and some are still unknown. Some of the known causes of cancer are given below: Causes of cancer i. Intake of carcinogenic substances like nicotine, toxins and carcinogenic chemicals formed in rotten fruits and vegetables ii. Intake of decayed, spicy, oily and mucor-contaminated food items iii. Hereditary characters of cancer in the genes of parents iv. Exposure to strong rays which penetrate our body. The rays may be x-ray, cosmic rays, ultraviolet ray, and radioactive rays v. Tobacco, lime, beetle-nuts and alcohol intake vi. AIDS is found mostly with generalized skin cancer called Kaposi's sarcoma vii. Some bacteria and viruses: For example: 178 Health, Population and Environment - 10

• Liver cancer by Hepatitis-B Virus • Gastric cancer by Helicobacter Pylori • Cervical cancer in females by Human Papilloma Virus (HPV) viii. Untreated wound for a long period of time ix. Disturbance of hormonal activities in body x. Excessive exposure to sunlight Signs and symptoms of cancer i. Abnormal growth and thickening of body parts. ii. Unhealed wounds with irregular bleeding for long period of time. iii. Unsolved indigestion for long period of time. iv. Tumors, warts, or moles grow in size. v. Pale appearance and fatigue. Prevention and control of cancer i. Modification of cancer-causing (carcinogenic) behavior to a healthy behavior is advised. ii. Adoption of healthy habits like proper exercise and rest, intake of healthy and hygienic diet, yoga and meditation, etc. It is estimated that about 40 percent chance of cancer is reduced just through healthy habits only. iii. Excessive exposure to sunlight and any other strong rays should be avoided. iv. Early diagnosis of cancer and timely attention to any abnormal growth or tumors or unhealed sores and wounds. v. The mother should continue breastfeeding to her baby throughout the full lactation period. vi. Wounds should be treated timely. vii. Environmental sanitation must be done to make it healthy. b) Heart diseases and cardiovascular diseases The heart is the busiest mechanical organ of our body that beats continuously from one’s fetal stage to death. It is one of the vital organs. The heart is made up of cardiac muscles and located inside the chest. It is a vital organ and its uninterrupted function is essential for survival. Health, Population and Environment - 10 179

Stoppage of heartbeat is synonymous to death. More than 17.5 million people die each year due to heart disease. According to WHO, cardiovascular diseases (CVDs) are the number one cause of death globally: more people die annually Cardiac Stroke (Heart Attack) from CVDs than from any other cause. Heart diseases are the result of minor mistakes and negligence. It is a leading non- communicable disease causing deaths of many people. The major factors behind heart disease are high blood pressure, high cholesterol, physical inactivity, diabetes, alcoholism, tobacco intake, unhealthy food habits, senescence, and genes inherited from parents. Cerebrovascular disease (disease of brain arteries) coronary artery disease (CAD), peripheral arterial disease(a disease when there is problem in supplying blood to the hands and feet), hypercholesterol (increase in blood cholesterol), valve damage, rheumatic heart disease, heart attack and stroke, etc. are some examples of heart diseases. i. Heart attack (Myocardial Infarction, MI) It is one of the major fatal diseases in the world. The early symptoms of a heart attack include shortness of breath and pain in the chest. The patient may die suddenly due to a heart attack. Excessive use of fatty foods and food containing cholesterol causes Cerebral Stroke arteriostenosis or narrowing of the arteries. The blood vessel that supplies blood to the heart muscle (i.e., coronary artery) is very thin, and a small obstacle like a blood clot may block the supply of blood completely or partially. As a result, some portion of the heart muscle is deprived of oxygen and other nutrients. Then the heart muscle loses the 180 Health, Population and Environment - 10

strength to pump blood out into the arteries. Ultimately the portion of the heart muscle starts dying too. This condition is known as heart attack. Most of the patients of heart attack experience some symptoms. Some may not have any symptoms, and they may die suddenly of cardiac arrest or sudden stoppage of the heartbeat. Symptoms of heart attack • Persistent chest discomfort • Frequent burning pain in the chest • Shortness of breath • Abnormal sweating • Palpitations (feeling of heartbeat over the ribs) • Lightheadedness, fatigue and fainting • Sudden death due to cardiac arrest ii. Stroke (Cerebral attack or cerebral ischemia) Stroke is the condition of sudden death of the brain cells due to inadequate blood supply. There is disruption of blood vessels followed by blockage of blood supply towards the brain. Though it is associated with the brain, it is studied as a heart disease because it is associated with the cardiovascular system of the human body. This may result from either a blockage or rapture of a blood vessel. When there is no blood supply towards the brain, the person may die due to sudden interruption of blood supply in the brain. Depending on the area of brain damage, the stroke may have the following symptoms: Symptoms of Stroke • Paralysis or inability of movement of any part of the body • Speech impairment, • Loss of memory and reasoning ability • Partial loss of body function: vision loss, sense loss, hearing power loss, etc. • If not diagnosed and treated in time, the victim may go in a coma or death. Preventive measures for heart attack and stroke • Get education and awareness regarding heart diseases. Health, Population and Environment - 10 181

• Adopt healthy food habits. Avoid intake of tobacco, alcohol, drugs. Avoid oily, spicy and fatty foods. • Avoid intake of sugar and excessive carbohydrates. • Increase intake of healthier food items. Always follow a balanced diet. Increase the intake of vegetables, fibrous food and fruits. • Obesity increases the workload on the heart. Excessive fatness can be reduced by doing regular physical exercise, yoga and mountaineering a good food habit. • Reduce mental tension, anxiety and depression. • Maintain physical, mental and social health as well. • Routine check-up of blood pressure can indicate the probability of a heart attack and stroke. c) Rheumatic fever and rheumatic heart disease Rheumatic heart diseases are associated with joint pains and infections of the bones and joints. Germs developed in the body during tonsillitis7 and pharyngitis8 are the main causes of rheumatic fever and rheumatic heart disease. In the age interval between three to 15 years, the onset of tonsillitis and pharyngitis is very common in children. If these are not treated properly and the onset is frequent, the patient is vulnerable to infection of bacteria called \"Beta-Hemolitis streptococcus Group-A\". The bacteria travel in the body with the bloodstream and reach the joints and heart. In the joints, they cause pain and swelling. Due to the presence of bacteria and their activities the victim gets fever, too. The situation of these collective symptoms is termed as 'rheumatic fever'. In the heart, it damages delicate heart valves. Children suffering from rheumatic fever have damaged heart valves and heart muscle. Damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria9, is called rheumatic heart disease. Rheumatic fever and rheumatic heart disease are two stages of the effects of the same causative agent. Rheumatic fever is the first stage of rheumatic heart disease. In order to prevent rheumatic heart diseases, sore throat, tonsillitis and pharyngitis should be treated properly in time. Antibiotics may be necessary to cure the sore throat, tonsillitis, and pharyngitis. 7 Tonsillitis: inflammation of tonsils 8 Pharyngitis: inflammation of pharynx 9 Streptococcal bacteria: a kind of Gram-positive spherical bacteria 182 Health, Population and Environment - 10

Rheumatic fever is the condition of the body with collective symptoms of joint pain, swelling and fever developed as a result of an infection by streptococcus bacteria, known as ‘Beta Hemolitis Streptococcus Group-A’ in the body. Rheumatic heart disease is the condition characterized by damage of the heart muscles, heart valves, joint pain and swelling caused due the infectious attack by streptococcus bacteria. Though there is presence of a foreign causative agent in rheumatic fever and rheumatic heart diseases, they are considered non-communicable because they do not transfer directly from person to person. They are caused due to internal aggravation of a strep throat, which may transfer through the contamination of causative agents. Prevention of rheumatic heart disease and rheumatic fever • Adopt a hygienic and healthy lifestyle. • Remain safe from throat infections. • Get treated earlier if there is onset of tonsillitis and pharyngitis. d) Diabetes Diabetes is a kind of metabolic disorder in the body marked by excessive excretion of urine and persistent thirst. The term diabetes, if not specified to any other type, stands for diabetes mellitus (DM) in conventional practice. It is a chronic disease that occurs either when the pancreas Pancreatic function in Diabetes does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar in the blood, is a common effect of uncontrolled diabetes, and over time leads to serious damage to the systems and organs, especially the nerves and blood vessels. Hyper : high level Glyc - : glucose, sugar -emia : condition of blood Hyper + glyc + emia : A condition with higher level of sugar in the blood Health, Population and Environment - 10 183

The normal range of sugar is 70-120 mg% in the blood before a meal. After a having meal, the glucose level increases up to 140 mg% in the blood. A diabetic person has increased glucose level more than the normal. The first onset of diabetes is characterized by increased glucose in blood but in the later stage, the sugar level of urine also increases. Insulin is a hormone produced by the pancreas that regulates blood sugar. Another form of diabetes is diabetes insipid us. It is a disease marked by excessive urination and thirst caused by lack of anti-diuretic hormone (or vasopressin) in the body. This hormone helps in the retention10 of water from the kidneys in blood circulation and prevents loss of water in the form of urine. Diabetes mellitus can be categorized into the following groups: Type 1 diabetes (Previously known as insulin-dependent, juvenile or childhood onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known, and it is not preventable with current knowledge. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 2 diabetes (Formerly called non-insulin-dependent or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of Type 1 diabetes, but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. Until recently, this type of diabetes was seen only in adults, but it is now also occurring in children. Gestational diabetes: Gestational diabetes is hyperglycaemia with onset or first recognition during pregnancy. Symptoms of gestational diabetes are similar to Type 2 diabetes. Gestational diabetes is most often diagnosed through prenatal screening, rather than reported symptoms. Source: http://www.who.int/en/diabetes, Feb. 2012 AD Signs and symptoms of diabetes • The first sign of diabetes is frequent urination followed by excessive thirst. • Sweating increases remarkably. • Excessive hunger but gradual weight loss. • Increased fatigue and lethargy11 . 10 Retention: re-absorption in the circulatory system. 11 Lethargy : feeling of having no energy in the body 184 Health, Population and Environment - 10

• Increased irritation and itching. • Weakness and fatigue in the patient. If it is not diagnosed in time, other chronic diseases are developed in the diabetic person. Some of the common chronic diseases are: i. Diabetic retinopathy: It is a disease of the retina of the eyes caused by diabetes. Increased sugar volume in the blood causes damage to the blood capillaries of the retina causing blurred vision first and ultimately blindness. Data show that about 10% diabetics suffer from severe visual impairment after 15 years of diabetes and 2% become completely blind. ii. Diabetic neuropathy12 : It is the damage to the nerves and neurons due to diabetes. The symptoms of diabetic neuropathy are marked by tingling pain in the hands and feet, loss of memory, loss of reasoning power and weakness. About 50% of diabetics get such problems. Persistent and non- healing feet ulcers are common in the later stage of diabetic neuropathy. iii. Diabetic cardiovascular disease: Cardiovascular diseases may be prompted by the increased level of sugar in the blood. About half of the total diabetic deaths are associated with cardiovascular diseases like hypertension, heart attack and brain stroke. Symptoms of Diabetes iv. Kidney failure: About 20 percent of diabetic people have complications in kidney functions and kidney failure. The increased sugar in bloodstream goes in the urine in the later stage of diabetes. Certain insects (example; ants), which like sweet taste, are seen in the latrine and urinals used by diabetic persons due to presence of sugar in the urine. Prevention and Control of Diabetes • Develop healthier food habit. • Avoid spicy, oily, fatty,and unhealthy food. 12 Neuropathy : disease of the nervous system Health, Population and Environment - 10 185

• Decrease excessive carbohydrates and fats. • Avoid tobacco and alcohol use. • Perform physical exercises like yoga on a regular basis. • Maintain physical fitness. Obesity and overweight motivate diabetes to occur. • Control mental tension and enjoy life with happiness. • . Monitor the glucose level frequently. • If sugar level is increased, follow the doctor's suggestions. Take food meant for diabetic patients only. e) Chronic obstructive pulmonary diseases (COPD) COPD is a lung disease, which persists for long and cannot be treated completely. It creates problems and difficulties in breathing. Lung airflow is obstructed that interferes with the normal breathing process. The nature and characteristics of COPD can be known by the meaning of the terms included in its name. Chronic: diseases existing for long term Obstructive: that causes obstruction Pulmonary: pertaining to lungs Disease: abnormal condition of body COPD is a great problem in poor and developing countries. About 90 percent of total deaths due to COPD occur in low and middle income countries. There are more than 80 million of people with this disease in the world. It is also a leading cause of death, particularly in polluted and industrial areas. In 2005, there were more than 3 million deaths due to this disease. This disease can be controlled with awareness, staying away from smoking and control of air pollution. It can be treated with available medications, too. Causes of COPD The primary cause of COPD is dust inhalation and intake of tobacco smoke (including passive smokers). Main causes include air pollution (indoor and outdoor) dust produced from industries, use of coal and wood for fuel, frequent respiratory infections during childhood, and respiratory organ diseases. 186 Health, Population and Environment - 10

Prevention and control measures for COPD • Avoid smoking. • Make the residential areas clean and dust-free. • Adopt appropriate preventive measures to be safe from occupational dust. Use masks. • Respiratory diseases should be treated in time. Notes • Communicable diseases are transferred from one person to others whereas non- communicable diseases do not. • In communicable diseases, illnesses are caused by a specific infectious agent or its toxic products. These agents may be living viruses, bacteria, amoeba, fungi, worms or insects. • Non-communicable diseases do not spread from one person to other. They are basically caused due to the disturbance in the body functions, unhealthy life style, lack of nutrients and different types of disorders found in the body systems. • Disease cycle is the path made by the causative agents of communicable disease that joins their reservoir and receiver through a certain medium. • The human body consists of about 70% water of the total volume of the body. Dehydration is the lack of water in our body. • Hepatitis, literally means the inflammation of liver. • Risk factors are defined as any attribute, habit or exposure of an individual, which increase the possibility of disease or injury. Risk factors of diseases can be classified into two groups, as modifiable and non-modifiable risk factors of non-communicable diseases. • Tobacco contains more than 4,000 toxic (poisonous) substances. More than 43 carcinogens including nicotine, tar and corbonmonoxide are found to be present in tobacco. • Mental tension creates some toxic substances in our body. They decline the performance of the different parts of the body. • Non-modifiable risk factors cannot be controlled by our effort. For example, everyone undergoes ageing with passage of time and age. No one can be younger after being old. • The blood vessel that supplies blood to the heart muscle is called coronary artery. It is very thin, and a small obstacle like a blood clot may block the supply of blood completely or partially. As a result, some portion of the heart muscle is deprived of oxygen and other nutrients. That may cause heart attack and cardiac arrest. • Stroke is the condition of sudden death of the brain cells due to inadequate blood supply. • Diabetes is a kind of metabolic disorder in the body marked by excessive excretion of urine and persistent thirst. • The primary cause of COPD is dust inhalation and intake of tobacco smoke. Health, Population and Environment - 10 187

Exercise A. Give very short answers to the following questions. 1. Define communicable disease. 2. What do you mean by vectors? 3. Who are the common victims of non-communicable diseases? 4. How does scabies transmit from one person to another? 5. What is the name of the causative agent of cholera? 6. Which species of mosquito transfer dengue viruses? 7. Why is the summer season more likely for the prevalence of mosquito- borne diseases? 8. Define influenza. 9. Name the types of Influenza Viruses. 10. What does a running nose mean? B. Give short answers to the following questions. 1. 'Communicable diseases have certain causative agents'. Why? Justify with any two examples. 2. Why is cholera dangerous? List the symptoms and preventive measures of cholera. 3. What is 'Dengue Triad'? Write down the major symptoms of dengue? 4. How can we remain safe from dengue? Suggest any five preventive measures of dengue. 5. Draw a diagram showing the general structure of Influenza Virus. 6. List the symptoms and preventive measures of Viral Influenza. C. Give long answers to the following questions. 1. How do non-communicable diseases differ from communicable diseases? List down any eight differences with examples. 2. List any five names of cardiovascular diseases and write details on any two of them with the causes, symptoms and preventive measures. 3. What are the chronic effects of prolonged elevation in the blood sugar? Give introduction to any four of them in brief. 188 Health, Population and Environment - 10

A d o lescence , 8 Sexual and R epr o d u c t i v e Health Education Contents 8.1 Sexually Transmitted Diseases 8.2 Safe Motherhood 8.3. Risky Conditions of Pregnancy 8.4 Maternal and Child Health (MCH) Care and Its Measures 8.4.1 Introduction to MCH Care 8.4.2 Importance of MCH Care 8.4.2 Care of Pregnant Woman, Neonatal and Postnatal Mother, and Newborn Child In general, adolescence is the period of life when a child develops into an adult. During adolescence, a child develops his or her reproductive organs to their maturity and become able to carry out the reproductive functions. According to WHO (World Health Organization), adolescence is the stage of life which ranges from 10 to 19 years of age. It is the period of rapid physical, mental and emotional changes in life. It is an important and short period marked with distinct physical, social and emotional changes. This is also known as a fast-growing period, changing period, the period of storm and stress, maturity period of life, etc. Adolescence is a vulnerable period from different points of views. Teenagers are curious to know various things and phenomena around them. They may practise an unhealthy lifestyle and unsafe sexual behavior. Therefore, they are likely to be infected by different sexually transmitted diseases. Health, Population and Environment - 10 189

8.1 Sexually Transmitted Diseases The diseases which are transmitted through sexual intercourse are called Sexually Transmitted Diseases (STDs). They are widely studied under STIs (Sexually Transmitted Infections) nowadays. The main cause of these infections is unsafe sex. Unsafe sex means to have sexual relations with many sexual partners without using a condom. There are more than 20 STIs including HIV, Hepatitis B, Gonorrhea, Syphilis, Chanchroid, Chlamydia and Trichomoniasis. a) HIV/AIDS The full form of AIDS is Acquired Immune Deficiency Syndrome. It is caused by RNA Retrovirus HIV (Human Immunodeficiency Virus). Syndrome is a collection of several signs and symptoms. More appropriately, it is also HIV and Human RBC's called a syndrome instead of disease because many signs and symptoms may be seen together in AIDS. HIV destroys the immune system of our body and creates a condition where there is deficiency of the immune power. The HIV virus attacks the CD4 positive T-lymphocytes and they increase their number billion times a day by continuous replication of viral RNA with the help of its replication enzymes. HIV was first recognized in USA in July 1981 in some African (Haitian) people. Since then it has been spreading all over the world rapidly. It is assumed that 7,500 people are infected with HIV each day and there are more than 33 million people infected with HIV in the world at present. HIV entered lately in Asia. It was first reported in Nepal in 1988. But its number is increasing rapidly in Nepal. Different studies have shown that there are about 75,000 HIV-infected patients in Nepal. Surveys show that it is most prevalent among those people who have returned from abroad. It has been remarkably found among injecting drug abusers, too. It is transmitted to a healthy person by blood, mucus, semen and vaginal secretions. HIV is a microscopic virus, which may be transmitted from an infected person to a healthy person in the following ways: 190 Health, Population and Environment - 10

HIV is transferred: • By transfusing HIV-infected blood. • By sharing a common syringe, needle, tattooing instrument and other materials which come in contact with blood. • By indulging in unsafe sex (oral sex, anal sex and sex without using a condom). • By a pregnant mother to her unborn fetus. • By breastfeeding mother to her child through breast milk. • By accidental piercing with an infected-blood-contaminated syringe to health workers. HIV infection cannot be treated with any medication till now. But its adverse effects can be controlled to a certain extent by using some anti-retroviral medications. There is a false belief that HIV can be transmitted if we go close to an infected person, work and live together. Such false belief has been a problem in the rehabilitation of infected persons in the family and society. HIV is not transferred • Through external touch and respiration. • By being and working together. • By sharing a common room, latrine, bathroom and utensils. • By hugging and kissing. • By mosquito and other insect-bites. • By playing, studying and living together. • By having safe sex using condom properly. Signs and symptoms of HIV/AIDS HIV and AIDS do not have similar meaning. HIV is the name of the virus and AIDS is the final stage of HIV infection. There is no AIDS immediately after the entry of the virus in the body. There are altogether four stages: incubation, acute infection, latency, and AIDS. HIV infection does not show any distinct symptom during incubation. The initial incubation period usually lasts between two to four weeks. Incubation is the period between the entrance of the virus and the first sign of its effects. There are some minor signs in the second stage, acute infection may last an Health, Population and Environment - 10 191

average of 28 days. This stage includes minor symptoms like fever, swollen lymph gland (lymphadenopathy), mouth and esophageal sores, and mild muscle pain (myalgia). The third stage, latency stage, may show very few or no symptoms at all and may last from two weeks to 20 years or more even. The final stage, AIDS, is the stage before death. This stage is characterized by various opportunistic infections. The immune power of an AIDS victim severely declines. The following symptoms are seen in the AIDS stage. • Enlarged and painful lymph glands (lymphadenopathy). • Oral, pharyngeal and esophageal sore. • Persistent unhealed skin wounds throughout the body surface. This may be Kaposi’s sarcoma. • Remarkable weight loss. • Unhealed malignancy of any part of the body. • Continuous fever, cough, sores, diarrhoea, etc. which remain unhealed. Major Causes of HIV/AIDS Prevalence in Nepal HIV/AIDS is spreading in Nepal due to many reasons. The most prominent reason is obviously the unavailability of its curative medicines or techniques. Once HIV enters in a person, s/he becomes a sure carrier and transmitter of HIV throughout his/her lifetime till death. Some of the most common causes behind the prevalence of HIV/AIDS in Nepal are: a) Unemployment and poverty There is a severe problem of unemployment and poverty in Nepal. A remarkable number of youths and adults are going aboard for employment. When they are far away from home, they try to satisfy their sex desire by having sex with others. Commonly, this process remains unsafe due to the concealed nature of sex-behaviors, and they acquire HIV in their body. When they return home, they transmit HIV into the body of the spouse and future children. b) Human trafficking Human trafficking, particularly to different towns of India, has become a common cause behind the increase in HIV/AIDS in Nepal. Young girls and women are sold in the flesh trade, and they become vulnerable to HIV. 192 Health, Population and Environment - 10

c) Commercial sex Commercial sex is the business or practice of engaging in sexual activity in exchange for payment or some other benefit. Though it is illegal in Nepal, it prevails in several town and rural areas. A person engaged in this profession comes in sexual contact with many people. There is a high chance of transmission of HIV as it is a sexually transmitted disease (STD). Therefore, a commercial sex worker's body becomes a carrier of the HIV viruses and serve like a transmission center of HIV/AIDS. d) Lack of awareness The behavioral control of HIV/AIDS needs proper awareness against this disease. People should have knowledge about how it is transmitted. If people are aware with adequate knowledge, attitude and safety behavior against HIV, it does not become a big problem. e) Restriction/Hesitation on talking about sex education Our society seems somehow conservative regarding even essential sex discussions among family members. Such discussions may include issues of sexually transmitted infections, menstruation, safety measures against sex-related hazards, adolescence, puberty changes, etc. This is mainly responsible for keeping youths and adults unaware about the health problems related to sex behaviors. b) Syphilis Syphilis is one of the most common sexually transmitted diseases. Though it is transmitted through sexual intercourse, it affects the vital organs like the heart liver, and brain. It is caused by a microorganism, Treponema Pallidum. Microscopic view of Treponema Pallidum Syphilis can also be acquired from blood transfusion. It is transmitted through common use of syringes. It is found spreading among injecting drug users. Syphilis is also transmitted from a pregnant mother to the fetus through the placenta. There is almost 50 percent chance of transmission of syphilis from an infected mother to the fetus. Health, Population and Environment - 10 193

Symptoms of Syphilis The symptoms of syphilis gradually develop over a long period of time. There are three stages of syphilis on the basis of onset of symptoms of the disease – primary stage, secondary stage and tertiary stage. i. Primary stage: The first sign of syphilis in its primary stage is an appearance of a chancre . It generally appears two to four weeks after infection. The most common locations for the chancre are the genitals, anus, lips, inner parts of mouth, and breast. The chancre does not have any pain or itch. It disappears itself within one to five weeks. ii. Secondary stage: Secondary stage of Syphilis begins anytime from one week to six months after the chancre heals. The symptoms include a pale red rash, fever, sore throat, headaches, poor appetite, weight loss, and hair loss. If it is not diagnosed and treated properly, it develops into the third stage of syphilis. iii. Tertiary or late syphilis: It is the third and final stage of syphilis. Late syphilis involves serious heart problems, eye problems, and brain or spinal cord damage. The patient becomes mentally deranged and dies. c) Gonorrhea In medical language, the prefix ‘Gono-’ denotes the genital organs and the suffix ‘-rrhea’ means discharge. In this way, the name of the disease suggests one of the main symptoms of this disease, i.e., unusual discharge of fluids from the genital organs. Gonorrhea is caused by microscopic bacteria called; Gonococcus of Neisser. The bacteria affects the male and female genital organs, and the anus and throat, too. It is transmitted through the contamination of infected blood. It is also acquired through infected blood transfusion. Gonorrhea is the oldest form of STI. Symptoms of Gonorrhea • In early stage of Gonorrhea, there may not be remarkable symptoms. • The main characteristic feature of Gonorrhea is the discharge of yellowish 194 Health, Population and Environment - 10

fluid with foul odor from the genital organs. • Swelling, appearance of red spots, and pain in the genital organs. • Fever with abdominal pain. • Frequent and burning urination. • There is accumulation of pus in prostate gland of males. • Infemales,thereislowerabdominalpain,fever,nausea,andirregularmenstruation cycle. • Gonorrhea may damage the reproductive organs resulting in infertility. • In infants, it is characterized with redness of eyes and its surroundings and over secretion of tear Preventive measures of Syphilis and Gonorrhea • There must be reliable blood monitoring before blood transfusion. • Common syringes should not be used. Encourage disposable syringes if needed. • Education about STIs and their mode of transmission should be given. • Avoid unsafe sex. If there are multiple sex partners, always use condom. • Identify the diseased person and treat him/her immediately. Penicillin has effective control over syphilis. • Do not use common razor, tattooing instruments, or any other piercing instrument that comes in contact with blood. d) Chancroid It is a sexually transmitted infection caused by the bacterium Haemophilul Ducreyi. The infection begins with the appearance of painful open sores on the genitals, sometimes accompanied by swollen, tender lymph nodes in the groin. These symptoms occur within a week Chancroid Ulcer after exposure to the causative agents. Symptoms in women are often less noticeable and may be limited to painful urination or defecation, painful intercourse, rectal bleeding or vaginal discharge. Health, Population and Environment - 10 195

It can be treated effectively with several antibiotics. Chancroid is one of the genital ulcer diseases associated with increased risk of transmission of HIV, the cause of AIDS. It is also known as soft chancre, soft sore and soft ulcer. Preventive Measures of Chancroid Ulcer Preventive measures of STIs: (Gonorrhea, Syphilis, Chancroid and HIV/ AIDS) • Never indulge in unsafe sex. If the partner is doubtful, use a condom. • Never use a common syringe and needle for any purpose. • Awareness program for community people about STIs, HIV and AIDS should be conducted. • HIV-monitoring must be done during blood donation and transfusion. • HIV infected females should not be pregnant. • Spread knowledge about condoms and method of appropriate use to prevent STIs and HIV/AIDS. • HIV infected persons should be treated normally without any sort of isolation and discrimination. Proper counseling may need adjustment of the patient in the family and society. • Provide proper care and help to the victims. • Health education should be made accessible to all. Inclusion of communicable diseases, precautions, safety measures and prevention methods should be included in health education. • If one’s spouse (husband/wife) or sex partner is diagnosed with any form of STI, probability of infection becomes high. In this condition, immediate check-up and treatment should be done. xi. STIs should not be concealed under any circumstances. It should be treated in the early stage. xii. Hesitation to discussion on sex and sex-related matters should be discouraged. STI, sexuality, safe and healthy sex-behaviors should be openly discussed among friends, teachers and family members. 8.2 Safe Motherhood The term ‘motherhood’ refers to the state of being a mother; and the term ‘safe’ refers to the condition of being protected from dangers or harm. In 196 Health, Population and Environment - 10

this light, ‘safe motherhood’ refers to the harmless and well-protected state of being a mother. Safe motherhood can be defined as the process of protecting a mother from complicated pregnancy, childbirth and recovery. Being a mother is a complicated task for a woman. This includes the period of pregnancy, childbirth, and recovery. During these stages, a mother has to tackle different types of problems. Some of the common problems are unsafe pregnancy, anemia, reproductive tract infection, miscarriage, difficult childbirth and delayed recovery. The international conference held in 1990 in the capital city of Egypt, often called the Cairo Conference, reported that 5,00,000 women died due to complicated pregnancy and delivery in the world every year. Nepal had already missed its own 2020 target to reduce maternal mortality to 125 per 100,000 live births as the rate was recorded to be 239 deaths per 100,000 live births. This might be due to Covid-19 lockdown and subsequen lack of access to helath services at problematic cases. In order to achieve this target, there must be appropriate efforts to promote the health of mothers all over the world. Safe motherhood includes proper age at marriage and pregnancy, proper care of the mothers, proper service and care during childbirth. Besides these, the following points must be considered for safe motherhood. a) Educating mothers about safe motherhood Appropriate education of safe motherhood is essential for all women. It includes knowledge about reproductive health and reproductive phenomenon, birth spacing, and maternal-child health care. Reproductive health education teaches the mothers about the hazards and harmful consequences of early marriage. Marriage before twenty years of age is harmful for girls because there is no proper development of internal reproductive organs that support and create an appropriate environment for the proper development of the foetus. Appropriate birth spacing helps the mother to regain physical and reproductive strengths after delivery of one child. Such basic information and knowledge must be given to the mothers for protection of their rights of being mother. b) Improvement in maternal diet A mother requires a balanced diet not only for her own health but also for the proper growth and development of the fetus. If there is no adequate balanced diet, the growth and development of the fetus is retarded. On the other hand, a mother’s health status also declines remarkably because Health, Population and Environment - 10 197

the mother needs more nutrients during this period. The mother should be given food items including cereals, green vegetables, meat, milk, eggs, fruits and other nutritious items. Nutritious food is generally needed for all the people. But the mother has to be more conscious on this matter during pregnancy and breastfeeding period because her body requires comparatively more nutrients than others. c) Proper care of prenatal, neonatal and postnatal mother Prenatal period is the period of pregnancy which starts from conception till childbirth. It is the time period during which a small fertilized egg develops into a child. It needs regular supply of necessary nutrients needed for the mother and fetus. After childbirth, the mother takes a few days to regain her normal health. The process of recovery needs more supply of nutrients as well as proper care. The period of about one week after childbirth is called the neonatal period. After this period, the mother feeds her breast milk to her child. Therefore, sound health of the mother is essential for sound health of the child too. d) Presence of TBA (Trained Birth Attendance) during childbirth There are some systems of giving traditional assistance to a mother during the period of childbirth. The traditional practices are not scientific and are not based on the reproductive phenomenon of human beings. They are based on traditional beliefs and blind faiths on imaginary existences of witches (boksi, lagan, lago, chudel etc.) Such assistance deprives the mothers of proper diagnosis and treatment of health problems. Trained birth assistance refers to the help and care given by trained health personnel to a mother during childbirth. We shall discuss about the ways of taking care of a mother during childbirth later on in this chapter. e) Counseling for planning of the family The health of the mother declines with an increasing number of pregnancies. More number of children in a family affects the quality of life in the family. Mothers should be provided with proper knowledge and information about the concept of family planning, devices and methods to 198 Health, Population and Environment - 10

use them in a proper way. They should have knowledge about the general reproductive phenomenon, concept of happy family, legal provisions regarding family matters like marriage, divorce, induced abortion, etc. There are many types of non scientific practices of unsafe and induced abortion. Due to this, many mothers are losing their lives. There must be dissemination of knowledge about legal and safe abortion to all the women so that they can save their as well as other’s life in problematic situations. 8.3. Risky Conditions of Pregnancy Pregnancy is not safe in all the cases. Complication in pregnancy and delivery have been main causes of maternal death all over the world. Therefore, it is wise to know the hazardous conditions of pregnancy. The followings are common problematic conditions of pregnancy: a) If the mother is less than 18 years or more than 35 years of age: Fecundity, or the biological reproductive capacity of females, is regarded to start from the first menstrual cycle. Achievement of fecundity power does not ensure safe conception and pregnancy. After conception, the mother must have the necessary strengths and environment to hold the fetus in the womb for its survival. Females generally get these accessory strengths of reproductive functions after reaching 18 years only. After crossing this age, she gains the psychological and physical maturity that is an essential factor to be a mother. b) If the weight of mother is less than 40 kg and height is less than 145 cm: Both these above-mentioned conditions do not meet the minimum limit of weight and height of a female to be a mother. Such conditions indicate the underdeveloped internal reproductive organs of females. A healthy baby cannot be born if the size of the vaginal canal and uterus is smaller than normal size. It is equally dangerous for the health of the mother, too. c) If the mother has HIV/AIDS diabetes, or heart diseases: If the mother is suffering from HIV/AIDS, diabetes, heart ailments or any other chronic diseases, pregnancy becomes problematic. The health of child is also affected adversely. There is high chance of HIV infection in children if the mother has HIV. In rare cases, the baby may not have HIV. Severe chronic diseases cause dangers to the health of the mother too. d) If the mother has malnutrition or has delivered many children: Malnutrition is a condition in which there is either less or excess accumulation of nutrients in the body. In both of the conditions, a healthy Health, Population and Environment - 10 199

baby cannot be delivered. If the mother has given birth to many children, reproductive organs become tired and cannot function well. e) If the mother is into in drugs, alcohol and smoking: The mother may have taken harmful drugs and chemical substances which harm the fetus inside her womb or uterus. In such a situation, a healthy baby cannot be born. 8.4 Maternal and Child Health (MCH) Care and Its Measures 8.4.1 Introduction to MCH Care Maternal health refers to the health of the mother. Similarly, child health is related to the health of the child. A child is a young baby below five years. Children are directly or indirectly affected by the health of the mother. Newly born infants depend upon the breast milk from their mother. Therefore, the health of children is closely connected with the health of the mother. In this context, child health and maternal health are studied together. Maternal and child health (MCH) care is defined as the process of promoting health of pregnant, neonate and breastfeeding mother as well as children below five years. The level of MCH care in developing countries is low in comparison to that of the developed countries. There must be necessary laws and their effective implementation to promote the status of MCH care in developing countries like Nepal. It is important for promoting the aggregate health of the nation. 8.4.2 Importance of MCH Care • It helps in healthy pregnancy and safe delivery. • MCHC provides trained birth attendants (TBA) at the time of delivery. It saves the lives of both the mother and infant. • It includes the appropriate care of the pregnant mother, including their balanced diet, immunizations, sanitation, and necessary precautions regarding pregnancy and delivery. Thus, it protects the mother during these complicated periods. • It protects the reproductive rights of women. • It helps to make family members aware about providing proper care to the mother in their family. • Children can live a healthy life due to implementation of MCH care. It gives focus to immunizations, balanced diet and healthy lifestyle of the children. 200 Health, Population and Environment - 10