Oasis Health, Population & Environment Education Book 10

10.1.3. Major Techniques of First Aid First aid techniques may differ according to the nature of the casualty, place of accident, and availability of resources. There are some common techniques of first aid. a) ABC Method of First Aid ABC method stands for Airway, Breathing and Circulation Method of First Aid. According to this method, airway organs like the mouth, nose, pharynx are checked carefully so that there is no obstacle in the path. Any foreign bodies like stone, straw, coin, pencil or other materials, if stuck along the airway, should be taken out safely. Breathing can be clearly examined in any casualty. If breathing stops, the casualty dies. It must continue even in an unconscious casualty. After examining, if there is any problem, the first aider should provide artificial respiration to resume normal breathing. Circulation is essential for survival. It is examined by listening to the heartbeat or feeling the pulses at different pulse points of the casualty. If there is a problem in the heartbeat or blood circulation, cardiac massage should be given to the casualty. b) Artificial Respiration Artificial respiration is a process of providing air with oxygen when one’s respiratory organs come to rest. This process can save the life of the casualty by maintaining the amount of oxygen needed for all the parts of the body. It should be done immediately after cessation. If there is no supply of oxygen for a long time, the casualty dies. In most of the cases, the sudden stoppage of respiration occurs due to some accident. In such situations, the casualty needs immediate first aid. The following steps should be followed for artificial respiration: i. Remove obstruction (if any) from mouth and nose. ii. Place the casualty in supine1 position, i.e. ventral part facing upward. iii. Raise the level of the head slightly up with the support of a pillow, thigh or any other soft thing so that the tongue does not obstruct the airway. iv. Close nostrils with the thumb and forefinger of one hand and grasp the chin with the other hand to open the mouth. v. If the mouth is strongly closed, pinch at the nostrils. vi. Grasp the chin to make the mouth open. 1 Supine: lying or resting on the back with the face, palm and ventral parts facing upward Health, Population and Environment - 10 251

vii. Seal your lips around the mouth and blow one breath every 3 to 4 seconds. viii. Observe the chest rise carefully. Give gentle chest compression for air to exhale. ix. If there is no heartbeat and pulse, heart massage is needed immediately. c) Cardiac Massage Cardiac cessation is the stoppage, or pause, or interruption of the heart movement. It should not last for more than five minutes for the survival of the casualty. There is need of immediate first aid to save the life of the casualty in such a situation. The heart is a vital and most busy organ of the human body. It is an ever-working muscular organ that never takes rest during the whole life. In most of the cases, death is first noticed and confirmed by learning about the stoppage of the heartbeat and heart movements. But, we should not confirm the death of a casualty if there is no heartbeat for a very short period of time. Do not forget that short cessation of the heartbeat can be restored with cardiac massage. It is the rhythmic compression of somebody’s heart in order to restore the heartbeat and blood circulation after the person has had a sudden stoppage of heartbeat. Method of giving cardiac massage: • Place the casualty in supine position (i.e, ventral part facing upward) • Place both the palms on the chest of the casualty one atop the other • Give rapid four compressions and make a pause for 4 to 5 seconds • Give one breath using mouth-to-mouth ventilation 252 Health, Population and Environment - 10

• Continue compressions, pause, and mouth-to-mouth ventilation until the heartbeat and normal respiration are restored. • Manage medical care as soon as possible Cardiopulmonary Resuscitation (CPR): It is the process of providing first aid by providing artificial respiration and cardiac massage simultaneously to a casualty who is suffering with difficulty in heartbeat and respiration. 10.2 First Aid in Certain Cases a) First Aid of Burns and Scalds2 A burn is an injury caused by fire, heat, hot liquids, very hot steam, radiation, chemical action, electricity or friction, resulting in redness and blistering of the skin and often causing damage to underlying tissues. On the basis of the damage and harm due to burns, it is classified into three groups: • First-degree burn or mild burn: A burn marked by pain and reddening of the skin but without blistering or charring of tissue. • Second-degree burn or the burn that causes blistering: A burn that causes blistering on the skin, but does not damage the deeper layers of the skin. • Third-degree burn or severest burn: A burn of the most serious kind, in which the skin and the tissues beneath it are severely damaged. First aids for burns and scalds: • If there is fire on any body parts, cover it immediately with wet pieces of cloth sacs. It prohibits supply of oxygen and helps to extinguish the fire. • Immerse the burnt part immediately in cold water for about 10 minutes. It reduces the extent of damage to the tissues. • Do not burst the blisters (water-filled projections). It causes further damage of tissues and assists in infection. • Cover the burnt part with sterile dressing to make it safe from bacterial infections. • Do not use random applications and ointments. Consult for medical aid immediately. Preventive measures for burns and scalds • Handle stoves and gases safely. • Keep inflammable materials away from children. 2 Scald : a type of burn caused by hot liquid or steam Health, Population and Environment - 10 253

• Switch off the electrical appliances after use. • Make your family members aware about the safety measures and first aid in the case of burns and scalds. • Avoid nylon clothes as far as possible. If it is worn, do not go near fire. • Handle hot water, irons, and chemicals carefully. Keep them away from children. b) Snakebite Snakes are dangerous. Some of them are Hood poisonous and their poison is very strong. Fang Most of the snakes are not poisonous, but a few of them have very strong poison in their poison Forked tongue glands. Snakebite takes many lives every year during the hot season. Snakes are the inactive during the cold season. Cobra In winter, they hibernate3 with no active life. Common poisonous snakes found in Nepal are cobra (Goman) and Karat. Symptoms of snakebite • The poisonous snakes have two fangs (sharp incisors). There is a distinct mark of the fangs with incisions • The affected part becomes red with pain and swelling • Discoloration of skin • Rapid pulse • Fatigue • Burning sensation in tissues • Blurred vision • Loss of sensation • Unconsciousness First aid for snakebite If there is a snakebite, we should provide first aid as quickly as possible. WHO (World Health Organization), Regional Office for South-East Asia published the “Guidelines for the management of snake bites” in 2010. The report states, “Unfortunately, most of the traditional, popular, available and affordable first aid methods have proved to be useless or even frankly dangerous. These methods include: making local incisions or pricks/ 3 Hibernate : to live with inactive and hidden life underground by certain reptiles and amphibian during the cold season 254 Health, Population and Environment - 10

punctures (“tattooing”) at the site of the bite or in the bitten limb, attempts to suck the venom out of the wound, use of snake stones, tying tight bands (tourniquets) around the limb, electric shock, topical instillation or application of chemicals, herbs or ice packs. Local people may have great confidence in traditional (herbal) treatments, but they must not be allowed to delay medical treatment or to do harm.” In light of such findings, the best method for providing first aid for snakebite described below: • First, make note of the snake so that the information could be provided to the doctor. Identify the mark of the fangs to know whether the snake is poisonous or not. • Give consolation to the victim so that s/he develops hope for life. • Advise the patient to remain calm and minimize movements. • Keep the stung part below the level of the heart if possible. • Do not let the victim move the bitten part. Apply a splint and tie it with a torniquet or bandage to prevent motion. • Do not waste any time in cutting the bitten area, sucking the poison, flushing with water or adopting any other unscientific traditional method instead of taking the victim for medical treatment as soon as possible. Health, Population and Environment - 10 255

• Manage an ambulance or any other appropriate means to take the victim to a hospital or health center. Apply full effort to take a victim to the snakebite treatment center. c) Electric Shock A shock is an unexpected, intense and distressing experience that has a sudden and powerful effect on somebody’s emotions or physical reactions. If such a shock has resulted electricity, it is called electric shock. Many people die every year due to electric shock. It may be mild or hard on the basis of intensity of its effects to the victim. Causes of electric shock • Negligence and ignorance • Lack of knowledge • Improper handling of electrical appliances • Lack of monitoring of the wiring system at home • Contact with electric wires and appliances • Leakage of electricity Safety measures for electric shock • Be careful while working with electrical devices • Educate family members about safety measures and first aid in the case of electric shock. • Handle electrical appliances appropriately • Check electrical wiring regularly • Keep children away from electrical appliances First aid for electric shock • Switch off the main supply of electricity • Unplug the cord • Pull the victim safely with insulator support (dry wood, plastic) • Check vital signs: respiration, heartbeat, pulse, sensation, consciousness, etc. • Provide CPR (Cardiopulmonary Resuscitation) if necessary • Take the victim for medical treatment immediately 256 Health, Population and Environment - 10

d) Altitude Sickness Altitude sickness is a condition caused by low level of oxygen in the air at high altitudes, resulting in breathlessness, nausea, vomiting, fatigue and unconsciousness. It is also called mountain sickness. Our body is adopted in normal environment where we live in. People living at high altitude have higher lung capacity comparatively to the people living at lower altitude. Due to lack of oxygen at high altitude, there is increase in heart activities to supply the required oxygen to the body. Due to this reason, the pulse rate, cardiac output and blood pressure increase. If the increase crosses the limit or the level of oxygen is too low, the travellers suffer from altitude sickness. Symptoms of altitude sickness • Difficulty in breathing • Increased pulse rate and blood pressure • Headache, nausea and vomiting • Dizziness and vertigo • Pulmonary and cerebral edema (i.e., swelling) • Unconsciousness First aid for altitude sickness • Supply oxygen as soon as possible • Bring the victim to lower altitude • Serve hot drinks • Tell the victim to do light exercises • Incaseofsevereconditionsandunconsciousness,managecardiopulmonary resuscitation and proper medical care e) Drowning To drown is to be under the surface of water in such a way that there is accumulation of unwanted water in the lungs. Drowning is a common problem near ponds, wells, rivers, lakes and similar other water resources. Health, Population and Environment - 10 257

People, especially children, must be made aware of it for its prevention. Symptoms of drowning • Difficulty in breathing • Cyanosis i.e., presence of blue color in body tissues. It is due to lack of oxygen in the blood • Unconsciousness • Vomiting of water First aid for drowning • Rescue the victim safely out of the water • Remove obstruction in the respiratory ways (if any) • Keep head downward and give gentle compression to the stomach to remove excess water accumulated • Apply CPR (cardiopulmonary resuscitation) if there is no respiration and heartbeat • Make medical care available for the victim as soon as possible f) Heatstroke Heatstroke is a condition caused by your overheating, usually as a result of prolonged exposure to or physical exertion at high temperatures. There is very high temperature in the hot seasons in the Terai region of Nepal. During the hot weather, when hot wind blows, it can cause rise in the temperature of our body. Heatstroke can occur if the body temperature rises to 104 F (40 C) or higher. Heatstroke requires emergency treatment. Untreated heatstroke can quickly damage the brain, heart, kidneys and muscles. The longer the treatment is delayed, more the risks of serious complications or death. Symptoms of heatstroke • High body temperature. • Altered mental state or behavior, confusion 258 Health, Population and Environment - 10

• Body shaking, agitation. • Slurred speech, irritability, delirium, seizures and coma • Sweating. • Nausea and vomiting • Flushed skin (Skin may turn red as the body temperature increases) • Rapid breathing • Rapid heart rate • Headache g) Choking Choking is the condition of severe difficulty in breathing because of a constricted or obstructed throat. Choking occurs when a foreign object becomes lodged in the throat or windpipe, blocking the flow of air. Young children often swallow small objects. Choking cuts off the oxygen supply to the brain. Therefore, first aid should be administered as quickly as possible. Signs and symptoms of choking • A person tries to give signals to the people around him/her. If the person doesn't give the signal, the following symptoms are seen: • Inability to talk • Difficulty in breathing or noisy breathing • Inability to cough forcefully • Sudden redness of the face • Skin, lips and nails turning blue or dusky • Loss of consciousness First aid for choking • Give up to five back blows. Hit them firmly on their back between the shoulder blades. Back blows should not be very hard as it may cause injury to the spinal cord. • If back blows do not dislodge the object, give up to five abdominal thrusts. Hold the child around the waist and pull inwards and upwards above their belly button. Health, Population and Environment - 10 259

• Give CPR, if the condition does not improve. • Provide medical assistance as quickly as possible. The victim should be taken to the medical center or an expert should be called immediately h) Poisoning Poison is a substance that cause disturbances in organisms, usually by chemical reaction or other activity, when an organism absorbs it through any route. The route may be oral (swallowing or eating poison) or respiratory(inhalation of poisonous gas). Sometimes, it may be dermal (through the skin, snakebite, insect-bite etc.). First aid for poisoning depends on the poison entered into the body. Sometimes, poisoning leaves very severe effects and needs proper first aid for the survival of the victim. Contacting a health center or hospital emergency room is the first step in getting proper treatment. Signs and symptoms of poisoning Signs and symptoms of poisoning can mimic other conditions, such as seizure, alcohol intoxication, stroke and insulin reaction. Common signs and symptoms of poisoning may include: • Burns or redness around the mouth and lips • Breath that smells like chemicals, such as gasoline or paint thinner • Vomiting • Difficulty in breathing • Drowsiness • Confusion or other altered mental status First aid for poisoning Looking at the signs and symptoms of poisoning, the first aider must try to find out the causative poison substance in the victim's body. According to the nature of poison and its effects, the most appropriate first aid method should be adopted. General first aid measures for poisoning are as follows: • Identify the cause of poisoning • If the victim is unconscious, take him/her as fast as possible to the health center or hospital. Do not try to force the victim to vomit or administer any other substances into his/her mouth. • If the victim is conscious and the poisoning is through the oral route, compress the abdomen and put a finger into the mouth to stimulate vomiting. (If petroleum substances, alkali or acid is swallowed, do not 260 Health, Population and Environment - 10

urge the victim to vomit). • If the victim has vomited, the sample should be collected and taken to the hospital along with the person. • Any empty bottle and pack found near the victim should be taken to the hospital for examination. • It is better to provide milk or clean water, if the victim is conscious. i) Frostbite Frostbite is an injury caused by freezing of the skin and underlying tissues. First your skin becomes very cold and red, then numb, hard and pale. Later, the color of the skin turns bluish and black when the effects are aggravated. Frostbite is most common on the fingers, toes, nose, ears, cheeks and chin. Exposed skin in cold, windy weather is most vulnerable to frostbite. Frostbite can occur on the skin covered by gloves or other clothing if they are thin and non-protective. The first stage of frostbite is called frostnip. It doesn't cause permanent skin damage. We can treat very mild frostbite with first-aid measures, including rewarming the cold skin. Severe frostbite requires medical attention because it can damage skin, tissues, muscle and bones. Possible complications of severe frostbite include infection and nerve damage. Common first aid measures to be followed for controlling the adverse effects of frostbite are: • Keep the victim in warm place. • Do not massage the frostbitten part. It may further damage the underlying tissues. • Do not expose the frostbitten part directly to fire. • It is better to put the frostbitten part in lukewarm water. • Provide warm water or fluid to the victim. • Seek medical assistance as far as possible, if the condition is worsening. 10.3 Human Health In simple words, human health refers to the state of health of the human race. The race includes about eight billions people living around the world. Health, Population and Environment - 10 261

Many factors affecting human health and the health of other species of the earth are common. But, we have some peculiar norms and standards against disease germs, micro-organisms, and several advanced organisms residing in the dirty habitats in defining health. Health is a relative state in which one is able to function well physically, mentally, socially and spiritually in order to express the full range of one's unique potentialities within the environment in which one is living. Health is basically affected and determined by a balanced diet, healthy environment, physical activities as well as a safer and healthier lifestyle. 10.3.1 Balanced Diet A balanced diet is the balanced intake of nutrients required for proper continuation of life processes. A balanced diet contains various groups of nutrients, particularly carbohydrates, proteins, and vitamins. It meets a person’s caloric need. The components of a balanced diet differ according to age, sex, physical activity and the physiological state. Children need more protein for growth and development. A person who works very hard needs more intake of carbohydrates and fats. A balanced diet includes the following three basic categories of food in appropriate proportion. a) Heat and energy yielding foods It is food containing carbohydrates and fats, which are responsible for the production of heat and energy in our body. They are needed more in comparison to other category of foods for our body. There must be 50- 60% of carbohydrates and 30-35% of fat in a balanced diet. They can be obtained from the foods including rice, maize, potato, sweet potato, honey, sugar, wheat, yam, oil, butter, ghee, etc. b) Body building food Food containing different forms of proteins is known as body building food as it is essential for the production of new cells and tissues. There must be 10-15% protein in daily food for balanced diet. Proteins are necessary for growth and development. Animal proteins can be obtained from fish, meat, egg, milk, etc. Plant proteins can be obtained from gram, bean, lentil, etc. c) Protective food It is a set of food containing minerals and vitamins, which are responsible 262 Health, Population and Environment - 10

for developing the protective power of the body against germs and diseases. They can be obtained from food items, including vegetables and fruits. A balanced diet is obtained from appropriate inclusion of different types of food. The importance of food is mentioned below. i. Food provides necessary heat and energy required for the body. ii. Food maintains homoeostatic features like temperature, blood pressure, limit of hormones, salts, etc. in the body. iii. It promotes growth by replenishing and repairing tissues. iv. It helps to regulate body processes and functions properly. v. It protects the body from disease. 10.3.2 Healthy Environment There are many people living in a common environment. This common environment must be healthy for the sound health of the people living there. There is an integrated and unified effort at sanitation, control of pollution, and other environmental hazards. Therefore, community health is very important for the development of the healthy environment. A healthy environment requires cleanliness of surroundings. For this, we should keep our home, courtyard, neighbourhood, and community clean. The process of keeping our environment clean is called environmental sanitation. Environmental sanitation, sometimes, is used synonymously as environmental health. A healthy and favourable environment always helps to provide productive manpower for the nation and it helps to maintain quality life. Environmental sanitation encompasses the activities like proper management of waste materials, a proper drainage system, supply of clean drinking water, management of clean latrine, etc. In this way, we can say that environmental sanitation and health are closely related to each other. 10.3.3 Physical Activities Physical activities are essential for a healthy life. We can improve the strength, agility, immunity and tolerance of our body with the help of physical exercises. Physical exercises are the movements of our body parts in a scientific ways to keep them healthy and strong. Physical exercises may be taken individually or in a group depending upon the type and steps of the exercises. Health, Population and Environment - 10 263

Health benefits of physical activities • Physical activity reduces the risk of diseases and mortality. • Physical activity reduces the risk of coronary heart disease, cardiovascular disease and stroke. • Physical activities help in developing fair skin and attractive body. • Physical activities reduce mental stress and tension. • Physical activity is an effective treatment for peripheral vascular disease and high blood pressure. • Active people have a 30% to 40% lower risk of developing type 2 diabetes compared to inactive people. Also, for those who have already developed type-2 diabetes, the risk of premature death is much lower for active and fit patients than for inactive and unfit patients. • Physical activity promotes strength, coordination and balance. This is particularly important for older people, in reducing their risk of falls and helping them to maintain their capacity to carry out common activities of daily living. As a result, physical activity can help older people sustain an independent lifestyle for longer. • Physical activity is associated with a reduction in the risk of cancer. • Physical activity reduces the risk of depression and cognitive decline in adults and older adults. 10.3.4 Safer and Healthy Lifestyle All humans have to eat food for the growth and maintenance of a healthy body, but we humans have different requirements as infants, children, teenagers, young adults, adults and seniors. For example, infants may require feeding every four hours until they gradually age and begin to take 264 Health, Population and Environment - 10

in more solid foods. Eventually they develop into the more normal pattern of eating three times per day as young kids. However, as most parents know, kids, teenagers and young adults often snack between meals. Snacking is often not limited to these age groups because adults and seniors often do the same. Some guidelines for a safer and healthier lifestyle are: • Have regular exercises every day. Keep yourself neat, clean and smart. • Eat at least three meals a day (breakfast, lunch and dinner). The meals should contain all types of nutrients in appropriate amounts. • Remain fresh and calm mentally. Excessive stress and mental tensions ruin our health. • The bulk of food consumption should consist of fruits, vegetables, whole grains and fat-free or low-fat milk products. • Choose food that is low in saturated fats, trans-fats, cholesterol, salt (sodium), and added sugars; look at the labels because the first listed items on the labels comprise the highest concentrations of ingredients. • Snacks should consist of items like fruit, grains, or nuts to satisfy hunger and not cause excessive weight gain. • Avoid sodas and sugar-enhanced drinks because of the excessive calories in the sodas and sugar drinks; diet drinks may not be a good choice as they make some people hungrier and increase food consumption. • Avoid eating a large meal before sleeping to decrease gastroesophageal reflux and weight gain. • If a person is angry or depressed, eating will not solve these situations and may make the underlying problems worse. • Avoid rewarding children with sugary snacks; such a pattern may become a lifelong habit for people. • Avoid heavy meals in the summer months, especially during hot days. • A vegetarian lifestyle has been promoted for a healthy lifestyle and weight loss; vegetarians should check with their physicians to be sure they are getting enough vitamins, minerals and iron in their food. • Cooking food (above 165 F) destroys most harmful bacteria and other pathogens; if you choose to eat uncooked foods like fruits or vegetables, they should be thoroughly washed with running treated (safe to drink) tap water right before eating. • Avoid eating raw or undercooked meats of any type. Health, Population and Environment - 10 265

Notes • ‘First aid’ is the first assistance, or help given to a casualty until a medical personnel and service become available. • Methods and procedures of first aid may not be same in every situation. They differ according to time, place and nature of the casualty. • A first aid box or a first aid kit is a small box with essential materials and equipments required for providing first aid. • ABC method stands for Airway, Breathing and Circulation • Artificial respiration is a process of providing air with oxygen when one’s respiratory organs come to rest. • Cardiac cessation is the stoppage, or pause, or interruption of the heart movement • Cardiopulmonary Resuscitation (CPR): It is the process of providing first aid by providing artificial respiration and cardiac massage simultaneously to a casualty who is suffering with difficulty in heartbeat and respiration. • A burn is an injury caused by fire, heat, hot liquids, very hot steam, radiation, chemical action, electricity or friction, resulting in redness and blistering of the skin and often causing damage to underlying tissues. • The traditional methods of first aid for a snakebite are rejected by WHO. It is recommended that we should not make any delay in the name of traditional healing in case of poisonous snakebite. The casualty should be taken to health centre as quickly as possible to provide proper treatment. Even small amount of poison circulated in the blood may be fatal. • Altitude sickness is a condition caused by low level of oxygen in the air at high altitudes, • A balanced diet is the balanced intake of nutrients required for proper continuation of life processes. • Physical activities are essential for a healthy life. We can improve the strength, agility, immunity and tolerance of our body with the help of physical exercises. 266 Health, Population and Environment - 10

Exercise A. Give very short answers to the following questions. 1. Define first aid. 2. Write one example of energy-yielding food. 3. What percentage of proteins should be there in a balance diet? 4. Name two materials in first aid box. 5. What do you mean by ABC rule? 6. Define cardiac massage. 7. What is wound ? 8. What is burn? 9. Name two symptoms of snake bite. 10. Define high altitude sickness. 11 What is heat stroke? 12. Write any one symptom of choking. 13. Write a nutrition components of protective food. 14. Write one basic requirement of a healthy environment. 15. Who is a first aider? B. Give short answers to the following questions. 1. What are the major objectives of first aid? Describe any two of them in brief. 2. Explain the advantages of first aid with examples. 3. \"The modes and methods of first aid may differ according to time place and nature of the casualty.\" Do you agree? Justify your answer with example. 4. How does balanced diet help in the growth and development of human body? 5. What do you mean by poisoning? How do you provide first aid to a victim of poisoning? 6. 'Frostbite may attack even if a person is wearing gloves'. Do you agree? Health, Population and Environment - 10 267

List the symptoms of frostbite. 7. Write short notes on: a. Body building foods b. Heat and energy yielding foods. C. Give long answers to the following questions. 1. What does a healthy environment' mean? How does it help to keep us healthy? Explain with examples. 2. How are environmental sanitation and human health interrelated? Explain the adverse effects of environmental pollution on human health. 3. How can we manage a balanced diet with the available food resources without buying expensive food items? Suggest your idea with examples. 4. Safe life style is necessary for healthy life. Justify. 5. Explain the importance of balanced diet. 6. Regular physical mobility increases immunity power. Justify. 7. Primary health care is important for us. Explain. 8. What is altitude sickness? Write down symptoms and first aid treatment for sprain. 268 Health, Population and Environment - 10

Model Question Issued by CDC, 2074 Subject: Health, Population and Environment Education FM: 75 Time: 2 hrs. 15 minutes PM: 24 Group ‘A’ 11 x 1 = 11 Give very short answers to the following questions. 1. What is biological aspect? 2. Write the formula to find out crude birth rate 3. Clarify the importance of communication. 4. How much percent of land of Nepal has been covered by the Himalayan region? 5. Availability of standard education increases quality of life, how? 6. Write any one utility of Yarsagumba. 7. How many types of dysentery are there and what are they? 8. Analyze AIDS and poverty in Nepal in two sentences. 9. Write any two significance of community health. 10. What is safe lifestyle? 11. Write any one symptom of high altitude sickness. Group ‘B’ 9 × 4 = 36 Give short answers to the following questions. 12. What are the aspects of health, population and environment education? Write. 13. Write the measures of population management. Or, How is the total fertility rate calculated? Clarify with formula. 14. Write any five importance of sustainable development. 15. Analyse the ecosystem of Himalayan region and its related aspects. 16. Clarify the elements of quality of life. Health, Population and Environment - 10 269

17. Focus on importance of biodiversity in human life. Or, Analyze the preservation measures of rare animals and birds. 18. Make a list of communicable diseases that are prevalent in Nepal. 19. Write the measures for safe motherhood. 20. Make a list of scopes of community health. Or, Write the measures to be protected from bad habits. Group ‘C’ 4 × 7 = 28 Give long answers to the following questions. 21. To conduct developmental works, we should pay attentions to measures of sustainable development. Clarify with examples. 22. What measures do you apply to maintain the quality of life of your family? Explain. 23. “Nepal is rich in biodiversity”. Write with reasons. 24. Describe the importance of balanced diet. - Best of Luck!! - 270 Health, Population and Environment - 10

Annex-1 New Evaluation Scheme for Practical Marks in the Secondary Education Examination (SEE) and Other Examinations (According to Curriculum Development Center, CDC, Nepal) (Total Practical Marks: 25) On examination, students are evaluated with two categories of assessment schemes. Students get a question of 75 full marks and write their answers in examination hall. The organization of questions follows the guidelines of Specification Grid. Remaining 25 marks are allocated for practical evaluation. Practical evaluation is based upon CAS (Continuous Assessment System). Allocation of marks in practical evaluation i. Positive Change in Behavior 5 Marks ii. Practical Evaluation File 10 Marks iii. Project Work, Field Trip and Report 5 Marks iv. Practical Examination 5 Marks Total Marks 25 Marks i. Positive Change in Behavior (5 Marks) The subject teacher traces each student’s behavior throughout the academic year and assigns marks according to healthier practices they adopt in their everyday life. Their attitude and behavior towards environmental protection is also observed and taken for evaluation. ii. Practical Evaluation File (10 Marks) A Portfolio is prepared for each student to record his/her works, attendance and activities and marks are provided according to the merit on portfolio. Health, Population and Environment - 10 271

iii. Project Work, Field Trip and Report (5 Marks) Students are instructed to accomplish at least one project work or field trip and prepare reports on them. Their work is evaluated to determine marks. Students may get marks on the basis of their contributions on the tasks of national importance. Students with specific and multi- talented skills are accessed with specific tools. iv. Practical Examination (5 Marks) It is based on field survey, class work, project work, creative works, skilled activities, research studies etc. in a continuous assessment system. 272 Health, Population and Environment - 10