INDUSTRIAL ATTACHMENT REPORT AT KI KISII

TEACHING AND REFERAL HOSPITAL BETWEEN APRIL TO

JULY 2022

NAME: OUMA WINNY ACHIENG’

REG NO: R/CCHJ21/4502

COLLEGE: KISII NATIONAL POLYTECHNIC

COURSE: COMMUNITY HEALTH

INSTITUTION: KISII TEACHING AND REFERAL

HOSPITAL

DEPARTMENT: PUBLIC HEALTH

i
DECLARATION

Candidate

I declare that this is my original work and has not been presented to any other institution or
examination body for any award.

NAME: OUMA WINNY ACHIENG’

Signature: ………………………………………….

Date: ……………………………………………….

Supervisor

This attachment report has been submitted to Kisii Teaching Referral with approval as the
student appointed supervisor.

Name:

Signature: ………………………………………….

Date: ……………………………………………….

ii
DEDICATION
This work is dedicated to the Almighty God, for His guidance and protection; Henry Misheal and
Judith Naswa for their support, all staff of KTRH who supported me and department of public
health, Mr. Wilson Nyakweba .God bless you all

iii
ACKNOWLEDGEMENT
I wish to convey my appreciation to my beloved parens for their moral support they gave me
during my attachment.
I would also like to acknowledge my supervisors during at attachment place Mr. Wilson
Nyakweba (PHO) for providing me with good guidance, advice and motivation during my
attachment period. My gratitude goes to KNP academic staff that has imparted vast knowledge

and has assisted me during the industrial attachment. I thank my lecturer/supervisor Mr. Joshua
despite of his tight schedules found time for the assessment exercise. I appreciate the
management of Kisii National Polytechnic, the principal (David Mwangi) through the human
resource officer Mr. Wilson Nyakweba for having given me the opportunity to be attached to the
public health department. I would like to acknowledge the entire staff of KTRH for their support
and cooperation. Through this attachment I came to know the value of teamwork and new
experience in working environment.

Lastly I would like to thank our almighty God for the keeping me health all through.

God bless you all.

iv
ABSTRACT
This report entails the following activities;
1.Community Entry
2.Community Strategy
3.Nutrition
4.Solid waste and Liquid waste
5.Tuberculosis
6.Prevention Mother to Child Transmission of Hiv and Aids
7.Disease surveillance.
8.Family Planning.
9.Water Treatment.
10.Occupational health and safety.
11.Audiology.

v
ABBREVIATIONS
KTRH – Kisii Teaching and Referral Hospital

FANC – Focused Antenatal Care

ANC - Antenatal Care

IBP – Individual Birth Plan

PMTCT – Prevention of Mother to Child Transmission of HIV/AIDS

TT – Tetanus Toxoid Vaccine

CCC – Comprehensive Care Centre

ART – Antiretroviral Therapy

QI – Quality Improvement

QC – Quality Control

CHV – Community Health Volunteer

PHO – Public Health Officer

MoH – Ministry of Health

TB – Tuberculosis

VL – Viral Load

Arvs-Anti retro vitals

HIV- Human immuno deficiency

vi
TABLE OF CONTENT

DECLARATION .................................................................................................................................... ii
DEDICATION........................................................................................................................................iii
ACKNOWLEDGEMENT ......................................................................................................................iv
ABSTRACT ........................................................................................................................................... v
ABBREVIATIONS ................................................................................................................................vi
TABLE OF CONTENT.........................................................................................................................vii
CHAPTER ONE......................................................................................................................................... 1
INTRODUCTION .................................................................................................................................. 1
1.0 BACKGROUND .............................................................................................................................. 1
1.1 HISTORY OF ORGANIZATION .................................................................................................... 1
1.2 KTRH CORPORATE OBJECTIVES ............................................................................................... 2
1.3 OUR CORE ...................................................................................................................... 2 1.4 OUR
VISION ................................................................................................................................... 2 1.5 OUR
MISSION................................................................................................................................. 2 1.6 OUR
MANDATE ............................................................................................................................. 2 1.7
ORGANIZATIONAL STRUCTURE OF KTRH ............................................................................. 3
CHAPTER TWO .................................................................................................................................... 4
FIELD ATTACHMENT ACTIVITIES .................................................................................................. 4
2.1 PUBLIC HEALTH DEPARTMENT ................................................................................................ 4
2.1.1 TOOLS FOR COMMUNICATIONS WITH PEOPLE WHO HAVE DISABILITY OF
HEARING IMPAIRED ...................................................................................................................... 4
2.1.2 WATER TREATMENT ............................................................................................................ 6
2.1.3 WASTE MANAGEMENT (SOLID WASTE) ........................................................................... 7
2.1.4 OCCUPATIONAL HEALTH AND SAFETY (GK PRISON KISII COUNTY) ..................... 10
2.1.5 DISPENSING ROOM OF TUBERCULOSIS (CHEST CLINIC) ........................................... 11
2.1.6 PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT) ................. 13
2.1.6 CCC DEPARTMENT (PHARMACY) .................................................................................... 17
2.1.7 NUTRITION ............................................................................................................................ 20
2.1.8 FAMILY PLANNING ............................................................................................................. 21
2.1.9 COMMUNITY HEALTH ENTRY PROCESS ........................................................................ 22
2.1.11 COMMUNITY STRATEGY ................................................................................................. 23

vii
 2.1.12 PUBLIC HEALTH EMERGENCY OPERATION ................................................................ 23
2.1.13 WASTE TRATMENT PLANT .............................................................................................. 24
CHAPTER THREE .................................................................................................................................. 26
3.0 SUMMARY, CONCLUSION AND RECOMMENDATIONS ...................................................... 26
3.1 SUMMARY .................................................................................................................................... 26
3.2 CONCLUSION ............................................................................................................................... 26
3.3 RECOMMENDATIONS ................................................................................................................ 26

viii
 CHAPTER ONE

INTRODUCTION

1.0 BACKGROUND
The industrial attachment training is an essential component of the curriculum of the college, Faculty
health science department. The attachment period is usually a maximum of three months during
which the students are expected to acquire additional practical experience to supplement, their
course of study in the college. They are also exposed to the real world of work and its challenges
which will prepare them towards their future careers.
This report is the outcome of the three months practical training I had at KTRH in Kisii County. It is
said to be a supervised program since Lectures from the faculty visit the students during this period
and at the end of the program to ascertain the success of the program and the amount of seriousness
students attached to it.

1.1 HISTORY OF ORGANIZATION

Kisii Teaching Referral Hospitals situated about one kilometer from the Capital along the Hospital
Road. With over 5,000 patients attending more than 300 doctors. KTRH is a level 6 hospital which
contribute to health sector in Kenya and is currently producing more than 5000 graduates every 5
years for both the Kenyan public and private sectors, accounting for more than 40 percent of the
technical workforce.
The institution boasts of a highly qualified and experienced teaching and administrative staff. It has
workforce of over 100 members of staff.
The national distribution of the hospital is its biggest uniqueness. The impact of the hospital is
improving the health care felt of Citizens in the country.
Today KNP has grown tremendously, curving a niche for itself as one of the largest Technical
training institution in Kenya and even beyond- drawing students from outside Kenya. This
unprecedented growth from humble beginnings to the complex college it is today is attributable to
the unwavering support of the government, hard work by the dedicated staff, students' diligence and
sound management.
KNP being one of the constituent technical colleges in Kenya has some departments which include;
1. Comprehensive Care Center
2. Chest clinic
3. Public health
4. Mother child health care

1
 5. Special clinic
6. Pharmacy

1.2 KTRH CORPORATE OBJECTIVES

 .To access health issues within the institution
 Promoting health living of the people
 To promote safe, secure and highly quality medical care
 To improve the patient experience by giving them quality and satisfactorily services
 Create a respective and a rewarding working environment for all

1.3 OUR CORE VALUES

 Infrastructure development and maintenance.

 Resource mobilization.
 Team work.
 Leadership and governance.
 Provide health education.

1.4 OUR VISION

An efficient and high quality health care system that is accessible, equitable and affordable for every
resident in Kisii County.

1.5 OUR MISSION

To promote and participate in the provision of integrated and high quality promotive,
preventive, curative and rehabilitative health care services to all.

1.6 OUR MANDATE

Support the attainment of the highest attainable medical care and sanitation services that will
improve lives at all levels of health care delivery

2
 1.7 ORGANIZATIONAL STRUCTURE OF KTRH

COUNTY DIRECTOR OF
HEALTH

HOSPITAL MANAGEMENT
BOARD

HOSPITAL MANAGEMENT MEDICAL SUPRITENDANT HOSPITAL REFORMS

TEAM

CONSULT- SOCIAL NURSE-IN HUMAN HAO ACCOUNTS

ANT WOKER CHARGE RESOURCE
MNGT
MEDICAL
OFFICER IN UNIT IN PUBLIC OFFICE ACCOUNTS
CHARGE CHARGE CLERK

MEDICAL WARD CLINIC

MAIN STORE
OFFICER IN CHARGE

CLINICIANS NURSE

3
 CHAPTER TWO

FIELD ATTACHMENT ACTIVITIES

2.1 PUBLIC HEALTH DEPARTMENT

Oriented about different offices dealing with public health programs

Emphasized about proper sanitation

Public health department consist of five offices where the first office deals with designing and
implementing health service, delivery systems to enhance the health of specific communities.

Design or use monitoring tools like screening, lab records and vital information to recognize health
risks.

The second office produces medical certificates and indicates the vaccine that you can be injected
when bitten by animals or human beings e.g. rabies vaccine BP and hepatitis B vaccine.

The third office’s role is to examine patients who have virus diseases by taking their stools/urine to
observe it if they have mucus and blood.

The fourth office is the administration office and the people dealing with accounts. In this office they
follow up delivery and to print documents.

The fifth office is the surveillance office where screening and evaluation of virus diseases is done.

The public health department contains two laboratories that is the parasitological laboratory and
microbiology laboratory.

2.1.1 TOOLS FOR COMMUNICATIONS WITH PEOPLE WHO HAVE DISABILITY OF

HEARING IMPAIRED
 Video /clips
 Brochures
 Writing in papers
 Boards
 Screens
 Lip-reading
 Cochlear implants

4
b) CHALLENGES FACED WHEN COMMUNICATING

 Dissatisfaction
 Impatient people
 Know it all
 Language Barrier
 Cultural Barrier
 Lack of transparency and trust
 Gender barrier
 Physical barrier
 Age difference

c) How to address people in the community using effective communication

 Audible
 Able to understand different language
 Clarity
 Dressing code
 Time management
 To be clear /brief and precise
 Observance
 Correction
 Consideration
 Concentration
 Courtesy
 Consciences


d) Five keys to effective communication

 Honesty
 Speak directly
 Practice active listening
 Adopt a participatory management
 Choose your words carefully

5
2.1.2 WATER TREATMENT
Water is composed into two forms

 Oxygen
 Hydrogen

Water treatment is making water portal for use by modifying and softening it.

Steps of water treatment

 Collection from the source
 Treatment of water e.g using water guard
 Screening and straining e.g Sieving, decanting and filtering
 Chemical additional e.g Chlorine, water guard and water top
 Figuration
 Sedimentation and clarification
 Filtration
 Disinfection e.g balancing h.p, putting chemicals
 Storage
 Distribution
 Water storage
 In tanks
 In jerricans

Types of treatment

 Primary treatment
 Secondary treatment
 Tertiary treatment

Sources of water

 Streams
 Boreholes(clean)
 Rivers
 Dams
 Springs
 Pipe systems
 Water shallows
 Rain water harvesting
 Water polls

6
Types of water supply

1. Ring system
2. Radial system
3. Dead end systems
4. Gridiron system (the main water)

Another name for water supply is Water system or water works

Water supply system consists of infrastructure for the collection, transmission, treatment, storage
and distribution of water for homes, commercial establishment, industry and irrigation.

2.1.3 WASTE MANAGEMENT (SOLID WASTE)

Waste management involves regular collection, transports, processing, recycling or disposal
and monitoring of waste materials.
Methods of waste disposal
 Recycling

7
  Landfills
 Incineration
 Composting
 Biological processing
 Animal feed
 Sea dumping

Landfill is to bury waste in the land

Incineration (combustion) burning waste at high temperature

Recycling (recovery) waste being converted into new products

Composting natural process that speeds up the decay of organic materials

The 3R’S in waste management are

1. R-REDUCE
2. RE-USE
3. R-RECYCLE

SOURCE OF WASTE

 Industrial waste
 Commercial waste
 Domestic waste
 Agricultural waste

Types of waste

Liquid waste
Solid waste
Organic waste
Recycling rubbish
Hazardous

Ways of disposal of waste at home

 Collecting the waste

 Transporting the waste
 Disposing the waste

Types of waste at KTRH

1. General waste

a) Paper

8
 b) Packaging material

c) Food

2. Infectious waste

a) Gauze

b) Dressing

c) Used IV fluid

d) Used gloves

3. Highly infectious waste

a) Anatomical waste

b) Teeth

c) Placenta

d) Pathological waste

e) Sputum container

f) Test tube container

g) Specimen

4. Sharp Waste

a) Infusion set

b) Broken slides

c) Broken vial

d) Lancet

e) Retractable

f) Scapels

g) Blades

h) Needles

i) Broken ampules

9
 Pictures showing waste management and disposal

2.1.4 OCCUPATIONAL HEALTH AND SAFETY (GK PRISON KISII COUNTY)

Occupational health and safety inspection in the workshops e.g carpentry, tailoring, welding
etc. The workers didn’t have personal protective equipments to secure /protect themselves
while working the only equipment they had were aprons.
The workers working in the workshops are inmates who are ready to be rehabilitated to make
their lives better .the inmates are given knowledge and skills on how to use the machines
/how to clean them we identified types of hazards e.g. physical hazards, psychosocial hazard,
biological hazard, mechanical hazard etc.
We educated the supervisors and police in-charge the importance of P.P.E’S in each
workshop.
The carpenters demonstrated to us how to decorate furniture’s e.g. drawing flowers with the
machine
The machine are well maintained
We visited the wards where the floors were clean, the wards were well ventilated, washrooms
were clean.
The kitchen was well ventilated, we did food inspection by testing the food it was well
cooked.
Common kitchen injuries like knife cuts, burns, eye injuries, lifting injuries were encountered
in the kitchen we gave them safety measures and precautions. The store was clean and the
foods were well arranged .No rodents and pests were found inside, proper sanitation is highly
practiced in the kitchen. The floors are always scrubbed.

B) MORTUARY (KTRH) INSPECTION

We did mortuary inspection in Kisii Teaching Referral hospital, when inspecting a mortuary
things you must consider are
 Check whether there is packing area

10
  It must have cooling chambers
 It must have a running water
 The body be clean before taken
 The must be washroom of male and female
 Check the state of the floor
 The floor should be washable e.g. tiles
 The walls will should be smooth
 If the floor is old should be rebuilt
 The hospital should have it its own mortuary
 Ventilation and lighting should be in the mortuary for proper sanitation

Duration of bodies which have no families are kept for 6 months .After the 6 months the body is
announced to the public e.g. police station, radios. The bodies are given 21 days if they have no
families they will bury in the hospital cemetery. KTRH is qualified to obtain bodies.

2.1.5 TUBERCULOSIS (CHEST CLINIC)

Filling presumptive DS TB register

How to write a health record of a client

Default tracing is done to clients

You must have commitment when taking TB drug

Smoking and drinking alcohol is prohibited to TB clients

Phases of tuberculosis

 Intensive face which last two months

 Continuous phase last four months

Signs and symptoms of TB

 Coughing for 3 or more weeks
 Coughing up blood or mucus
 Fatigue
 Fever
 Chills
Side effects of TB
 Stomachache
 Joint paints
 Diarrhea
 Vomiting
 TB can affect brain kidney, spine

The section also deals with skin clinical care

11
The section has two offices one for consultation and the other for pharmacy

DOTS –Directly observed therapy (when being monitored)

They also give clients A.R.V.S drugs

Tuberculosis can make your stomach to swell and legs

Optimistic disease of TB is HIV AIDS, pulmonary tuberculosis which affect the lungs

TB affects every part of the body except hair and nails

When you become stubborn you don’t take the drugs as prescribed you can be jailed

Complications of tuberculosis are

 Spinal pain.
 joint damage
 swelling of the membranes that cover your brain
 liver or kidney problems
 heart disorders

Signs and symptoms of lung cancer are

 Chronic coughing
 Chest pain
 Wheezing sound
 Coughing of blood
 Nail clubbing
 Raspy hoarse voice

Basic treatment regimens of tuberculosis

 An initial treatment
 Continuation phase
 Indicators of tuberculosis

1. Increasing case notification

2. Treatment success rate

3. X-pert utilization

4. RR TB surveillance

5. Health care workers TB screening

6. How to handle medicine when describing them to patients

12
Hemoptysis is coughing of blood /Pleural infusion is also a type of TB.

Managing of side effect of TB is by

1. Eating nutrition food

2. Taking drugs embedded in banana

3. Avoid smoking

2.1.6 PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT)

Folic acid is used to prevent abnormalities to develop to the unborn babies.

Tetanus toxoid vaccine is given to mothers after 16weeks of pregnancy

Iron medicine is given to pregnant mothers to boost the hemoglobin

Focused antenatal care it is the care given to pregnant women from the time she realizes she’s
pregnant until the birth of the baby

The aim of FANC is to ensure the mother and the foetus are in good health, any problem during
pregnancy are realized, treated and referred promptly. (MOH 2004)

The elements of FANC are as follows:

1. To promote and maintain the physical, mental, providing education on Nutrition, personal hygiene
and birthing process.

2. To detect and treat complications arising during pregnancy whether medical, surgical and
obstetrical

3. To ensure that the pregnant woman makes an individual birth plan (IBP)

4. To promote safe delivery at an health baby with minimal stress and injury to the mother and the
baby

5. To help prepare mothers to breast feed successfully, experience normal purperium and take good
care of the child physical, psychologically and socially.

The additional components of FANC include PMTCT in full (prevention of mother to child
transmission of HIV) Intermittent presumption treatment of malaria in the affected regions and
developing of an individual birth plan recommended content of FANC in Kenya are as follows:

a) A pregnant woman should have 4 comprehensive personal services specifically tailored to the
timing.

b) The guidelines also emphasize that each visit should consist of different combination service
appropriate to the timing.

13
1st visit 0-16 weeks .

1. Take history (Bio data subjective.)

2. Physical examination (head to toe) concentration on the breast and abdomen.

3. Look for signs of anaemia.

4 .Screen of syphilis and HIV

5. Give Tt to primigravides or subsequent Tt as per schedule.

6. Give iron and folic acid as supplements.

7. Educate on danger sign and care during pregnancy.

2. 2nd visit 16-28 wks

1. Check on individual birth plan .

2. Physical examination and vital signs

3. Listen for fetal heart sounds

4. Give iron and folic supplements

5. Counsel and educate

6. Give a return data

3rd visit 28-32weeks

1. Check on individual birth plan

2. Give second supplements iron and folate.

3. Give 2nd TT if its aprimi 4 weeks from the first dose.

4. Listen to foetal heart sounds

5. Counsel and educate

4th visit 36weeks and above

1. Update on individual birth plan

2. Look for signs of anaemia.

3. Check for foetal heart sounds and foetal presentations.

4. Give iron and folate

14
5. Counsel and educate

The codes of counseling are follows:

1. Birth plan (where to deliver) transport birth companion save more money for delivery

2. Danger signs e.g vaginal bleeding fits, headache

3. Family planning

4. HIV

5. Supplement feeding e.g iron and folic acid

6. Breast care

7. Infant feeding emphasize on exclusive breast feeding

8. Use of insecticide treated net

Expectant mothers are given free nets when they visit the clinic, when the doctor physically examine
you and can’t detect the position of the baby you will be requested to take am ultra sound

SCHEDULE OF TETANUS TOXOID

1st dose –give to primigravida /first contact

2nd dose-give 4 weeks after TT

3RD dose-give during the second pregnancy any time before 8months of pregnancy

4th dose- give during 3rd pregnancy any time before 8months of pregnancy

5th dose –give during 4th pregnancy give protection for life

In MCH department gather has a different

Meaning

G- Greet her

A- Ask if she has made an individual birth plan

T- Tell her about danger and signs

H- Help her make an individual birth plan

E- Explain about malaria, IPT and treated nets

R- Remind her about danger signs individual birth plan and 4 ANC visit schedule (16weeks 1-
26:26-34 over 34)

15
Antenatal care is done to the mothers

1. Routine examinations during a repeat visit

2. Determine the clients mass

3. Test urine for protein, glucose, ketones

4. Determine blood pressure

5. Abdominal examination fetal heart fundal height lie descent .presentation

6. Examine for oedema, varicose veins DVT

7. Repeat blood tests when indicated HB, RH antibodies

The indicators of fetal well-being are as follows:

1. Increasing material weight corresponding to uterine size and gestation age of fetus

2. Regular pattern of fetal movement from the time they were first felt

3. Fetal heart rate should be between 110-160bpm

Schedule of visits is a minimum of 4 comprehensive individualized visits recommended

1.1st visit less than 16 weeks

2.2nd visit 16-28 wks

3.3rd visit 28-32 wks

4.4th visit 32-36 wks

When you have blood group O and your rhesus is negative you be injected anti D

CARE DURING PREGNANCY

1. Eat one extra meal every day during pregnancy

2. Eat plenty of fruits and vegetables

3. Take iron and folic acid tablets

4. Avoid heavy work and rest more

5. Sleep under an insecticide treated bed net

6. Go for ANC Visit as soon as possible and least 4 times during the pregnancy

16
DANGER SIGNS DURING PREGNANCY

1. Any vaginal bleeding

2. Fits

3. Severe abdominal pain

4. Severe headache

5. Very pale

6. Fever

7. Reduced or no foetal movements

8. Breaking of water

9. Getting tired easily

10. Swelling of the face and hands

11. Breathlessness

If the mother is HIV positive the baby should get prophylaxis (nevirapine and AZT zidovudine )
during breast feeding and HIV test at 6 weeks of age .A HIV Positive couple can get a HIV
negative baby.

2.1.6 CCC DEPARTMENT

It deals with HIV/AIDS and TB drugs Acriptega drug is given to 1st regimen patient (TLD)
fumarate de tenofovin disoproxil et lamivudine comprime given to 2nd regimen patients

MEDICATION USE COUNSELLING CHECKLIST

1. Introduce yourself

2. Identify who is being counseled

3. Check what the client /patient or his/her representative understands how this medication work

5. Ask for the clients and patient questions and concerns

6. Give the name of medicine and describe appearance

7. Name the route of administration

8. Give directions and instructions

9. Give information on the possible drug

10. Give information on the possible drug interactions. (Herbs and other medicine.)

17
11. Check the understanding of the clients /patient or his /her representative by asking them to repeat
back to you key information. Remind them of information they left out.

12. Final check for questions and concerns

Pictures showing abnormalities in children when the mothers don’t take folic acids while pregnant

18
HOW TO REPORT ON POOR QUALITY MEDICINE PRODUCTS

1. Documents the facility details

2. Document product details, brand name, genetic name, batch number, data of manufacture and
expiry, name of manufacturer, name of supplier, product formulation.

3. Describe the complaint e.g broken, discoloration, crumbling, incomplete pack etc

4. Describe the storage conditions of the product

5. State whether the product was dispersed and returned by a patient

6.Write your

1. Name

2. Contact

3. Date of reporting

7. Send the report and appropriate quantity of sample to: DEPARTMENT OF

PHARMACOVIGILANCE AT THE PHARMACY AND POISONS BOARD OF
EVALUATION.

WHAT ARE PrEP AND PEP

PrEP and PEP are medicines to prevent HIV. Each type is used in a different person

1. PrEP –stands for pre-exposure prophylaxis. It is for people who don’t already have HIV but are at
a very high risk of getting it. PrEP is daily medicine that can reduce this risk with PrEP .If you do
get exposed to HIV, the medicine can stop HIV from taking hold and spreading throughout your
body.

2. PEP –stands for post exposure prophylaxis .PEP is for people who have possibly been exposed to
HIV. It is only for emergency situations .PEP must be started within 72 hours after a possible
exposure to HIV.

COMPREHENSIVE CARE CENTRE-Manages in a comprehensive way people living with

HIV through at Multidisciplinary approach to achieve A.R.T goal

SUB –DEPARTMENTS OF CCC

1. Consultation room

2. Reception

3. Pharmacy

4. Laboratory room

19
5. Guiding and counseling

Activities taking in CCC

1. Default tracing

2. HIV testing

3. Guiding and counseling

4. Health monitoring of the patients

5. A.R.V.S

6. Prevention of HIV

7. Taking samples and monitor cd4 PrEP and PEP

2.1.7 NUTRITION
Nutrition is the process of providing or obtaining the food necessary for health and growth.

Nutrition is the study of nutrients in food, how the body uses them and the relationship between diet
health and disease.

Nutritionists use ideas from molecular biology, biochemistry and genetics to understand how
nutrients affect human body.

Nurses have responsibility to ensure that patients and clients nutritional needs are met. Nutritionist
provides nutrition screening and nutrition advice.

Nutritionists transform eating habits by first assessing the health needs and diets of their clients, they
then develop meal plans that improve nutrition, meat budgets and satisfy individuals’ preferences.

QUALITIES OF A NUTRIONIST

1. Have interacting skills

2. Speaking skills

3. Analytical skilss

4. Organization skills

Types of nutritionist

1. Clinical dieticians work in hospital, long term care institutions and other health facilities to
improve patients’ health.

2. Management dieticians-focus on meal programs for cafeterias, hospitals and food corporations.

20
3. Community dieticians –specialized in educating the public and work with specific groups such as
elderly.

2.1.8 FAMILY PLANNING

STEPS INFAMILY PLANNING COUNSELLING.THE GATHER APPROACH

1. G-greet the client

2. A-ask the clients about themselves

3. T-tell them all about family planning methods

4. H-help them to choose a method

5. E-explain how to use method

6. R- appoint a return visit for follow up

Main purpose of family planning is to allow people to attend their desired no of children and to
determine the spacing of their pregnancies.

TYPES OF BIRTH CONTROL

1. The intrauterine device (IUD)

2. Contraceptive pill

3. Vaginal ring

4. The implant

5. Contraceptive patch

6. Emergency morning after” contraception(p2)

Contraceptive methods

1. Barrier methods e.g female condoms diaphragm, cervical cap and contraceptive sponge.

2. Short –acting hormal methods

3. Long –acting hormal methods

4. Sterilization

5. Spermicide or vaginal gel

6. Fertility awareness methods

21
SIDE EFFECTS OF FAMILYPLANNING

1. Menstrual changes –(heavier bleeding a menorrhea/ oligomenorrhea0

2. Changes in weight

3. Dizziness

4. Nausea

5. Headaches

6. Cardiovascular impacts

2.1.9 COMMUNITY HEALTH ENTRY PROCESS

Community entry refers to the process of initiating nurturing and sustaining the desirable
relationship with the purpose of in securing and sustaining the community interest in all aspects of a
program.

Preparations made before entry

1. Form a reconnaissance team which spy.

2. Read about the community, read annual report from DHMT, District Assembly, special report,
disease durance report, newspapers health journals.

3. Collect informal information about the community this is done through interview with individuals
through focus groups discussion, through mapping, contract opinion leaders, through house to house
census.

CRITICAL ACTIONS IN COMMUNITY ENTRY

1. Identify the community by gathering information through formal and informal means.

2. Reading from available literature

3. Talking to knowledge people.

4. Informal sources such as market places, drinking places such as bars, funerals ,festive occasions

5. Identify the leadership

PROCESS IN COMMUNITY ENTRY

1. Knock and enter upon responses

2. First greet the chief and elders. introduce yourself to the chief elders and other local leaders

3. Inform them of your work with them.

4. Ask for their permission and advice state your mission

22
5. Thank them for their cooperation

6. Identify contact person e.g prominent head of families and head of schools.

2.1.11 COMMUNITY STRATEGY

Bringing health services to the people so as people own it and to be empowered.

Process of community strategy

1. Mobilizing the community (going to the chief)

 By knowing the community unit

 The clan elders
 Community own resources
 Holding a baraza

The people of the community choose CHVS and CHC

2.1.12 PUBLIC HEALTH EMERGENCY OPERATION

IDSR-Integrated disease surveillance

IHR-International Health regulation

It deals with covid 19 data, vaccination data, co-ordination, information of sharing, mobilization
of resources for purpose of response public health emergency.

TYPES OF SURVEILLANCE

Active –direct involved

Passive-deal with reports

Sentinel-specific side monitoring data

Importance of surveillance

1. Monitor

2. Policy change

3. Monitoring a location

Explain tools collecting surveillance

1. MOH 505-Weekly reports

2. MOH 502-daily based

3. MOH 503-line listing form

4. MOH 502A –validation form

23
 DISEASE

1. Acute Flaccid paralysis-stool

2. Adverse events following immunization(AEF)

3. Acute malnutrition in children

4. Measles –(blood)

5. Cholera

Covid variants

Alpha

Delta –worst

Challenges of surveillance

1. Poor motivation

2. Unequipped lab

3. Immerging and emerging diseases

4. Rivalry between departments

5. No funds

6. Lack of sensitization and new materials.

2.1.13 WASTE TRATMENT PLANT

Manual work is done during the treatment to release waste

Scales helps to prevent overflow of water

Flow meter helps to know the consumptive flow of water

A) ANAEROBES PONDS

Water takes 28days before released

That is removed using rakes to prevent clogging

B) FACULTATIVE PONDS

Dug 1.8m deep for easy operation

It dissolves oxygen

Water rakes 28 days

24
Workers are vaccinated before doing the work which prevents common diseases e.g typhoid and
cholera

C) MATURATION POINT 1

There is algae formation

More dissolved oxygen where some organisms can survive

Dug 1.8 deep

Sludge settles

Pictures showing sewer treatment plant

25
 CHAPTER THREE

3.0 SUMMARY, CONCLUSION AND RECOMMENDATIONS

3.1 SUMMARY
In the course of my attachment I learnt that COMMUNITY HEALTH is made up of many
ACTIVITIES which involve many people in the community’ that offers community health services.
It also involves linking health facilities with clients which improves the health of individual .the
public health is like the backbone of the organization since nearly all the department relies on it, so it
should be handled with seriousness it deserves by all parties that are concerned for it to be
successful.

Persons working in the public health department need to have a lot of skills and knowledge in order
to carry out the assignments that are undertaken in the public health department. In addition to that
the department needs to be very carefully since most of the corruption cases usually originate from
the public health department, hence persons working in the department needs to be honest and
dedicated to their work.

3.2 CONCLUSION
In conclusion I would like to stress that public health department is very vital to organization for it to
function smoothly. The success of any organization depends entirely on how efficient its
procurement department is. For me I have acquired a lot of valuable skills and information that will
make me confident in discharging my duties in the career. Public health department needs to have
people who are well educated and honesty is the most important thing for anyone to discharge his
duty without fear or favors.

The public health department in KTRH needs to be upgraded to fit the modern technology in Public
health that is embracing the community to access health services in hospitals and not going to
midwives and native doctors by use of new Technology the health sector will upgrade.

26
3.3 RECOMMENDATIONS

After acquiring vast experience during field attachment

They need to build a well and big room which can accommodate all students that needs to
be attached in the department. In the issuing side they need to have specific months for
receiving students so as to give the personnel working in the department time to organize
themselves and this will give room for good organization in the department.

I recommend that KTRH should widen their room to allow more students to try and get chance to the
institution.

27