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Approved by the Government of Nepal, Ministry of Education
Curriculum Development Centre (CDC), Sanothimi, Bhaktapur, Nepal.
HEALTH, POPULATION
AND ENVIRONMENT
EDUCATION
Revised and Updated Edition
Grade
Author
10
Ram Kumar Rai
Published by
TU Road, Kuleshwor, Kathmandu, Nepal

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PREFACE
This book has been prepared as a text book according to the latest curriculum of
Health, Population and Environment Education for grade 10 approved by the
Curriculum Development Center (CDC), the government of Nepal and covers all the
contents of the Syllabus.
In this revised edition, every possible effort has been made to present the subject
matter in easy, clear, lucid and systematic manner as far as possible. It is hoped
that this book meets the objectives set forth by the national curriculum and fulfills
the requirement of the students of grade 10. The text is divided into ten units as
prescribed by the curriculum.
I hope that the activities and project works provided in each chapter help the
students foster their inherent strength and enable them to identify the problems
prevailing in the society and come forward for their measures. At the same time, I
believe that a sample of project work provided at the end of this book will certainly
help the students to carry out research works for the practical exam. Moreover,
simple language, updated data, illustration with pictures and diagrams will make the
text more readable and adds to its utility.
I would like to express my heartfelt regards to the Readmore Publishers and

Distributors who supported in every step while preparing this book.
Last but not least, I also put forward my sincere regards to the layout designers Sameer
Shakya and Sunil Maharjan for their skillful hands for creative designing.
I also apologize for any error or discrepancy despite the sincere efforts that has been
made to make the book credible as far as possible.
Lastly, I humbly request all the colleagues, students, subject teachers and well-wishers
to provide valuable and constructive suggestions and feed back.
- Author
Table of Contents Pages
UNIT 1 CONCEPT OF HEALTH, POPULATION AND ENVIRONMENT EDUCATION....................7
1.1 Various Aspects of Health, Population and Environment....................................................................7
1.2 Interrelationship of Health, Population and Environment Education in Terms of Various Aspects.......9
UNIT 2 DEMOGRAPHY, POPULATION CHANGE AND MANAGEMENT......................................15

2.1 Demographic Components, Process and Measurements....................................................................15
2.1.1 Introduction...............................................................................................................................................15
2.1.2 Demographic Components........................................................................................................................16
2.1.3 Demographic Process................................................................................................................................16
2.1.4 Demographic Measurements....................................................................................................................16
2.2 Consequences of Rapid Population Growth.......................................................................................38
2.2.1 Consequences of RPG on Environmental Aspect...................................................................................... 38
2.2.2 Consequences of RPG on Socio-economic Aspect....................................................................................41
2.3 Population Management...................................................................................................................46
2.3.1 Methods of Population Management.......................................................................................................47
UNIT 3 POPULATION, ENVIRONMENT AND DEVELOPMENT..................................................68

3.1 Population, Environment and Development Activities.......................................................................68
3.2 Regional Balance in Development......................................................................................................73
3.3 Sustainable Development..................................................................................................................75
3.3.1 Importance of Sustainable Development..................................................................................................75
3.3.2 Objectives of Sustainable Development....................................................................................................76
3.3.3 Principles of Sustainable Development.....................................................................................................77
3.3.4 Application of Sustainable Development..................................................................................................79
UNIT 4 POPULATION AND ENVIRONMENTAL STATUS OF NEPAL..........................................82

4.1 Population Distribution by Ecological Region.....................................................................................82
4.2 Concept of Ecosystem........................................................................................................................83
4.2.1 Ecosystem of Nepal by Geographical Region.............................................................................................84
4.3 Effects on Ecosystem by Ecological Regions and Mitigating Measures................................................94
4.3.1 Effects on the Ecosystem of Mountain Region and Mitigating Measures..................................................94
4.3.2 Effects on the Ecosystem of Hilly Region and Mitigating Measures..........................................................96
4.3.3 Effects on the Ecosystem of Terai Region and Mitigating Measures..........................................................98
4.4 Management and Conservation of Environment................................................................................99
4.4.1 Major Activities on Environment Conservation and Management...........................................................100
UNIT 5 FAMILY LIFE EDUCATION AND QUALITY OF LIFE......................................................105

5.1 Concept of Quality of Life and its Components...................................................................................105
5.1.1 Introduction to Quality of Life...................................................................................................................105
5.1.2 Need and Importance of Quality of Life....................................................................................................108
5.1.3 Elements of Quality of Life........................................................................................................................110
5.2 Bases of Quality of Life......................................................................................................................114
5.3 Happy Life Indicators.........................................................................................................................117
5.4 Interrelationship between Quality of Life and Low Quality of Life......................................................120
UNIT 6 NATURAL RESOURCES AND BIODIVERSITY..............................................................125

6.1 Concept of Biodiversity......................................................................................................................125
6.1.1 Ecosystem Diversity...................................................................................................................................127
6.1.2 Species Diversity........................................................................................................................................127
6.1.3 Genetic Diversity.......................................................................................................................................129
6.1.4 Importance of Biodiversity........................................................................................................................129
6.1.5 Need of Conservation................................................................................................................................132
6.1.6 Conservation Measures of Biodiversity.....................................................................................................134
6.2 Biodiversity of Ecological Belt............................................................................................................136
6.3 Rare Animals and Plants....................................................................................................................138
6.3.1 Introduction of Rareness of Plants and Animals........................................................................................138
6.3.2 Common Causes of Rareness of Plants and Animals.................................................................................138
6.4 Adverse Effects of Human Activities on Biodiversity and Conservation Methods................................157
6.5 National and Local Level Biodiversity Conservation Programs............................................................158
UNIT 7 ENVIRONMENTAL HEALTH AND DISEASES................................................................167
7.1 Introduction to Communicable and Non-communicable Disease........................................................167
7.1.1 Concept of Disease....................................................................................................................................167
7.1.2 Types of Disease........................................................................................................................................168
7.2 Some Major Communicable Diseases.................................................................................................170
7.2.1 Food and Water Borne Diseases................................................................................................................170
7.2.2 Air-borne Disease......................................................................................................................................175
7.2.3 Diseases Transmitted by Contaminated Needles......................................................................................176
7.3 Non-Communicable Disease..............................................................................................................178
7.3.1 Causes or Risk Factors of Non-communicable Diseases............................................................................179
7.3.2 Some Non-communicable Diseases..........................................................................................................180
7.4 Environmentally Infectious Diseases..................................................................................................188
UNIT 8 ADOLESCENCE, SEXUAL AND REPRODUCTIVE HEALTH EDUCATION........................194

8.1 Some Major Sexually Transmitted Infections (STIs)............................................................................194
8.1.1 HIV and AIDS.............................................................................................................................................194
8.1.2 Syphilis.......................................................................................................................................................198
8.1.3 Gonorrhoea...............................................................................................................................................200
8.1.4 Chanchroid ...............................................................................................................................................201
8.2 Safe Motherhood...............................................................................................................................201
8.2.1 Introduction to Safe Motherhood.............................................................................................................201
8.2.2 Education and Health Service Related to Safe Motherhood.....................................................................202
8.3 Maternal and Child Health Care and its Measures..............................................................................206
8.3.1 Introduction and Importance of Maternal and Child Health Care.............................................................206
8.3.2 Maternal Child Health Care.......................................................................................................................207
8.3.3 Infant and Child Health Care.....................................................................................................................211
UNIT 9 CONSUMER HEALTH AND COMMUNITY HEALTH........................................................217

9.1 Concept of Community Health...........................................................................................................217
9.1.1 Introduction to Community Health...........................................................................................................217
9.1.2 Importance of Community Health.............................................................................................................219
9.1.3 Scope of Community Health......................................................................................................................221
9.2 Health Service Providing Agencies and their Activities.......................................................................223
9.2.1 Introduction...............................................................................................................................................223
9.2.2 Health Service Providing Agencies of Nepal..............................................................................................225
9.2.3 Voluntary Health Agencies........................................................................................................................231
9.2.4 Major Health Problems of Nepal...............................................................................................................236
9.3 Policies and Programs of Health Sector..............................................................................................240
9.3.1 Policies of Health Sector............................................................................................................................240
9.3.2 Major Programs in Health Sector..............................................................................................................243
9.4 Bad Habit, Its Consequences and Preventive Measures......................................................................249
9.4.1 Introduction...............................................................................................................................................249
9.4.2 Consequences of Bad Habit.......................................................................................................................250
9.4.3 Preventive Measures from Bad Habit........................................................................................................250
9.5 Smoking, Drugs and Alcoholism.........................................................................................................251
9.5.1 Smoking.....................................................................................................................................................251
9.5.2 Alcohol.......................................................................................................................................................253
9.5.3 Drugs.........................................................................................................................................................255
UNIT 10 PRIMARY HEALTH CARE, PRECAUTION AND SECURITY ON RISK.............................261

10.1 Methods and Procedure of First Aid...................................................................................................261
10.1.1 Meaning of First Aid..................................................................................................................................261
10.1.2 Importance of First Aid..............................................................................................................................262
10.1.3 Points to be Considered by the First Aider.................................................................................................262
10.1.4 First Aid Box...............................................................................................................................................262
10.1.5 Major Methods of First Aid.......................................................................................................................263
10.1.6 Some Accidents and its First Aid Methods................................................................................................265
10.2 Human Health and Safe Lifestyle........................................................................................................275
10.2.1 Human Health...........................................................................................................................................275
10.2.2 Safe Life Style.............................................................................................................................................279
GRID....................................................................................................................................282-283
A SET OF MODEL QUESTION............................................................................................... 284-285
A SAMPLE OF PROJECT WORK............................................................................................ 286-296
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UNIT
CONCEPT OF HEALTH, POPULATION
1 AND ENVIRONMENT EDUCATION
Learning Achievement
After completing this unit, students will be able to:
Explain the various aspects of health, population and environment.
Describe the interrelationship among different aspects of health, population and
environment.
1.1 Various Aspects of Health, Population and Environment

Health, Population and Environment Education is a multidisciplinary subject. Due to
its interdisciplinary nature; the subject matters related with various aspects of human
life can become the scope of this subject. The subject matters and various aspects
that are related with this subject are considered as the aspects of Health, Population
and Environment Education. Those associated aspects are explained below:
A. Physical Aspect
Physical aspects include natural and man-made things. Natural physical aspects like
air, water, temperature, soil, rocks, climate, etc are created by the nature. On the
other hand canal, water taps, buildings, bridges, roads, hospitals, industries, schools,
etc are man-made physical aspects. The quantity and quality of physical aspects
make a great difference in the survival of living beings. People prefer to live in those
places where more physical facilities are available. Investment in physical aspects like
hospitals, power plants, canal, roads and transport system can promote the health
and well being of the population.
B. Biological Aspect
Various aspects of health, population and environment are influenced by the biological
factors of the environment. The degree of quality of life is determined by the richness
of biological resources of that place. People get their foodstuffs and other various
kinds of life supporting materials from them.
Besides this, biological aspect contributes to maintain sound health and keep the
environment clean and healthy. Similarly, it helps to improve living standard of the
people through proper utilization of the biological resources in various sectors like
agriculture, industries, trade and other socio-economic sectors. At the same time, we
Health, Population and Environment Education-10 7

have to pay proper attention to bring balance between their utilization and proper
management.
C. Socio-cultural Aspect
People have created social and cultural norms, values as well as rules and regulation.
Social customs, traditions, rituals, festivals and religious practices are some examples
of socio-cultural aspects. Different aspects of health, population and environment are
interrelated with socio-cultural aspects. The customs, festivals, religious practices,
food habits and way of living affect the health and environment. It is necessary to
build up such tradition and culture not to affect the environment adversely. So, people
should celebrate their socio-cultural practices without affecting the environment.
This will definitely help to protect the environment.
D. Economic Aspect
The economic aspect is directly related with various aspects of health, population
and environment. All areas of health, population and environment will be adversely
affected by the poor economic condition of the nation. All kinds of economic activities
depend upon the environment. For example, industries, factories, pharmaceuticals,
agriculture, etc need raw materials from the environment. It helps to boost up
the economic status of the family, community and the nation. On the other hand,
poor economic condition spoils the health and productivity of the people. Besides
it, the rapidly growing population causes economic problems and environmental
degradation side by side.
E. Science and Technological Aspect
Science and technology are the outcomes of human innovation. They are the
significant means of development process. It has made the world a small place and
human life productive and comfortable. There is unbelievable development in the
field of medicine, communication, transportation, education and agriculture and
conservation sectors with the contribution of science and technology. The proper
utilization of benefits by science and technology makes human life comfortable and
productive. On the other hand, misuse of boon of science and technology ruins the
civilization and existence of the world. The aforementioned point maintains that
Health, Population and Environment Education are interrelated on the ground of
science and technology.
F. Political Aspect
Political aspect includes the plans and policies launched by the high political level or by
state administration and the government agencies. The plans, policies and programs
in relation to health, population and environment are formulated by the political will
in broad term. Political commitment is felt mandatory to execute health, population
8 Health, Population and Environment Education-10
and environment related programs in an effective way. If there is high level of political
will, there is less chance of misuse of health services, over exploitation of resources
and encroachment in the conservation areas. At the same time, preservation and
rational utilization of resources is possible.
G. Psychological Aspect
Psychological aspect represents feelings, attitude, understanding and behaviour of
the individuals. They are directly related with Health, Population and Environment
Education. The will power of the people will provide motivation to conserve
environment and promote overall health condition of the mass population.
Programs and policies cannot be effective until and unless people are willing
to participate from their heart in the conservation plans as well as population
management programs. Hence, we can conclude that Health, Population and
Environment Education are directly interrelated through psychological aspects.
1.2 Interrelationship of Health, Population and Environment
Education in Terms of Various Aspects
Since Health, Population and Environment Education are interrelated, they are
integrated and introduced as a single subject. Due to its interdisciplinary nature,
change in contents of one subject affects the other subjects. For examples: rapid
population growth adversely affects the various aspects of Health and Environment
education. At the same time, degraded environment causes healthy living and quality
of life almost impossible.
Proper management of population leads to healthy and prosperous life. Health,
Population and Environment education are supplementary to each other in terms of
various aspects such as physical, biological, socio-cultural, science and technological
aspects and so on. Due to the inter-relationship among health, population and
environmental education, they are introduced as an integrated subject. If there is
any change in one of the associated subjects, the remaining two subjects are also get
affected. As for example, rapid population growth and unmanaged population affect
the health and environmental aspect.
Moreover, the decline in environmental aspect makes it difficult to live healthy life. On
the other hand, if healthy environment can be preserved, then there will be positive
effect on population and health. In the same way, if the population can be properly
managed there will be positive effect on the health and environment. In this way,
all these subjects have become complementary to one another. Health, population,
and environment education are interrelated with one another and the study of this
subject helps to create a healthy, active, and safe society. Health, Population and
Environment Education are related with the following aspects of human life:

Biological
Aspect
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So Asp ct
Population
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Science al
En
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Techno t
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Physical
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Fig- 1: Interrelationship of Health, Population and Environment Education in terms of

Various Aspects
A. Relation of Physical Aspect with other Aspects

Physical aspects include natural and man-made things. Natural aspects like air, water,
temperature, soil, rocks, climate, etc are created by the nature. On the other hand
canal, water taps, buildings, bridges, roads, hospitals, industries, schools, etc are
man-made physical aspects. The quantity and quality of physical aspects make a great
difference in the survival of living beings. For example; people prefer to live in those
places where more physical facilities are available. Investment in the physical aspects
like hospitals, power plants, canal, roads, transport system, etc increases population
density of that place. At the same time, the sound condition of physical aspect helps
to ensure quality of life. Proper utilization of physical aspects plays an important role
in the conservation of environment and regulation of ecological processes. In fact,
physical aspect is related with environment, health and population.
B. Relation of Biological Aspect with other Aspects
The availability of biological resources of a place determines the environment and
health of the people. For instance, people get their foodstuffs and other various kinds
of life supporting materials from the biological resources. The status of the biological
resources are also determined by the physical, socio-cultural, and other various
aspects. The biological aspect supplies food, oxygen and so many things to the people
and helps to promote their health condition. At the same time, presence of abundant
vegetation make positive contribution in the balance of ecosystem. The living standard
of the people can be raised through proper utilization of the biological resources in
various sectors like agriculture, industries, trade and other socio-economic sectors.
So, we can say that biological aspect is directly or indirectly related with other various
aspects of health, population and environment.
C. Relation of Socio-Cultural Aspect with other Aspects
People have created social and cultural norms, values, as well as rules and regulation.
Social customs, traditions, rituals, festivals and religious practices are some examples
of socio-cultural aspects. The socio-cultural aspects are interrelated with biological,
political, physical and other various aspects of health, population and environment
education. The customs, festivals, religious beliefs, traditions, culture, etc determine
the health and environmental status of a place. For instance, our way of living,
food habits and other social behaviours are more or less influenced by the climate,
vegetation, economic status, etc. It is our need to build up such a social system
so that we can protect our environment, improve our health and manage the
population. People should celebrate their socio-cultural practices without affecting
the environment. This kind of social behaviour definitely help to establish cordial
relationship with other aspects of health, population and environment.
D. Relation of Economic Aspect with other Aspects
The economic aspect is directly related with various aspects of health, population
and environment. The rapid population growth creates unemployment problem.
Unemployment may invite the consequences like poverty, malnutrition, ill health
and low productivity. In this situation, people are compel to over exploit the forest
resources, marginal land, including other resources of the environment. These
activities definitely causes degradation in the environment. The degraded environment
eventually affects human health adversely. So, it is our responsibility to establish
proper coordination between economic and other various aspects of environment,
health and population.
E. Relation of Science and Technical Aspect with other Aspects
Science and technology are human innovations. They are the significant means of
development process. It has made the world a small place and human life productive
and comfortable. If there is proper utilization of science and technology it brings
positive impact on health, population and environment. It is possible to make an
unprecedented progress in the field of social, economic, political and biological
aspects. It makes human life easy and productive. For instance, there is remarkable
development in the field of medicine, communication, transportation, education,
agriculture, industrialization and conservation sectors with the contribution of science
and technology. However, misuse of science and technology ruins the civilization and
development process. It damages the ecological balance, degrades human health and
civilization. You can imagine the consequences of atomic and biological weapons in the
war. The aforementioned point maintains that Health, Population and Environment
Education are interrelated to one another on the ground of science and technology.
F. Relation of Political Aspect with other Aspects
The political parties forms the government. They formulate national plans and
policies in the area of health, population, environment and other various sectors.
If those plans and policies are good then it will contribute in the conservation of
environment, population management and upliftment of the human health. The
policy and program of the government to provide basic health services to the citizen
free of cost definitely help to improve the health condition of the people. Similarly,
the appropriate environmental policy helps to protect the forest resources and other
environmental resources. Political commitment is crucial to execute the health,
population and environment related programs in effective way. If there is high level
of political will, it is possible to manage population, conserve the environment and
improve the health status of people in the nation. In fact, political aspect is also
related with other various aspects of health, population and environment.
G. Relation of Psychological Aspect with other Aspects
The perception, attitude and behaviour are associated with psychology of an
individual. Human psychology plays an important role in the learning process of
health, population and environment education. The positive psychology will provide
motivation to the individuals for the conservation of environment and to promote the
overall health condition of the population. Similarly, people with positive perception
are always motivated for the management of population in a family, community and
the national level. Programs and policies cannot be effective until and unless people
are willing to participate in the environment conservation as well as population
management programs. Hence, we can say that Health, Population and Environment
Education are interrelated to one another through psychological aspects too.
Activity
There is a wetland nearby a Lohorung Rai community. There are more than 90
species of flora and fauna in that wetland. The farmers of the nearby area use water
of that wetland for irrigation. There was enough water in the past but the wetland
is drying out nowadays. What sorts of impact will be there on health, population
and environment of that locality and what measures can be adopted to protect that
precious wetland. Prepare a report and present it in your class.

Summary
Ü Health, Population and Environment Education is a multidisciplinary subject. Due

to its interdisciplinary nature; the subject matters related with various aspects of
human life can become the scope of this subject.
Ü The subject matters and various aspects that are related with this subject are
considered as the aspects of Health, Population and Environment Education.
Ü Natural physical aspects like air, water, temperature, soil, rocks, climate, etc are
created by the nature.
Ü Canal, water taps, buildings, bridges, roads, hospitals, industries, schools, etc are
the examples of man-made physical aspects.
Ü Proper utilization of physical aspects plays an important role in the conservation
of environment.
Ü Social customs, traditions, rituals, festivals and religious practices are some
examples of socio-cultural aspects.
Ü Our way of living, food habits and other social behaviours are more or less influenced
by the climate, geographical structure, vegetation, economic status, etc.
Ü The economic aspect is directly related with various aspects of health, population
and environment.
Ü Political aspect includes the plans and policies launched by the administration
and the government.
Ü If there is high political will, there is less chance of misuse of health services, over
exploitation of resources and encroachment in the conservation areas.
Ü Health, Population and Environment education are supplementary to each other
in terms of various aspects such as physical, biological, socio-cultural, science and
technological aspect.
Ü Health, population, and environment education are interrelated with one
another, and the study of these subjects helps to create a healthy, active, and
safe society.
Ü The living standard of the people can be raised through proper utilization of
the biological resources in various sectors like agriculture, industries, trade and
other socio-economic sectors. So, we can say that biological aspect is directly
or indirectly related with other various aspects of health, population and
environment.
Ü The proper utilization of science and technology brings positive impact on health,
population and environment. It makes human life easy and productive.
Ü Human psychology plays an important role in the learning process of health,
population and environment education.
Ü Programs and policies cannot be effective until and unless people are willing to
participate from their heart in the environment conservation as well as population
management programs.
EXE RC IS E
A. Very short answer questions.
1. What is meant by physical aspect of environment?
2. In what aspect of health, population and environment does the plan, policy
and law fall under?
3. What is meant by psychological aspect of health, population and environment?
4. Give any two examples of science and technological aspect of Health,
Population and Environment.
5. Mention the role of economic aspect in Health, Population and Environment
Education in one sentence.
B. Short answer questions.
1. Illustrate the relation of science and technology in health, population and
environment education.
2. List down the various aspects of health, population and environment and
explain any one.
3. Explain the biological aspect of health, population and environment with
suitable examples.
C. Write short notes on:
1. Socio-cultural aspect of environment
2. Relation of economic aspect with other aspects
D. Write differences:
1. Biological and physical aspect of environment
2. Social and economic aspect of health, population and environment
E. Long answer questions.
1. Explain the interrelationship among Health, Population and Environment
Education in terms of various aspects.
2. Explain the various aspects of health, population and environment with the
help of a diagram.
Project Work
Visit a place nearby your school and observe the biological, socioeconomic and
physical aspects of that place. Write a report analyzing the interrelationship of those
aspects among one another and discuss in your class.

UNIT
DEMOGRAPHY, POPULATION
2 CHANGE AND MANAGEMENT
Introduce demographic components, process and measures.
Measure fertility rates, mortality rates and migration rates.
Measure rate of natural increase, population doubling time, sex ratio and
dependency ratio.
Elaborate the consequences of rapid population growth on socio-economic and
environmental aspects.
Explain the various methods of population management.
Explain the various kinds of contraceptive devices with their merits and demerits.
2.1 Demographic Components, Process and Measurements

2.1.1 Introduction
Demography is the scientific study of human population. John Graunt is the first person
who examined the trend of mortality and fertility from the death record maintained
by the churches in London in his famous book ‘Natural and Political Observation
Made upon the Bills of Mortality’ in 1662 AD. This work has been considered as the
start of population study. So, the credit for initiating population studies goes to him.
Therefore, he is also called as father of Demography or Population Study.
Achille Guillard is the first person to use the term Demography. He used the term
Demography in 1855 AD in his book “Elements of Human Statistics or Comparative
Demography” by combining the two Greek words ‘Demos’ and ‘Graphia’. In
Greek word, ‘Demos’ carries the meaning people and ‘Graphia’ meaning to study.
Demography can be defined as the statistical and scientific study of population size,
composition, distribution and change therein.
Population of an area always changes over the time period because it is a dynamic
phenomenon. Population change is brought about by the change in the rate of fertility,
mortality and migration, in which fertility adds to the population size while mortality
subtracts from it. Similarly in-migration and immigration add to the population
whereas out-migration and emigration subtract from it. However, when the world
population is concerned, migration neither adds nor subtracts but merely redistribute
the existing population. Hence, it can be said that population of an area is the function
of birth, death and migration. These components are also known as determinants
of population change. Of these three components, fertility has the most influencing
strength in affecting population change. Migration on the other hand, is not universal
so far.
Fertility and mortality are natural process. Migration is also a demographic process
in which people move from less prosperous areas to more prosperous areas for
the betterment of life. We know that birth is related to fertility, death to mortality
and migration is related to mobility process. The process like fertility, mortality and
migration are called demographic process.
Table 2.1: Demographic Components, Process and Measures
Demographic
Components Process Measures
• Birth • Fertility • Fertility Rates: CBR, GFR, ASFR, TFR
• Death • Mortality • Mortality Rates: CDR, ASMR, IMR, CMR, U5MR
• Migration • Migration • Migration Rates: I-MR, O-MR, NMR, GMR
Source: Health, Population and Environment Education, Class 10, CDC, GoN, 2074 BS
2.1.2 Demographic Components

The factors changing the population size are termed as demographic components.
Birth, death and migration are considered as demographic components since they
are the determining factors of population change. For instance, birth increases the
population size while population is decreased by death. Incoming migration causes
increase in population size and outgoing migration causes surplus in the size of
population. Therefore, the size of population is determined by the demographic
components like birth, death and migration.
2.1.3 Demographic Process

There are various process to bring the change in population situation. Fertility,
mortality and migration are considered as demographic process. Fertility is related
with population growth and mortality with depopulation. Similarly, migration is
related with population change due to incoming and outgoing phenomena. The study
of demographic process (fertility, mortality and migration) deals with the population
size, structure and its distribution pattern. Fertility, mortality and migration are the
ongoing demographic process resulting in population as a dynamic phenomenon.
2.1.4 Demographic Measurements

The study of pattern and change in the demographic phenomena over the time period
through statistical or mathematical calculation is called demographic measurements.
The level and trend of fertility, mortality and migration over the time period are
measured through demographic measurements. Hence, demographic measurements
are carried out with the help of various statistical or mathematical formula. For
instance, birth, death and migration measurements are mathematically measured by
fertility rates, mortality rates and migration rates respectively. Demographic measures
are very useful for the analysis of the size, composition and distribution of population
of the given place over the certain time period. It is an important tool for studying
population situation on various aspects.
Table 2.2: Fertility, Mortality and Migration Rates
Fertility Rate Mortality Rate Migration Rate
M Crude Birth Rate (CBR) M Crude Death Rate M In-migration Rate
M General Fertility Rate (CDR) (IMR)
(GFR) M Age Specific Death M Outmigration Rate
M Age Specific Fertility Rate (ASDR) (OMR)
Rate (ASFR) M Infant Mortality Rate M Net Migration Rate
M Total Fertility Rate (IMR) (NMR)
(TFR) M Child Mortality Rate M Gross Migration Rate
(CMR) (GMR)
A. Measures of Fertility
The study of human fertility occupies a vital position in the study of population
dynamics for several reasons. Thus, in population dynamics, fertility is a positive
force, through which the population expands. Fertility, is a process of giving birth to
baby by a woman. It is also called reproduction. Usually, the period between 15-49
years of women is considered as the reproductive period.
Sometimes the words “fertility” and “fecundity” are used synonymously but
the meaning is quite different. For instance, fertility can be defined as ‘the actual
reproductive performance of a woman or a group of women’. So, a woman is
considered fertile if she had ever born any child otherwise she is considered as an
infertile woman. Fertility is determined by social, cultural, psychological as well as
economic factors. The fertility of the individual are limited by their own fecundity
strength.
Fecundity refers to “the capacity of a man and a woman, or a couple to participate in
reproduction”. In other words, fecundity is a biological capacity of a woman, man or a
couple to have children. It is a child bearing capacity and has no reference to whether
or not a woman actually has given birth to a child. It can be defined as: the biological
potential and physiological capacity to participate in reproduction. The absence of
this potential is called infecundity.

Difference between Fecundity and Fertility
Fecundity Fertility
Ü It is the biological capacity to Ü It is the actual performance of
participate in reproduction process. reproduction.
Ü It is related with both of the male Ü It is related with a woman or group
and female. of women only.
Ü All fecund women are not fertile. Ü All fertile women are fecund.
Ü It does not directly affect Ü It directly affects population growth
population growth rate. rate.
Ü It cannot be counted in number. Ü It can be counted in number.
Ü It is the foundation of fertility. Ü It is the outcome of fecundity.
1. Crude Birth Rate (CBR)
Crude Birth Rate is the most common and easily computed measure of fertility. It is
the total number of live births per 1000 midyear population of a given place for the
specified year. It is customary to say crude birth rate since it cannot measure actual
fertility rate due to the placement of total midyear population in the denominator
where only a small portion of that population involve in the fertility process. The CBR
of Nepal according to the Demographic and Health Survey 2011 AD was 24.3. It can
be computed with the following formula:
CBR = B P x 1,000
Where,
B Ü Total number of live births during the given year
P Ü Total mid-year population of the same year
CBR Ü Crude Birth Rate
Merits of Crude Birth Rate (CBR)
It is the most easily computed and easily understood measurement of fertility.
Only the data of total live births and total midyear population are required.
It simply helps to analyze the trend of fertility level for different time period.
Demerits of Crude Birth Rate (CBR)
It is merely a crude measurement of fertility.
It is not effective to compare the fertility levels between the countries or regions.
It is highly affected by the sex-age composition of the population.
Example
Suppose, the total mid-year population of Itahari sub-metropolitan city in 2015 AD
was 2,20,000 and the total live births during the same year was 6,000. Calculate
Crude Birth Rate.
Solution
Given,
Mid-year population (P) = 2,20,000
Total live births (B) = 6,000
Crude Birth Rate (CBR) = ?
We know that
CBR = BP x 1,000
6,000
= 2,20,000 x 1,000
= 27.27
\ The CBR of Itahari sub-metropolitan city in 2015 AD was 27.27 per 1000 Midyear
population.
[Computation Procedure of Midyear Population]
Midyear population is considered as the total population of a given place at the mid
of the year. It can be calculated by the two alternative methods as given below:
i: (First Method)
In this method, the midyear population can be computed by enumerating the total
population of the country or the defined territory on the 1st day of the 7th month of
specified year (i.e. July 1st according to the English Calendar).
Example
The population of Singapore on July 1st, 2012 AD was 5.2 million. This population itself
is the midyear population for that reference year.
ii: (Second Method)
In this method, the midyear population is calculated by taking average of the total
population of the 1st day and the last day of a given year. It can be computed by
applying the formula that is given below:
Po + P t
P=
2
Where,
P Ü Total midyear population of the specified year
P0 Ü Total population of the 1st day of the given year (initial population)
Pt Ü Total population of the last day of the same year (succeeding population)
Example
Suppose, the total population of a country was 22,60,00,000 on January 1st
2012 AD and 23,20,00,000 on 31st December in the same year. Calculate the midyear
population of that country.
Solution
Given,
Total population of the 1st day of the given year (P0) = 22,60,00,000
Total population of the last day of the same year (Pt) = 23,20,00,000
Mid-year population (P) = ?
We know that
Po + Pt
P= 2
22,60,00,000 + 23,20,00,000
= 2
= 22,90,00,000
\ The Midyear population of that country in 2012 AD was 22,90,00,000.
2. General Fertility Rate (GFR)

General fertility rate is the total number of live births per 1,000 midyear women’s
population of the reproductive period. It is a refined measurement of fertility over
the Crude Birth Rate because it is calculated by dividing the total number of live births
by the midyear population of the women in reproductive period and multiplied by
1,000. The GFR of Nepal according to the Demographic and Health Survey 2011 AD
was 96. It is computed by the following formula:
B
GFR = x 1,000
P (15-49)
f
Where,
GFR Ü General Fertility Rate
B Ü Total number of live births
Pf(15-49) Ü Total mid-year population of the women in the reproductive period (15-49
years)
Example
In Nepal, according to 2001 AD census, the total number of live births were recorded
7,66,314 and midyear female population of reproductive period during the same year
was 56,02,160. Calculate General Fertility Rate.
Solution
Given,
Total number of live births (B) = 7,66,314
Total midyear female population of the reproductive period Pf(15-49) = 56,02,160
General Fertility Rate (GFR) = ?

Now,
B
GFR = x 1,000
P (15-49)
f
7,66,314
= x 1,000
56,02,160
= 136.8
\ GFR of Nepal in 2001 AD was 136.8 per 1,000 midyear women population of child
bearing period.
3. Age Specific Fertility Rate (ASFR)

Age Specific Fertility Rate is the total number of live births per 1,000 Midyear female
population of a specific age group of the reproductive period. It is calculated on
the basis of interval of five years age group of women in reproductive period. It is
believed that women in all age groups do not have the same level of reproductive
performance. ASFR also makes possible to calculate total fertility rate and helps to
study fertility differentials of women by age groups even within the reproductive
period. Age Specific Fertility Rate can be calculated with the following formula:
B
ASFR = fa x 1,000
Pa
Where,
Ba Ü Total number of live births given by women of specific age group ‘a’
Pfa Ü Total mid-year female population of the same age group ‘a’
Table 2.3: Calculation of ASFR of Nepal (1991 AD)
Number of Women Number of Live (Ba)

Age Group ASFR = x 1000
by Specific Age (Pfa) Birth (Ba) (Pfa)
(3)
(1) (2) (3) (4) = x 1000
(2)
15-19 9,14,792 86,877 95
20-24 8,57,484 2,45,240 286
25-29 7,26,141 1,97,510 272
30-34 6,01,962 1,27,616 212
35-49 5,11,018 77,164 151
40-44 4,32,727 33,320 77
45-49 3,69,800 10,074 28
Source: Rai R. K., HPE Education, Class 10, 2015 AD

Example
If the total number of mid-year female population of the age group 25-29, in a VDC
in 2010 AD was 50,000 and the total number of live births given by the women of the
same age group during the same year was 6,000. Calculate ASFR.
Solution
Given,
Total number of live birth given by the age group (B 25-29) = 6,000
Total mid-year female population of that age group (Pf 25-29) = 50,000
Age specific fertility rate (ASFR) = ?
We know that
B
ASFR = fa x 1,000
Pa
B(25-29)
= f x 1,000
P (25-29)
6,000
= x 1,000
50,000
= 120
\ ASFR of the women in the age group 25-29 years of that VDC in 2010 AD was 120
per 1,000 midyear population.
4. Total Fertility Rate (TFR)

Total Fertility Rate is the average number of live births to a woman throughout her
reproductive period. It summarizes the pattern of age specific fertility rate. It is just
a mathematical estimation of fertility rate rather than actual calculation. TFR can be
calculated by multiplying the sum total of age specific fertility rate by 5 and dividing
by 1,000. It can be calculated with the following formula:
5 × ∑ASFR
TFR =
1,000
Where,
TFR Ü Total Fertility Rate
ΣASFR Ü Sum total of Age Specific Fertility Rates
Example
Calculate the TFR from the following table of ASFR.
Age group ASFR
15-19 84
20-24 236
25-29 188
30-34 121
35-39 77
40-44 39
45-49 13
Total: ∑ASFR = 758
Source: CBS, 2003 AD
Solution
Given,
ΣASFR = 758
TFR = ?
We know that
5 × ∑ASFR
TFR =
1,000
5 x 758
= 1,000
= 3.8
\ TFR = 3.8 per woman.
B. Measures of Mortality
Mortality is also an important component of population change. It is a continuous
process tending to reduce population. In common sense, mortality means death.
According to WHO, death is “the permanent disappearance of all evidence of life at
any time after birth has taken place.” It is an inevitable event of life. It is an essential
biological phenomenon for maintaining balance in nature. There are various measures
of mortality rates. Some basic measures are discussed below:
1. Crude Death Rate (CDR)
Crude Death Rate is the simplest and the most common measure of mortality. CDR
is the total number of deaths per 1,000 mid-year population of a given place for the
specified time period. It is calculated by using the following formula:
D
Crude Death Rate = x 1,000
P
Where,
D Ü Total number of deaths in a specified year
P Ü Total midyear population of the same year
Example
Suppose, the midyear population of Dhangadhi Sub-metropolitan City was 1,80,000
in 2015 AD. If 1,500 people died during the same year. Find CDR.
Solution
Given,
Number of death persons (D) = 1,500
Mid-year population (P) = 1,80,000
Crude Death Rate (CDR) = ?
We know that
D
CDR = x 1,000
P
1,500
= x 1,000
180,000
= 8.33
\ CDR of Dhangadhi Sub-metropolitan City in 2015 AD was 8.33 per 1,000 Midyear
population.
2. Age Specific Death Rate (ASDR)
It is another important method of calculating mortality rate. Mortality rate varies by
age of the people. Generally, mortality rate is high in infanthood, childhood and old
age. On the other hand, it is low during the adulthood. So, it is necessary to calculate
mortality rate according to age groups to evaluate the age pattern of mortality. It can
be calculated with the help of the formula that is given below:
D
ASDRa = P a x 1,000
a
Where,
ASDRa Ü Age specific mortality rate for the age group ‘a’
Da Ü Total number of deaths of the persons in a given year of the specified age
group ‘a’
Pa Ü Total mid-year population of the same year and of the same age group ‘a’
Example
Suppose, the mid-year population of the age group 35-39 years of Baglung was
36,000 in 2012 AD. Altogether 220 persons died during the same year. Find ASDR of
that district.
Solution
Given,
Number of death of people of the age group 35-39 (D35-39) = 220
Total mid-year population of the same age group (P35-39) = 36,000
Age Specific Mortality Rate (ASDRa) = ?
Now,
D
ASDRa = P a x 1,000
a

D(35-39)
= x 1,000
P(35-39)
220
= x 1,000
36,000
= 6.1
\ ASDR of Baglung in 2016 AD of the age group 35-39 was 6.1 per 1,000 mid-year
population.
Activity:- Calculate ASMR for all age groups on the basis of the following data:
Age group Population No of deaths ASMR
0 4,00,000 30,000 ------
1-4 5,00,000 27,000 ------
5-9 6,60,000 22,000 ------
10-14 3,40,000 20,000 ------
15-19 3,10,000 4,000 ------
20-24 2,60,000 2,800 ------
25-29 2,00,000 1,600 ------
30-34 1,80,000 800 ------
35-39 1,30,000 820 ------
40-44 90,000 960 ------
45-49 - - ------
50-54 - - ------
55-59 - - ------
60-64 - - ------
65-69 - - ------
70-74 - - ------
75-79 - - ------
80+ 80,000 22,000 ------
3. Infant Mortality Rate (IMR)

Infant mortality rate is considered as one of the most important indicators of
socioeconomic as well as health condition of a country. In Demography, infants are
defined as those children whose age come under one year, namely zero age. In other
words, the children who have not yet reached one year of age are called infants.
Infant Mortality Rate can be defined as the total number of deaths of infants per
1,000 live births of a given place for a specified year. It can be calculated with the
following formula:
D
IMR = o x 1,000
B
Where,
IMR Ü Infant Mortality Rate
D0 Ü Total number of death of infants before reaching one year of age
B Ü Total number of live births in a given year
Example
Suppose, 3,200 live births were recorded in Hetauda Sub-metropolis in 2016 AD.
Among them 120 infants died before completing one year of age. Find Infant Mortality
Rate.
Solution
Given,
Total number of live births (B) = 32,00
Total number of infant deaths (D0) = 120
Infant Mortality Rate(IMR) = ?
Now,
Do
IMR = x 1,000
B
120
= x 1,000
32,000
= 37.5
\ IMR of Hetauda Sub-metropolis in 2016 AD was 37.5 per 1,000 live births.
4. Under 5 Child Mortality Rate (U5MR)

Under 5 Mortality Rate can be defined as the total number of death of children
under 5 years of age per 1,000 live births. It is also considered as an indicator of
socioeconomic situation of a place, territory or country. U5MR can be computed with
the following formula;
U5MR = B x 1,000
D< 5 year
Where,
U5MR Ü Under 5 Child Mortality Rate
D<5 year Ü Total number of death of children under 5 years of age
B Ü Total number of live births

Example
Suppose, 40,000 live births were recorded in Kailali District in 2016 AD. During the
same year 3,200 died before reaching the age of 5 years. Find U5MR of that place.
Solution
Given,
Total number of death of children under 5 years of age in the same year (D<5 years) = 3,200
Under 5 Child Mortality Rate (U5MR) = ?
We know that
U5MR = B x 1,000
D< 5 year
3,200
= x 1,000
40,000
= 80
\ U5MR of Kailali District in 2016 AD was 80 per 1,000 live births.
5. Maternal Mortality Ratio (MMR)

According to WHO, Maternal death is the death of the women while pregnant or
within 42 days of termination of pregnancy, irrespective of the duration and site
of the pregnancy from any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental causes.
Maternal Mortality Ratio is the number of death of women during pregnancy, child
birth or post natal period from puerperal causes per 100,000 live births in a year.
Maternal Mortality Ratio can be mathematically calculated as:
Dp
MMR = x 1,00,000
B
Where,
DP Ü The total number of death of women during pregnancy, child birth or post
natal period from puerperal causes in a given year
B Ü Total number of live births during the same year
Example
Suppose, 88 maternal deaths occurred due to puerperal causes in Jhapa District in
2015 AD. 53,200 live births was recorded in the same year. Find Maternal Mortality
Ratio.
Solution
Given,

Total number of death of women due to puerperal causes (DP) = 88
Maternal Mortality Ratio (MMR) = ?
Now,
Dp
MMR = x 1,000
B
88
= x 1,00,000
53,200
= 165.4
\ Maternal Mortality Ratio of Jhapa District in 2015 AD was 165.4 per 1,00,000 live
births.
C. Migration
Migration is the third component of population change as the other two are mortality
and fertility. The nature of migration as a factor affecting population size is quite
different from that of mortality and fertility. It is not a natural phenomenon. Generally,
each migratory movement is deliberately made and it is driven or influenced by social,
cultural, economic, political and physical circumstances.
Migration can be defined as ‘the movement of people from one place to another
place by crossing its migration defining area and minimum time duration by changing
usual place of residence is called migration’. For demographic purpose, two broad
types of migration are studied i.e. ‘Internal Migration’ and ‘International Migration’.
Internal Migration
Internal migration refers to the movement of people from one place to another place
by crossing its migration defining area and minimum time period but within the
boundary of the nation.
Here the term ‘In-migration’ refers to the movement of people into an area from
outside the migration defining area but within the same country. The term ‘Out-
migration’ refers to the movement of people in which they depart from an area by
crossing its boundary to outside but within the same country.
International Migration
International migration refers to the movement of people across international
boundaries. It is termed as Immigration and Emigration.
The term “Emigration” refers to the migration of native population outside the country.
The term “Immigration” refers to the migration of foreigners into the country.
Measures of Migration
There are various measures of migration. Some basic measures are discussed below:

i. In-Migration Rate (I-MR)
ii. Out-Migration Rate (O-MR)
iii. Net Migration Rate (NMR)
iv. Gross Migration Rate (GMR)
1. In-migration Rate (I-MR)
In-migration Rate is the total number of in-migrants per 1,000 mid-year population of
a specific place during the specified year. It is computed by dividing the total number
of people coming to a place by the total mid-year population of the same place and
multiplied by 1,000. It is calculated by the following formula:
I-MR = I x 1,000
P
Where,
I Ü Total number of in-migrants of the specified area in a given year
P Ü Total midyear population of the same year
Example
Suppose, the total midyear population of a city in 2015 AD was recorded 7,00,000 and
the number of in-migrants were found to be 42,000. Find In-migration Rate.
Solution
Given,
Midyear Population (P) = 7,00,000
Number of In-Migrants (I) = 42,000
In-migration Rate (I-MR) = ?
We know that
I-MR = I x 1,000
P
42,000
= x 1,000
7,00,000
= 60
\ In-migration Rate of that city in 2015 AD was 60 per 1,000 mid-year population.
2. Out-Migration Rate (O-MR)

Out-migration Rate is the total number of out-migrants moving outside the place
of origin per 1,000 mid-year population during the specific time. OMR is computed
dividing the number of out-migrants by the mid-year population of the same place
and multiplied by 1,000. It is calculated by the following formula:
For Internal Migration
O-MR = O x 1,000
P
Where,
O Ü Total number of out-migrants of the specified area in a given year
P Ü Mid Year Population of the same year
For International Migration
EMR = E x 1,000
P
Where,
E Ü Total number of emigrants of the particular country at a given year
P Ü Total Mid Year Population of the same year
Example
The Mid Year Population of Terai region in 1991 AD was 8,628,078 and the total
number of out-migrants in the same year was 1,02,136. Find OMR of that region.
Solution
Given,
Total number of out-migrants (O) = 1,02,136
Total midyear population (P) = 8,628,078
Out-migration Rate (O-MR) = ?
We know that
O-MR = O x 1,000
P
1,02,136
= x 1,000
86,28,078
= 11.84
\ Out-migration Rate of the Terai region in 1991 AD was 11.84 per 1,000 midyear
population.
3. Net Migration Rate (NMR)

Net Migration Rate is the difference between in-migration and out-migration rate.
NMR can be defined as the difference between the total number of people arriving in
an area and the total number of people leaving that area in a specified year per 1,000
midyear population in a given place. The calculated value of Net Migration Rate may
be positive or negative. Positive value denotes that number of in-migrant population
is more than the number of out-migrants whereas the negative value denotes that
the population of out-migrants has outnumbered the in-migrant population. It is
calculated with the following formula:
NMR = I - O x 1,000
P
Where,

I Ü Total number of In-migrants of the given year
O Ü Total number of out-migrants of the same year
P Ü Total midyear population during the same year
Example
In a VDC of Sankhuwasabha district 1,200 people in-migrated from other regions
in 2015 AD and 1,800 people left that VDC and out-migrated to different parts of
the country in the same year. During the same year 16,000 midyear population was
recorded. Now, calculate Net Migration Rate of that place.
Solution
Given,
Total no. of In-Migrants (I) = 1,200
Total no. of Out-Migrants (O) = 1,800
Mid Year Population (P) = 16,000
Net Migration Rate (NMR) = ?
We know that
NMR = I - O x 1,000
P
1,200 - 1,800
= x 1,000
16,000
- 600
= x 1,000
16,000
= - 37.5
\ The Net Migration Rate of that VDC of Sankhuwasabha district in 2015 AD was
(-37.5) per 1,000 Midyear population.
4. Gross Migration Rate (GMR)

Gross Migration refers to the sum of the total number of persons arriving in an
area and departing from that area in a given year. In other words Gross migration
rate involves the total number of people participating in both in-migration and out-
migration process with respect to total midyear population. It can be defined as the
total number of in-migrants and out-migrants in a specified year per 1,000 midyear
population of the same year.
Mathematically, it can be calculated as:
GMR = I + O x 1,000
P
Where,
I Ü Total number of in-migrants
O Ü Total number of out-migrants
P Ü Total midyear population
Example
Suppose; in a VDC of Rautahat district, the midyear population in 2015 AD was
40,000. During the same year, 6,000 people came in that VDC from different parts of
the country and 2,000 people left that place. Find Gross Migration Rate.
Solution
Given,
Total no. of In-Migrants (I) = 6,000
Total no. of Out-Migrants (O) = 2,000
Total mid-year population (P) = 40,000
We know that
GMR = I + O x 1,000
P
6,000 + 2,000
= x 1,000
40,000
8,000
= x 1,000
40,000
= 200
\ The Gross Migration Rate of that VDC in 2015 AD was 200 per 1,000 midyear
population.
D. Other Demographic Measures
1. Rate of Natural Increase (RNI)
Rate of natural increase can be defined as the rate at which a population of a particular
place is increasing or decreasing in a given year due to the surplus or deficit of births
over deaths, expressed as percentage of the base year. The RNI does not include the
effects brought about by migration. The Rate of Natural Increase is the difference
between the Crude Birth Rate and Crude Death Rate. It can be mathematically
calculated as:
RNI = CBR - CDR x 100 OR RNI = CBR - CDR
1,000 10
Where,
RNI Ü Rate of Natural Increase
CDR Ü Crude Death Rate
Example
According to 2001 census, the CBR and CDR of Nepal were 33.1 and 9.6 respectively.
Find out the Rate of Natural Increase.

Solution
Given,
Crude Birth Rate (CBR) = 33.1
Crude Death Rate (CDR) = 9.6
Rate of Natural Increase (RNI) = ?
We know that
RNI = CBR - CDR x 100
1,000
33.1 - 9.6
= x 100
1,000
= 2.35%
\ The Rate of Natural Increase of Nepal in 2001 AD was 2.35%.
Note:
If the birth exceeds the death, RNI carries +ve value then population increases and vice
versa. At the same time, if births equals to deaths, then population becomes stable or
with zero rate of natural increase.
2. Population Growth Rate (PGR)
The population of a place or a country change continuously. Birth, death and migration
are the major demographic factors behind the population change. Population growth
rate shows either the population of a place is increasing or decreasing. Population
Growth Rate can be defined as the rate at which population increases in a given year
due to the interplay of rate natural increase and net migration rate; expressed as
percentage of the base population. It can be calculated with the following formula:
PGR = CBR - CDR + NMR x 100 OR PGR = RNI + NMR x 100
1,000 1,000
Where,
CDR Ü Crude Death Rate
NMR Ü Net Migration Rate
PGR Ü Population Growth Rate
RNI Ü Rate of Natural Increase
Example
Suppose, the CBR and CDR of a country were 28 and 7.2 respectively in 2015 AD. The
Net Migration Rate was 6 per thousand mid-year population in the same year. Find
PGR of that country.

Solution
Given,
Crude Birth Rate (CBR) = 28
Crude Death Rate (CDR) = 7.2
Net-Migration Rate (NMR) = 6
Population Growth Rate (PGR) = ?
We know that
PGR = CBR - CDR + NMR x 100
1,000
28 - 7.2 + 6
= x 100
1,000
= 2.68%
\ Population growth rate of that country in 2015 AD was 2.68 %.
3. Population Doubling Time (PDT)

Population doubling time refers to the number of years required for the population
of a place to double its size with reference to the current rate of population growth.
Doubling time is a crude way of estimating future population size because it assumes
a constant growth rate over decades but population growth rate is always changing
over the time periods. Population doubling time helps to give a clear picture of how
fast the population is increasing. It is computed by dividing 70 by the population
growth rate. Mathematically, it can be calculated with the following formula:
PDT = 70
PGR
Where,
PGR Ü Population Growth Rate
PDT Ü Population Doubling Time
Example
The population growth rate of Nepal was observed 1.35% in the 11th census 2011 AD.
Find population doubling time of that country.
Solution
Given,
Population Growth Rate (PGR) = 1.35%
Population Doubling Time (PDT) = ?
We know that
PDT = 70
PGR

= 70
1.35
= 51.85
\ Population Doubling Time of Nepal with the PGR 1.35% is 52 years.
4. Dependency Ratio
The dependency ratio is considered as the ratio between dependent and independent
population. It is measured by considering the distribution of population by three
broad age groups such as 0-14, 15-59 and 60 years and above. In these age groups,
the age groups of 0-14 and 60 and above years are considered as dependent age
groups and assumed that they may not be able to earn for livelihood. Similarly, the
age group of 15-59 years population is called independent population and assumed
as economically active, even though the large proportion of this age group population
is not really economically dependent. Dependency ratio simply shows the number of
persons dependent upon every 100 persons of independent age group. Dependency
ratio further may be measured as child dependency ratio and old dependency ratio
too. It can be computed dividing the number of dependent population by independent
population and multiplying by 100. It can be calculated by the following formula.
Dependent Population
Dependency Ratio = Independent Population x 100
Symbolically,
Popn(0-14) + Popn(60 & above)
DR = x 100
Popn(15-59)
Where,
Popn(0-14) Ü The child dependent population, under 15 years
Pop (60 & above) Ü The old dependent population, 60 years and above
n
Popn(15-59) Ü The independent population, between the age of 15-59 years

DR Ü Dependency Ratio
Dependency Ratio can be further classified into two sub groups such as:
a. Child Dependency Ratio
b. Old Dependency Ratio
Child Dependent Population
a. Child Dependency Ratio = Independent Population x 100
Symbolically,
Popn(0-14)
CDR = x 100
Popn(15-59)
Where,
Popn(0-14) = Population of children under 15 years.
Popn(15-59) = Population of 15-59 years.
Old Dependent Population
b. Old Dependency Ratio = Independent Population x 100
Symbolically,
Popn(60 & above)
ODR = x 100
Popn(15-59)
Where,
Popn(60 & above) = Population of 60 years and above.
Popn(15-59) = Population of 15-59 years.
Example
Calculate dependency ratio from the data given in the following table:
Age group Population
0-14 20,54,520
15-59 28,30,880
60 & above 60,650
(a) Dependency Ratio:

Popn(0-14) + Popn(60 & above)
DR = x 100
Popn(15-59)
20,54,520 + 60, 650
= x 100
28,30,880
= 74.4
\ Dependency Ratio = 74.7%
(b) Child Dependency Ratio:
Popn(0-14)
CDR = x 100
Popn(15-59)
20,54,520
= x 100
28,30,880
= 72.6%
\ Child Dependency Ratio = 72.6%
(c) Old Dependency Ratio:

Popn(60 & above)
ODR = x 100
Popn (15-59)

60,650
= x 100
28,30,880
= 2.1%
\ Old Dependency Ratio = 2.1%
5. Sex Ratio
Sex Ratio is the ratio of male population to the female population and generally,
expressed as the number of male population for every 100 female population. It is
computed with the following formula:
M
SR = F x 100
Where,
SR Ü Sex Ratio
M Ü Male population of a place in a given year
F Ü Female Population of that place in the same year
Example
In Nepal, the male population was 1,28,49,041 and the female population was
1,36,45,463 in 2011 AD census. Calculate the Sex Ratio.
Solution
Given,
Male population (M) = 1,28,49,041
Female population (F) = 1,36,45,463
Sex Ratio = ?
We know that
M
Sex Ratio = F x 100
1,28,49,041
= x 100
1,36,45,463.
= 94.2
\ Sex Ratio of Nepal in the census 2011 AD was 94.2.
Activity
Write down the various formula of Fertility Rates, Mortality Rates and Migration Rates
including other demographic formula in a chart paper and discuss with your friends
about their applications in your class.

2.2 Consequences of Rapid Population Growth
In a simple term, population growth can be defined as the rate at which a population
is increasing due to natural increase and net migration, expressed as a percentage of
the base population. The population growth rate with more than 2% and TFR with
more than replacement level (2.1) is considered as rapid population growth rate. The
rapid population growth is a universal problem in the developing countries. According
to the data of the population census 2011 AD, the population growth rate of Nepal
was 1.35%. It shows that there is no rapid population growth rate in Nepal. Even
though, the TFR is still much more high (2.6).
The density and size of population increases due to rapid growth of population. It
causes adverse effects on the social, economic as well as environmental aspects of
the society and the country. For the sustainable development of the society and the
nation, there must be balance between population growth rate and socio-economic
development. If population can be managed in an effective way, there will be positive
impact on the social, economic and environmental aspects. It is obviously known that
rapid population growth rate brings negative impact on various aspects of human life.
Some of the consequences of rapid population growth rate are as follows:
2.2.1 Consequences of RPG on Environmental Aspect
A. Forest and Vegetation
Forest and vegetation are the
invaluable assets of human life. They
help to balance ecological process. At
the same time, they are also playing
important role to prevent landslide,
soil erosion, air pollution, etc.
About 57% of the land was covered
by forest some decades ago but at
present it is reduced to 29%. It is
Deforestation
estimated that the forest area is
depleting at the rate of 1.7% annually. Deforestation rate is very high due to rapid
growth of population especially in the case of Nepal. The common problems like soil
erosion, flood, landslide, desertification, drought and irregular rain are caused by
deforestation. At the same time there is loss of biodiversity and wildlife depletion as
severe environmental problems due to the degradation of forest.
B. Aquatic and Terrestrial Animals
One of the major environmental problems of rapid population growth is environmental
degradation. Degraded environment causes adverse effect on both of the aquatic and

terrestrial animals. There is depletion of land animals due to deforestation, forest fire,
unscientific agricultural system, land fragmentation and so on.
People do poaching of rare and endangered animals like elephant, tiger, musk deer,
leopard, one horned rhino for their precious skin, fur, tusk, bones and their other
organs. Rapid growth rate of population brings negative impact on aquatic animals.
Due to rapid growth of population there is depletion of water animals. Acid rain
causes destruction of aquatic animals and plants. Due to the environmental pollution
the population of aquatic animals like fish, tortoise, crocodile, etc are decreasing.
Consequently, it results problems in aquatic ecosystem.
C. Air Pollution
Air is vital environmental factor for all the living beings. The Earth is completely
enveloped by the atmosphere. All the living beings need air to survive. Air gets
polluted due to dense population. Industrialization, urbanization and construction
works cause air pollution. Actually, air pollution is caused by dust, smoke and other
harmful gases released from industries, vehicles, firewood. Consequently, dozens of
air borne diseases are spread due to air pollution.
D. Water Pollution
Water is also one of the essential
elements for living beings. The rapid
population growth has brought
adverse effect in quality and quantity
of water. There is acute shortage of
drinking water in the urban areas
due to high density of population. At
the same time, the rate of pollution
in water is increasing day by day
Water Pollution
due to undue pressure of growing
population especially in the towns and cities.
E. Land Pollution
Land is also one of the important
natural resources. It is very important
for the ecological balance and
human survival. It is essential for
the agricultural production, shelter
and other various purposes. Rapid
population growth has created
adverse impact on productivity of Land Pollution

land. To meet the needs of the growing population, farmers use pesticides, insecticides
and chemical fertilizers in excessive amount. This kind of irrational activities damage
the productivity and quality of the soil.
The situation of deforestation and exploitation of marginal land for cultivation emerges
in order to obtain food, cloth, housing and other needs of existing population. Similarly,
green belts and cultivated lands of different places are encroached by constructing
houses, factories and industries to fulfill the needs and demands of growing
population. The above definitions prove that land degradation is a major Utilization
of ground water for drinking problem created by rapid growth of population.
F. Minerals
Metallic and nonmetallic substances like gold, silver, lime, copper, magnesium, coal,
petroleum, etc present in the Earth are called minerals. Construction of bridge,
vehicles, machines, buildings, etc is not possible without minerals. They are also
equally essential for the growth and maintenance of the living organisms. It shows
that there is a close relation between minerals and population. Truly speaking,
distribution of minerals is not equal in the Earth.
As the population growth rate increases the exploitation rate of mineral resources
also increases. Minerals are nonrenewable resources. Hence, it is quite certain that
the deposit of minerals will be exhausted in the future. Consequently, there will be
imbalance in the ecosystem and the world may suffer from energy crisis.
G. Sound Pollution
Clean and quiet environment provide pleasure
to human. In this juncture, people cannot live
pleasant and quiet life due to sound pollution
resulted by rapid population growth. The life in
densely populated areas are full of noise from
the means of transport, industries, crowd of
the people, different types of instruments and Sound Pollution
gadgets, etc. This may lead to various kinds of
diseases like hypertension, depression, anxiety,
deafness, insomnia, irritation, etc. Hence, rapid
growth of population needs to be controlled to
reduce the level of sound pollution.
H. Flood, Landslide and Soil Erosion
Flood, landslide and soil erosion are the
natural disasters which are the most serious
Flood

environmental problems in Nepal. Rapid population growth is also one of the
problems of environmental problems. The needs and demands of food and other
materials automatically increases with the growth of population. Hence, rapid growth
of population compels the people to exploit marginal land for cultivation and so on.
As a result, during rainy season, it may cause soil erosion and landslides and flood.
Though soil erosion and landslides are natural calamities, they are induced by human
activities. People have to face great loss of lives and property due to deforestation,
over exploitation of marginal land and unsustainable construction cause great damage
to the lives, property and ecological process.
2.2.2 Consequences of RPG on Socio-economic Aspect

A. Health
Healthy manpower is required for the development of society and the nation. Healthy
people can execute productive works and contribute in the development of the
community and the entire nation. But rapid population growth rate has brought a
big challenge in the health of the people. For instance, people are not getting enough
food to eat. They are not getting quality health services and facilities adequately in
time due to rapid growth of population. Health services should be expanded to meet
the needs of the people. But it is not possible to increase the health services in the
same ratio of population growth rate. In this context, doctors and health workers
are compelled to check up more patients beyond their capacity. At the same time,
hospital beds are quite inadequate in terms of their requirements. The following
table give a clear picture of the situation of health services in Nepal:
Table 2.4: Situation of Health Services in Nepal, 2015/2016 AD
Health Services Number Health professionals Number
Hospitals (Private, 405**
Government, Community (govt. - 104) Doctors 16,854*
and Teaching) (pvt. - 301)
Primary Health Centers 202** Senior A.H.W/HA 9,500

Health Posts 3,803** AHW (Auxiliary Health Worker) 19,098
Sub-Health Posts 3,176 Nurses 38,759**
ANM (Auxiliary Nursing and
Ayurvedic Service Centres 305 25,398**
Mid wife)
Village Health Worker 7,175 Kaviraj/Vaidhya 741
Source: CBS, Nepal in figures, 2015 AD, ** CBS, Nepal in figures, 2016 AD , *Nepal Medical Council

B. Education
Education is one of the important components of development of the country. People
can get knowledge and are able to change their attitude and behaviour with the
help of education. Hence, it is important to provide quality education to the people
for the production of efficient and skilled manpower as per the requirement of the
nation. But it is difficult to provide quality education to the people if the population
increases rapidly. Due to rapid increase of number of students every year, it is difficult
to increase the number of schools, manpower and physical infrastructure of schools
and colleges in effective manner. In this situation, it is also difficult to manage trained
teachers and necessary educational materials for quality education. Consequently,
there will be declination in the status of education due to rapid population growth.
So rapid population growth needs to be controlled to enhance quality of education.
Table 2.5: Situation of Educational Services in Nepal 2001/02 - 2014/15 AD
2001/02 2014/15
Indicator Lower Higher Lower Higher
Primary Secondary Primary Secondary
Secondary Secondary Secondary Secondary
School 19,498 4,230 2,309 - 34,335 14,952 8,825 3,596
Teachers 77,948 13,225 12,132 - 1,85,562 52,349 38,861 19,179
Students 30,34,710 4,33,428 4,21,709 - 43,35,355 18,35,135 9,00,585 4,16,995
Source: CBS, Nepal in figures, 2002 and 2015 AD
C. Culture and Cultural Heritages

Our invaluable folk songs, tale, folk dance, music, customs, languages, religions,
monuments, chaityas, monasteries, temples, mosques, churches, festivals, etc that are
inherited by our ancestors since time immemorial are called cultural heritages. Such
cultural heritages play important role to give identity in the national and international
arena. Our country is a multicultural, multiethnic, and multilingual nation.
Some of our cultural heritages are also enlisted in the world cultural heritage
list. Kathmandu Durbar Square, Patan Durbar Square, Bhaktapur Durbar Square,
Changunarayan Temple, Lumbini Area, Pashupatinath Area, Swyambhunath,
Baudhanath Area are some of the cultural heritages that are enlisted in the world
cultural heritage. To make it a reality, programs of protection and promotion of
physical and non-physical cultural heritages, should be protected. Different programs
will be implemented effectively to prevent them from theft, losses, damages, and
other immoral activities.
We can see adverse impact on such invaluable cultural heritages due to the pressure
of rapid population growth. Our unique culture is in threat due to blind imitation and
modernization. The activities like encroachment in the heritage sites, constructing
trade centers in those places are increasing nowadays. It is necessary to protect our
cultural heritages from the pressure of rapid population growth. If we cannot protect
such heritages now, our future generation will not be able to see them.
Activity
Nepal is rich in cultural heritages. These invaluable heritages are being deteriorated
day by day. What are the specialities and importance of cultural heritages in your
community? How can those heritages be conserved? Prepare a report and present it
in your class.
D. Employment
People have various kind of needs. People have to earn by hard work to fulfill their
needs. Employment also helps in the promotion of personality of an individual. In the
context of Nepal, the people in the active age group 15- 59 years need employment
opportunities. Currently, in Nepal, 2.5 million people of working age are unemployed.
At present, 40 million people are entering labour market every year. Because of rapid
population growth rate; out of the total population, 30 percent is unemployed. High
unemployment rate creates economic crisis. Side by side, it also creates the social,
political and psychological problems also. It is the prime responsibility of state to
promote employment opportunities by imparting knowledge and skills to national
human resources in line with national and international labour market.
E. Drinking Water
Safe drinking water is one of the
basic needs of human being. Water
is necessary to the people from
birth till death. We get water from
various sources like tap, tube-well,
stone spout, river, pond, well, etc. It
is essential to purify water for good
health. The sources of water cannot
be increased as per the growth
rate of population size. The human
Queue for Drinking Water
activities like random disposal of
solid wastes, improper use of chemical fertilizers, improper management of sewage,
unmanaged urbanization, deforestation, unmanaged industrialization, etc pollute the
water sources. Because of this, a large population are suffering from the scarcity of
safe drinking water.
In Nepal, only about 80 percent people have got the facility of drinking water. Urban
people are facing acute water supply problem. The water supplied to the public is also
not safe for drinking. At the same time, more than 20% rural population do not have

access to improved water supply. Because of deforestation, unmanaged urbanization
and random industrialization the water sources are drying out and people are suffering
from acute scarcity of drinking water. In some rural areas people walk for hours and
hours to fetch drinking water. Eventually, there will be great loss of time and labour of
the people in the management of drinking water service according to the demand of
the people are the main problems of this sector.
Impact of Population growth rate on drinking water:
Difficulty to supply drinking water to each and every house.
The water supplied to the public through improved sources also may not be safe
for drinking.
The sources of water are drying out due to deforestation in the rural areas.
The ground water in the cities cannot get recharged due to the concrete jungle
like unmanaged buildings and physical construction.
Water from the stone spouts, wells, tube-wells, etc are decreasing due to human
encroachment.
F. Food
Food is one of the very important
needs of human being. At present,
there is rapid population growth in
the developing countries but it is not
possible to increase the production
and supply food in the same ratio of
the population growth rate. In this
context, rapid population growth rate
creates the problem of food scarcity.
A Set of Foodstuffs
As a result, people suffer from
malnutrition and become vulnerable to nutrient deficiency diseases like Kwashiorkor,
Marasmus, Night Blindness, Scurvy, Rickets, Beriberi, etc. Then eventually, people
suffer from unhealthy and unproductive life.
Effect of Population Growth on Food
Decrease in per capita food supply
Sky rocketing in food price due to increase in demand
Low consumption of quality food for the poor and marginalized people
Increase in the natural calamities like soil erosion, landslide and flood due to
cultivation in the marginal land
Emergence of condition to import food from outside the countries
Devastating deforestation in the name of land used for cultivation

G. Residence
Residence is also considered as one of the basic human needs. According to Maslow’s
classification of human needs, housing comes under the security related need. People
need good housing facility for their healthy and productive life. Housing is necessary
because it protects us from various unfavorable external environment. We know that
rapid population growth creates adverse impact on housing facility of the people. For
instance, rapid population growth increases the cost of house rent. Consequently,
population density per room also increases. Moreover, there will be increase in slum
areas in the marginal land especially at the bank of the river in the urban areas and
nearby the jungle in the rural area. After all, there will be deterioration of health
condition of the people.
Effect of Population Growth on Residence
Living space becomes limited and congested
Different kinds health problems will be seen to the individuals
Environmental pollution increases due to more crowded people and generation
of more solid wastes
Increase in the community health problem social problems
Agricultural land being converted in to the residential areas
Increase in the deforestation tendency in the name of land occupation for residence
H. Clothing
Clothing is also considered as one of the essential basic human needs after food and
housing. It comes under the security need of the people. People should get adequate
clothing according to the nature of work, weather and season. For instance, people
in the high Himalayan region need warm clothes. Similarly, people living in the Hill
and Terai region need warm or thin clothes according to seasonal variation. The
textile industries are not expanded to supply clothes according to the demand of the
rapidly growing population in our country. So, clothes are imported from neighboring
countries. If the family size is big it is not possible to manage sufficient clothes
according to the season to the family members. Rapid population growth increases
the demand of clothes. Consequently, it increases the price of the clothes. As a result,
people suffer from various kinds of health problems. It ultimately hampers quality of
life of the people.
Effect of Population Growth on Clothing
Increase in clothes price due to high demand
Compel to wear low quality clothes
Difficult to manage necessary clothes to the family members adequately
Import of foreign clothes causes flight of national property outside the country

I. Security and Entertainment
Security and entertainment is also considered as an important human need. Safe
environment plays an important role to live happy, prosperous and productive life.
Although a person is well to do with the physical facilities if s/ he does not feel secured,
it is considered that the person is not living a quality of life. Every citizen needs peace
and security from birth until death. Security of property and life is mandatory in the
family, society, nation everywhere. As the population increases, there is increase in
social crimes like theft, robbery, gang fights, looting, kidnapping, burglary, rape, etc.
Consequently, it creates challenges in peace, harmony and security.
Entertainment is considered as an inseparable aspect for mental and emotional
refreshment in human life. Entertainment plays an important role to get relief from
mental stress, tiredness, grief and lethargy. People can get entertainment through
playing, singing, dancing, painting and many more activities. Moreover, they also get
entertainment by organizing picnic, excursion, games and sports, carnivals and so on.
Some people also get refreshed by visiting zoo, national parks, religious sites, etc.
Rapid population growth creates unnecessary pressure on the public parks, religious
places and other means of entertainment. Similarly, the tendency of encroachment in
the area of playground, pond, public parks, national parks, conservation area, religious
places, etc in the name of human settlement, cultivation, physical construction
and development work is increasing day by day. It is only possible to make proper
management of entertainment facilities to the people if there is control of rapid
population growth in time.
2.3 Population Management
Rapid population growth has become one of the great problems for the developing
countries. It is the fact that rapidly increasing population is threatening the very
existence of human beings. It is quite clear that, population is increasing faster in the
developing countries including our nation whereas resources cannot be multiplied
in the same proportion. In this situation, population management is the best
instrument to maintain balance between population growth rate and socio-economic
development of the society and nation. “Population management can be considered
as a process by which growth rate and distribution pattern of population can be
managed in accordance with the carrying capacity of the available resources of the
given place.” As people are dependent on nature and natural resources for their daily
life, management of population concerns their survival. Population management does
not mean only to control growth rate of population but also accelerates the growth
rate of depopulation. Population management gives focus on population distribution,
composition and migration pattern along with their linkage with total development
process.

2.3.1 Methods of Population Management
The plans, policies and programs undertaken to reduce the rapid growth rate of
population or to carry out the measures to increase the growth rate of population
to maintain balance between the existing resources and population is considered
as population management. There are various population control measures for the
management of population.
These controlling measures can be divided into direct and indirect measures. The
direct population control measures deal with those measures which directly control
the population growth rate. The controlling measures like appropriate age at marriage,
proper birth spacing, legal abortion, control of migration, use of contraception are
considered as the direct population control measures. Similarly, the measure which
indirectly support to control the population growth rate are perceived as indirect
population controlling measures. The controlling measures such as education, health
facilities, women empowerment, gender equity and equality, employment, awareness
can be taken as the examples of indirect population controlling measures.
Direct Population Management
Indirect Population Management Methods
Methods
• Late Age at Marriage • Population Education
• To Keep Proper birth Spacing • Increase in Awareness through Education
• Legal Abortion • Women Empowerment
• Control of Migration • Gender Equity and Equality
• Use of Contraceptive Devices • Employment and Income Generation
Activity
Some of the measures to control rapid population growth rate are as
explained below:
1. Proper Birth Spacing
Birth spacing is the period between the birth of the first child to the birth of the next
child. It is said that birth spacing of 4/5 years is ideal for both the mother and child for
their health. If the couple follow proper birth spacing they can get ample time to take
care of their children and at the same time mother’s health also will be sound. Such
planning may also help to maintain small family and eventually this practice helps the
nation to control rapid growth rate of population.
2. Appropriate Age of Marriage

Appropriate age of marriage refers to the age when he or she is physically, mentally,
emotionally, economically and socially capable for having a married life. Generally,
the appropriate age of marriage for male is considered as 25 and above since they are
growing up to 25 years. Similarly, the proper age at marriage for female is considered
between 20 to 30 years since this period is believed to be healthy fecund period. It
is also believed that the first conception before 20 years and after 35 years are not
good for the mother and child from the reproductive health perspective. Marriage at
appropriate age also helps to control the rapid growth of population.
3. Women Empowerment
In Nepal, more than 50 percent of the
total population is occupied by female.
But it is a fact that Nepali women are
far behind in access to education,
health services, social service,
political opportunities and economic
opportunities compared to their male
counter parts. The female literacy rate
is far below the to male literacy rate. Women Empowerment
Even though, there is legal restriction of child marriage in our country, more than 40
percent girls are found married before the age of 19. The above data reveals that the
condition of female is very low and they are discriminated and exploited in various
aspects.
Hence, education and economic opportunities are urgently required to empower
and uplift their status. It makes them self dependent and helps to have decisive role
in the family and society. Women empowerment eventually helps to control rapid
population growth.
4. Gender Equality
Gender equality refers to the equal enjoyment by women, girls, boys and men of
rights, opportunities, resources and rewards. Equality does not mean that women
and men are the same but their enjoyment of rights, opportunities and life chances
should be equal whether they were born female or male. Mostly in rural communities
of Nepal, men are considered superior to women and men have dominated role in
decision making. The unpaid works like household chores performed by women are
still considered as non-productive works and the only accepted role of women is
considered to beget children. If the gender discrimination cannot be checked in time,
it hinders the quality of life in the family.
Similarly, parents give birth to many daughters in the desire of son. This kind of practice
also consequently increases the population of the family and nation. Hence, there is
an urgent need to recognize women’s capacities, knowledge, skills, competencies and
contribution in the development process of the society and nation. It also helps to
control the fertility and population growth rate.

5. Use of Contraception
Family planning is the means to maintain appropriate size of the family. Family
planning is possible through the proper use of contraception. They are of two types:
i.e. natural methods of contraception and artificial contraceptive devices. Natural
methods of contraception is the processes of avoiding unwanted pregnancy through
fertility awareness based methods like Rhythm (Calendar) and Withdrawal method.
Artificial method of contraception is also of two types like permanent and temporary
contraception. In which the effective use of temporary contraceptive devices maintain
birth spacing and delay birth for certain period of time. Different types of devices like
Condoms, Pills, Norplants, IUDs, Deprovera, etc can be precisely used for temporary
contraception. However, the permanent contraception like Vasectomy for male as
well as Minilap and Laparoscopy for Female Sterilisation can be widely used if the
couples have already had desired number of children. They are also called male and
female sterilization.
Proper use of contraception helps to maintain birth spacing and limits the family
size. It helps to maintain quality of life of every couple and helps to make happy and
prosperous family. Family planning is indeed a part of family management since it
is the way to maintain prosperous family life through the proper balance between
available resources and appropriate family size. The importance of family planning
can be mentioned as follows:
M It helps to manage proper birth spacing and promotes health of mother and child.
M It helps to maintain desired family size and helps to acquire quality of life.
M It helps to ensure the reproductive rights of the individuals.
M It helps to control fertility rate.
Types of Contraception
There are two types of contraception which are described below:
A. Natural Methods of Contraception
Natural contraception method is the process of avoiding unwanted pregnancy without
using any artificial contraceptive devices. This method depends on identifying the
fertile phase of the menstrual cycle which occurs at the time of ovulation. This method
is also known as fertility awareness based method. Some of the natural contraception
methods are discussed as follows:
(i) Calendar (Rhythm) Method
It is one of the important female natural contraception method. It is the fertility
awareness based contraception because its main objective is to know the fertile
period (i.e. unsafe or ovulation time period) and not to involve in sexual intercourse
during that unsafe period.

For relying on this method, firstly, the woman should record the number of days in
each menstrual cycle for at least 6 consecutive months. Here, the first day of menstrual
bleeding always should be counted as day 1. Then secondly, she has to record the
length of the shortest menstrual cycle and the length of the longest menstrual cycle
from among the six recorded menstrual cycles. Then, she has to subtract 18 from the
length of her shortest recorded menses cycle. This tells her 1st day of fertile or unsafe
time period. Similarly, she has to subtract 11 from her longest recorded menstrual
cycle. This tells her the last day of her fertile or unsafe period. After confirmation
of the total number of days of her fertile or unsafe period, the couple either should
avoid sexual intercourse or male partner has to follow withdrawal method during this
period.
Example
Step I: Woman’s recorded length of 6 menstrual cycles
Menses Cycles 1st 2nd 3rd 4th 5th 6th
Jan Feb March April May June
Months
33 29 29 30 34 30
Step II: Confirmation of the length of the shortest and the longest menstrual cycles
Length of the longest cycle = 34
Length of the shortest cycle = 29
Step III: Subtraction of 18 days from the shortest menses cycle
29 - 18 = 11 (i.e. 11th day is the first day of unsafe period)
Step IV: Subtraction of 11 days from the longest menses cycle
34 - 11 = 23 (i.e. 23rd day is the last day of unsafe period)
Step V: Confirmation of fertile (unsafe) period
I II III
Safe period Fertile period Safe period

Days
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
Bleeding Safe Unsafe Safe
Period Period Period Period
Fertility Awareness Method of Contraception
i.e. 11th to 23rd days are confirmed as the unsafe or fertile days for all the consecutive
menstrual cycles until and unless there is any change in the length of shortest day and
longest day of menstrual cycle.
(ii) Withdrawal Method (Male)

Coitus interruptus or male withdrawal method is the oldest method of reversible
contraception. In this method, male has to take out his Penis from the Vagina just

before the ejaculation of semen. And semen needs to be ejaculated outside from
the Vagina. It is not 100 percent sure because sometimes sperms can enter into the
Vagina before it is ejaculated outside. It is about 82% effective. It is also called coitus
interruptus method.
(iii) Cervical Mucus Test Method

It is also an important natural female contraception method. In this method, the
texture, colour and thickness of the Cervical mucus is examined for confirmation
of unsafe and safe period. Normally, in the beginning days right after completing
menstrual bleeding, vagina remains dry. During this time the cervical mucus consists
of a thick plug at the Cervix. But after few days, under the influence of the rising
level of Oestrogen, the Cervix releases thick, translucent and non-slippery mucous.
However, around the ovulation time, Cervix produces thin, transparent, slippery and
non-breakable mucous. Hence, if the mucous is obtained transparent, slippery and
stretchable, it can be confirmed as a fertile period. In this condition, couples should
avoid sexual intercourse.
Safe period Unsafe period

• Thick • Thin
• Translucent • Transparent
• Non-stretchable • Stretchable
• Non-slippery • Slippery
Cervical Mucus Test Technique
Cervical mucus test method refers to test of mucus secreted by Cervix. We can find
out the chance of conception by checking the cervical mucus carefully. If the mucus
is thick, there is high chance of conception and if mucus is thin there is less chance
of conception. But we should not forget that it is not 100 percent effective to stop
conception.
(iv) Lactational Amenorrhea Method

The Lactational Amenorrhea Method (LMP) is the use of breastfeeding as a temporary
family planning method. There are various endocrine studies which have shown that
breastfeeding delays the return of menstruation, ovulation and conception after child
birth. During the time of breast feeding, there is less chance of conception because
it suppresses production of Estrogen and Progesterone hormone which are essential
hormone for ovulation. If breastfeeding is practiced properly, (i.e. at least 8 times in a
day and at least 2 times at night and for 20 minutes each time) it may resist ovulation
at least from 6 months to as long as 18 months. In this parlance, LMP provides natural
protection against pregnancy. If she keeps breast feeding very often, her protection
from pregnancy may last longer than 6 months and perhaps as long as 18 months.
On the other hand, most of the mothers who do not breast feed have resumed
menstruation and ovulation may be as early as six weeks after delivery.
(v) Basal Body Temperature Method

It is also one of the important natural contraception method. It is probably the
first scientific method based on periodic abstinence to be developed. Essentially, a
woman should record body temperature immediately on waking each morning to
get a reading of basal temperature. To get proper record of every change of body
temperature, the thermometer should be kept either in the mouth or arm pit.
The process should continue throughout the month. During the early part of the
menstrual cycle BBT remains at lower level. At the time of ovulation, the temperature
of female rises by about 0.2°C to 0.5°C (0.4°F to 10°F) and then maintains higher level
until the onset of the next menstruation. The shift of temperature from a lower to a
higher level indicates for ovulation. Sexual intercourse should be avoided for three
consecutive days in which the temperature has been recorded at the higher level.
Then the woman can start sexual intercourse with a very little risk of conception.
NAME: .................................................................. MONTH: .........................

DATA
o
C 37.6
37.5
37.4
37.3
37.2 1 2 3
37.1
37.0
36.9
36.8
36.7
36.6
36.5
36.4
36.3 6 5 4 3 2 1
36.2
36.1
36.0
DAY of CYCLE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 32 32 33
PERIOD and
MUCUS
P P PP P P P
P = Period (bleeding)
Basal Body Temperature Method

B. Use of Artificial Contraceptive Devices
Artificial contraception method includes both temporary and permanent
contraception. They are of different types. Some of them are described below:
(i) Temporary Contraceptive Devices
The use of Temporary contraceptive Devices delay the birth and help to maintain
birth spacing too. They help to widen the gap between the first and the second child.
There are different devices for female and male. They are described below:
1. Physical Method (Barrier Method)
Condom, Femidom, and Diaphragms come under the barrier method of artificial
temporary contraception.
a. Condom
A condom is a sheath made up of thin latex
rubber. Some condoms are coated with a dry
lubricant or with spermicide. It is used by male. It
is elastic and oily which makes sexual intercourse
comfortable. It is worn in an erected Penis just
before the sexual intercourse. It is found in
average size in different colours and textures.
It prevents the sperms to spill over the Vagina.
It keeps the sex partner safe from different
sexually transmitted infections (STIs) including HIV and AIDS. The user should handle
it properly because there may be chance of tearing.
Advantages
It prevents STIs including HIV and AIDS as well as pregnancy when used correctly
It is inexpensive
It can be used without medical advice
It is safe, no hormonal side effects
It increases sexual enjoyment since it avoids chance of pregnancy or STIs
Helps to prevent ectopic pregnancies
Can be stopped at any time
Can be used by men of any age
In general, anyone can use condoms safely and effectively if not allergic to latex
Disadvantages
It can be used only once
Latex condoms may cause itching for a few people who are allergic to latex and
lubricant
There is small possibility of tearing or slip off during sex
May embarrass some people to buy, ask partner to use, put on, take off, or throw
away condoms
b. Femidom
Femidom is a woman controlled artificial
contraceptive device to protect against
STIs including HIV/AIDS and unwanted
pregnancy. It is made up of thin, transparent,
soft plastic bigger in size compared to the
male condom. Before sex, a woman places
the closed end of the sheath in her Vagina. During sexual intercourse, the man’s Penis
goes inside the Femidom. Then it does not let the sperm enter into the Uterus. It is
also useful for those females who have side effects of contraceptives.
Advantages
There isn’t any side effect and no allergic reaction of using it
It can be used without medical advice
It prevents from sexually transmitted infections (STIs)and unwanted pregnancy
It does not hinder the sexual satisfaction
Controlled by woman
Disadvantages
It is expensive at this time
It is difficult to maintain privacy
High chance of failure
It can be used only once
Usually needs partner’s consent
There is problem of place to dispose it after use
Woman must touch her genitals
c. Diaphragm
The Diaphragm is a soft hemispherical dome
shaped rubber cap that covers the cervix. It
should be kept on the cervix before sexual
intercourse with spermicidal jelly or cream. It is
available in different sizes in the market. So the
women should use it according to the size of
their Uterus. It works like Condom and Femidom.
It becomes barrier against sperms. Diaphragms

block sperms from entering the Uterus and Fallopian Tubes , where sperms could
meet an ovum. The female needs to have special training and counseling before using
them.
Advantages
It prevents pregnancy effectively if used correctly with every act of sexual
intercourse
Safe, woman-controlled method that almost every woman can use
It doesn’t reduce sexual satisfaction
It can be stopped at any time
No effect on breast milk
Easy to use with a little practice
No hormonal side effects
Disadvantages
Requires fitting by a family planning provider, involving pelvic examination
May be difficult to remove. Sometimes Diaphragm can tear as the woman
removes it
It cannot be used without training
2. Chemical Methods
Oral and vaginal tablets come under this method. They are described in detail below:
a. Oral Contraception (Pills) Missed 2 or more of these first 14 pills? Take 1 now. Take all
A substance or a combination the rest as usual. Also use condoms or spermicide for 7 days.
of substances, usually steroids Missed 2 or more of

these 7 pills? Take 1
administered orally which now. Take the rest
prevents pregnancy is called oral of this row, one each
day.
contraception or pills. The main Start a new pack the
forms of oral contraception include next day. Throw the
the combined oral pills containing last row of this pack

away.
both Oestrogen, Progestagen and Also use condom or
Missed any of these 7 pills? Throw the
the progestagen-only pills (POP) spermicide for 7 days
missed pills away. Take the rest as usual.
and hormonal post-coital pills.
Oral Pills Taking Method
The latter post-coital pills can
be used in emergency right after unprotected sexual intercourse. In combined pills,
there are 28 pills in a kit. Among them, 21 pills are called active pills which contain
synthesized female sex hormones called oestrogen and progestagen. The remaining 7
tablets are iron tablets which are brown in colour and called “remainder pills”. The 21
active pills suppress the development of ovum and stops ovulation. The users should

start from active pills because they are for stopping conception. When active pills are
finished then remainder pills should be taken. Women who use oral contraceptives
should swallow a pill each day to prevent pregnancy. At present day, combined oral
contraceptives contain very low doses of hormones. They are often called low dose
combined oral contraceptives. Similarly, progestin-only oral pills contain very small
amounts of only one kind of hormone i. e. progestin. They do not contain Oestrogen
and also called mini pills. It is better to take them in the evening. In case of missing,
the users must take immediately when they remember. But these pills should not be
taken by the women who are suffering from Diabetes , Cancer, Asthma, T. B. Hepatitis,
etc.
Advantages
It is inexpensive
It is 99.99% effective, when used correctly
It reduces abdominal pain during menstruation
It helps to continue menstruation
It is beneficial for the woman with low weight
No need to use anything at the time of sexual intercourse
Increase sexual enjoyment because no need to worry about pregnancy
Can be used as long as a woman wants to prevent pregnancy
Fertility returns soon after stopping
Disadvantages
It is not effective if not taken regularly
It causes breast tenderness, slight weight gain, nausea and mild headache
The amount of milk may decrease if woman is breast feeding (in the case of
combined pills)
Doctor’s advice should be taken before using it
Problem of blood pressure might be seen in some females
It can cause nausea, headache, acne, etc
In a few women, it may cause mood change including depression, less interest in
sex
Very rarely can cause brain stroke, blood clots in deep veins of the legs or heart
attack
Do not protect against STIs and HIV and AIDS
b. Foam Tablet
Foam tablet is a kind of chemical contraceptive. It is a tablet which contains an active
spermicide with foaming ingredients and are placed deep in the vagina close to the
Cervix. It should be kept at the cervix at least 10 minutes before sexual intercourse.
It melts due to body temperature
and converts into foam which Contraceptive
makes thick layer and blocks Foaming Tablets
sperm to enter into the Uterus.
It also destroys the mobility
of sperms and helps to inhibit
conception. It is called ‘Kamal Foam Tablet (Kamal Chakki)
Chakki’ in Nepali market.
Advantages
It is useful for the female who has vaginal dryness
It doesn’t have any side effects
It can be used without advice of medical personnel
It doesn’t need any training to use so that any interested female can use it
It prevents against infection in the vagina
No effect on breast milk production
Easy to use with a little practice
No hormonal side effect
May increase vaginal lubrication
Disadvantages
It is ineffective after 1 to 2 hours of use
The users should wait at least for 10 minutes so that it needs patience
Irritation of vagina may occur in some females
It may reduce sexual satisfaction
It is burdensome to the user since it has to be used before each intercourse
May cause warm sensation
May cause irritation to woman or her partner, especially if used several times a
day
c. Gossypol
It is an oral tablet for male. It was brought into
practice by the scientists of China. The scientists
claim that it was experimented in about 4
thousand males and 4 thousand females. It is
not easily available in the market. The users
may feel fatigue, lack of appetite and other
different problems after using it.
Gossypol Pills

3. Injectable Contraceptives
Depo-provera, Intra-Uterine Device, Nor plants, etc come under these types of
contraceptives. They are described as follows:
a. Depo-Provera Injection
Depo-provera is a female contraceptive device.
It is also called Depot-medroxyprogesterone
acetate (DMPA), Depo and Megestron. It
contains progestin hormone which is released
slowly suppresses the development of ova. It
also thickens mucus in the cervix which does
not allow the sperms to pass into the uterus.
Normally, It works for three months. So that it is also called quarterly injection. It
should be taken within 7 days of menstruation, specially in thigh, buttock or arm.
Advantages
It is 99% effective
It doesn’t interfere with sex
It lasts for three months after using once
The female who has blood pressure problem can also use it
Increase sexual enjoyment because no need to worry about pregnancy
No tension of daily pill taking
May help prevent uterine fibroid
Helps prevents ectopic pregnancy
Disadvantages
Change in menstruation bleeding is likely, including light spotting or heavy bleeding
It may increase the weight of the body in some females
It doesn’t prevent against STIs including HIV and AIDS
Swelling, especially in leg is seen in some female
It may cause headache, moodiness, breast tenderness, nausea, less sex drive and
or acne are observed in some women
b. Intra-Uterine Contraceptive Device (IUCD)

Intra-uterine Contraceptive device is a very effective,
reversible, long- term temporary female contraception. Intrauterine
Uterus device
In Nepal, Copper T (TCU - 380A) is most widely used. (IUCD)
It is an English letter ‘T’ structured small plastic device Cervix

wrapped by copper. So, it is also called Copper ‘T’. It
Strings
is kept in the Uterus by the help of doctor or expert.

It makes sperm inactive and works as barrier against sperms. It also does not allow
conception in the Uterus. Once it is used, it works for 12 years. It is not recommended
to use this device to female sex workers and the women who have already given birth
to more than two children. A provider can remove the IUD easily with the help of the
doctor.
Advantages
It is 99% effective
No interference with sex
Long lasting, It works at least for 10 years
It doesn’t disturb health of women
It is useful to mothers who are breast feeding
Increases sexual enjoyment because no need to worry about pregnancy
Does not suppress the production of breast milk
No interaction with any medicine
No hormonal side effects
Disadvantages
May come out of the Uterus , possibly without the woman’s knowledge
Pain in waist and lower abdomen might be felt in some females
Longer and heavier menstrual bleeding or bleeding between periods possibly
contributing to anaemia
It doesn’t prevent against STIs including HIV and AIDS
Irregular menstrual bleeding is observed in the beginning
Severe cramps and pain may occur to some women
c. Norplants
The Norplant implant system is a set of 6 small
(3-4 cm long), white plastic capsules. It is also
called subdermal implants. It is made up of soft
and flexible white colour rubber capsule. Each
capsule is about the size of a small matchstick.
Each capsule contains Progestin hormone. They
are placed under the skin of a woman’s upper
arm within 7 days of menstruation. It should
be inserted by a doctor or a trained health
worker. It needs simple incision to insert them.
Way of using norplants
When they are inserted in the arm they start
to release the hormone gradually and mix up in the blood stream. Then it suppresses
production of ova and thickens the mucus layer in the Cervix which doesn’t let the
sperm pass into the Uterus. A set of Norplant capsules can prevent pregnancy for at
least 5 years. All six capsules should be taken out, if users want baby and after 5 years
of insertion.
Advantages
It works for five years
It is not so expensive
It makes woman free from using different devices every day
Very effective even in heavier women
No Estrogen side effects
Fertility returns almost immediately after capsules are removed
Disadvantages
Pain and tenderness in breasts might be felt in some females
Menstruation becomes irregular in the beginning
It doesn’t prevent against STIs including HIV/AIDS
It may cause acne, headache, nausea, etc
Change in menstrual bleeding, including: light spotting, prolong bleeding and or
amenorrhea may occur
Weight gain, hair loss, acne, dizziness and enlargement of ovarian cysts may
occur
(ii) Emergency Birth Control Devices and their Uses

Emergency contraception refers to postcoital methods: those used after unprotected
sexual intercourse. An emergency contraception may be appropriate if a regularly
used method has failed (for example, if a condom breaks) or if unprotected sex has
occurred. Similarly, the IUD is also used by a few number of women as emergency
contraceptive. Emergency contraceptives are designed only for emergency use and
should not be relied on as a regular method. The most frequently used emergency
contraceptive is a two-dose regimen of certain combined oral pills.
Emergency birth control devices can be used in the following conditions
Ü If used IUD has been missing
Ü If intake of pills forgotten for more than two days
Ü If ejaculation takes place inside the vagina during the fertile period
Ü If tearing of condom, slipping or coming out of diaphragm takes place
Ü If subjected to sexual violence like rape
Ü If natural birth control methods are failed
Ü If sexual intercourse is established without using any contraceptives

The following precaution should be adopted before using birth control devices
Ü The pregnant women are not allowed to use such devices
Ü Before using these devices, health check up of women is necessary by the experts
Ü The women who have swollen blood vessel in her knees and symptoms of breast
cancer should not use it
The following can be considered as emergency birth control method
1. Use of Combined Pills for Emergency
It is very popular method. In this method, woman should take 4 low-dose combined
active pills within 72 hours as a first dose, equal number of pills need to be taken after
12 hours as the second dose. At present , two pills have been packaged as emergency
contraceptive and available in the pharmacies. These two doses emergency pills
have to be taken 12 hours apart. The first dose must be taken within 72 hours after
unprotected intercourse (the sooner, the better) and the second dose must be taken
right after 12 hours of the first dose. The most common side effects are nausea,
vomiting and breast tenderness.
Combined normal oral pills Using method

Within After 12
72 hours hours
1. First dose within 72 2. Second dose after 12

hours of unprotected hours of the first dose.
intercourse.
Using methods of Combine Pills as Emergency Contraception
Effects after taking emergency (combined) pills

Vomiting may occur within 24 hours of administration of the pills in about 50% of
women. If vomiting takes place within two hours, another dose should be provided.
It is better to apply efforts to stop vomiting. To avoid vomiting during this time, it is
better to eat fruits and protein rich diet.
2. Progestin only pills for emergency
These pills contains progestin hormone. Nepal Family Planning Association and Nepal
CRS Company distribute these pills in Nepal. At the same time they are distributed by
other international companies too. One Progestin Only Pill must be taken within 72
hours of unsafe sex and equal dose should be taken after 12 hours of the first dose.
It is 98% effective if used correctly and causes less nausea and vomiting compared to
the combined Pills.

Progestin only emergency pills Using method
After 12
Within
hours
72 hours
1. First dose within 72 2. Second dose after 12

hours of unprotected hours of the first dose.
intercourse.
Using methods of Progestin Only Pills as Emergency Contraception
Effects of Progestin only pills

The effects of these pills are also similar to combined pills. It also makes women to
experience nausea or vomiting. However, there are very few adverse effects.
3. Use of IUD
IUD also can be used as emergency contraception. If inserted within five days of
unprotected intercourse, they are even more effective than emergency pills. This
service is provided in different clinics of Nepal Family Planning Association, Marie
Stopes and other authorized health centre’s. The IUD has to be taken out during
menstruation period. The probability of getting pregnant with its use is 0.1% if used
correctly.
(iii) Permanent Methods of Contraception

1. Vasectomy
Vasectomy is a permanent method of family
planning for male. It is the most effective method
for those who decide they will not want more
children. It is a safe, simple and quick surgical
procedure. It is not castration. It does not affect
Vasectomy Site
the function of Testes and does not affect sexual

ability. It is also called male sterilization or male
surgical contraception. It needs simple incision
on the upper part of Scrotum. It is done by cutting
Vasdeferenses and tying them in both sides. So
that sperms cannot pass to Seminal Vesicles. It is
effective 6 to 10 weeks after surgery. Therefore,
it is better to use condom during sexual intercourse for 20 times of ejaculation or
should apply any other method of contraception at least for 10 weeks.

Advantages
It is very much effective
There isn’t any problem in sexual satisfaction
There isn’t any side effect in the body
It doesn’t reduce sexual ability
A single, quick procedure leads to lifelong, safe and effective family planning
Nothing to remember except to use condoms or another effective method for
the first 20 ejaculations or the first three months, whichever comes first
No repeated clinic visits required
Disadvantages
It doesn’t prevent against STIs and HIV and AIDS
Sometimes, this operation is found unsuccessful due to rejoining of ducts
Pain in the Scrotum, swelling and bruising
Not immediately effective
Reversal surgery is difficult, expensive , and not available in most areas of the
world
2. Laparoscopy
Laparoscopy is a permanent Laparoscopy
contraception for female. It is also Site
called female sterilization or female
surgical contraception. In this
sterilization a small incision (2 cm-
5 cm) is made just below the Navel.
An instrument called Laparoscope is
entered through the incision. With
the help of Laparoscope, fallopian
tubes are closed with a ring, a clip or
by electro coagulation. Due to this,
ova and sperms cannot meet together and fertilization becomes impossible. It should
be done within 30-42 days of delivery or within 5 to 8 days of menstruation.
Advantages
It is an effective measure of contraception
It makes couple’s life happy
It avoids burden from using contraception frequently
It avoids fear of conception during sexual intercourse

Disadvantages
It doesn’t prevent against STIs and HIV and AIDS
It needs expert doctor or health worker to use it
It is complex and risky method
It cannot be used by the woman who has already have abdominal operation
3. Minilap
Minilap is also a permanent
contraception for female. Minilap Site
Small incision is made
in lower abdomen just
above the pubic hair. Then
the Uterus is raised with
an instrument (uterine
elevator) to bring each of
the 2 fallopian tubes under
the incision. After that, the
fallopian tubes tied and cut
down or else closed with a
clip or ring. It stops to pass
ova through fallopian tubes
and conception is not possible even though sperms are ejaculated inside the vagina
during sexual intercourse. It must be done within 45 days of delivery or within 8 days
of menstruation.
Advantages
It is 100% successful
It is not so complicated like Laparoscopy
It helps to limit the family size
No need to admit in hospital for operation
Disadvantages
It is difficult to reverse, if anyone wants
The service is not available everywhere
It cannot prevent STIs including HIV/AIDS

Comparison Between Male Sterilization and Female Sterilization
Male Sterilization (Vasectomy) Female Sterilization (Minilap/Laparoscopy)
Ü It is very effective but slightly Ü It is very effective, slightly lower failure
higher rate of spontaneous rate.
recanalization and pregnancy.
Ü Become effective 6 to 8 weeks Ü Become effective immediately.
after surgery.
Ü Very slight possibility of serious Ü Slight possibility of serious infections.
infection including Tetanus
under conditions of poor
hygiene.
Ü There is no anesthesia related Ü There are few anesthesia related
deaths. deaths.
Ü Can be performed by a trained Ü One doctor and at least two assistants
person with or without an are needed for vasectomy.
assistant.
Ü Safely performed by nurses and Ü Usually only doctors with training in
paramedics. gynecology can perform Laparoscopy
and more difficult for paramedics.
Ü Does not requires specialized Ü Laparoscopy requires; expensive,
equipment. complex equipment.
Ü Medical problems are not seen. Ü There is slight risk of ectopic pregnancy.
The following factors are to be considered after Minilap, Vasectomy and Laparoscopy
Ü Complete rest is required up to 15 days of surgery.
Ü Balance diet should be taken.
Ü It is better to avoid sexual intercourse until the wound recovers, and especially
in the case of Vasectomy other temporary contraceptives must be used for 20
ejaculations.
Ü It is appropriate to avoid heavy works, until the wound recovers.
Ü The activities like cycling, horse riding, motorcycling should be avoided till the
wound recovers.
Ü It is necessary to calculate Age Specific Death Rate to evaluate the age pattern of
mortality rate according to age group.
Ü Population Growth Rate can be defined as the rate at which population is
increases in a given year due to the interplay of rate natural increase and net
migration rate; expressed as percentage of the base population.

Summary
Ü Achille Guillard is the first person to use the term Demography. He used the term
Demography in 1855 AD in his book “Elements of Human Statistics or Comparative
Demography” by combining the two Greek words ‘Demos’ and ‘Graphia’.
Ü John Graunt is the first person who examined the trend of mortality and fertility
from the death record maintained by the churches in London in his famous book
‘Natural and Political Observation Made upon the Bills of Mortality’ in 1662 AD.
This work has been considered as the start of population study. Therefore, he is
also called as father of Demography or Population Study.
Ü Fertility can be defined as ‘the actual reproductive performance of a woman or a
group of women’. So, a woman is considered fertile if she had ever born any child
otherwise she is considered as an infertile woman.
Ü Fecundity refers to “the capacity of a man and a woman, or a couple to participate
in reproduction”. In other words, fecundity is a biological capacity of a woman,
man or a couple to have children.
Ü CBR is the total number of live births per 1000 midyear population of a given
place for the specified year. It is customary to say crude birth rate since it cannot
measure actual fertility rate due to the placement of total midyear population
in the denominator where only a small portion of that population involve in the
fertility process.
Ü General fertility rate is the total number of live births per 1,000 midyear women’s
population of the reproductive period. It is a refined measurement of fertility
over the Crude Birth Rate because it is calculated by dividing the total number of
live births by the midyear population of the women in reproductive period and
multiplied by 1,000.
Ü Population doubling time refers to the number of years required for the population
of a place to double its size with reference to the current rate of population
growth.
Ü The population growth rate with more than 2% and TFR with more than
replacement level (2.1) is considered as rapid population growth rate.
Ü Population management can be considered as a process by which growth rate
and distribution pattern of population can be managed in accordance with the
carrying capacity of the available resources of the given place.
Ü Birth spacing, use of contraception and legal age at marriage are considered as
the direct measures of population control.
Ü Status of women, education, gender equality and equality, women employment
etc are considered as the indirect measures of population control.
Ü Natural contraception method is the process of avoiding unwanted pregnancy
without using any artificial contraceptive devices. This method depends on
identifying the ovulation or fertile period of the menstrual cycle. Hence, it is also
known as fertility awareness based contraception method.

EXE RC IS E
1. Give a definition of Demography.
2. Who is known as the father of Demography?
3. Mention any two social consequences of rapid population growth rate.
4. What is Sex Ratio?
5. What is midyear population?
6. Mention any two adverse impact of uncontrolled migration on social aspects.
7. Give any two examples of direct population control measures.
8. Write any two disadvantages of Norplants.
1. What is total fertility rate? How is it calculated?
2. Briefly explain about oral pills along with their advantages and disadvantages.
3. Give the meaning of migration. How is gross Migration Rate calculated?
4. Briefly describe the cervical mucus method of contraception.
5. Define Infant Mortality Rate. Suppose, 2,100 live births were recorded in
Pathari Sanischare Municipality in 2015 AD. Among them 60 infants died
before completing one year of age. Find Infant Mortality Rate.
6. Explain the impact of migration on socio-economic and environmental
aspects.
C. Write differences between:
1. Fecundity and fertility
2. Natural and artificial factors of population change
3. Vasectomy and Minilap
4. Net Migration Rate and Gross Migration Rate
D. Write short notes on:
1. Basal body temperature method
2. Rate of Natural Increase
3. Depo-Provera
1. What is Rapid Population Growth Rate? Explain the consequences of rapid
population growth on social, economic and environmental aspect.
2. What is dependency ratio? How do you calculate old and young dependency
ratio? What are the advantages of having knowledge of dependency ratio?
Project Work
Collect the data of birth, death, migration and total family members from 10
households of your community for a specific year. Calculate CBR, GFR, CDR, NMR,GMR
of that place and present the report in the class.
UNIT
POPULATION, ENVIRONMENT AND
3 DEVELOPMENT
Explain the development activities in different sectors.
Explain the interrelationship among population, environment and development.
Elaborate the need and importance of regional balance in development of the
nation.
Define and tell the importance and principles of sustainable development.
3.1 Population, Environment and Development Activities

We know that population is the total number of people residing in a particular place
or a country in a particular time period. The aggregate of all the external forces or
condition that directly or indirectly influence the growth and development of human
life including their social and economic condition is called environment. In other
words, environment denotes the sum total of physical and biological factors that
affect the survival, growth, development and reproduction of organism. Population,
environment and development activities are interdependent among one another.
Environment is the key factor, which influences the life pattern of the living organism,
human behaviour and socio-economic development process.
Development denotes positive change in the perception, social system, way of living,
economy and institutional set up. We know that development is really much more than
merely economic growth. Development always involves progressive transformation
of economy and social system. The satisfaction of human needs and aspirations is the
ultimate objective of development. It helps to fulfill the various needs and necessities
and also increases the capability of people to be self-dependent.
We know that man is a part of environment. Therefore, there is never ending interaction
between man and the environment. Man can establish positive and negative
interaction with the environment. Positive interaction of man with the environment
helps to maintain ecological systems in proper order. In this situation, we can have
sound environment to survive, fresh air to breath, clean water to drink and healthy
habitat to live in. On the other hand, man’s negative interaction with environment
results into pollution, energy crisis, spread of diseases and unprecedented natural
hazards.

People exploit the resources to conduct development activities. While carrying out
development activities we need to maintain balance and coordination between
population, development activities and environment. Population control, environment
conservation and development process can go together side by side if people carry out
development activities in sustainable manner. All sorts of population and development
related activities are conducted within the environment. People should realize that it
is their responsibility to protect the environment while carrying out activities in those
sectors. The development activities without proper plan and long-term vision affect the
environment and sustainability of life. Thus, development activities should be carried out
under the backdrop of long-term vision. For sustainable living, man needs to establish
good coordination among population, environment and development activities.
We know that environment and development activities are interrelated to each other.
It is obvious that environment is the source of many things for human beings. During
the interaction with the environment, people either get adapted or modify the natural
environment. Development activities generally bring change in the existing condition of
the environment. But, while carrying on development works we should not forget the
existence and association between human and environment. Therefore, environmental
aspect should be put in centre while conducting developmental activities. This type of
development model helps to keep balance between development and environment.
The activities that are illustrated in the following diagram can be considered as the
activities under population, environment and development.
Environment
Culture Health Security

Communication Human Resource
Environment
Environment
Technology Population & Development Housing
Agriculture Education Industry Employment
Environment
Development Activities in Different Sectors
According to the above diagram, the various activities in the sector of agriculture,
industry, health, education, transportation, communication, security, human
settlement, science, technology, and employment come under the scope of population,
environment and development. Some major activities are explained below:
A. Agriculture
Agriculture is considered to be backbone of Nepalese economy. It is the major source
of livelihood of Nepalese people. Around 60 percent of the total population still
depends on agriculture for their subsistence. Most of them are small and marginal
farmers. As one third of the GDP comes from agriculture sector, it is quite clear that
it has an immense role to play in reducing poverty and ensuring food security and
balance of trade of Nepal.
Contrary to very important position of agriculture sector in development of Nepal,
there is not so much attraction in this sector due to nominal benefit. However,
development in agriculture is possible through scientific land reform, protection of
farmers’ rights, commercialization of the agricultural products, diversification, and
use of modern science and technology in agriculture sector. The government should
give priority in agricultural sector so that it can create employment opportunities
and supplies adequate food materials to the people. If there is proper utilization and
market management of the agricultural products, it can support the development of
other sectors also.
B. Industry
Industrialization is one of the activities of population, environment and development.
Industrialization is taken as one of the most vital indicators of economic growth
and prosperity of the nation. Therefore, today’s main necessity is to support
industrialization by establishing industries based on agriculture and local resources in
rural sector and establishing and developing industrial zones in urban areas.
Industrialization plays an important role to alleviate dependency on agriculture
and existing unemployment and poverty of the nation. Investment in industries
also contribute in the creation of employment, development of resources, skill
and productivity. Adequate infrastructures have to be managed for the promotion
of industrialization and encouraging local and foreign investment in industries.
Industrialization creates both negative and positive impact on population and
environment. Unmanaged industrialization creates negative impact on environment.
Consequently, it spreads various kinds of diseases and impair human health and
their productivity. On the other hand, well managed industries creates employment
opportunities, checks import of goods and boost up socio-economic condition of the
people without deteriorating the environment.
Activity
Visit some local level development activities related sites of your locality. Observe
those activities and get detail information about that activities in the following table:
Development Impact on
S.N. Social Benefit Economic Benefit
Activities Environment
1.
2.
3.

C. Health
Health is the basic human right of the people. The Constitution of Nepal, 2072 BS
has incorporated health as a fundamental right of the people. The basic foundation
of development is the healthy and productive human resource. Quality health
services and healthy environment and good nutrition are very important components
for healthy life. So, it is the obligation of the government to provide basic health
services free of cost. It is also equally necessary to make provision of safe drinking
water and sanitation facilities to the people for their healthy life. In the context of
Nepal, there is a problem in the delivery of quality health services due to lack of
economic development and resources. People cannot live healthy life if there is lack
of safe drinking water and sanitation facility. Hence, health related activities can be
considered as one of the important foundation of the development process.
D. Social Security
Social security is primarily a human welfare program providing social protection, or
protection against poverty, old age, disability, unemployment and others. It enhances
social justice. Social Security is a public provision for the economic security and social
welfare of individuals and their families, especially in the case of income losses due to
unemployment, work injury, maternity, sickness, old age, and death. The term social
security encompasses not only social insurance but also health and welfare services.
Social security may refer to social insurance, where people receive benefits or services
including provision for retirement pensions, disability insurance, survivor benefits and
unemployment insurance. Social security system can be promoted through the social
justice, poverty alleviation and other various welfare programs. Nepal is yet to go for
a wide range of social security programs to provide benefit to the needy people.
E. Housing
Residence is also one of the basic needs of the people. There is improvement in the
overall health condition of the individuals if there is provision of appropriate residence
for them. However, unmanaged human settlement creates adverse impact on the
individual’s health. In fact, well planned human settlement helps for the management
of population and environment. In this context, human settlement creates both of the
negative or positive impact on population, environment and development.
F. Education
Education is an effective tool for personal empowerment and enhancement of
human dignity. It plays a significant role in the welfare of people, as well as the
socio-economic development of the nation. It enhances access to information that
is necessary to carry out various essential activities of daily life and work, and has
an impact on an individual’s ability to participate in society and better understand
important public issues. Investment in education could be seen as an investment in
human capital formation and an instrument for acquiring skilled human resources. A
population with strong education background places a country in a better position to
meet the complex socio-economic challenges that it confronts.

G. Communication
Communication is a process of dissemination of message, information, feeling and
idea from one place to another place or one person to another. We can exchange
our views, knowledge, ideas and information through the means of communication.
Newspapers, magazines, telephone, postal service, cell phones, internet, television,
radio, etc are the examples of means of communication. The world has become
just like a small village due to the advancement of means of communication. It
plays an important role for the social and economic development of the society
and the nation. Nepal is also advancing towards advanced technology in the field
of means of communication. Similarly, excess in information and communication is
increasing even in the remote areas of the country. The information and messages
through various means of communication play important role for the management
of population, family management, sanitation and environment conservation. Hence,
it is necessary to maximize the utilization of information and communication for the
overall development of the country.
H. Human Resource
The individuals who are working in different business, occupation and service is
considered as human resource. In other words, educated, skillful and well trained
work force in the field of education, communication, agriculture, health, science and
technology are considered as human resource. Doctors, engineers, teachers, lawyers,
surveyors, journalist, pilots, electricians, plumbers, etc are the examples of human
resource. Human resource is the foundation for the social and economic development
of the nation. It helps to increase economic growth rate and alleviate poverty of the
country. Human resource has been given priority in every periodic development
plans of Nepal. There should be good set up of infrastructures like education, health,
employment, etc for the development of human resource in order to prevent youths
from emigrating outside for the foreign employment.
I. Employment
Employment is to generate income by involving in the business or occupation. In
another words, employment is the job done by an individual for earning income.
When people are employed they can solve their economic problem and fulfill their
needs. Continuous involvement and dedication in the profession can make a person
entrepreneur, industrialist or trader in the society, nation and even in the international
arena.
In the context of our country, some common fields of employment are civil service,
farming, tourism, teaching, trade, animal husbandry, carpentry, business of metal and
bamboo items, etc. These professions generate income sources to the people. Such
income helps to meet the needs of family members by providing education, health,
nutrition, etc. The condition of having no job or employment in the working age is

known as unemployment. The jobless people without any income generating sources
are called unemployed people.
It is the prime responsibility of the state to promote employment opportunities to the
human resource by imparting education, trainings and skills. Currently, in Nepal, 2.5
million people of working age are unemployed and labour participation rate stands
at 83.4 percent. Out of the total population, 30 percent is either unemployed or
underemployed whereas 400 thousand people are entering labour market every year.
Employment opportunities can be generated by creating environment for
entrepreneurship, skill development new job opportunities. It helps in the management
of population in one hand and there is possibility of sustainable development by
proper utilization of environmental resources.
J. Culture
Culture is considered as the total way of life, social interaction, pattern of behaviour.
Infact, culture is a broad term that includes our way of living, moral and manners,
languages, arts, rituals, festivals, religions, costumes and traditions, etc. Our culture
and cultural aspects remain lively through preserving and promoting the important
archaeological, religious and cultural heritages of the nation. These historical,
archaeological and religious heritages are the important foundation for the social and
economic development of the nation. If it is possible to develop eco-tourism, culture
and industrialization through expanding their identity, conservation and promotion.
3.2 Regional Balance in Development
The proportional development in all regions is considered as regional balance
of development. Even though the concept of the regional development for the
balanced development of the nation in Nepal was emerged during the fourth and
fifth plan period, the materialization of the objective of maintaining regional balance
has not been experienced yet. Consequently, the results of the development could
not be equally delivered among the people due to the growing imbalance among
the political regions. Therefore, it has become the need to speed up the effort to
develop the backward regions in balanced manner. Nepal is transforming into the
federal structure. It is necessary to set the goal to make balanced development even
in different districts, towns and villages of the same province or state. Therefore,
keeping in view the integration of national economy, a strong strategy for regional
development is necessary in order to appropriately utilize the available human
resources and natural resources as well for the balanced development of the country.
Based on the available data, an enormous gap is seen between the Human Development
Index of the urban and rural areas. The Index of Mid-Western Development Region
and Far-Western Development Region are found weaker in comparison to other
development regions. Gender Development Index, Gender Empowerment Index
and Human Poverty Index have also shown that the condition of the rural areas
and the Mid-Western Development Region is weaker than in other areas/regions of
the country. The above mentioned situation shows that the past efforts made for
achieving the goal of balanced development could not be successful. Therefore, the
present need is to make effort for developing all the regions in a balanced way by
reducing the regional inequality, integrating the national economy, and utilizing the
available natural resources.
In this context, with the vision of raising the living standards of the people of
all the regions of the country in just and equitable manner through the balanced
development of all the regions of the country, the Plan has set the following objective
and strategies.
There should be identification of the economic possibilities of different places and
formulating and implementing the economic development plan for these areas. The
backward areas in respect of economic and infrastructure development should be
given special priority while allocating resources. Emphasis should be given in the
development of the production system where local resources and skills are utilized on
the basis of sectoral comparative advantage and local competitive capacity. Priority
will be given in the development of physical and social infrastructures such as road,
electricity, drinking water, basic health services, etc in the areas lacking infrastructure
development.
Importance of Balanced Regional Development
It ensures proportional development process in all regions and sectors.
It helps to reduce regional inequality in development process.
It encourages the state and entrepreneur for dispersion of industrial and
development activities in different regions and sectors.
It helps to reduce the gap between center and periphery.
It helps to paves the way for optimum utilization of resources available in different
parts of the country.
It creates employment opportunities in different parts of the country.
Table 3.1: The HDI of Nepal According to Regions, 2011 AD
Geographical Regions HDI (2011 AD)
Eastern and Mid Mountain 0.475
Eastern and Mid Hill (Except Kathmandu Valley) 0.490
Eastern and Mid Terai 0.463
Kathmandu Valley 0.622
Western Hill 0.511
Western Terai 0.480
Western, Mid Western and Far Western Mountain 0.398
Mid Western and Far Western Hill 0.423
Mid Western and Far Western Terai 0.472
Nepal 0.490
Source: Nepal Human Development Index, 2011 AD
Activity
Discuss the consequences of unbalanced development activities in the country with
the help of the HDI table given above. At the same time, also discuss about the
appropriate strategies to be adopted by the government to maintain regional balance
in the development process and programs.
3.3 Sustainable Development
Sustainable development is the foundation for human beings for their sustainable
life. It helps to get a desirable future for human society in which living conditions and
resource-use meet human needs without undermining the sustainability of natural
systems and the environment. So that future generations may also have their needs
without suffering from crisis. Indeed, sustainable development ties together the
concern for the carrying capacity of natural systems with the social and economic
challenges being faced by people in their day to day life. Simply speaking , it is an
environment friendly long lasting development.
The Brundtland Commission (1987 AD), in its report ‘Our Common Future’ has
quoted the definition of sustainable development as “development process that
aims to meet the needs of the present generation without compromising the ability
of future generations to meet their own needs is called sustainable development.”
This development approach gives emphasis on the environmental, economic, and
socio-political dimensions of development works by exploring changing patterns of
consumption, production and distribution of resources for the sustainability.
According to the principle of sustainable development, any kind of activities should
not be far beyond the carrying capacity of environmental resources. So, we should
not exploit the resources excessively in order to satisfy our needs. If over exploitation
of resources take place, it causes adverse effects on environment. The ultimate
goal of sustainable development is to keep balance in population, environment and
development. Therefore, the objective of sustainable development can be pursued
through proper management of forest resources, watersheds, wetland ecosystem,
industries, transport system, sustainable farming, and maintaining integrity between
man, nature and developmental works. Hence, it ensures maximum and long term
benefits with minimum exploitation of existing means and resources. In this situation,
we can promote our quality of life through the sustainable use of available means and
resources without deteriorating environment and the nature.
3.3.1 Importance of Sustainable Development
Sustainable development provides foundation for environmental conservation, It is
also a means to achieve development goal of the nation. In this regard, sustainable
development has a great importance to keep balance between development works
and ecosystem. Some of the importance of sustainable development are explained
below:

A. Proper Utilization of Resources
Sustainable development gives emphasis for the proper use of resources. For this,
people should develop positive attitude and behaviour for the rational utilization of
natural resources. In this situation, we should get help from eco-friendly technology
to run development works. It helps in the protection of environment and controls the
over exploitation of the resources.
B. Realization of Responsibility
Sustainable development changes people’s knowledge, skill and thinking. People
realize the importance of forest, wildlife, watersheds, land and other resources as
well. They have realized that the resources are their common properties in which
individuals cannot use according to their personal vested interest. So, this kind of
felling is really helpful for the conservation of natural resources.
C. Development of Basic Areas
Sustainable development emphasizes on the development of basic areas. Health,
education, agriculture, tourism, water supply, housing, transportation are to be taken
in basic areas. But while doing work in basic areas, conservation measures need to be
integrated.
D. Focus on Public Participation
To achieve the goal of development, focus should be made on public participation.
It encourages people for development and conservation of resources. Therefore,
sustainable development provides ample opportunities for the integration of
environment conservation and development programs.
E. Determination of the Limit of Development
Though the limited resources are enough to meet the human needs, people desire
to conduct development works beyond the limits. Development works beyond the
limit of carrying capacity causes adverse effects on environment, resulting into the
degradation of the resources. In this regard, sustainable development helps people
to develop a feeling of proper development considering the carrying capacity of the
Earth.
F. Long-term Vision
Sustainable development aims to gear up economic and social development without
any damage on the environment. It tries to alter the attitude of people so that the
resources can be preserved for future generation. Therefore, sustainable development
always contributes for the conservation of resources having long-term vision.
3.3.2 Objectives of Sustainable Development

Sustainable development is an important development concept of the 20th century.
It gives assurance of human welfare and environmental conservation at present
generation and guarantees the protection of the future generation. Sustainable
development deserves the following objectives:
e Conservation of environment
e Rationale use of natural resources
e Conservation and promotion of wildlife
e To fulfil human needs
e To alleviate poverty
e To foster social justice and prosperity
e To protect the human existence
e To conserve cultural heritages
e To increase public participation and self-dependency
e To increase economic growth rate
Activity
Conduct a talk program in your school on ‘need and importance of sustainable
development in for the sustainable living without compromising the needs of the
future generation’ by inviting development expert.
3.3.3 Principles of Sustainable Development

It is obvious that the Earth and human civilization can be preserved only through
sustainable development. Man is the driver of development works. Thus, s/he should
conduct any development activities in eco-friendly way. Some of the principles of
sustainable development activities are mentioned below:
A. Conservation of Ecosystem
The principle of sustainable development is
to keep balance between biotic and abiotic
aspects of environment. This principle helps
to protect the existing ecosystem of the
Earth. In order to conserve it, the aquatic and
terrestrial ecosystem should be protected at
different time periods.
Wetland Ecosystem
B. Sustainable Development of Society
Sustainability of society depends on the availability of healthy residence, balanced
diet, adequate health service, employment and quality education. If these elements
are developed and become available to the people in the society, it becomes a
sustainable society. It assists in developing their positive attitude towards nature and
living beings. The society is driven towards conserving the environment.

C. Conservation of Biodiversity
Conservation of biodiversity resources is
essential for balanced development. Thus,
sustainable development always focuses
for the conservation of biodiversity. For
this, conservation programs at national and
international level can be conducted.
D. Population Management
People survive by consuming the means and Silver Bullet Mammal, New Zealand
resources of the Earth. But rapid population
growth increases the consumption rate of resources. But it is the fact that resources
of the Earth cannot be increased as per the need of people. Sustainable development
focuses to control population growth rate to minimize the exploitation of resources
so as to balance the ecosystem.
E. Development of Human Resource
Humans have important role in utilization and conservation of resources. For the
sustainable use of resource conservation, knowledge and skill of people should be
developed. The development of human dexterity helps to apply the principle of
sustainable development.
F. Increase in People’s Participation
Local people are both the consumer and conserver of the resources. In the absence
of people’s participation, conservation of natural resources is almost impossible. In
this regard, sustainable development emphasizes to increase people’s participation.
G. Conservation of Cultural Heritage
Social tradition, customs, religious places and culture are the priority area of
sustainable development. These important gifts of society are to be preserved
reforming the bad customs. Conservation of these aspects really contribute for the
H. Limit of Carrying Capacity
Human being should run the development works considering the carrying capacity of
the ecosystem and the Earth. We know that, the Earth has limited carrying capacity.
Over use of resources and unsustainable development activities results in to adverse
impact on environment. Therefore, man should conduct development activities
within the limit of carrying capacity of the Earth and its components.
I. Improvement in Quality of Life
Another principle of the sustainable development is to acquire quality of life. The
ultimate goal of sustainable development program is to improve the level of quality of
life. Inclusive development and human resource development help to acquire quality
of life. Sustainable development always gives focus on quality of life.
J. Environment Conservation
Sustainable development always gives focus on the conservation of environment. So,
it is also called environment friendly development. Development activities are carried
out without deteriorating the quality and status of biological resources, ecological
balance and environmental components.
3.3.4 Application of Sustainable Development
The principle of sustainable development should be interlinked with the various
fields of developmental works. Improper utilization of natural resources makes the
existence of living beings more challenging. It also causes inequality and injustice,
consequently it hampers the balanced development in all parts of the society and
nation. Development and environment are just like the two sides of a coin. Therefore,
we should not forget to protect environment while carrying out development works. It
is mentioned in the Human Development Report that “Development without adequate
environmental conservation is weak. At the same time, without development, the
means for necessary investment will lack and the environmental conservation will be
unsuccessful.” Hence, the principle of sustainable development need to be applied
appropriately in each and every field.
Agriculture, industrialization, construction, education, health, forestry, transportation
and tourism are the scope of development programs. Hence, while carrying out
the development activities, environment should be put in the centre. In addition
to this, bioengineering, eco-tourism, nuclear energy generation are the fields
in which principle of sustainable development is mandatory. Eco-tourism and
community forest management programs are some of the examples of application
of sustainable development. The World Tourism Organization declared, “2002 AD
as the International Year of Eco-tourism,” highlighting the growing importance of
The following concepts should be integrated while carrying out development works
for the sake of sustainable development:
e All kinds of development activities should be integrated with conservation programs.
e Emphasis should be given for the social development.
e The programs of conserving animals and plants should be adjusted in accordance
with development works.
e Natural resources should be used rationally. Perpetual resources should be used
maximum whereas there must be the minimum use of nonrenewable resources.
e Development works should be limited within the Earth’s carrying capacity.
e The production and use of destructive objects are dangerous to human society
and environment. Thus they should be made illegal and prohibited at global level.
Summary
Ü Development denotes positive change in the perception, social system, way of

living, economy and institutional set up. Development always involves progressive
transformation of economy and social system. The satisfaction of human needs
and aspirations is the ultimate objective of development.
Ü Development in agriculture is possible through scientific land reform, protection
of farmers’ rights, commercialization of the agricultural products, diversification,
and use of modern science and technology in agriculture sector.
Ü Unmanaged industrialization creates negative impact on environment and it
spreads various kinds of diseases and impair human health and their productivity
but managed industries creates employment opportunities, checks import of
goods and boost up socio-economic condition of the people without deteriorating
the environment.
Ü Newspapers, magazines, telephone, postal service, cell phones, internet,
television, radio, etc are the examples of means of communication. The world
has become just like a small village due to the advancement of means of
communication.
Ü Educated, skilful and well trained work force in the field of education,
communication, agriculture, health, science and technology are considered as
human resource.
Ü Doctors, engineers, teachers, lawyers, surveyors, journalist, pilots, electricians,
plumbers, etc are the examples of human resource.
Ü Human resource is the foundation for the social and economic development of
the nation. It helps to increase economic growth rate and alleviate poverty of the
country.
Ü It is the prime responsibility of the state to promote employment opportunities
to the human resource by imparting education, trainings and skills.
Ü Currently, in Nepal, 2.5 million people of working age are unemployed and labour
participation rate stands at 83.4 percent.
Ü Out of the total population, 30 percent is either unemployed or underemployed
whereas 400 thousand people are entering labour market every year.
Ü Nepal is transforming to the federal structure. It is necessary to set the goal to
make balanced development even in different districts, towns and villages of the
same province or state.
Ü The development process that aims to meet the needs of the present generation
without compromising the ability of future generations to meet their own needs
is called sustainable development.
Ü The sustainable development approach gives emphasis on the environmental,
economic, and socio-political dimensions of development works by exploring
changing patterns of consumption, production and distribution of resources for
the sustainability.
EXE RC IS E
1. What is development?
2. What is environment?
3. What is the ultimate goal of development?
4. Mention any two principles of sustainable development
5. Give any two examples of social security.
6. When was the report of Brundtland Commission of ‘Our Common Future’
published?
7. Mention an importance of regional development.
1. Explain the interrelationship between population, environment and development.
2. What is development? Mention any four importance of it.
3. Why is development work necessary for the development of the nation?
Give reason.
4. Demonstrate the role of agriculture in the overall development of the nation.
5. Demonstrate the relation of balanced regional development with sustainable
development with reference to Nepal.
6. Mention the objectives of sustainable development.
7. How can you relate the role of environment while carrying out the various
kinds of development activities?
1. Human resource
2. Carrying capacity of the earth
3. Communication
D. Long answer questions.
1. What is sustainable development? How can you apply the principles of
sustainable development in your context?
2. ‘Focus should be given on regional balance in development activities for
the delivery of equal benefits of those activities in all places of the nation.’
Explain with justification.
Project Work
Observe any one development program of your locality and prepare a report based
on the heading or subtitle that is given below by taking information from the field
work.
a. Title of the Study
b. Introduction of the Study
c. Objective of the Study
d. Method of Data Collection
e. Socio-economic Benefit of the Program
f. Environmental Impact of the Program
g. Conclusion and Recommendation
UNIT
POPULATION AND ENVIRONMENTAL
4 STATUS OF NEPAL
Explain the trend of population distribution in Nepal by ecological region.
Tell the meaning of ecosystem.
Elaborate the ecosystem of Mountain, Hill and Terai Region.
Identify the impact of human activities on the ecosystem of Mountain, Hill and
Terai Region.
Mention the mitigating measures of effects on the ecosystem of Mountain, Hill
and Terai Region.
Participate in environment management and conservation programs.
4.1 Population Distribution by Ecological Region

The arrangement of population according to the ecological division is called
population distribution by ecological region. Geographically, our country is divided
into three ecological regions. They are Mountain, Hill and Terai. Ecological division
reflects the variation in climatic condition and the variation of agricultural land and
other resources. The population of Nepal is not distributed evenly. The population
distribution of the country by ecological regions for the census years 1971 AD to
2011 AD is shown in the following table:
Table 4.1: Distribution of Population by Ecological Division, Nepal 1991 AD - 2011 AD
Ecological 1991 2001 2011
Region Population (%) Population (%) Population (%)
Mountain 1,44,31,130 7.8 16,87,859 7.3 1,78,792 6.7
Hill 84,19,889 45.5 1,02,51,111 44.3 1,13,94,007 43
Terai 86,28,078 46.7 11,21,453 48.3 1,33,18,705 50.3
Source: CBS, 2012 AD
The table reveals that the population of the Terai region has been increasing rapidly
in every census year. The Terai region had enumerated 46.7 percent of the total
population in the census year 1991 AD and it has reached to 50.27 percent in the
census year 2011 AD. On the other hand, there has been a remarkable decrease in
the share of population in Mountain and Hilly regions. For instance, the population
of Mountain region has been declined from 7.8 percent in 1991 AD to 6.73 percent in
2011 AD. Similarly, the population of Hilly region declined from 45.5% in 1991 to 43%
in 2011 AD.
Initially, Terai region was covered with dense forests highly infested with Malaria
and other transmissible diseases. However, the diseases were controlled later.
The increasing rate of deforestation for the human settlement and the pattern of
population distribution by ecological zone has also changed. According to the 11th
national population census report 2011 AD, Terai alone shared about 50.27 percent of
the total population, whereas Hill and Mountain regions occupied 43 and 6.7 percent
respectively
The population of Nepal is not evenly distributed due to the diversity in topography
and uneven distribution of means and resources, climate, unequal distribution of
facilities, services and their accessibility. For instance, we observe high density of
population in those areas with adequate provision of employment, education, health
services, transportation, electricity services and other facilities in comparison to
those places with inadequate facilities and opportunities.
Reasons of Unequal Population Distribution in Nepal by Development and
Ecological Regions
Diversity in land topography
Uneven distribution of means and resources
Diversity in climatic condition
Uneven distribution of fertile land
Lack of regional balance in development programs
High rate of in-migration from Mountain and Hill to the Terai region
Uneven access to socio-economic and political opportunities and facilities
4.2 Concept of Ecosystem
Generally speaking, ecosystem can be considered as the system resulting from the
integration of all the living and nonliving factors of the environment. In other words,
Ecosystem is a basic functional unit consisting of both biotic and abiotic components
interacting with each other for maintenance of life process. The term ‘ecosystem’ is
derived from two words ‘eco’ and ‘system’ where ‘eco’ implies to environment and
‘system’ implies to interacting and interdependent complexity. An ecosystem may be
as small as a pond or cropland ecosystem and as large as an Ocean, desert and forest
ecosystem.
We can observe that the ecosystem influences the food habits, economic activities
and the way of life of the people living in those places. Furthermore, it also influences
habitats, reproduction and regeneration process of plants and animals. Similarly,
the growth, expansion and development process of the total living organisms are
governed by the complexity of ecosystems.
Air
Sun
Consumer
(eagles)
Water
Producer Rock and

(Pine trees) Soil
Decomposer
(Fungi, Bacteria)
Natural Ecosystem of Mountain Region
4.2.1 Ecosystem of Nepal by Geographical Region

Nepal is a small country in between two big countries, located on the northern margin
of South Asia. The country is rectangular in shape with a total area of 1,47,181 square
km which accounts 0.03 percent and 0.3 percent of the total land area of the World and
Asia respectively. Nepal lies between the longitude of 80°4’ to 88°12’ East and latitude
of 26°22’ to 30°27’ North. The country has nearly 885 km length and 193 km breadth
in its spatial extension. Its altitude ranges from 60 to 8,848 meter from the sea level.
The topography of Nepal is full of amazing altitude variation from the lowland plain to
perpetual snowy ranges above 8,000 meters. According to physiographic division, the
country is divided into the following sub-divisions:
The Trans Himalaya The Mahabharat Range Bhawar
Outer Himalaya The Midland Hill The Inner Terai
The Main Himalaya The Siwalik Range The Plain Terai
The Churia is the Southern fragile Hill Region of Nepal, geologically known as the
Siwalik. Bhitri-Madhesh, also known as Inner-Terai is disjointed from the Terai by the
Churia range and has topographic features similar to those prevailing in the plain Terai.
The Terai region lies in the extreme southern part of the country. It is continuously
extended from the East to West with the breadth almost 16 km to 32 km bordering
with India. According to Land Resource Mapping Project, 1986 AD, 20.7% of the total
area of Nepal is occupied by cultivable land.
A. Mountain Region
The Mountain Region lies in the northern part of the country. This region is distributed
ranging from the altitude of 4,877 to 8,848 meter. It occupies about 35 percent of the
total land area of the country. The Mountain Region is divided into different sub-
divisions such as Main Himalaya,
Outer Himalaya and Trans (Inner)
Himalaya. In which, the Main
Himalaya are the outstanding
geographic divisions with most
prominent peaks like Dhaulagiri
(8,167 m), Annapurna (8,019 m),
Manasalu (8,163 m), Mt. Everest
(8,848 m) and Kanchanjungha
(8,586 m). They are the valuable
natural assets of the country and
symbol of identity of Nepal for the Topography of Mountain Region
outside world. Similarly, the areas
beyond the main Himalayas is called Trans-Himalayas. They are also known as Bhots.
In addition, there are several small valleys. Highland dwellers like Bhote and Sherpa
people have been living in some places on the elevation of above 4,000 meter over
there. There are 16 districts in this region.
1. Physical Aspects
Physical aspect of the ecosystem includes land topography, climate, rivers and edaphic
factors. The Mountain region has beautiful mountain ranges, snow capped peaks and
valleys. Dolpa, Mustang, Dolakha, Manag are some of the places of this region. For
instance Kanchanjungha, Langtang, Mahalangur, Ganesh, Annapurna, Dhawalagiri
and Kanjirowa are the major mountain ranges. The lakes like Tilicho, Rara, Phoksundo,
Tso- Rolpa, Imja, etc are famous lakes of this region. This region occupies 35% of
the total land area of the country. According to Land Resource Mapping Project
(1978/79 AD); of the total land of the Mountain region, only 4.4% land is under
cultivation. The rugged terrain, high altitude and steep slope are the main limiting
factors. Moreover, a large proportion of land in the mountain region is rocky and
barren.
Topographic condition of this region is rugged. The mountains above 5,000 meters
are always covered with snow and ice. During the winter, season snowfall occurs up
to the elevation of 3,000 meter. This region is divided into three sub-divisions: Main
Himalaya, Inner-Himalaya and Outer Himalaya. This region is extended from 4,877 to
8,848 meter altitude from the sea level. There is no rainfall in the inner Himalayan
region like Manang, Mustang, Mugu, Dolpa which lie beyond the main Himalaya. So,
these areas are also called as rain shadow areas of Nepal. In this region, the snow line
starts from the elevation of 4,000 meters in the West and from the altitude of 5,000
meters in the Eastern part of the country. The climate of this region is extremely cold
compared to that of the Hill and Terai Region.
Physical Aspects: Some Facts of Mountain Region
Land coverage : 35 percent
Cultivable land : 4.4 percent
Altitude : 4,877–8,848 meter
Climate : cold, humid and dry
Topography : rough, steep, rugged, snow covered
Sub-division : Main Himalaya, Inner Himalaya and outer marginal Himalaya
Mountain peaks : Sagarmatha, Dhaulagiri, Annapurna, Manaslu, Choy, etc.
Snowline : 4,000 meter in the west and 5,000 meter the East
Precipitation : Snowfall in the winter
Mountain ranges : Kanchanjungha, Mahalangur, Annapurna, etc.
Soil type : Unfertile, silty and rocky
Valleys : Arun valley
2. Biologic Aspects
Animals, plants, vegetation and birds are included in the biological aspects of the
ecosystem. Mountain region has extreme variation in land topography and climate
within a small area, because of this it has become the habitat of various plants,
animals, birds and wildlife. The animals and plants which have adapted in the cold
and dry climate, and less oxygen are found here. Though, the agricultural production
is very low, barley, potato, buckwheat and Uwa are cultivated in this region. Similarly,
green vegetables like carrot, spinach, onion and radish are also produced here. Apple,
lemon, orange and some other citrus fruits are grown here. Rice is also cultivated by
the people in some lower part of valleys and basins. The trees like Maple, Gobre Salla,
Devdar, Rhododendron, Bhojpatra, Sprus are found in this region. The medicinal
plants like Jatamasi, Panchaunle, Yarsagumba, Timur, Padamchal are also found here.
Shrubs are found above 4,000 meters altitude. The wild animals like Snow Leopard,
Wildboar, Black Bear, Red Panda, Jharal, Ghoral, Yak, Sheep, Assamese Monkey are the
common animals found in this region. Similarly, the birds like Danfe, Munal, Koklas,
Chilme Kalij, Luinche, etc are found in this region. The plants and animals which can
be adapted in the cold climate and low oxygen can only survive here.
Biological Aspects: Some Facts of Mountain Region
Trees : Maple, Gobresalla, Devdar, Bhojpatra, etc.
Herbs : Jatamasi, Yarsagumba, Timur, Padamchal, etc.
Wild animals : Snow Leopard, Wild boar, Red Panda, Assamese monkey, Musk
deer, etc.
Domestic animals : Sheep, Horse, Yak, Bhote Kukur, etc.

Birds : Damphe, Munal, Koklas, Chilme, Snow Pigeon, etc.
Fruits : Apple, Lemon, Orange, etc.
Crops : Barley, Potato, Buckwheat, Millet, Uwa, Junar, etc.
Vegetable : Carrot, Spinach, Onion, Garlic, Radish, etc.
3. Socioeconomic Aspects
Socioeconomic aspect denotes
language, religion, occupation, food
habits and way of life of the people.
The Sherpa, Thakali, Magar, Mugal,
Manangis, and Bhote communities
live in this region. People wear thick
woollen clothes like Bakkhu, Docha
woollen hat, etc in this region.
Human settlement is found along
the river side and some areas near
steep slopes even up to the elevation People ploughing and planting rice plant
of 4,572 meters altitude. Lhosar,
Buddha Purnima, Dhumje, Dashain, Udhauli, Ubhauli and Mani Rimdu are the festivals
celebrated by the people of this region. Most of the festivals are celebrated with much
feasting, dancing and singing. Most of the people of this region are Buddhist and
Hindus. Various mother tongues like Sherpa, Gurung, Hyalmo, Thakali, Rai, Magar,
Bhote, etc are spoken by the overwhelming population in this region. There are 16
districts in this region.
The famous places like Olangchungola, Namche, Muktinath, Chame and Thakkhola
lie in this region. People of this region have tendency to migrate to the Hill and the
Terai temporarily because of snow fall and cold climate in the winter and return back
in the summer. The housing, food habits, and clothing, occupation and life styles of
the people of this region are different from other regions. Houses of this region are
mostly constructed with stones and wood having flat roof. Generally, the people of
this region keep cattle in the ground floor of their house.
There are many famous religious sites including Muktinath, Gosaikunda, Pathibhara,
Tanboche gumba and Mustang gumba in this region. If the infrastructures were well
set in this region, people would have raised their economic status by tourism and
other economic activities.
Due to the cold climate, geographical constraints, lack of fertile soil and modern
facilities, this region is sparsely populated. According to the census of 2068 BS, only
6.73% population of the country had been enumerated in this region.

Socio-economic Aspect: Some Facts of Mountain Region
Population : 6.73 percent
Districts : 16 districts
Castes/Ethnic groups : Sherpa, Thakali, Manangi, Chhetri, Rai, Limbu, Bhote, etc.
Festivals : Lhosar, Buddha Purnima, Dhumje, Udhauli- Ubhauli, Mani
Rimdu, Dashain, etc.
Religion : Buddhist, Hindu, Kirant, etc.
Language : Sherpa, Thakali, Rai, Bhote, etc.
Famous Religious Sites : Muktinath, Gosaikunda, Pathibhara, Mustang gumba,
Tangboche gumba, etc.
Clothes : Bakkhu, Docha, Woollen hat, etc.
House : Stone house having flat roof with small windows.
Famous places : Olangchungola, Namche, Chame, Thakkhola, etc.
Occupations : Agriculture, mountaineering, tourism, domestic trade,
animal husbandry, etc.
Life style : People temporarily migrate to the hill and Terai in winter
along with their cattle and return in summer.
B. Hill Region
The Hill Region lies between the
Mountain and Terai Region. This
region is expanded ranging from
the elevation of 610 to 4,877
meter from the Sea level. This
region has occupied about 42% of
the total land area of the country.
This region is divided into three
sub-divisions such as Midland Hill,
Mahabharat Range, and Siwalik
Range. It extends from East to West Topography of Hill Region
without any break.
The Mahabharat Range (also known as Lesser Himalayan) has remained as a natural
defensive wall towards the south so as to protect the mountain people and their
culture from the southern invasion. Furthermore, the Midland Hill Region (commonly
known as Pahad) is a broad zone between the Mahabharat range and the Main
Himalaya. This is a zone of innumerable valleys, river basins and tars. Kathmandu and
Pokhara are famous fertile valleys in this region. This region has the elevation ranging
from 610 meter to 4,877 meter. At present, this region is under the serious attack of
environmental maladies. Due to severe deforestation, in most of the places people
are facing acute shortage of fuel, wood and fodder to run daily life. Soil erosion has
become nonstop phenomena, aggravated by floods and landslides.
1. Physical Aspect
The Hilly region is situated between the Mountain in the north and the Terai in the
south and extends from east to west without any break. This region ranges from
610 to 4,877 meters altitude between the Mountain and the Terai. It is formed by
rugged topography with hills and hillocks. Valleys, basins, tars and plain lands are
the major settlement areas of this region. Hills of various topographical structures
with terraces are found here. It has occupied about 42% of the total land area of the
country. This region occupies an intermediate position in the proportion of cultivated
land. According to Land Resource Mapping Project (1978/79 AD), of the total land of
this region 17.2% is cultivated there. This region is divided into three sub-divisions
such as Mahabharat range, Mid land, and Chure or Siwalik. Due to the topographical
difference, rich diversity of ecosystems is found in this region. It has moderate climate
which is suitable for settlement. Hence, this region is enriched with vast diversity of
biological resources.
Physical Aspect: Some Facts of Hilly Region
Altitude : 610–4,877 meter
Climate : Moderate mild and healthy
Topography : High, peak hill, valley, basin, tar, etc.
Sub-division : Mahabharat range, Midland, Siwalik
Valleys : Kathmandu, Pokhara, Surkhet
Lakes : Phewa, Rupa, Begnas, Madi, etc.
Precipitation : Heavy rainfall during monsoon
Soil type : Silty and unfertile
2. Biological Aspect
Due to the physical diversity, Hilly region is rich in biological diversity. Hilly region is the
main area of deciduous and mixed forests. Uttis, Gobre Salla, Paiyu, Katus, Chilaune,
Ranisalla, Khayar and Kharsu are the main species of trees of this region. In the higher
altitude, Rhododendron and Kharsu are predominantly found. Bojho, Bell, Chirauto,
Tejpat, Timur, Chutro, Kalo, Dhaturoo, Panch Aunle, Rato chyau, Amala, Harro and
Barro are some of the medicinal plants of this region. Maize, Potato, Rice, Millet,
Buckwheat and Soybeans are cultivated in this region. Clouded Leopard, Leopard cat,
Rhesus monkey, Porcupine, Wild dog, Chital, Monkey, Jackal, Sloth bear and Wild Cat
are predominantly found wild animals of this region. Cow, Buffalo, Horse, Donkey and

Goats are the domestic animals that are found in this region. This Region is suitable
for livestock farming, fruticulture and silviculture. The fruits like; Orange, Lemon,
Guava, Banana, Strawberry, Pomegranate, etc are cultivated in this region. Similarly,
the vegetables like Spinach, Pumpkin, Bitter gourd, Brinjal, etc are found in this region.
Kalij, Falcon, Eagle, Dove and Parrot are the common birds of this region. In the rivers,
rivulets and streams fish of different species including Asala and Jalkapur are found in
this region. So, this region can also be termed as the paradise of biodiversity.
Biological Aspect: Some Facts of Hilly Region
Trees : Uttis, Chilaune, Gobra salla, Paiyu, Katus, Khayar, Kharsu, etc.
Herbs : Tejpat, Chiraito, Chutro, Kalo dhaturo, Panch aunle, Harro, Barro,
Rato Chyau, etc.
Wild animals : Clouded Leopard, Leopard cat, Sloth bear, Wild cat, Porcupine,
Chital, etc.
Domestic animal : Cow, Buffalo, Horse, Goat, Donkey, etc.
Fruits : Orange, Lemon, Guava, Banana, Strawberry, etc.
Birds : Kalij, Falcon, Hawk, Wild cock, Eagle, Parrot, Dove, etc.
Crops : Paddy, Wheat, Maize, Millet, etc.
Cash crops : Coffee, Tea, Sugarcane, Oil seeds, Cardamom, etc.
Vegetable : Brinjal, Spinach, Bitter gourd, Pumpkin, etc.
3. Socioeconomic Aspect
Because of moderate climate,
people of Hilly region wear
seasonal clothes. Thick woollen
clothes are preferred in the winter
and thin cotton clothes in the
summer by the inhabitants. People
of different ethnic groups speak
their respective mother tongues
like Newari, Rai, Tamang, Sherpa,
Gurung, Magar, Chepang, Raute,
Kusunda, Nepali, etc in their Cultural heritage of our country
communities.
The people of various castes and ethnic communities like; Rai, Limbu, Magar, Brahmin,
Chhetri, Newar, Dhami and others have settled down in this region. They celebrate
different festivals in accordance with their rites and rituals. People of this region
celebrate festivals like Dashain, Tihar, Shivaratri, Buddha Purnima, Udhouli-Ubhouli,
Maghe Sakranti, Losar, Id, Ramzan, Christmas and other national and local festivals.
Most of the village people are engaged in agriculture horticulture, livestock, poultry
farming for their livelihood. The people in urban areas are mostly engaged in business,
production, banking, social service, civil service but majority of the people are in
agriculture. They cultivate fruits, rice, potato, millet, etc in tars, basins and plain lands.
Houses of this region are mostly made up of stones, bricks or mud with thatched
roofs and tiles. But, concrete buildings are also being constructed especially in the
towns and city areas. The famous religious and cultural sites such as Haleshidham,
Pashupatinath, Swyambhunath, Manakamana, Changunarayan, Ruru Kshetra,
Dakshinkali, Boudhanath, Swargdwari, Ridi, etc lie in this region.
Majority of the people of this region live in the rural areas. Kathmandu, Pokhara,
Banepa valleys are located in this region. Ilam, Bhaktapur, Banepa, Bhojpur,
Okhaldhunga, Dhankuta, Diktel, Pokhara, Kathmandu, Lalitpur, Kirtipur, Dhulikhel are
the major towns and cities of this region. The places with elevation above 3,000 meters
in this region are sparsely populated due to the physiographic and climatic difficulties.
On the other hand, the lower hills and valleys are densely populated. Actually, hill
landscape is both natural and cultural mosaic shaped by geological forces and human
effort. Agricultural land of this region is excessively exploited due to the pressure of
population growth. As a result of inadequate and due to lack of development works,
people of this region are found to be migrating to the Terai specially in the urban
areas due to various facilities. According to the census of 2068 BS, 43.01% of the total
population are living in this region. There are 39 districts in this region.
Socio-ecomomic Aspect: Some Facts of Hilly Region
Castes/Ethnic groups : Gurung, Magar, Rai, Limbu, Newar, Damai, Tamang, etc.
Clothes : Thick woollen clothes in the winter and thin cotton
clothes in the summer.
House : House mostly made up of stones, bricks or mud with
thatched roofs and tiles in the village and concrete
buildings in the city areas.
Festivals : Dashain, Tihar, Buddha Purnima, Udhauli-Ubhauli,
Maghe Sakranti, Id, Christmas, etc.
Religion : Hindu, Buddhist, Islam, Christian, Kirant, etc.
Language : Nepali, Newar, Magar, Gurung, Tamang, Rai, Limbu, etc.
Famous Religious places : Pashupatinath, Swoyambhunath, Budhanilakantha,
Sworgadwari, Ruru, Dakshinkali, Manakamana, etc.
Famous places : Pokhara, Kathmandu, Dhulikhel, Kakani, Sindhuli gadhi,
Ilam, Dhankuta, Palpa, etc.
Occupation : Agriculture, service, business, trade, tourism, industry, etc.
C. Terai Region
The Terai region lies in the southern
most part of the country. It is
continuously extended from the East
to West. It has occupied about 23%
of the total land area of the country.
This region expands to the altitude of
60 to 610 meter from the Sea level. It
is divided into three sub-divisions such
as; The Bhaban region, The southern
plain Terai and Inner Terai. Its average Topography of Terai Region
breadth is about 30 kilometers. In this
region, the temperature is hot and humid. The topography is plain and the soil is
alluvial and fertile. The Terai includes several dun valleys like Surkhet and Rapti Valleys
(Dang) in western Nepal and the Rapati Valley (Chitwan) in Central Nepal. There are
20 districts in this region.
1. Physical Aspects
In contrast to Mountain and Hill region, the land of Terai is flat and the climate is hot
and humid. The fertile alluvial flat land of Nepal extends from the East to the West
stretching along the Nepal-India boarder and paralleling the Hill region. It covers 23%
of the total land of the country. According to Land Resource Mapping Project, this
region has occupied about 51.7% of the total cultivable land of the country. Terai
region of Nepal also includes some inner valleys like Rapati (Chitwan), Deukhuri (Dang)
which are also called dun valleys. The Terai region is divided into two sub division,
Inner-Terai and the Main Terai. The structure of ecosystems of three divisions are
different to each other. The fertile soil is deposited here by the rivers from the north.
Physical Aspect: Some facts of Terai Region
Altitude : 60-610 meter
Climate : Hot and humid
Topography : Plane
Sub-division : Main Terai, Inner-Terai
Precipitation : Heavy rainfall during monsoon
Soil type : Alluvial and fertile
2. Biological Aspects
There are different species of animals, birds and plants. Sal, Sisau, Satisal, Karam,
Sahaj, Dhayaro, Simal, Pipal are the common species of trees found here. Bengal

Tiger, Asiatic Elephant, One-horned Rhinoceros, Barking Deer, Common Leopard,
Wild boar, Swamp deer, Hispid hair, Squirral, etc are the common species of animals
of this region. Vultures, Kites, Falcon, Dove, Crane, Eagle, Crow, Kingfisher, Peacock
and Giant pied hornbill are the birds commonly found in this region.
The soil of this region is fertile and suitable for agricultural production. Rice, Maize,
Wheat, Tobacco, Pulse, Sugarcane, Jute, etc are cultivated in this region. Harro, Neem,
Tulsi, Bojho, Pudina, Barro, Dhaturo, Serpentina are the commonly found medicinal
plants of the Terai region. Various species of fish like Kauwai, Rahu, Mungri, Singhi,
Grass carp, Common carp, Silver carp, etc are found in the streams, rivers and ponds.
Biological Aspects: Some facts of Terai Region
Trees : Sal, Sisau, Satisal, Karam, Simal, Pipal, etc.
Herbs : Neem, Pudina, Ghiukumari, Sarpagandha, Bojho, Dhaturo, Ghod
Tapre, Titepati, etc.
Wild animals : Asiatic Elephant, Bengal Tiger, Common Leopard, One-Horned
Rhino, Barking Deer, Swamp Deer, etc.
Domestic animals : Cow, Buffalo, Pig, Goat, Horse, Donkey, etc.
Fruits : Banana, Pineapple, Jackfruit, Papaya, Watermelon, Pomegranate,
Guava, etc.
Birds : Eagle, Hornbill Dove, Parrot, Luiche, Sparrow, Crow, King Fisher,
Vulture, Nightingale, etc.
Crops : Paddy, Wheat, Maize, Millet, etc.
Vegetable : Cabbage, Cauliflower, Brocauli, Brinjal, Ladys Finger, Tomato, etc.
3. Socio-economic Aspects
The Terai region has some unique socioeconomic characteristics than that of the
Mountain and Hill. Availability of alluvial soil has made the Terai region as granary
basket of Nepal. Most of the people of this region are engaged in agriculture,
business and services. People celebrate the festivals like Id, Maghi, Chhat, Holi, Sama-
chakhewa, Dashain, Tihar, etc. Rajbansi, Tharu, Rajput, Satar, Dhimal, Majhi, Yadav,
Jha, Teli, Kayastha, Musahar, Harijan are the common castes/ethnic groups living in
this region. Various temples, monasteries, churches, mosques are found here. Some
religious and cultural places are Lumbini, Tribeni, Barah Kshetra, Janaki mandir,
Debghat, Gadhimai are very famous in this region. People from Mountains and Hills
are migrating to the Terai region due to the availability of the facilities like transport,
education, trade, employment and the fertile land.
Houses are constructed with wood and mud with thatched or tiled roofs. In the towns
and cities people mostly live in RCC buildings. The socioeconomic characteristics is
influenced by Indian culture to some extent. According to the census of 2068 BS,

50.27% people live in this region. The natural resources of this region are over
exploited due to the high population pressure. There are 20 districts in this region.
Socio-economic Aspect: Some facts of Terai Region
Castes/Ethnic group : Rajbansi, Tharu, Dhimal, Majhi, Rajput, Satar, Yadav, Jha,
Teli, Kayastha, etc.
Festivals : Id, Maghi, Chhat, Holi, Hipawali, Sama-Chakhewa, etc.
Religion : Hindu, Muslim, Jain, Sikh, Christian, etc.
Language : Maithili, Bhojpuri, Tharu, Dhimal, Santhal, Rajbansi,
Nepali, etc.
House : Wood, mud, dry grass, bamboo with thatched or tiled
roofs in the village and RCC buildings in the city area.
Famous religious Places : Ramdhuni, Barahakshetra, Budasubba, Lumbini, Janakpur
dham, gadhimai, etc.
Famous places : Dharan, Janakpur, Birgunj, Biratnagar, Dipayal,
Mahendranagar, etc.
Occupation : Agriculture, industry, trade, service, business, etc.
4.3 Effects on Ecosystem by Ecological Regions and Mitigating
Measures
Various human activities have brought in adverse effect on the ecological process
of the ecosystems of different parts of the country. The unsustainable development
works like unplanned industrialization, unmanaged urbanization, unplanned
construction works, random use of chemical fertilizer in the agricultural field have
caused adverse effect on the ecological balance. Similarly, the human activities like
deforestation, poaching of wild animals and unmanaged transportation system have
further aggravated the existing condition of the environment. Some of the effects of
human activities on the ecosystems by geographical regions are mentioned as follows:
4.3.1 Effects on the Ecosystem of Mountain Region and Mitigating
Measures
Due to the rough topography and geographical remoteness, it is difficult to carry out
development work in the mountain region. The population density is very low in this
region in comparison to Hill and Terai region. There are less number of industries
here in Mountain Region due to lack of infrastructures like; electricity, transportation
communication and other facilities. Employment opportunities are inadequate in this
region due to the lack of industrial development and unsustainable agriculture. There
is lack of technological advancement as there is no strong base of infrastructures

for development activities. As a result, there is less impact of development works
and modernization in the Mountain ecosystem. Some effects of human activities and
mitigating measures on the ecosystem of Mountain region are described below:
Effects Mitigating Measures
Ü Deforestation and excessive use of Ü Proper management of forest
forest resources. resources and search of alternative
sources of fuel.
Ü Landslide, soil erosion and soil Ü Proper management of eco-friendly
sterility due to improper use of land and terrace farming and use of
resources. compost manure, follow crop cycle.
Ü Depletion of pasture land due to Ü Proper management of pasture land,
indiscriminate livestock farming. controlling indiscriminate grazing.
Ü Increasing land pollution because of Ü Proper management of wastes in
mountaineers. those mountaineering area.
Ü Global warming causing Glacier Lake Ü Control in emission of green house
Outburst Flood (GLOF) gases and proper management of
glacier lakes.
A. Use of Forest Resources and its Protection
Though this region is less densely populated, people have to rely on natural resources.
Illegal cross-border trade of wood planks of trees with Tibet is also one of the major
problems of deforestation in this region. Firewood has been the major source of
fuel in this region. So the people of this region cut down a large number of trees for
firewood and cross-country trade of timber with Tibet. These activities have caused
in deforestation in this region. Indiscriminate grazing of the pastureland has also
caused the depletion of forest resources of this region. To minimize these impacts
afforestation program should be launched. At the same time, alternative source of
fuel should be searched as well.
B. Use of Land and its Protection
In this region, only 4% land is suitable for cultivation. So, the agricultural production
of this region is low which cannot support the inhabitants of this region even for half
a year even though they work hard for the whole year. This region is a food deficit
region so people residing here are cultivable land hungry. People even cultivate in
steep slope area which increases the rate of landslide and soil erosion. Outdated
traditional pattern of agriculture is also the cause of low production in this region.
To mitigate these effects, farmers need to be encouraged for sustainable farming.
Forage plants should be cultivated in sloppy area or cultivation need to be done with
terrace system.
C. Livestock Farming
It is needless to say that livestock farming is the main occupation of the people in
this region. However, due to lack of scientific knowledge people allow their cattle
for indiscriminate grazing in the pasture land. It hinders the regeneration process of
small saplings and may also deplete the pasture land.
Awareness campaign need to be conducted to make the people sensitive and
responsible for sustainable collection, utilization and management of forest resources.
At the same time people should be encouraged to grow grass by themselves for their
animals in their own land to minimize the effects on the pasture land.
D. Growing Pollution because of Mountaineers
Many tourists are attracted by snow capped landscape of this region, they come for
trekking purpose. During the mountaineering and trekking period the waste materials
like cans, bottles, plastics, ropes, etc carried by them are not disposed properly. It has
created serious problem in the mountain ecosystem specially in the trekking areas.
So, proper management of waste materials in the trekking routes is essential to
mitigate the environmental problems.
4.3.2 Effects on the Ecosystem of Hilly Region and Mitigating Measures
The Hilly region has more favourable environment for settlement and development
activities in comparison to the Mountain region. There is a gradual development
of infrastructures for development activities like transportation, electrification,
communication, education, etc. In this region, the urban areas are more densely
populated in comparison to the rural areas. As a result, the effect of modernization
and development activities are more pronounced in the urban areas than in the rural
areas. People of this region are engaged in various occupations such as agriculture,
business, animal husbandry, etc. People in the urban areas are also attracted to
the civil service, trade, production and industrial entrepreneurship. Various human
activities have brought adverse effects on the ecosystem of Hilly region. Some of
them are mentioned below:
Ü Deforestation is done for the Ü Search for alternative source
extension of agricultural land and for fuel and awareness towards
fuel resource. utilization of forest resources
without deteriorating.
Ü Farmers are using huge amount Ü Awareness on less use of chemical
of chemical fertilizer, insecticides fertilizers and biological control
and pesticides which deteriorates measures of insects and pests.
aquatic and terrestrial ecosystem.
Ü Indiscriminate grazing by livestock. Ü Controlling of indiscriminate grazing.

Ü Environmental problem like Ü Controlling cultivation on marginal,
landslide, soil erosion, flood are fragile and sloped land. Terrace
emerging with deforestation for the cultivation system should be
sake of agricultural land. adopted.
Ü The grassland are being converted Ü Overgrazing should be controlled.
into desert due to overgrazing.
Ü The water resources like river, Ü Awareness programs on water
rivulets, ponds of our surrounding pollution and sanitation should be
are getting polluted. conducted.
A. Use of Forest Resources and its Protection
The vegetation, sources of water resource and natural habitats of wildlife are destroyed
while carrying out the construction activities. At the same time, more than 65% people
of this region use firewood as a source of fuel for cooking. There is high demand of
timber for furniture, construction of house and other miscellaneous works. There is a
tendency of allowing cattle free in forest for grazing. These activities have resulted into
deforestation in this region. To minimize these effects afforestation, public awareness
and resource conservational programs should be conducted effectively in sustainable
manner.
B. Livestock Farming
Livestock farming is also one of the important occupations of the people of this region.
The natural environment has been degraded due to overgrazing, collection of fodder,
firewood and herbs in indiscriminate manner, which has caused gradual decline of
forest resources and grassland.
To mitigate these effects, people should be rationale while utilizing the resources.
Likewise, indiscriminate grazing and over exploitation of forest resources need to be
controlled in time.
C. Use of Land and its Protection
Most of the people in this region are engaged in farming. They do not stop themselves
even from cultivating the extremely steep and marginal land in order to meet the
demand of cultivable land for growing population. Similarly, the calamities like soil
erosion and landslide have also degraded the ecosystem of this region. Moreover, the
indiscriminate use of chemical fertilizer has also degraded the quality and productivity
of the land.
To control these effects, the marginal fragile land should not be used for cultivation.
If necessary, terrace system should be used for cultivation in the sloppy land. Farmers
must be encouraged to use organic compost manure. Alteration of crops also help to
increase the productivity of land.

4.3.3 Effects on the Ecosystem of Terai Region and Mitigating Measures
There is more population pressure in the Terai region than in the Mountain and Hill.
In-migration from Hill and Mountain to the Terai region has been increasing over
the few decades. Due to the plain geophysical structure and sufficient development
infrastructures like transportation, communication and education are more in
this region compared to that of the Hill and Mountain Region. The unsustainable
development works and undue population pressure have adversely affected the
ecosystem of this region. Some major effects and their mitigating measures are
described below:
Ü Deforestation Ü Proper management of forest
resources.
Ü Excessive use of marginal land. Ü Proper utilization and management of
land resources.
Ü Over grazing. Ü Control of indiscriminate grazing.
Ü Depletion of ecosystem by random Ü Environmental Impact Assessment
construction work. before the construction work.
Ü Industrial pollution. Ü Proper management of industrial
waste and chemicals.
Ü Flood and loss of life. Ü Tree plantation at the bank of the
rivers and afforestation.
Ü Fertile and plain land is being Ü Landslide in hilly region and Churiya
submerged by the flood with stone, region should be stopped by planting
soil, sand and silt resulting into trees.
infertility.
A. Use of Forest and its Protection
The people of Terai depend mostly on agriculture and forest products as other regions.
Forest of Terai region has been depleted for the expansion of settlement, cultivation
and timber. Smuggling of the forest resources especially for timber is the main cause
of its depletion. To mitigate these effects, awareness programs and proper execution
of Forest law need to be carried out effectively. Moreover, deforestation and absolute
poverty should be eradicated by providing alternative sources of livelihood access
to opportunities to the low income families, who depend on the forest resources for
their livelihood.
B. Constructional Work and Conservation
Due to the favourable geo-structure, more constructional works such as roads, canals,
etc are possible here. Random construction of physical structures have brought
adverse effects on the ecosystem of this region. Thus, integration of conservation
programs while carrying out the construction works is an essential part of sustainable
development works.
C. Livestock Farming
The forest resource has been utilized conventionally to feed the animals even in the
Terai as in other regions. Indiscriminate grazing of the grassland has destroyed the
young saplings and they cannot be regenerated again. Thus, overgrazing should be
controlled in sustainable manner. At the same time while collecting grass for the
cattle, forest resources should be utilized rationally in order to mitigate the adverse
effects.
D. Industrial Development and
Pollution Control
Due to the easy access to raw materials and
better infrastructure for development, a large
number of industries have been established
in Terai region. The waste materials coming
out from the industries like dust, smoke, and
other by-products are affecting adversely the
ecosystem of this region. Cow Farming
Various programs need to be conducted to control pollution. Modern eco-friendly

technology should be used in industries. Plantation of trees around the industries can
also help to minimize the effect of dust, smoke and noise pollution.
E. Use of Land and its Protection
The soil of this region is alluvial and fertile but it has been depleted due to flood,
waste materials and random use of chemical fertilizers.
Landslide and soil erosion and deforestation of Hilly region should be controlled
to check flood in the Terai Region. Use of compost manure should be promoted to
maintain the quality and fertility of the soil. Solid and liquid waste of industries should
be well-managed.
4.4 Management and Conservation of Environment
Environment! A literally known word to everybody, but very few have realized its
importance. There is no doubt that environment plays an important role for the
survival, growth and development of human beings. Human beings utilize various
types of natural resources available in the environment. Our survival is not possible
in the absence of environmental resources and its components. The increasing
needs and demands of the goods and services of the human society may pose
undue pressure on the existing environment and its components. Environment has
not been given much importance especially in third world countries like Nepal. The
major environmental problems such as physical congestion, air pollution, water
pollution, aesthetic pollution due to municipal and industrial wastes, poor sanitation,
inadequate sewerage, loss of public open spaces and loss of cultural heritage has not
been addressed yet as a result of which environmental pollution has been increasing

day by day and has become from worse to worst. Hence, immediate action is needed
to address these problems in an integrated manner.
In this situation, proper management and conservation of the environment should
be felt necessary for balancing the consumption and preservation of the resources of
the environment. In order to bring balance between exploitation and preservation of
the environmental resources, environment management should regulate and control
the human activities over the environmental components in such a way so that the
strength of the environment to sustain the needs and demands of future generation
should remain unimpaired.
The ultimate goal of environmental management is rational utilization of the
environmental components for human welfare and productive life. In other words,
environment management aims to mitigate the undue pressure of human activities
on environment. Simply, the management and conservation of environment is to
preserve the depleting resources and utilizing the other resources to address the
needs of the human for their survival and productive life. Many environment related
activities have been carried out in action in this decade for the conservation and
management of the various components of the environment. For instance, many
international conventions, policies, strategies, legal provisions and programs have
been established for the management of environment.
4.4.1 Major Activities on Environment Conservation and Management
Conservation of living natural resources like plants, animals, and microorganisms
and the nonliving components of the environment of the earth are crucial for the
development of the society and the nation. Continuous increase in the size of human
population has resulted into increasing demand of resources. This situation ultimately
increases the possibility of the crisis of resources. In this condition, the renewable
natural resources in general and the non-renewable resources in particular are
overexploited and may end after some time. We need to take proactive and radical
step to conserve these invaluable resources in time. We can carry out the following
activities for the conservation and management of our precious environment:
A. Conservation of Forest
Forest resource plays an important role for the balance of natural environment. We
can get various kinds of resources from the forest. In this context, various kinds of
forest conservation programs are carried out at local, community and national level in
relation to the management of the environment of the particular place or region. We
can see forest conservation programs at local and national level under the initiation of
the Community Forest Management Program. In addition, The Ministry of Forest and
Soil Conservation has also conducted many forest conservation programs at various
levels.
B. Conservation of Soil
Soil conservation is also one of the areas of the environment management program.
The government agencies like The Ministry of Forest and Soil Conservation and The
Ministry of Agriculture are working for the conservation and management of soil of

the country. In order to conserve the soil, we
should not use chemical fertilizer, insecticides
and pesticides randomly. We also need to
protect grassland from overgrazing. Moreover,
it is better to incorporate this issue in the
curriculum in school and college education.
C. Management of Waste Materials
There should be proper management of waste
materials for the conservation of environment. Forest conservation campaign
We should go through different steps of activities
like collection, classification, composting, incineration and proper disposal of wastes.
It plays an important role for the management and conservation of the environment.
D. Control of Pollution
Environment pollution has reached extreme in the world. Our country is not the
exceptional case in this issue. Now it is very common to see warning at public place as
“air unfit for breathing”, “water unfit for drinking” and so on. Dust particles, garbage,
smoke, wastewater and other disposable waste materials are the main agents of
pollution. It is our prime responsibility to control these pollutants from the clean,
safe and healthy environment.
E. Public Awareness
Unless the people are not aware about the
need and importance of the environment, they
will not be motivated for the conservation of
the environment. So, for the conservation of
the environment, people should realize its
importance for healthy and productive life. In
this context, awareness program should be
carried out at local and national level.
F. Management of Watershed Classification of solid wastes
Watershed plays an important role for balancing
the ecological process. It is essential for the
survival and growth of the aquatic flora and
fauna. In addition, it is also equally important
for agriculture, industries, hydropower,
fisheries, and other activities. It supplies water
for drinking and other household chores.
Therefore, there must conduct various programs
for the proper management of watersheds
at local and national level. We can do tree Watershed management
plantation on the bank of the watershed area.
Moreover, we should control water pollution, which helps to supply safe and clean
water as per the requirement.

Summary
Ü Ecosystem is a basic functional unit consisting of both biotic and abiotic

components, interacting and interdependent to each other.
Ü We can observe that the ecosystem influences the food habit, economic activities
and the way of life of the people living in those places. Similarly, it also influences
the growth, expansion and development process of the living organisms.
Ü Geographically, the Mountain region is divided into different sub-divisions such
as: Main Himalaya, Outer Himalaya and Trans-Himalaya.
Ü Geographically, the hilly region is divided into different sub-divisions such as:
Midland hill, Mahabharata range and Siwalik range.
Ü Geographically, the Terai region is divided into different sub-divisions such as:
Southern Plain Terai and Inner-Terai (bhitri madhes).
Ü There is less impact of development works and modernization on the mountain
ecosystem in comparison to the hilly and Terai region due to difficult topography,
geographical remoteness, weak base of development infrastructure, lack of
industrial development and low population density.
Ü The snow line begins at the altitude of 4,000 meter in the west and 5,000 meter
in the eastern part of the Mountain region.
Ü The area beyond the Main Himalaya is called Trans-Himalaya. It is also known as
Bhot. This area remains dry throughout the year.
Ü The Mountain region is important for animal husbandry, fruit farming,
hydroelectricity, mountaineering, medicinal plants, etc.
Ü The Hilly region is important for livestock farming, fruiticulture, vegetable
farming, tourism, beekeeping, poultry, etc.
Ü The Terai region is important for industries, crop farming, animal husbandry,
poultry, fishery, jute, and sugarcane and oil seed cultivation.
Ü According to Land Resource Mapping Project, 1986 AD, out of the total cultivable
land of Nepal AD, 8.3% in Mountain, 40% in Hill and 51.7% in the Terai region’s
land area are occupied by cultivable land.
Ü Watershed plays an important role for balancing the ecological process.
Ü The ultimate goal of environmental management is rational utilization of the
environmental components for human welfare and productive life.
Ü We should go through different steps of activities like collection, classification,
composting, incineration and proper disposal of wastes.

EXE RC IS E
1. Which aspects are comprised to ecosystem?
2. What percentage of cultivable land is there in the mountain region?
3. What is the altitude range of hilly region of our country?
4. Which aspects of ecosystem do the festivals and food habits of the people
indicate?
5. Which region of Nepal is more affected by modernization?
6. Write any two festivals that are celebrated in Terai region.
7. Mention the sub-division of Mountain region.
8. In which geographical region Baraha Kshethra lie?
9. At what altitude snow line exists in the eastern part of Nepal?

1. Compare the socioeconomic characteristics of Mountain and Terai Region.
2. How does modernization affect the ecosystem? Explain with examples.
3. What is ecosystem? Explain its components.
4. How does conservation of wildlife help to protect the ecosystem? Justify
with example.
5. Explain briefly the socioeconomic aspect of the place where you are living.
6. Compare the physical aspects of Hill and Terai Regions in any five points.
7. List any six community based local environment conservation programs and
explain any two of them.
8. Explain the economic aspect of hilly region.
9. What type of human activities destroy the ecosystem of Terai Region?
Explain.
10. Write any five measures for the conservation of cultural heritages of your
country.

1. Physical aspects and biological aspect of the ecosystem
2. Biological aspects of Hill and Mountain region
3. Preservation and conservation of natural resources

1. Soil conservation
2. Economic aspect of Terai Region
3. Livestock farming
4. Utilization and conservation of forest resources

1. Compare the ecosystem of the Mountain Region with that of the Terai
Region.
2. Explain the ecosystem of the Hilly Region with the Terai Region with the
suitable examples.
3. Compare the biological and physical aspects of the Hilly Region with the
Mountain Region.
Project Work
Observe the development activities that are in operation in your locality. Discuss about
the benefits and environmental implications of those activities with the community
members of that place and prepare a report on the basis of the criteria that is given
below:
• -----------------------------------------------
1 Name of the development activities • -----------------------------------------------
• -----------------------------------------------
• -----------------------------------------------
2 Socio- economic benefits of that project • -----------------------------------------------
• -----------------------------------------------
• -----------------------------------------------
3 Impact of that project on environment • -----------------------------------------------
• -----------------------------------------------
• -----------------------------------------------
4 Mitigating measures of impacts • -----------------------------------------------
• -----------------------------------------------

UNIT
FAMILY LIFE EDUCATION AND
5 QUALITY OF LIFE
Define quality of life and tell its importance.
Explain the elements of quality of life.
Demonstrate the interrelationship between quality of life and low quality of life.
Explain the bases of quality of life.
Mention various indicators of happy life.
Analyze the status of HDI trend of the various countries of the world including
SAARC countries.
5.1 Concept of Quality of Life and its Components

5.1.1 Introduction to Quality of Life
The term “Quality” is derived from the Latin word “Qualitas” and its meaning is
appropriate standard. Hence, the etymological meaning of quality of life is the
overall standard of life of individual or members of the family or society. In general,
quality of life is the general well-being of individuals and society. The term ‘quality
of life’ is associated with comfort, productivity and prosperity of human life. But the
term quality of life itself is a relative term so that different people from different
socioeconomic, cultural and political background develop different perspectives and
sense towards it. Hence, the concept of quality of life depends upon the sociocultural
and economic background as well as personal felt needs, preferences and philosophy
of life.
Indeed, quality of life is a very complex phenomenon to translate in day to day family
life since it is determined by the function of biophysical needs, psycho-social needs
and personal aspirations. Thus, it is difficult to measure the level of satisfaction. It is
a common phenomenon that even the persons with the same socioeconomic family
background working in the same office or doing same business may have different
sense towards quality of life. At the same time, when rich people are not satisfied
with their life, the poor people who are passing through hardship of life may be
living with smile and hopes. It is thus due to the variation in personal aspirations
and perspectives, quality life can take different meaning to different people. But we

must not forget that the quality
life of family and society is
impossible without satisfying the
basic needs like food, clothes,
housing, security, fresh air, safe
and potable water, health service
and education. Similarly, other
various needs of the people such
as physical, psychological, social
and spiritual needs have to be
fulfilled along with attainment of
basic needs. Quality of life means the method of existence of life along with happiness
and satisfaction from the fulfillment of basic needs and other social, cultural and
psychological needs of the people. In addition, it is the sense of being pleased with
what one has.
According to the demographer, R.C. Sharma, “Quality of life is a very complex concept
as it involves the satisfaction of the emotional needs and social aspirations of the
community as society’s ability to meet the basic needs of food, clothing, housing,
energy and space by itself ”.
Similarly, the other scholar Bernard Berelson opined that “Quality of life is a state in
which prosperity in place of poverty, education in place of ignorance, health in place of
morbidity, adequacy of food articles, in place of hunger, adequacy of housing facilities
in place of slums, environmental beauty in place of environmental deterioration and
full opportunities for the next generation of children in place of current limitation”.
In this context, we can say that quality of life is a complex relative term, used for
maximization of comfort which includes both physical, social, economic and
psychological dimensions of human life. And finally, we can assume that quality of
life is the satisfaction of the various needs of people such as physical, psychological,
spiritual on the one hand and consumption of necessary basic needs for survival on
the other hand. Quality of life is proportionately related with the fulfillment of human
needs. Those needs are described below:
A. Biophysical Needs
Physiological needs are also known as biological needs. The needs like air, water,
food, rest and shelter are considered as physiological needs. They are also called as
fundamental needs since they are essential for our survival. These needs are supposed
to be fulfilled for healthy and quality of life.

B. Sociocultural Needs
The needs which give individual exposure in the community and society are called
social needs. The needs like education, transportation, communication, health
service, rituals and parties come under socio-cultural needs. They are needed to be
fulfilled for the attainment of quality of life.
C. Spiritual Needs
The needs that keep person’s mind at peace and give relaxation are called spiritual
needs. The needs like freedom to worship the gods by choice, freedom to believe in
what is right, freedom to practice the belief without any restriction and honesty are
the examples of spiritual needs. The fulfillment of these needs help to attain quality
of life.
D. Mental and Emotional Needs

Mental and emotional needs also play important role for the attainment of quality
of life. These needs include thoughts, understanding, love, affection, belongingness,
honour, recreation, etc. We should put effort to satisfy these needs for the attainment
of quality of life.
Broadly, the needs are:
i. Basic physiological needs:
Food and nutrition, housing, clothing, sex, etc are considered as basic physiological
needs.
Spiritual Needs
Freedom to worship the gods, honesty
Freedom to practise beliefs without restriction
Mental and Emotional Needs

Thoughts, understanding, love, affection,
Quality of Life
belongingness, recreation, etc.

Fulfilment
Social Needs
Education, transportation, communication,
health service, working condition, etc.
Biophysical Needs
Air, water, shelter, food, rest, etc.
Various Needs for Quality of Life

ii. Socio-cultural needs:
Education, health service and facilities, employment, transportation and
communication, human right and freedom, recreation and entertainment, etc come
under Socio-cultural needs.
5.1.2 Need and Importance of Quality of Life

Quality of life is felt very essential and crucial for the prosperity of family life. Quality
of life denotes the overall condition of life status of the family and its family members.
There was less concern about quality of life but now individual, family, nation and
the world have focused their attention on attainment of quality of life so that people
can live happy, healthy and productive life. The ultimate goal of development and
prosperity is after all to give comfort, happiness and satisfaction to the people. So,
quality of life is mandatory in human life. Some of the importance of quality of life are
mentioned below:
A. Fulfillment of Basic Needs
Basic needs can be easily fulfilled of those families where they are enjoying quality of
life. If there is quality of life in the family, every member of independent age group
can be involved in income generating activities and it provides a great momentum to
fulfil the basic needs. At the same time, the families having quality of life are found
with small family size. In this condition family is capable to fulfill all forms of basic
needs. For example, family needs like quality foods, clothes, shelter as well as other
additional needs are easily fulfilled if they are enjoying quality of life.
B. Management of Health Services
Sound health is the basic component of
quality of life. In the absence of good health,
there is difficulty in maintaining quality of life.
The family having quality of life can easily get
balanced diet, healthy settlement, seasonal
clothing and so on. At the same time they can
manage exercise and rest; eventually the family
members can live healthy and prosperous life.
A person getting health service
The family having quality of life can manage
budget for regular health checkup which is essential for sound health. It is difficult to
manage the above mentioned provisions in the family having low quality of life.
C. Attainment of Quality Education
A family that is enjoying quality of life usually place education in high priority. Hence,
the family members having quality of life have good access to education. Compared to
ignorant people, educated people can solve the family problems wisely and are able

to get optimum satisfaction with minimum resources. As a result, family members
can enjoy happy and productive life. It helps to maintain peace and prosperity in
the family. In addition, educated family members can involve in income generating
occupations which provide satisfaction to them.
D. Environment for Women Empowerment
Women empowerment is the process to make women educated, skilful, confident and
competent in every sector. Women have been demonstrating considerable leadership
quality in community and organizations as well as in public offices. However, the under
representation of women in decision making position in the area of art, culture, sport,
medicine, education, law and politics have prevented women from attaining quality
of life. Family cannot meet its standard of quality of life if women are not empowered.
Gender discrimination cannot give satisfaction and comfort to all individuals especially
to females. If there is quality of life in the family, women are empowered and they
are involved in different income generating activities and make way for themselves in
decision making level.
E. Facilities for Maternal and Child Welfare
There will be provision of maternal and
child welfare if there is quality of life in the
family. Pregnant as well as postnatal mother
need more diet, more care, and regular
health checkups than normal period. But, it
is possible only in the family having quality
of life. For the proper care of mother and
child, adequate family income as well as
mutual understanding among the family
members is required. At the same time,
A mother with her new born baby
family members should have knowledge
about maternal and child welfare. Many infants and mothers are living poor lives due
to lack of effective, affordable and reliable health services and facilities. To mitigate
and control such problems, we should give emphasis for the attainment of quality of
life. In this way, quality of life ensures maternal and child welfare to some extent.
F. Opportunity of Income Generating Activities and Employment
To expand the source of income generation, the family should have quality of life
so that their family members can have sound health and work efficiently. They
can attain necessary skills and trainings to adopt in the possible circumstances.
They can have easy access to education. If they do not get job they can create self-
employment activities and generate the source of income for the family.

5.1.3 Elements of Quality of Life
Quality of life is in fact a multidimensional
discipline. To acquire quality of life, there should
be fulfillment of various kinds of needs such as
nutritious food, safe drinking water, clothing,
education, health service, security, housing,
adequate income sources, entertainment,
freedom, honour, etc some of the fundamental
elements of quality of life are explained below:
A. Nutritious food
An important element of quality of life is
nutritious food which helps physical, mental and
intellectual development of the people. We need Nutritious Food
food for three purposes:
i. Energy
ii. Body building
iii. Body protection
A balanced diet which is essential for human being is made up of at least one food
from each group. The balanced diet makes our body and mind healthy. When we lack
nutritious and balanced food, we lose physical and mental efficiency. Malnutrition
deteriorates physical and mental efficiency. Consequently, people become weak,
powerless and incompetent. They also suffer from several kinds of diseases. Life
becomes troublesome. Therefore, every members of the family have to get a balanced
and nutritious diet regularly to maintain quality of life.
B. Family Size
Family size is also considered as one of the major elements of quality of life. A larger
number of family members need more family needs, which cannot be easily fulfilled.
On the other hand, if the family size is small, limited resources are also sufficient to
fulfil the needs of the family members. But it is impossible in large family size. In a large
size family, there is high possibility of misunderstanding, dissatisfaction and conflict
among the family members. If the family size is large the limited sources should be
distributed among the large family members which brings problem in maintaining
quality of life. Hence, to attain quality of life, couple should be aware and accountable
to maintain small family size.
C. Health
Health is an invaluable asset of human life. Healthy human power is essential for
development of the society and the country. Healthy people can take part in different

gainful activities which help to acquire quality of life. Healthy people are physically
fit and energetic so that they can increase their efficiency in work which increases
productivity and helps to maintain quality of life. Unhealthy people cannot contribute
towards their family and nation despite their willingness. Instead of this a large
amount of family income needs to be spent in their treatment. Due to this, needs of
the family members cannot be fulfilled and it becomes difficult to maintain quality
of life in the family. So, health always should be in our priority for the attainment of
quality of life.
D. Sanitation
Sanitation is control of all those factors in
man’s physical environment which may
cause adverse effect on his development.
It normally includes drainage, safe
drinking water, cleanliness of the houses
and surrounding management of human
excretal, as well as management of
solid waste materials. Sanitation is
the foundation of health, dignity and
development. Access to sanitation is
Health and Hygiene
also recognized as a basic right of citizen.
Despite this fact, the sanitation condition in our country is gloomy. Sanitation of the
environment in fact, helps to attain quality of life. Everyday activities of the human
being depend upon the environment. To enhance the standard of quality of life, change
of behaviour of the people in hygiene and sanitation is a must. The surrounding of the
house should be clean and public places like pond, temple and market should be free
from pollution for attaining the quality of life. When the community is clean epidemic
and communicable diseases have a very less chance to be spread. So, sanitation is
mandatory for the achievement of quality of life.
E. Education
Education is also considered as an important factor of quality of life. It can overcome
social evils in an easy manner. It helps to acquire quality of life since it produces skilled
and trained human power which is useful for maintaining quality of life. At the same
time, education teaches people to keep balance between income and expenditure.
Moreover, educated people can fit anywhere in every situation.
Education helps to maintain quality of life in the following ways.
Ü Motivates people to keep balance between income and expenditure.
Ü Creates awareness to the people.
Ü Increases skill and work efficiency in the work of the people.
Ü Can handle the family problems tactfully.
Ü Can develop mutual understanding
among the family members.
Ü Provides knowledge of balance diet,
hygiene and sanitation.
Ü Encourages people for small and happy
family.
F. Security
Kids busy in learning at school
Security is also considered as one of the major
elements of quality of life. Security plays an
important role for making family secured and
productive. If there is no guarantee of social
security, people are compelled to live fearful
life. Crime, like violence, murder, theft and
robbery, create disorder in the society, which
eventually become the sufficient cause of poor
quality of life. So, security is also considered
as an important factor of quality of life.
G. Saving Security at gate
Saving can be considered as another important element of quality of life. Saving at

present is for the future. It provides financial support to attain quality of life in the old
age too. Saving ensures quality of life to some extent. Saving is not an easy job. Well
and farsighted plan is necessary to make saving.
Saving helps a family in the following ways:
Ü Develops habit to minimize the expenditure
Ü Helps to attain quality of life
Ü Helpful and useful in emergency
Ü Utilization of money in productive areas
Ü Motivates people to live according to the available resources
H. Housing
Housing is also one of the basic needs of a family which is a basic requirement to
maintain quality of life. It protects us from cold, heat, rain, storm, wild animals and
unfavourable weather. To have quality of life, a comfortable house with healthy rooms
and apartments is necessary. If the rooms are congested, quality of life of the family
declines. Therefore, the house should be managed according to the family size.

I. Social and Cultural Values
The social and cultural values play
significant role for the attainment of
quality of life. Superstitious beliefs,
gender discrimination, caste or race
discrimination, untouchability and social
domination deteriorate quality of life.
For instance, some sociocultural values
like: dowry system, alcohol consumption
in feast and festivals, untouchability,
isolation of women from decision making
Celebration of ritual
role, importance of son are still in practice
in our society. They hinder the attainment of quality of life. To ensure quality of life,
such unscientific and irrational practices should be eradicated from the society. We
should adopt positive cultural values and practices in order to establish social justice,
harmony and prosperity.
J. Income
Income of the family is an important
element of the quality of life. Income
increases living standard of the
family and helps to fulfill needs and
aspirations of the family members.
When the income of the family is
sound, family needs are easily fulfilled
and eventually productivity of the
family increases.
Hence, sound income contributes the family to attain quality of life in the following
areas:
Ü Promotes the living standard of the family.
Ü Maintains peace and harmony in the family.
Ü Family needs are easily fulfilled.
Ü Maintains harmonious relationship among the family members.
Ü Develops the skills and productivity of the family members.
K. Proper Spiritual Development
Spiritual development is also considered as an important aspect of quality of life. It
plays a crucial role in the overall development of an individual’s personality. A person
with good spiritual development live his/ her life with high morale, honesty, self-

discipline and hard work. These qualities of human beings are the foundation for the
attainment of quality of life.
5.2 Bases of Quality of Life
Quality of life is a complex concept. So, there is no single definition of quality of life.
It is determined by the psychological and personal aspirations of individuals and their
different levels of socioeconomic background.
Despite the difficulties to find out exact bases of quality of life, some basic approaches
are mentioned below:
A. Basic Needs Oriented Approach
The basic needs oriented approach is one of the major approaches in the measurement
of quality of life, especially for the developing countries. This approach attempts to
define the minimum resources necessary for the long term physical well-being in
terms of consumption of goods.
This approach was introduced by the International Labour Organization (ILO), in
1970 AD. Indeed, this approach was introduced to replace the traditional per capita
income approach. According to this approach the minimum basic needs of individuals
must be fulfilled for the measurement of quality of life. Furthermore, Noman Hicks
and Paul Strefin developed the indicators to measure the fulfillment level of basic
needs (1979 AD).
In the context of Nepal, the government gave attention on the basic needs approach
by setting the goal to fulfill the minimum basic needs of its citizen from the sixth five
year plan (2037-2042 BS) onwards. The basic needs maintained by the government
are given in the following table:
Basic Needs of People According to the Government of Nepal
• Food • Education
• Housing • Employment
• Safe drinking water • Improved sanitation services
• Environmental sanitation • Medicine
• Health services • Fresh air
B. Physical Quality of Life Index (PQLI)
Physical quality of life index is one of the major noneconomic measurement Index
of quality of life. The PQLI was introduced by the sociologist, Morris D Morris in
1976 AD. It is the composite index of three indicators: (i.e. life expectancy at birth
Index, infant mortality rate Index and literacy rate). Once a country’s performance in
life expectancy index, infant mortality rate index and literacy rate have been computed,

the PQLI can be calculated by taking average weightage of those three index values
(i.e. literacy rate, infant mortality index and life expectancy index). Indeed, PQLI is a
means to measure the quality of life of the people living in the given place or country.
The value of PQLI ranges between 1 to 100 digit. The countries having higher PQLI
score is assumed as the countries enjoying better condition of quality of life and the
countries having low PQLI score is assumed to be the country where people are living
low quality of life.
[For Additional Knowledge]
PQLI Calculation Procedure
Step 1: Find the literacy rate.
Step 2: Find the infant mortality rate.
Then calculate Infant Mortality Rate Index = (166 - infant mortality) × 0.625
Step 3: Find the life expectancy at birth.
Then calculate Life Expectancy Index = (Life expectancy - 42) × 2.7
Literacy Rate + Infant Mortality Rate Index + Life Expectancy Index
Step 4: Calculate PQLI =
3
C. Human Development Index (HDI)
The concept of Human Development Index was developed by Pakistani economist
Dr. Mahbub Ul Haq and an Indian economist Dr. Amartya Sen in 1990 AD. Human
development index is one of the important bases for the measurement of quality of
life.
HDI can be computed with the help of Health Index, Education Index and Income
Index. The HDI value always ranges between the digit 0 and 1, where 0 indicates the
lowest HDI and 1 indicates the highest HDI. Therefore, the countries having high score
of HDI are considered as the countries with high quality of life. On the other hand,
the countries with low HDI score are known as the countries with poor quality of life.
According to the recent provision of new methodology, the HDI is categorized into
four levels such as:
Level of Human Development (HDI) HDI Score
Very High Human Development 0.800 - 1.000
High Human Development 0.700 - 0.799
Medium Human Development 0.551 - 0.699
Low Human Development 0.00 - 0.550
Since its inception period, 1990 AD, the UNDP has been continuously publishing
annual HDI report. Nepal attained 138th rank with the score of 0.527 in 2006 AD.
Similarly, in 2011 AD, Nepal was placed in 157th rank with the score of 0.458 out of
the 187 countries and again maintained 157th 145th position with the score of 0.463
and 0.548 in the world in 2012 AD and 2014 AD respectively. Again in 2016 AD, Nepal
has retained 144th rank with the score of 0.558. According to the classification of HDI
category, Nepal falls in low human development group. The status of Nepal in HDI is
illustrated by the table that is given below:
Table 5.1: The trend of HDI in Nepal (2004 - 2016 AD)
Years HDI (Rank) HDI (Score)
2004 140 0.504
2006 138 0.527
2011 157 0.458
2013 157 0.463
2014 145 0.548
2015 145 0.548
2016 144 0.558
Source: UNDP, HDI Report 2004-2016 AD
The following table illustrates the HDI status of SAARC countries.

Table 5.2: The Trend of HDI in SAARC (2013 - 2016 AD)
HDI Rank HDI Score
Countries
2013 2016 2013 2016
92nd 73rd Sri Lanka 0.715 0.766
104th 105th Maldives 0.688 0.701
136th 131st India 0.554 0.624
140th 132nd Bhutan 0.538 0.607
146th 139th Bangladesh 0.515 0.579
157th 144th Nepal 0.463 0.558
146th 147th Pakistan 0.515 0.550
175th 169th Afghanistan 0.374 0.479
Source: UNDP, HDI Report 2013 AD and 2016 AD
The above table reveals that Sri Lanka is the superior amongst the SAARC countries
placing 92nd and 73rd rank in 2013 and 2016 AD respectively. It falls in the category of
high human development countries and is followed by Maldives, India and Bhutan
respectively. Among the SAARC countries, Afghanistan got the least position 175th and
169th ranks with the score of 0.374 and 0.479 according to the HDI report, 2013 AD
and 2016 AD respectively.
Furthermore, the top ten very High Human Development Countries for the year 2016
AD are illustrated by the following table:

Table 5.3: Human Development Index of the Top 10 Countries in the World, 2016 AD
HDI Rank Countries HDI Score
1st Norway 0.949
2nd Australia 0.939
2nd Switzerland 0.939
3rd Germany 0.926
5th Denmark 0.925
5th Singapore 0.925
7th Netherlands 0.924
8th Ireland 0.923
9th Iceland 0.921
10th Canada 0.920
10 Singapore 0.912
Source: Human Development Report/UNDP, 2016 AD
The above table reveals that, Norway has occupied the first rank with the score of
0.949 and followed by Australia, Switzerland and Germany respectively.
5.3 Happy Life Indicators
The economic development rate and population growth rate are directly related with
quality of life. The economic growth rate should be always more than the population
growth rate for the attainment of quality of life. The low economic growth rate invites
poor quality of life. The ultimate objective of every family is to ensure happy and
prosperous life of its family members through welfare activities. The family members
should change their attitude, behaviour and way of living positively. It helps to bring
improvement in the status of social, economic, educational, spiritual and emotional
aspects of the family members and possible to acquire quality of life. Some of the
indicators of quality of life are explained below:
A. Small Family Size
The family size is also considered as an important factor of quality of life. If the family
is small, the family needs can be fulfilled easily. Little income is sufficient to fulfil family
needs like food, education, health services and clothing including other biophysical
and other needs. All possible efforts should be utilized to make small family size for
quality of life. For this, the couple must use the means of family planning and keep
proper birth spacing as well in order to ensure quality of life in the family.
B. Quality Education
Education is one of the strong foundation of quality of life. Indeed, education helps
to maintain quality of life in a family since it gives light on the ground reality of
life and trains the family members for proper management of family. For instance,
the educated people can get good job and opportunities and are able to manage
available resources in a proper way. Educated person can understand the feeling of
others and can treat them accordingly which is helpful to establish cooperation and
understanding. On the other hand, it enables the family members for right decision to
solve the day to day problems in the family. It also helps couples to discuss about the
use of contraceptives and control family member’s size. Moreover, it also helps the
family by providing family management skills to run the family smoothly.
C. Marriage at Appropriate Age
Proper age at marriage plays a vital role for the attainment of quality of life. If
marriage is done at right time, the couples can manage family problems wisely. They
are matured biologically, economically and socially to run the family. They can have
knowledge and skills about the proper use of family planning measures (contraceptives
like pills, condom, vasectomy, laparoscopy, etc). At the same time, they can involve
in different income generating activities and can enhance economic condition of the
family. On the other hand, they also understand the problems of large size family.
Eventually, they can acquire sound health, education and are able to balance income
and expenditure of the family without any difficulty.
D. First Pregnancy at Appropriate Age
The first pregnancy of the women after the age of 20 years is considered as the first
pregnancy at the appropriate age. At this age, their reproductive organs well developed
and reach their maturity. If the women get their first pregnancy at the appropriate
age, they can complete their education and can be involved in income generating work
also. If they get pregnancy at proper age, the couples can get maximum satisfaction
of conjugal life. At the same time, they can take correct decision about birth spacing,
family planning, proper parenthood, family income and expenditure and other issues.
So, pregnancy at appropriate age provide foundation for the happy and prosperous
family.
E. Birth Spacing
Birth spacing is also considered as an important determinant of quality of life. So,
couples should plan for appropriate birth spacing for the planning of family. An interval
of at least 4 or 5 years between the babies is considered as ideal birth spacing. If the
couples follow proper birth spacing, mother will have good reproductive health and
the child also gets adequate care and consequently both the mother and child will be
physically, mentally and intellectually sound and strong. As a result, they can enjoy a
healthy and productive life.

F. Health and Sanitation
Nepali people are suffering from various kinds of environmental problems like: poor
sanitation, lack of safe drinking water, improper management of solid waste, etc. As
a result, the prevalence of communicable diseases like diarrhoea, worm infestation,
hepatitis, typhoid, etc are very high. Furthermore; due to the wrong diet and lack of
regular health check up, large number of infants, children and pregnant as well as
lactating mothers are suffering from various kinds of nutrition deficiency diseases.
These diseases and health problems create burden to family. It has also created
challenge in the social and economic development. It ultimately hampers the degree
of quality of life. Hence, if we keep our house, courtyard, street and public places neat
and clean; our surrounding remains clean and healthy. We can make our surrounding
clean and healthy through the proper management of public latrines, drainage and
proper disposal of human excreta. As a result, family members can lead healthy,
prosperous and productive life. It will further help the family to uplift the standard of
quality of life.
G. Nutritious Food
Proper nutrition is equally important to the people of all age groups. Balance diet
is essential for the sound health of the people. Therefore to achieve the optimum
standard of quality of life, balanced set of nutritious food is beneficial. It also helps
to build immunity power. Healthy people are more likely to maintain good economic
status as they are fit for doing work. For this, every individual should have knowledge
for proper utilization of locally available foods in every-day diet. So, every individual
should put effort to maintain balanced diet using the available food material to
enhance quality of life.
H. Gender Equality
One of the important current issue is gender equality, but what is gender? Simply
speaking , gender is the social differences between females and males throughout
the life cycle. It is deeply rooted in every culture. It is changeable over time and has
wide variation both between and within cultures. “Gender” along with class and race,
determines the role, power and resources for females and males in any society.
Gender equality refers to the equal rights enjoyed by women, girls, boys and men.
Equality does not mean that women and men are the same but the enjoyment of
rights, opportunities and life chances, which are not limited for being born as a
female or a male. If there is no space of gender equality it is not possible to acquire
quality of life. In our social context, females are still treated as subordinate to male
counterparts. They are also deprived of decision making role. Due to the tradition and
superstitious beliefs; education, health and career of the females are not in priority.
Therefore to maintain quality of life, gender equality is essential. It also helps to
improve the living standard of the family in different ways. The difference between
women empowerment and gender equality are as follow:
Women Empowerment Gender Equality
Ü Women empowerment refers to Ü Gender equality means equal
improving their existing status right enjoyed by men and women
through special provision of in social, political and economic
education, training, health and opportunities.
career development opportunities.
Ü It is directed to uplift the status of Ü It helps to uplift the status of both
women. male and female.
Ü In women empowerment, all Ü In gender equality, concern
possible efforts are made to make on equality & prohibition and
them empowered. discrimination by gender is focused.
I. Performance of Designated Role
Performance of the designated role means to fulfil the duty and responsibility by
the individual in the family, community, society or in the working institutions. When
we are confined to family, the members have their responsibilities as per their
position in the family. Moreover, if parents can provide the essential care to their
family members children become responsible, obedient, honest, confident and hard
working. If the designated roles are not performed by the family members; distrust,
misunderstanding, jealousy and conflict may prevail in the family. Hence, all the
members need to perform their designated roles in proper way in order to acquire
quality of life.
J. Saving
Saving is also an important component of quality of life. It is important to a family
for the fulfillment of basic needs. Saving can be used in income generating activities.
Moreover, it is equally useful during casualties and emergency. After all, it will help in
the upliftment of socio-economic status of the family.
5.4 Interrelationship between Quality of Life and Low Quality of
Life
Quality of life and low quality of life are two opposite conditions which we have to
face in our everyday life. It means, both of them cannot exist once at a time. However,
they are complimentary to each other. In which quality of life is taken as state of
happiness and low quality of life is symbol of grief.

The interrelationship and difficult life between quality of life and low quality of life is
shown in the following diagram:
Quality of Life
Saving Lack of saving
Good income source of the family Low income and poverty
Nutritious diet Unbalanced diet
Small size of the family Large size family
Security Lack of security
Sanitation Problems of health and sanitation
Sound health Elements of quality Elements of low High maternal and child mortality rate
of life quality of life
Interrelationship between quality of life and low quality of life
In general understanding, quality of life moves upward in ascending order. It begins

with the fulfilment of basic needs but low quality of life moves in descending order.
According to the above diagram; to get quality of life, a person’s numerous biophysical,
social and psychological needs to be fulfilled in systematic order. On the other hand, if
these needs do not get fulfilled, the condition is called low quality of life. Therefore, in
a family, quality of life and low quality of life cannot exist together at the same time.
So, they are complementary to each other and mutually associated. Hence, our effort
should remain for uplifting of standard of quality of life.
Comparison Between Quality of Life and Low Quality of Life
Quality of life (%) Low quality of life (%) Quality of life (%) Low quality of life (%)
+100 -100 -100 +100
+80 -80 -80 +80
+60 -60 -60 +60
+40 -40 -40 +40
+20 -20 -20 +20
+0 -0 -0 +0
The above diagram clarifies that the standard of quality of life gets decreased with the
elevation of low quality of life and vice versa. In this context, we can draw a conclusion
that there is inverse relation between quality of life and low quality of life. So, we
need to put all possible efforts to bring down the degree of low quality of life. There
after, we can enjoy standard of quality of life.

Summary
Ü Quality of life is the life with the satisfaction of the various needs of the people
such as psychological, spiritual and social needs in one hand and fulfillment of
basic needs for survival on the other hand.
Ü The degree of quality of life is precisely determined by the level of comfort,
productivity, equity, prosperity and freedom.
Ü The term ‘quality of life’ takes different meaning to different people due to the
variation in personal aspiration and perspective towards it.
Ü Quality of life is a very complex phenomenon since it is the outcome of biophysical
needs, psycho-social needs and personal aspiration related needs.
Ü The sense of quality of life differs from person to person and society to society
due to the variation in their social, economic and political background and in
their perspectives and aspirations as well.
Ü Quality of life is impossible in the absence of the fulfillment of the survival needs
and other psycho- social and individual aspirations.
Ü The basic needs oriented approach: This approach was introduced by the
International Labour Organization (ILO) in 1970 AD. This approach opines that the
basic needs of the people or the minimum resources for their long term physical
wellbeing must be fulfilled to measure quality of life.
Ü According to the ILO, the basic need like: food, clothing, housing, education, health
service, safe drinking water, improved toilet, productive work and medicine are
the indicators for the measurement of quality of life.
Ü Physical quality of life index (PQLI): It is a noneconomic measurement of quality
of life. This approach was developed by the renown sociologist, Morris D. Morris
in 1976 AD.
Ü PQLI can be calculated with the formula:
PQLI = Literacy Rate + Infant Mortality Rate Index + Life Expectancy Index
3
Ü Human development index (HDI) was introduced in 1990 AD by the Pakistani
economist Dr. Mahabub Ul Haq and the Indian economist Dr. Amartya Sen and
used by UNDP from the same year.
Ü HDI is indeed a summary measure of the three dimensions of human development:
i.e a long and healthy life (life expectancy), access to knowledge (education) and
decent standard of living (income).
Ü According to the recent methodology (2010 AD onwards), the HDI value is
categorized into four levels i.e very high (0.800- 1.00), high (0.700 - 0.799),
medium (0.551 -0.699), low (0 - 0.550).
Ü Nepal has maintained 157th position among the 185 countries with the HDI score
of 0.558 in 2016 AD. In the same year, Norway maintained the first position with
the HDI score of 0.949.
EXE RC IS E
1. Define quality of life.
2. What is low quality of life?
3. Write any two advantages of quality of life.
4. Name any two physical needs of quality of life.
5. What type of needs of quality of life is education and health services?
6. Mention any two conditions of low quality of life.
7. Who introduced the concept of physical quality of life index?
8. When was the approach of basic needs developed?
9. Write two measures to attain quality of life.

1. “Quality of life differs from family to family”. Justify with example.
2. “Quality of life is the cornerstone for prosperous and productive family life.”
Justify.
3. Why do you think the quality of life does not have any absolute measurement
yard stick? Explain with example.
4. Explain briefly any five elements that determine quality of life.
5. “Illiteracy is the main cause of low quality of life”. Justify it.
6. What is gender equality? Mention the role of women empowerment for
quality of life.
7. Mention briefly about the role of marriage at appropriate age and birth
spacing in ensuring quality of life.
8. Explain basic needs approach as one of the important bases for the
measurement of quality of life.
9. Discuss the role of health and sanitation for quality of life.

1. Recent status of SAARC countries in terms of human development index
2. Status of top ten countries in the world with reference to HDI
3. Women empowerment and gender equality
D. Write differences:
1. Quality of life and low quality of life
2. PQLI and HDI
3. Biophysical needs and social needs
4. Basic need and additional needs

1. What is happy life indicator? Critically explain the different indicators of
quality of life with suitable examples.
2. Classify Human Development Index? Critically analyze the trend of Human
Development Index of the developed countries and the SAARC countries.
3. Give an introduction to happy life indicator and demonstrate any seven
indicators of quality of life.
Activity
In Nepal about half of the population are compelled to live below absolute poverty
line. It has created a decline in the standard of life of the Nepali people. The couples
are not able to provide their children with an opportunity of good education.
Topics of discussion
i. Education is the main reason for low quality of life among the people.
ii. Poverty is a major factor resulting into low quality of life in a family.
iii. Education does not play any role in low quality of life of a family.
The students in a class will be divided into various groups for discussion on the
following topics:
M Why does life become less qualitative?
M What are the factors responsible for low quality of life?
M Illiteracy and poverty are the reasons for low quality of life. Why?
M What should be done for the attainment of quality of life?
At the end, prepare a report on the basis of the aforementioned issues and present it
in the class with the help of your subject teacher.
Project Work
Conduct a case study of any ten households of your locality in quality of life. Then
present your findings in the class under the supervision of your subject teacher.

UNIT
NATURAL RESOURCES AND
6 BIODIVERSITY
Clarify the concept of biodiversity with its types.
Mention the importance of biodiversity.
Tell the various conservation measures of biodiversity.
Explain the status of biodiversity of Nepal by ecological regions.
Give introduction to some rare species of plants and animals of Nepal.
List down the names of protected animals and birds of Nepal.
Explain the adverse impact on biological resources and their mitigating measures.
Elaborate biodiversity conservation program at national and local level.
6.1 Concept of Biodiversity

There are numerous plants, animals and micro
organisms on the Earth. They differ from
each other in terms of their habitat, life cycle,
reproduction, heredity, etc. Their diversity
or variation is explained by biodiversity.
Biodiversity, is the basis of life on the Earth
and is needed to maintain ecosystem balance
of the Earth. It influences all key ecosystem
processes, including productivity, nutrient
cycle, evolution and so on. These processes, in
turn provide multiple benefits to mankind through the variety of ecosystem goods
and services. Simply speaking, biodiversity connotes the meaning of richness in
variety and variability of species of all living organisms in a given region.
In other words, biodiversity can be considered as the totality of genes , species , and
ecosystems in a region. According to Crouchar “biodiversity refers to the variability
among living organisms from all sources including terrestrial, marine and other
aquatic ecosystems and the ecological complexes of which they are a part”. In this
context, we can conclude that biodiversity means the richness, variety or variability
of all animals, plants and micro-organisms including the number and frequency of
ecosystems in a particular area.
Biodiversity can be classified into three different levels such as genetic diversity,
species diversity and ecosystem diversity. As biodiversity is the sum of species
diversity, genetic diversity and ecosystem diversity; it becomes our duty to give
equal focus and priority to the species of animals and plants including their habitats.
Without an intact ecosystem, no species can sustain. Therefore, priority needs to be
given to the conservation and maintenance of healthy ecosystems. At present we are
living in a time of unprecedented mass extinction of biological resources. Around the
world, biological resources that took millions of years to develop are being devastated
within few years by our inhuman activity. The main causes of present extinction
is habitat destruction due to deforestation, overgrazing of grassland, draining
wetlands and pollution. Another major cause of extinction is the over harvesting of
plants and animals especially in the name of development works, urbanisation and
industrialisation.
Biodiversity is invaluable and important assets to human beings, for livelihood and
sustainable living. They provide many things to us like fibers, fruits, vegetables,
timber, medicine, fodder, oxygen and many more life supporting resources.
Nepal is blessed with a rich diversity of landscapes, flora and fauna. Nepal’s diverse
terrain encompasses a wide variety of ecosystems including tropical jungles, forested
valleys, frozen mountain peaks and high altitude arid regions similar to the Tibetan
plateau. In this situation, we can illustrate the types of biodiversity as follows:
Species Genetic Ecosystem
Diversity Diversity Diversity
• The frequency • The genetic • The frequency and

and variability variation among variety of distinct
among the living the population of ecosystems in
organisms by a single species a given area is
species variation and between the called ecosystem
in a geographical different species diversity.
area is called is called genetic
The forest
species diversity. diversity.
ecosystem,
Elephant, Snow Leopards the cropland
Tiger, Leopard, with individual ecosystem and the
Sparrow, Parrot, coat, the puppies Ocean ecosystem
Rhododendron, with different are the examples
Lotus are the colours as of ecosystem
examples of well as Snow diversity.
species diversity. Leopards and
Clouded Leopards
encompasses
the examples of
genetic diversity.
Types of Biodiversity

6.1.1 Ecosystem Diversity
Ecosystem, generally is termed as the interrelationship and interdependency between
biotic and abiotic components of the environment. In other words, the complex
interaction and richness of the biological resources with the physical environment
is known as ecosystem. There is a close relationship between the living beings and
the physical environment. It develops a unique ecosystem in that place. We can see
various types of aquatic and terrestrial ecosystems in the world due to geographical
variation.
Ecosystem diversity can be defined as “the variety and frequency of distinct ecosystems
including the variability of habitats, biotic communities and ecological process in the
given place is called ecosystem diversity.”
Ecosystem diversity helps to conserve and promote the biodiversity of a place.
So, ecosystem diversity can be perceived as the diversity of a place at the level of
ecosystem or it is the variety of ecosystems present in a given place. Nepal is endowed
with 118 types of ecosystems, including 75 types of vegetations and 35 types of forest
ecosystems (Ministry of Forest and Land Conservation-2014 AD). It is said that Nepal
is in the 25th position in the world in terms of richness in biodiversity.
Moreover, almost all types of ecosystems of the world except the desert and ocean
ecosystems are found in this country. The variation in topography and soil type, slope
and steepness, altitude, etc have made Nepal rich in ecosystem diversity. Because
of ecosystem diversity; the existence of the various types of agro ecosystems, forest
ecosystems, variability in rangeland ecosystems and wetland ecosystems are possible
in this country. The variation in topography, slope of the land, altitude, climate and
vegetation has created such a large number of ecosystems.
6.1.2 Species Diversity

A. Concept of Species Diversity
We know the Earth is the only one planet where living beings exist. So, it is called a
living planet. There are millions of species of plants, animals, birds, microbes including
human beings in the Earth. A species can be defined as a group of similar organisms
which has distinct inheritable feature and are reproduced by interbreeding within
the same group. In other words, species refers to a population of organisms whose
members are able to interbreed freely under natural condition. The basic feature of
species is reproduction that takes place within the population of the same species.
They are different among one another. It is known as biodiversity.
Biodiversity can be defined as “...the frequency and variability among the living
organisms by species variation within a geographical area or habitat is called species
diversity”.

B. Status of Species Diversity in Nepal
The total number of species in the world has been estimated ranging from 5 million to
30 million. Out of which approximately 1.7 million species of all kinds of living beings
have been described to date.
Nepal is quite rich in biodiversity due to sharp variation in its topography, climate
and altitude. Nepal covers only 0.03% of the world’s total land area but it contains
over 2.2% of the world’s flowering plants, 9.3% of the world’s birds, 2.6% of Algae
and 4.5% of the mammals. Over 700 species of medicinal plants are identified in
Nepal. Moreover, Nepal harbours large varieties of crops and plants which are still
unexplored. For example, the breeding section in Khumaltar has about 200 different
species of rice. Nepal is endowed with many beautiful endangered species such as
the wild yak, one horned rhinoceros, Bengal tiger, red panda, snow leopard, barking
deer, brown bear, wild water buffalo and so on. It has been said that Luinche (Red
jungle fowl) is the genetic resource of all the chickens in the world. Moreover,
many medicinal plants of Nepal have carried great importance for the treatment of
fatal diseases. For instance the taxol of himalayan yew is used in cancer treatment.
Similarly, Yarsagumba is widely used as a natural viagra, antibiotics and tonic. The
status of species diversity of Nepal has been shown in the following table:
Table 6.1: Status of Biodiversity in the World and Nepal
Number of Plant Species Number of Animal Species
Plant Group Animal Group
World Nepal Percent World Nepal Percent
Gymnosperm 529 31 5.9 Mammals 4,675 212 4.5
Angiosperm 2,31,638 6,973 3.0 Birds 10,000 867 8.7
Mosses 16,600 583 3.5 Reptiles 6,300 123 1.9
Lichen >17,003 771 4.5 Amphibians 4,780 117 2.5
Algae >40,000 1,001 2.5 Fish 10,000 230 2.3
Fungi >70,000 2,025 2.9 Butterfly 17,500 651 3.7
Bryophytes >14,000 1,150 8.2 Spiders 39,490 175 0.4
Pteridophytes 10,369 534 5.1 Insects NA 5,052 0.7
Moths 1,60,000 3,958 2.5
Mollusks 85,000 217 0.3
Rotifers 2,180 61 2.8
Platyhelminthes NA 168 1.4
Source: Ministry of Forest and Land Conservation, Nepal National Biodiversity Strategy and Action
Plan, 2014-2020 (Pg:17) NA: Not Available

6.1.3 Genetic Diversity
Genetic diversity can be defined as, the variation and variability found within the
population of a single species and between the species among the living organisms in
a given region is called genetic diversity. It is due to the variation of genetic materials
within the nucleus of cells found in their body. There is variation among the species
of plants and animals existing on the Earth. Genes transfer hereditary characters of
all living beings in their offsprings. Thus, genetic diversity of living beings help to give
space to biodiversity.
Simply speaking, genetic diversity is the total variety of genetic characteristics in the
genetic makeup of species. It denotes genetic variation between distinct population
of the same species. In common sense, the variation in chromosomes, genes and
DNA plays an important role to make each individual and species unique distinct to
each other.
6.1.4 Importance of Biodiversity

Biodiversity is very essential for human beings to fulfill their needs to survive.
Biodiversity supplies ecological goods to human beings such as oxygen, waste
assimilation, nutrient cycling, climate regulation, food and medicines. Biodiversity
contributes to regulate the natural function and process like water cycle, flow of
energy, recycling of carbon, nitrogen and oxygen cycle. Besides this, it also helps to keep
balance in temperature, precipitation, moisture, productivity of soil, etc. Therefore,
biodiversity has an important role in the human life and natural ecosystem. It plays a
vital role for our healthy living. For instance, plants, animals and micro organism supply
human with free ecological services such as generating soil, balancing atmospheric
gasses and many other biological processes. The benefits and services provided by
biodiversity are described as given below:
Importance of Biodiversity
1. Agriculture Products
Biodiversity provides suitable environment
for the sustainable development of the
agriculture sector. The crops like paddy,
wheat, maize, barley, etc are the main
sources of foods in Nepal. From the ancient
period people have been using different
species of flora and fauna from the wild
and cultivating those biological resources
in agriculture. So, the biodiversity provides
opportunity for the development of Agro Farming
agricultural products.
2. Animal Products
Biodiversity provides space for the
richness of genetic resources. Animals are
the sources of milk, meat, eggs, labour
and other materials. Moreover, fish is
another source of food. Similarly, birds
can be utilized for meat, feather, eggs,
recreation and for other purposes. Some
medicines can be prepared by using the Poultry Farming
animal products. All the animal products
are the sources of biodiversity.
3. Vegetative Products
Plants are the sources of food for the
animals including human beings. Industries
utilize various species of biological
resources like; leaves, barks, fruits, fibres,
flowers,and other valuable resources for
the production of useful materials. Several
species of mushrooms, medicinal plants,
Vegetable Farming
fruits, vegetables, crops and other plants
can be commercialized to fulfil human needs. Plants have economic, religious as well
as environmental value for the improvement of living standard of the people.
4. Improvement of Breeds
Biodiversity provides an ample opportunity for the improvement of breeds. It gives
wider scope for cross breeding among the plants and animals. Animals and plants
are used for breeding to produce new hybrids. It is all done for yielding more and
improving their quality. Wild animals, birds and other living beings are valuable
sources that can be used for cross-breeding. It can help to improve productivity of
animals and plants. The genetic resources of plants and animals can be crossed to
generate new varieties of breeds. Introduction of hybrids help to produce disease
resistant and high yielding genetic resources.
5. Soil Conservation
Land is one of the important natural resources of the Earth. It is the source of many
essential materials to humans and other living beings. However, soil erosion deteriorates
the productivity and quality of land. In this situation, plants and vegetation help the
land resources from erosion and landslide. Moreover, the vegetation and plants play
an important role to preserve the moisture and nutrients for the maintenance of land
and natural properties of the soil.
6. Watershed Conservation
The vegetation and plants contribute
in the conservation of watersheds.
The roots of the plants blot water in
the soil and help to bring the water
table up in the Earth. At the same
time, the plants also contribute to
slow down the evaporation process.
Thus, eventually vegetation and
plants get help for the conservation
Watersheds
of watersheds.
7. Natural Beauty
Nepal is endowed with enumerable varieties of species of the fauna and flora existing
in its landscape. The mosaic of different plants and animals indeed increase the beauty
of the nature. Nepal’s wealth of genetic diversity is the result of unique topography
and sharp variation in temperature and climate. It has given us the boon of beautiful
landscape and natural beauty.
8. Income Generation
Biodiversity also plays an important role in the expansion of income generation
sources. Proper way of preservation and commercialization of biological resources
helps to promote the scope of income generation. For instance, the proper utilization
of medicinal plants, crop yielding, and other products for commercial purpose may
improve the living standard of communities and the nation.
9. Development of Tourism
The places in and around the Mountain, Hill and Terai regions encompass their own
natural and agricultural biodiversity. There are different species of plants, animals,
and insects in these places. The richness and abundance of biodiversity have added
natural beauty in various aspects. For instance, large number of tourist flow is
observed in Chitwan National Park, Annapurna Conservation Area and Koshi Tappu
Wildlife Reserve. In this situation, flow of tourists provide ground for the development
of tourism sector. After all, the development of eco-tourism helps the local people to
improve their standard of living and provide ample opportunity for socioeconomic
development of the nation.
10. Function of Natural Ecosystem

Biodiversity plays an important role in the regulation of natural ecosystem. Different
species of living organisms and nonliving components of the environment of the given
habitats are inseparable parts in themselves. Biodiversity contributes to regulate the
natural function and process like water cycle, flow of energy, recycling of carbon,
nitrogen and oxygen cycle. Besides this, it also helps to keep balance in temperature,
precipitation, moisture, productivity of soil, etc. Therefore, biodiversity has an
important role in the human life and natural ecosystem.
11. Study and Research

Innovative knowledge and information are the basic prerequisites for the exploration
and study of biodiversity. It is essential to conduct research and study on the different
aspects of biodiversity for the economic and social development of human kind. The
knowledge, skills and informations obtained from the research and study should be
utilized for the preservation and promotion of the species of living organisms and
their habitats. The research and study in biodiversity would be a great help for the
exploration of all kinds of flora and fauna.
12. Environmental Balance

Environment is related with various aspects of biological, socio-cultural and physical
components of the ecosystem. It is integrated to biological, natural, social, economic
and physical aspects. They are related to human activities in social and cultural fields.
Biological aspects keeps the whole environment alive with the disappearance or
destruction of any aspect, the status of biological aspect of environment is disturbed.
Biodiversity is essential to maintain the ecological balance in a given place.
6.1.5 Need of Conservation

The conservation of biodiversity means the conservation of life supporting system of
the whole living beings. Biodiversity has detrimental role for the existence of living
organisms including human beings. The need of biodiversity conservation is described
below:
A. For the Existence of Living Beings
The Earth is only a single living planet in the universe. It is the habitat for all of the
living beings. Physical diversity of any of the country supports to make the diversity
in plants, animals and small organisms. Some of the species are also used in the
breeding purpose to yield a better variety. They should be preserved for the future
generation too.
B. For the Long-term Conservation of Resources
Biodiversity is the source of agricultural, animal, herbal and other various kinds of
genetic resources. People get necessary materials from it in order to make their
livelihood. It is difficult to survive and manage livelihood in the absence of sufficient
volume of biological resources. Due to its importance, we have to use biodiversity
rationally.

C. Promotion and Preservation of Natural Scene
We know that the variety and variability of animals and plants add beauty to the
landscape. It has a great importance for the environmental conservation and
socioeconomic development through eco-tourism. Such valuable gifts of nature
should be given due respect by their proper use and conservation. Hence, biodiversity
should be conserved since it adds natural scene.
D. Economic and Social Development
The flora and fauna of the environment are the sources of our livelihood. Animals and
plants can be the good source of income. The necessary goods are available from the
proper utilization of biodiversity. Proper conservation and utilization of biodiversity
helps to provide raw materials and genetic resources for performing economic, social
and industrial activities.
E. Balance the Natural Process
The different activities in ecosystem such as birth and death of the living being is
a natural process. The function of plants, birds, animals and micro organisms have
helped in automatic running of these activities. If the conservation of biodiversity is
not done, properly the organisms will be affected by the unbalanced natural process.
F. For Study and Research
Adequate study and research on biodiversity expands our existing knowledge about
the values and contribution of biodiversity in human’s life and the total ecological
system as well. With the help of study and research, we can know about the usefulness
of different varieties of biological resources for different purposes. It is also possible
to know the causes of depletion of biodiversity and measures to control them. At
the same time, research study helps to identify and explore new species and their
usefulness. We can conclude the need of conservation of biodiversity in the following
points:
Conservation of biodiversity after all helps in the protection of the existence of
living beings.
It explores the sustainability of resources.
It promotes the natural scenic beauty.
It maintains the balance in natural process.
It helps for the socioeconomic development of the country.
It provides field for study and research.
It provides varieties of medicines against the diseases.
It supports for the regulation and balance of ecological process.

6.1.6 Conservation Measures of Biodiversity
A. Information and Knowledge of Biodiversity
Information about biological diversity plays and important role for the conservation
of biodiversity. Therefore, local people of each region must get information on
biodiversity. Their role on the conservation program will be clear when they know
the importance of biodiversity. It is essential to have knowledge about the status of
the plants and animals. At the same time we should know about the biodiversity of
the geographical region. According to the status of plants and animals, their causes of
depletion, plans and policies should be formulated for their conservation.
B. Public Private Partnership
Biodiversity conservation programs should be implemented in association with local
organizations. Local agencies like VDC, NGO, youth clubs and community people
should conduct the participatory programs for the conservation of biodiversity.
Local people are the consumers and conservers of the resources. Thus, their active
participation helps to preserve the biodiversity. So there should be coordination
between community and the institutional organizations for the sustainable use and
conservation of the biological resources.
C. Promotion of Religious Value for the Conservation
We should be able to utilize our religious and cultural tradition as a useful tool in
biodiversity conservation. Peepal, Bar, Bel, Lotus, Tulsi and different types of flowers
have important place in our religion and culture. Animals like Tiger, Elephant, Deer,
and Peacock are also important from religious point of view. Thus our religious and
cultural traditions should be promoted to conserve the biodiversity.
D. Active Role of Local Agencies
It is not possible to carry out all activities from the central level. So, the local level
organizations like eco clubs, local level professional organizations, community
based organizations and local level political parties can play important role for the
conservation of biological resources in their locality. They can conduct awareness
campaign, plantation program, forest conservation program, etc. The Self Governance
Act, 2055 BS has given the conservation authority to the VDC and Municipalities.
E. Focus on Sustainable Use
The feeling of conservation of the biological resources not only for the present
generation but also for the future generation can help in the sustainable use of the
biological resources. The need, importance and sustainable use of the biological
resources need to be explained to each and every individual in the community.
Hence, biological resources can be used for income generating purposes without

deteriorating their existing quantity and quality. In this context, some portion of the
income can be utilized for the conservation of the biodiversity. We can apply the Re-
use, Recycle, and Reduction principle in our day to day life so that there will be proper
management of available resources.
F. Establishment and Management of Protected Areas
The biodiversity can be protected through Ex-situ and In-situ conservation measures.
The biological resources which are rare and vulnerable can be protected in their own
natural habitat which is known as In-situ conservation. Similarly, the endangered
species of the biodiversity can be protected in the Ex-situ like botanical garden, zoo,
sanctuary, nursery, herbarium, etc.
G. Strict Implementation of Law
Conservation laws are essential to conserve biodiversity with their effective
implementation. Awareness programs are to be conducted to make the people know
about environment conservation rules and laws. This effective execution of laws
controls people from smuggling and poaching of the resources and contribute to
preserve biodiversity.
H. Change in Consumption Pattern
People are exploiting the resources indiscriminately. It results in the destruction
of biodiversity. Thus, conservation attitude should be followed while utilizing the
resources. Rational use of resources helps the people to meet their present needs
without hampering the desires of future generation.
I. Commercialization
Local people should be educated about the importance of biodiversity and their
ways of utilization. Biodiversity can be utilized in income generation but while doing
so their quantity and regeneration process shouldn’t be disturbed. Some portion
of the income generated by those biological resources should be used to conserve
biodiversity.
J. Conservation Friendly Attitude and Activities
Biodiversity is important to us since each species plays specialized role in maintaining
ecological balance. So, people should develop positive attitude and behaviour towards
the sustainability of biodiversity. For this, we must internalize conservation attitude
while utilizing the biological resources to sustain ecological balance. It is possible to
promote attitude of the people towards the conservation friendly activities through
discussion, TV and Radio programs, drama, poster, pamphlet and formal education
program.

6.2 Biodiversity by Ecological Belt
Nepal’s biogeography setting and climatic variations provide a unique habitat for the
growth of different biological species in a small area of 1,47,181 square kilometer.
Hence, one could see the variation in biological species within a minimal elevation
differences. The country occupies only 0.03 percent of the total land area of the world
but it harbours about 2 percent of the world’s flowering plants, 5 percent of bryophytes
and 3.4 percent of pteridophytes. These examples indicate the richness of Nepal
in biodiversity. The country has been divided into three ecological regions namely,
Mountain, Hill and Terai Region. Each region has different, distinct environment and
ecological process due to the geographical and climatic variation. The biodiversity in
different geographical regions are mentioned as follow:
A. Terai Region
Terai region lies in the southern part of Nepal. This region has occupied about 23%
of the total land area of the country. The climate is hot and suitable for agriculture
especially for the production of paddy, wheat, sugarcane, jute, oil seeds, etc. It is the
granary basket of Nepal. Biodiversity of this region are mentioned in the following
points:
The Terai region has tropical evergreen forest and monsoon type of vegetation.
Similarly, Harro, Barro, Amala, Asuro, Pipal are the medicinal plants of Terai
region.
Sal, Sisou, Simal, Khayar, Pipal, Jamun are the trees found here.
As the soil is alluvial and fertile people cultivate food crops like; Maize, Rice,
Wheat and cash crops like; Pulse, Sugarcane, Jute, Tobacco, etc.
This region is the habitat for the animals like Bengal tiger, Asiatic elephant, One-
Horned Rhinoceros, Common Leopard, Spotted Deer, Wolf, Ghariyal, etc.
This region is suitable habitat for Peacock, Crane, Falcon, Eagle and other birds.
Different species of fish like Asala, Kauwai, Jhinge Machha, Rahu, Common Carp,
Grass Carp, Silver Carp, etc are also found in the streams, rivers and ponds of
Terai region.
B. Hill Region
Geographically, Hilly region lies in the mid of Mountain and Terai region. This region
has occupied about 42% of the total land area of the country. This region is rich in
biodiversity due to the great variation in physical features and altitudinal elevation as
well as diverse climate within a small area. This region has large range of ecosystem
and micro-habitats. Temperate and mixed forest are found in this region. Biodiversity
of this region are mentioned in the following points:
Rani Salla, Dhupi Salla, Chilaune, Gobre Salla, Rhododendrons, Devdar and Katus
are the forest trees that are abundantly found in this region.
The agricultural products like Maize, Barley, Potato, Buckwheat, Millet, Paddy,
Soyabean, Wheat, etc are grown in this region.
Fruits like Mango, Pear, Orange, Lemon and banana are also abundantly found in
this region.
Medicinal plants like; Amala (Indian Goosberry), Allo, Chandan, Chiraito, Berbery
(Chutro) Timur, Cinnamom, Pakhanbed, etc are found in this region.
The wild animals such as Sloth Bear, Clouded Leopard, Barking Deer, Leopard Cat,
Rhesus Monkey, Wild Cat, Chital, etc are found in this region.
This region is also famous for various species of birds like Kalij, Kite, Dove, Black
Buck, Eagle, Falcon, Parrot, Crane, Luiche, etc.
Different species of fish like Asala, Jalkapur, Tite Machha, etc can survive in the
ponds, streams and rivers of this region.
C. Mountain Region
The Mountain region lies in the extreme northern part of Nepal. This region occupies
about 35% of the total land area of the country. The topography of this region is
rough. There are mid hills, small valleys, tars, basins and gorges in this region. High
mountains covered with snow are also found here. The climate is very cold in this
region. However this region is very cold the species of flora and fauna which can
adapt in that climate are found in adequate number. Biodiversity of this region are
mentioned in the following points:
The evergreen coniferous alpine forest is found in this region.
The tree species like Rani Salla, Dhupi Salla, Jhuse Salla, Thigure Salla, Burch,
Gobre Salla, Rhododendron, Devdar, Maple, Fir, etc are found in this region.
The medicinal plants like Timur, Panch Aunle, Padamchal, Yarshagumba, Jatamasi,
Bikhama, Pakhanbed, Kutki, Atis, Guchhi Chayu, etc are found in this region.
Agriculture production is limited because of cold climate and lack of fertile soil.
However, people cultivate Potato, Buckwheat, Barley, Maize, Millet, Uwa, etc in
this region.
The fruits like Apple, Lemon, Orange and other citrus fruits are also cultivated in
this region.
Yak, Chauri, Sheep, Tibetan Goat, Horse, Dog, Mule are the domestic animals that
are abundantly found in this region.
The birds like Danphe, Munal, Kalij,Koklas, Chilme, Chir, etc are found in this
region.
Assamese Monkey, Jharal, Ghorai, Musk Deer, Red Panda, Wild Yak, Black Beer,
Snow Leopard are the wild animals found in this region.
Similarly, Cauliflower, Cabbage, Carrot, Spinach, Garlic, Radish, etc are the major
vegetables of this region.
6.3 Rare Animals and Plants
6.3.1 Introduction of Rareness of Plants and Animals
The situation of species that have small total number due to limited geographical
range or low population density and not at vulnerable or endangered stage at present
but are at risk is called rareness. A large number of plants and animals including small
organisms are in threat due to human activities. Food and habitat of animals are being
destroyed due to uncontrolled human activities. Rareness of animals and plants are
considered as the condition in which their number is not sufficient and under the
threat of danger in comparison of other species.
There are 867 species of birds that are found in Nepal in which 31 species are in the
endangered list in the world. According to the Ministry of Forest and Land Conservation
(2014 AD), 9 species of vegetation, 55 species of mammals, 149 species of birds 64
species of amphibians and 21 species of fish are enlisted in the endangered stage by
IUCN I its Red Data Book. At the same time the government of Nepal has declared 27
species of mammals, 9 species of birds, 14 species of angiosperms and 4 species of
gymnosperms as protected species. If present human activities continue, it will move
to the condition of vulnerable stage or in endanger stage. Some of the conditions to
consider the plants and animals to be rare are mentioned as follows:
e If plants and animals found in our country are very less in number in comparison
to other parts of the world, they are considered as rare plants or animals. For
example; one horned rhinoceros, bengal tiger, giant pied hornbill, etc.
e Similarly, plants and animals which were more in number in the past but has
decreased at present and are having considerably very small population, they are
also known as rare plants and animals. For example; the number of one horned
rhinoceros has decreased at present. Therefore it is a rare animal.
6.3.2 Common Causes of Rareness of Plants and Animals
Human beings need to carry out various activities on the environment. Their activities
may cause the plants and animals rare, if conservation measures are not to become
adopted in time. Destruction of habitats, climate change and pressure from exotic
species are the main causes of their rareness. Some of the causes of rareness of plants
and animals are listed below:
e Acid rain
e Disease
e Poaching
e Deforestation
e Destruction of habitats
e Invasion of exotic species

e Habitat fragmentation
e Pollution and habitat degradation
e Global and regional climate change
e Mutation in the living organisms
e Over exploitation of biological resources
e Natural calamities like earthquake, volcano, landslide, flood, etc
e Forest fire and explosion bombs, nuclear power and chemicals
e Natural calamities like earthquake, volcano, landslide, flood, etc
e Unnecessary breeding of new species of vegetation and animals without proper
research and scientific study
A. Status of Protected Animals
Some of the protected animals and birds of Nepal are described below:
1. Clouded Leopard (Dhwase Chituwa)
Clouded Leopard is an
endangered mammal of Nepal.
Its scientific name is pardofelis
nebular. It has a long body and tail
and short limbs. There are brown
spots with white on its pale grey
to yellowish brown coat. There
are few spots on head, leg and
tail. Total length of an adult male
is 0.8 to 0.9 m and weight around
Dhwase Chituwa (Clouded Leopard)
18 to 25 kg. Its upper canine teeth
are quite large. They are skilful in climbing trees; occasionally jumps from one tree to
another. Their life span is believed to be for 12-17 years in average.
The clouded leopard is reported to inhabit in deciduous forests. They prey upon
jungle-fowl, deer, wild boar, monkeys, hares and small rodents, The gestation period
is 3-4 months. One to five cubs are produced at a time. Generally caves and hollow
tree trunks are used for baby issue. They are found in Nepal, Sikkim, Bhutan, India,
and Burma, The distribution of clouded leopard in Nepal is poorly known. They live in
the forests at the elevation of up to 3,500 meter. They spend much of their life in trees.
The social behaviour of clouded leopards is virtually unknown. They are, however,
thought to be solitary animals. And though they are mostly nocturnal, evidence has
shown them to be active during some periods of the day. Rapid habitat loss due to
deforestation and illegal hunting for traditional Chinese medicines demand for its
beautiful skin are the main causes of decline of clouded leopard population as well

as. It is protected in Makalu Barun National Park and Conservation Area, Lamtang
National Park and Annapurna Conservation Area.
Monograph of Clouded Leopard
Scientific name : Pardofelis nebular
Common Name : Common Leopard (English) Dhwase Chituwa (Nepali)
Weight : Around 18-25 kg
Height : Around 0.8 to 0.9 m
Gestation period : 3-4 months
Life span : 12-17 years
Litter size : 1-5
Diet : Jungle fowl, deer, wild boar, monkey, hare and small
rodents.
Species Description : Long body and tail with short legs, brown spots with
white on its pale grey brown coat, few spots on head,
legs and tail
Conservation Status : Endangered
National Distribution : Hill forest distribution pattern is poorly known
Distribution outside Nepal : India, Myanmar, Bhutan
Main Threats:
M Poaching and illegal trade
M Reduction in prey base
M Habitat loss
2. Red Panda (Habre)

The scientific name of Red Panda
is Ailurus fulgnes. It is one of
the rare animals of Nepal found
at the altitude between 1,800-
3,800 meter in the dense grass
and bamboo area. It is slightly
larger than a domestic cat. It is
also called lesser panda or red
cat-bear. It has reddish brown
fur with distinct white marks on
Habre (Red Panda)
its face and tail. It has a very long
fluffy tail and small ears. Its weight is 3 to 6 kg. Its life span ranges between 8 to 12
years. It is a solitary animal, mainly active from dusk to dawn, and is largely sedentary

during the day. It has gestation period with roughly 4 to 5 months. It also has small
litters, producing about two to four on average and are born in the late spring and
summer. They live only in the temperate forests, in the foothills of the Himalayas.
A bamboo understory grows in these forests provides the bulk of red panda’s diet.
The population continues to decline and is threatened by habitat loss poaching and
inbreeding depression. Red pandas have a large range that extends from western
Nepal to northern India, China, Bhutan, Laos and Myanmar. It is estimated that there
would be about 2,400 population in the world and about 200 in Nepal. It is protected
in Langtang National Park, Sagarmatha National Park, Rara National Park, Makalu
Barun National Park and Conservation Area.
Monograph of Red pan
Scientific name : Ailurus fulgens
Common Name : Red Panda (English); Habre, Punde Kundo (Nepali)
Weight : Around 3 to 6 kg
Life span : 8-12 years
Litter size : 2-4
Species Description : Reddish brown colour coat on the body, with white
snout, inner ears and cheek patches. Dark brown or
black legs and paws. Bushy tail with rings of alternating
light dark red colour
Diet : Bamboo shoots, bamboo leaves, fallen fruits, etc
National Population Size : Around 200
National Distribution : Annapurna Conservation Area, Dhorpatan Hunting
Reserve, Kanchenjunga Conservation Area, Makalu-
Barun National Park, Manaslu Conservation Area, Rara
National Park, Sagarmatha National Park, Lantang
National Park (1,800-3,800 meter)
Distribution outside Nepal : India, China, Bhutan, Laos and Myanmar
Main Threats:
M Habitat loss
M Forest fire
M Poaching
M Injury and death caused by local dogs

3. One-horned Rhinoceros (Ek Shinge Gaida)
One-horned rhinoceros (Rhinoceros
unicornis) is the second largest
terrestrial mammal, with a height of 1.1
to 1.7 m and a weight of about 2,000 to
2,500 kg. Now, there are around 3,200
one horned rhinos left in the world. They
are found in alluvial plain grasslands,
where the grass can grow tall, and in the
adjacent swamps and forests. However,
as the habitat of rhinos is diminishing
Ek Shinge Gaida (One-horned Rhinoceros)
due to human activities, rhinos are now
often found in cultivated areas, pastures and modified woodlands. In addition to
increasing loss of habitat, another major threat to the rhino is poaching. In Nepal, it
is found in Chitwan National park, Bardia National Park and Suklaphant Conservation
Area. Nepal Rhino Count in 2015 AD recorded 645 individuals in Nepal. It is classified
by the IUCN Red Data Book as “endangered”, the category belonging to animals facing
a very high risk of extinction in the near future.
Monograph of One horned Rhino
Scientific name : Rhinoceros unicornis
Common Name : Greater One-horned Rhino (English); Gaida (Nepali)
Weight : Around 2,000 to 2,500 kg
Life span : 50 years
Litter size : One
Species Description : Skin is hairless and of grey colour. Large folds of skin
across the flank of the shoulder. It has a single black
horn about 20-60 cm long
Diet : Its diet consists almost entirely of grasses, but it also
eats leaves, branches of shrubs and trees, fruit and
aquatic plants
National Population Size : 645
National Distribution : Bardia National Park, Chitwan National Park and
Shuklaphanta and Parsa Wildlife Reserve
Distribution outside Nepal : India and Srilanka

Main Threats:
M Poaching for trade in body parts mainly horn, skin, foot nail (Khur)
M Deforestation and Habitat loss
M Human-wildlife conflict
4. Bengal Tiger (Pate Bagh)

Bengal tiger is one of the most beautiful
terrestrial mammal on the Earth.
The scientific name of Bengal tiger is
panthera tigris. An adult Bengal tiger
has got the height of one meter and
weighs about 130 to 200 kg. It has got
black spots with stripes in its body. It can
give birth to two to six cubs at a time. Pate Bagh (Bengal Tiger)
They are found in the tropical and sub-tropical dense forest of Nepal, India, Bhutan,
Sri lanka, and Bangladesh. It is in the endangered category according to the Red
Data Book of IUCN. It is a protected animal in Nepal. In Nepal, it is found in the
Terai forest. Chitwan National Park, Parsa Wildlife Reserve, Baridya National Park
and Shuklaphanta Wildlife Reserve are the most favourable habitat of Bengal tiger.
Such tiger is found in the dense forest, grassland and the areas with enough water. In
2013 AD, 198 Bengal tigers were enumerated in Nepal. Illegal export of its valuable
organs is the main cause of its rareness. Deer, boar are the sources of its food. It lives
for about fifteen years.
Monograph of Bengal Tiger
Scientific name : Panthera tigris
Common Name : Royal Bengal Tiger (English); Bagh (Nepali)
Weight : Around 130-200 kg
Height : Around 0.9 meter tall
Gestation period : 103 days
Litter size : 2-6
Diet : The main diet consists of medium to large ungulates
such as Wild Boar, Chital, Hog Deer, Sambar and will
also predate on livestock
Species Description : Orange coat with black stripes. The back of the ears
are black with white spot. Long banded tail and white
undersides
National Population Size : Ranges between 124 to 229
National Distribution : Bardia National Park, Chitwan National Park, Parsa
Wildlife Reserve and Shukla Phanta Wildlife Reserve
and the districts of Banke, Bara, Bardia, Chitwan, Dang,
Kailali, Kanchanpur, Makawanpur, Nawalparasi, Parsa
and Rupandehi
Distribution outside Nepal : India, Bangladesh, Bhutan
Main Threats:
M Poaching and illegal trade
M Reduction in prey base
M Habitat loss and fragmentation
M Forest fire
M Human-tiger conflict
5. Asiatic Elephant (Jangali Hatti)

Asian elephants are one of the largest terrestrial
mammal in Asia. They are around 3.5 meter
tall and weigh between 3,500 to 5,000 kg. The
female of this species has no or only small tusks.
They have grey skin that is sparsely covered with
hair. Despite their size, elephants are graceful in
their movements. According to IUCN, there are
around 130-150 wild elephants in Nepal. They are
classified as endangered category by the IUCN.
Due to poaching of elephants to attain ivory tusk,
and the loss of habitat, they are endangered. Jangali Hatti (Asiatic Elephant)
They live in many different habitats including open grasslands, marshes, tropical
rainforest and deciduous forests. They are distributed in the countries like, India,
Nepal, Bhutan, Bangladesh, Sri Lanka, Myanmar, Thailand, Cambodia, Laos, Vietnam,
Malaysia and Indonesia.
These mammals need around 250 to 350 kg of fodder (grasses, leaves, bamboo
shoots, bark, bamboo leaves) per day to sustain their massive size. Their life span is
believed to be around 70 years in captivity. The gestation period for an elephant is
about 22 months (630 to 660 days).
Monograph of Asiatic Elephant
Scientific name : Elephas maximus
Common Name : Asian Elephant (English); Hatti (Nepali)

Weight : Around 3,500-5,000 kg
Height : Around 3.5 m
Gestation period : 22 months
Litter size : One
Species Description : The largest land animal in Asia. Grey wrinkled skin,
long trunk and large ears. Males have large tusks whilst
females have small dental protuberances called tushes
Diet : Grass, bamboo shoots, bark, shrubs : around 250 -
350 kg per day
National Population Size : 130-150 Wild Asian Elephants
National Distribution : Bardia National Park, Chitwan National Park and
Shuklaphanta Wildlife Reserve
Distribution outside Nepal : Bangladesh, Bhutan, Cambodia, China, India, Malaysia,
Myanmar, Sri Lanka and Thailand
Main Threats:
M Habitat degradation
M Deforestation
M Forest fire
M Human-wildlife conflict
M Potential risk of disease
M Habitat shrinkage outside protected areas
6. Giant Pied Hornbill (Dhanesh Charo)

There are two species of hornbill in Nepal (small
and big). In Scientific name Giant Hornbill is called
Bucerus bicornus. Its body length is around 95-105 cm
(0.9 meter) and 3 to 3.5 kg of weight. It is typically
large-headed, with thin neck, broad wings and long tail.
Its nest is mainly found casque in large tress. It is one of
the rare birds of Nepal. The main habitat of this bird is
in the Terai forest. Such birds are hunted for meat and
medicine. It has come into the stage of rareness due to
the destruction of forest and poaching. Its life span is
about 7 years in average.
Dhanesh Charo
(Giant Pied Hornbill)

Monograph of Giant Pied Hornbill
Scientific name : Becerus bicornus
Common Name : Giant pied hornbill (English) Dhanes charo (Nepali)
Weight : Around 3 to 3.5 kg
Body length : Around 0.9 meter
Life span : 7 years
Species Description : Large head, thin neck, broad black wings and long
white banded tail
Diet : Fruits, insects, nestling birds and small lizards
Conservation Status : Rare
National Distribution : Forest of the Terai region
Distribution outside Nepal : India
Main Threats:
M Poaching for meat
M Deforestation and habitat loss
M Forest fire
7. Asiatic Rock Python (Ajingar)

Asiatic Rock Python is the rare python of
Nepal. This species of python is distributed
in Nepal, India, Pakistan, Bangladesh and
Bhutan. It is under the protected category in
Nepal. In the country, it is reported only from
Bardia district. However, its occurrence in
other parts of the Terai region is quite possible.
Its distribution range in Nepal is recorded up
to 250 m altitude. It is usually found in the Ajingar (Asiatic Rock Python)
forest near water bodies and large marshes.
Its body is light yellowish to brownish and black mixed colour and is marbled with
yellow and black. It is around 7-9 meter long. Its weight is about 90 kilograms. This
is the biggest snake in the world and it is nonpoisonous. It is carnivorous and mostly
prays on warm blooded vertebrates. It can swallow the kids of goat and deer entirely.
The Asiatic rock python is estimated to live for about 19 years. An adult female rock
python can clutch about 80 to 100 eggs at a time. It is hunted for its skin, oil and flesh.
Monograph of Asiatic rock Python
Scientific name : Python molurus
Common Name : Asiatic rock Python (English); Ajingar (Nepali)

Weight : Around 90 kg
Length : Around 7-9 meter
Clutch size : 80-100 eggs at a time
Diet : Warm blooded vertebrates like deer, rabbit, wild boar,
birds, etc.
Species Description : The colour of the body is light yellowish to brownish
and black mixed band
Conservation Status : Vulnerable
National Distribution : Forest of the Terai region up to the elevation of
250 meter altitude.
Distribution outside Nepal : India, Pakistan, Bangladesh and Bhutan
Main Threats:
M Poaching for meat, oil and skin
M Deforestation and habitat loss
M Forest fire
M Degradation of wetlands
B. Measures to Conserve Rare Animals and Birds
Climate change, natural calamities, poaching, destruction and fragmentation of
habitats are the major reasons for the rareness of animals and birds. Their depletion
affects the whole ecosystem. Therefore, following measures are to be applied for
their conservation:
1. Study and Research
The study and research on birds and animals provide correct information of their
status and measures for their conservation can be identified in systematic way. It also
helps for the implementation of program to conserve birds and animals.
2. Restriction on Poaching
In the case of rare animals of Nepal, they are more vulnerable to the endanger stage
due to illegal hunting and smuggling. If this inhuman activities continue after few years
the rare animals will be extinct. Hence, poaching of rare animals and birds should be
strictly prohibited. The people who are involved in smuggling of animals should not
be given any kind of excuses.
3. Conservation of Habitats
Many animals and birds are being endangered due to the deforestation and
fragmentation of habitat. At the same time aquatic animals like fish and other animals
living in the water bodies are in the peril of depletion due to water pollution. The
greedy people destroy jungle to fulfil their needs. Ultimately, it destroys the habitat
of terrestrial animals. Therefore, we should preserve their habitat to conserve rare
birds and animals. We can preserve their habitat through the In-situ and Ex-situ
conservation. In which, In-situ conservation is the type of conservation where the
genetic resources are preserved in their natural habitat. For this , we can increase
the number and area of National Park, Wildlife Reserves and Conservation Areas.
Similarly, Ex-situ conservation is that conservation in which animals and birds are
conserved in man-made conservation area. There must be proper management of
zoo, botanical gardens, nurseries, gene banks and tissue banks for the preservation of
genetic resources at the endangered state. Therefore, in order to protect the species
we need to preserve their habitat first.
4. Public Awareness
Awareness programs are to be conducted among the people. They should be
educated about the importance of rare animals and birds, way of conserving them
and conservation of their habitat. If we are able to aware them about the importance
of rare birds and animals their causes of rareness, measures for conservation, they
will realize the importance and become responsible to conserve them.
5. Implementation of Law
To discourage the smuggling of animals and birds, conservation laws need to be
implemented strictly. All conservation laws if executed properly help to conserve rare
animals and birds.
6. Reduction in Effects of Human Activities

Human being performs various activities on natural environment. It may bring
negative impact on food and habitat of the birds and animals. Therefore, conservation
measures need to be integrated while utilizing resources. It helps to conserve birds
and animals.
C. Legal Status of Rare Species According to IUCN Category
Due to rapid growth of population, deforestation, unmanaged urbanization and
industrialization, as well as invasion of exotic species of plants and animals the
native and endemic species of biological resources are at the verge of extinction.
Unmanaged rapid urbanization and unorganized industrialization have resulted into
various environmental problems like global warming, climate change, acid rain,
desertification, pollution and so on. These environmental hazards create direct impact
on the status of biodiversity. When environment is degraded by human activities, the
population size of many species will be reduced and become endangered. At the same
time some species will go extinct. According to the Red List of IUCN (2007 AD), out of
1253 species of vertebrate animals 78 species are in the verge of extinction. Nepal is

not remained untouched by this problem since it has become a global problem. The
Legal Status of Rare Species According to IUCN Category:
1. Threatened (T)
Species which come under the category of ‘Endangered’, ‘Vulnerable’, ‘Rare’ and
‘Insufficiently Known’.
2. Insufficiently Known (I)
Species that probably belong to one of the conservation categories but are not
sufficiently well known to be assigned to a specific category.
3. Rare (R)
Species that have small total number due to limited geographical range or low
population density and not at vulnerable or endangered stage at present but are at
risk.
4. Vulnerable (V)
Species which are likely to move on to endangered category in near future if the
factors causing their reduction are not removed.
5. Endangered (E)
Species that have a high likelihood of going extinct in the near future due to reduction
in their number to a critical level.
6. Extinct (EX)
Species which are not definitely located or no longer existing despite repeated search
since 50 to 100 years.
Table 6.2: Name of protected animals and plants
IUCN
SN Common Name Local Name Scientific Name
Status
Mammals
1 Red Panda Habre Ailurus flugens E
2 Black buck Krishnasar Antilope carvicapra V
3 Gaur Gauri Gai Bos gaurus V
4 Wild Yak Yok Nak Bos mutus E
5 Wild water buffalo Arna Bubalus bubalis E
6 Tibetan woulf Bwanso Canis lupus V
7 Hispid Hare Hispid Kharayo Caprolagus hispidus E
8 Swamp deer Barasinghe Cervus duvaceli E
9 Asiatic elephant Jangali Hatti Elephus maximus E
10 Lynx Lynx Felis lynx E
11 Striped hyaena Hundar Hyaena hyaena E

12 Asamese monkey Asamese Rato Bander Macaca assamensis --
13 Chinese pangolin Salak Manis pantadactyla --
Himalayan Musk
14 Kasturi Moschus chrysogaster E
Deer
15 Great Tibetan Sheep Nayan Ovis ammon I
16 Royal Bengal Tiger Bagh Panthera tigris E
17 Snow Leopard Hiun Chituwa Panthera uncia E
18 Tibetan Antelope Chiru Pantholops hodgsoni --
19 Clouded Leopard Dhwanshe Chitwa Pardofelis nebulosa V
20 Gangetic Dolphin Sauns Platanista gangetica V
21 Leopard Cat Chari Bagh Prionailurus bengalensis --
22 Spotted Lingsang Silu Prionodon pardicolor --
Greater one-horned
23 Gainda Rhinoceros unicornis --
Rhinoceros
24 Pigmy Hog Sano/Pudke Bandel Sus salvinus E
Four-horned
25 Chausingha Tetracerus quadricornis --
Antelope
26 Brown Bear Himali Rato Bhalu Ursus arctos --
27 Indian Pangolin Salak Manis Crassicaudata E
Birds
1 Great Pied Hornbill Thulo Dhanesh Buceros bicornis --
2 Cheer Pheasent Cheer Catreus wallichil E
3 Black Strock Kalo Saras Ciconia nigra --
4 White Strock Seto Saras Ciconia ciconia --
5 Bengal Florican Khar Majur Eupodotis bengalensis E
6 Common Crane Saras Grus grus --
7 Impeyan Pheasant Danfe Lophophorus impejanus --
8 Lessar Florican Sano Khar Mujur Sypheotides inidica --
Crimsom-horned
9 Munal Tragopan satyra --
Pheasant
Reptiles
1 Gharial Crocodile Ghadial Gavialis gangeticus E
2 Asiatic Rock Python Ajingar Python molurus V
Golden Monitor
3 Sun Gohoro Varanus favescens I
Lizard
D. Status of Rare Plants of Nepal
1. Champ (Golden Michelia)
Golden Michelia is one of the rare plants of Nepal. Its scientific name is Michelia
Champaca. It is found in the upper part of Terai and Mid Hilly region at the altitude
between 600 to 1,500 meter. This is a typical evergreen tree with straight trunk which
bears golden yellow fragrant flowers. In Nepal, there are two species (big and small
golden champ). It spreads in a large canopy shape
and is useful for men and animal for shade in
summer and useful for birds to make nest. The
height of big species goes approximately 30 meter
high whereas the height of the small species
grows up to 8 meter.
These trees are useful for making furniture and
firewood which are the main causes of depletion.
Oil can be extracted from its flower which can
be used for the treatment of eye disease and
gout. Similarly, the bark and fruits can be used
as medicine for leprosy, skin disease, cough,
rheumatism and ulcer. Its cutting, exploitation and
Golden Michelia (Champ)
export are banned and kept by the government
under the category of endangered and protected status. Regeneration of this plant
can be made through seed and branch but difficult and time consuming.
Monograph of Golden Michelia
Scientific name : Michelia Champaca
Distribution : Hilly region (Between the altitude of 600-1,500 meter)
Type : Evergreen Tree
Species : Two species (small and large)
Flower : Golden Yellow
Height : Between the range of 8-30 meter.
Useful parts : Timber, bark and flower
Importance:
M Oil extracted from its flower is used for the treatment of the eye disease and
gout.
M Bark is used as medicine for the treatment of leprosy, cough, rheumatism and
ulcer.
M Timber of this tree can be used for furniture.
2. Jatamasi (Spikenard)
This is another rare plant found in Nepal. It is also known as Jatamasi. Its scientific
name is Nardostachys grandiflora. It grows upto the height of 60 cm and leaves
divided into three heart shaped parts. It is found in the northern part of high Mountain
region at the elevation of 3,000 to 5,000 meter. It is a small perennial herb with thick
aromatic rhizome covered with fibres of old leaves, lower leaves larger than the upper
ones. Its roots look reddish brown. Its flowers are pinkish white in colour.
Its rhizomes can be used to extract oil which can be used in
preparing Ayurvedic medicine. The oil of this plant is used to
prepare the medicine of cholera, epilepsy, cough, cold, spleen
disease, intestinal worms and haemorrhoids and altitude
sickness, high blood pressure, insomnia and heart disease.
It oil also can be used in perfume. Its dust is used to make
sweet incense. Its export outside the country is banned. It
is protected in Shey Phoksundo National Park, Annapurna
Conservation Area. Reproduction can be done either by seed
or by bulb.
Spikenard (Jatamasi)
Monograph of Spikenard
Scientific name : Nardostachys grandiflora
Distribution : Mountain region (Between the altitude of 3,000-5,000)
Type : Herb with thick aromatic rhizome covered with fibres.
Flower : Pinkish white
Height : Around 60 cm
Useful part : Rhizome
Importance:
M Medicine for the treatment of the cholera, cough, cold, haemorrhoids, altitude
sickness, high blood pressure, epilepsy, insomnia and heart disease.
M The oil of this plant also can be used to make perfume.
M By-product (dust) of the rhizome can be used to make incense.
3. Sarpagandha (Serpentina)
Serpentina is also known as Sarpagandha. It is also
one of the endangered and protected medicinal plants
of Nepal. Its scientific name is Rauwolfia Serpentina. It
is a small erect perennial plant with the red and white
flowers in bunches. It grows up to the height of 1 meter
tall. It is found in the Terai and Hilly region in the forest
of Sal at the altitude up to 1,200 meter.
It is scattered in the Sal forest. Its stem is dry and white.
Its leaves are wide and long. It produces white and red
bunches of flowers during summer. It bears pea like fruit
Serpentina (Sarpagandha)
which is green in the early stage. The fruit gradually
becomes red and black when ripped. Its rhizomes are very much beneficial for the
treatment of blood pressure, pain relief, insomnia, insanity, dysentery cholera, etc. It

is completely prohibited to export crude drug but processed extracts may be exported
after the permission from the department of forest. It can be reproduced through
seeds and stems.
Monograph of Serpentina
Scientific name : Rauwolfia Serpentina
Distribution : Sal forest in the Terai and hilly region (Up to 1,200 meter altitude)
Type : Small erect perennial plant
Flower : Reddish white blossom during summer
Fruit : Pea like fruit in the early stage; turns into black when it is ripped
Height : Around 1 meter
Useful parts : Rhizome
Importance:
M For the treatment of the blood pressure, pain relief, insomnia, insanity, dysentery
and cholera.
4. Launth Salla (The Himalayan Yew)

The scientific name of Himalayan Yew is Taxus
baccata wallichana. It is also called Lauth Salla.
The Himalayan Yew is not so tall. It grows up to
8 meter. This is a plant of pine species. In Nepal, It
is distributed at the altitude ranging between 1,700
to 3,400 meters from the sea level especially in the
central and western region of the country. It is a slow
growing tree. For instance, it gradually grows for
100 years. Its leaves get shaded during the month
of Jestha and Ashad and flowers blossom during
the month of Chaitra to Jestha. It bears small round
shaped seeds, which turns into red colour when it
is riped. It can be cultivated through its seeds and Himalayan Yew (Launth Salla)
stem cutting. In Nepal, the Dabar Nepal Pvt. Ltd. has
produced its saplings from its nursery in Banepa and the Taxol is extracted from the
factory established at Rampur Tokani of Bara district.
The Taxol extracted from its leaves is used to cure cancer of earlier stage specially for
cervical cancer. In addition, Ayurvedic medicine can be made using Taxol of its leaves.
For instance, it can be used as medicine for intestinal diseases, headache, respiratory
infection, diarrhoea, high blood pressure and dry cough. It is banned to cut down and
export outside the country.

Monograph of Himalayan yew
Scientific name : Taxus baccata wallichana
Distribution : Hilly region (At the altitude from 1,700-3,400 meter)
Type : Soft wood small tree
Leaves : Shed during the month of Jestha and Ashad
Seed : Bears small round shaped turns into red colour when it is ripped
Height : Up to 8 meter tall
Useful parts : Leaves
Importance:
M Medicine for the treatment of the early stage cancer in general and cervical
cancer in particular.
M The taxol also can be used for the treatment of the diseases like headache,
respiratory infection, diarrhoea, high blood pressure and dry cough.
5. Panch Aunle (Aterrestrial Orchid)

The scientific name of Panch Aunle is doctylorhiza
hatagirea. Panch Aunle is also called Aterrestrial orchid.
It is distributed at the altitude of 2,300 to 3,600 meters.
Its rhizome is divided into three or five finger like lobes
and looks like our palm with fingers. It produces attractive
flower like rose. The structure of its leaves resembles the
weapon, ‘sword’. The colour of its flower is purple. This
plant’s height grows up to 90 cm.
Its rhizomes are pulled out and sold illegally. The rhizomes of
three or four years old can be taken out without uprooting Aterrestrial Orchid
(Panch Aunle)
the plants. It falls in the endangered category. Its rhizomes
can be used for the treatment of cough, stomach troubles, heal wound cuts. Asthma,
anaemia, burns as well as energy booster and tonic in homeopathy.
Monograph of Panch Aunle
Scientific name : doctylorhiza
Distribution : Hilly region (At the altitude of 2,300-3,600 meter)
Type : Herbal erect perennial plant
Flower : Bears small purple coloured flowers
Rhizome structure : Palm shaped
Height : Up to 90 cm
Useful parts : Rhizome

Importance:
M For the treatment of the diseases like cough, stomach trouble, wound cuts,
asthma and anemia.
M It also can be used as energy booster and tonic in homeopathy.
6. Yarsagumba (Cordyceps Sinesis)

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

Size : Around 5-8 cm long
Color : Fruitification (mushroom) dark brown and stalk (dead larva)
Yellowish white.
Market value : Above 1.5 million per kg
Useful parts : Whole part
Importance:
M For the treatment of kidney problem, pulmonary tuberculosis, chronic cough,
night sweating, tiredness, shortness of breathing, dizziness, anaemia, weakness
and sexual impotence.
M In addition, it also can be used as tonic and cardiac tonics.
E. Conservation Measures of Rare Plants
Plants and vegetation are very essential for the livelihood of human beings. They
provide us various useful materials like; vegetables, fruits, fodders, fibres, medicines,
etc. Moreover, they supply us oxygen and help to maintain ecological balance as well.
Since the beginning, people are using plant resources for their survival. But their over
exploitation have made them rare. Hence, the conservation measures is very urgent.
Some of the measures for the conservation of rare plants are described below:
1. Control of Forest Fire
Haphazard forest fire is also considered as one of the main causes of rareness of
the plant resources. Forest fire destroys a vast quantity of forest resources in Nepal
specially during the dry season. Hence, forest fire needs to be controlled effectively
for the preservation of forest resources from being rare.
2. Control of Indiscriminate Grazing
Overgrazing hinders the regeneration capacity of the grass and the saplings of
growing plants. Therefore, indiscriminate grazing of the animals should be controlled
in time. And afforestation and plantation of sapling should be done in the open area.
Moreover, there must be proper management of those areas.
3. Execution of Law
Effective execution of laws is a must to conserve the biodiversity. The laws should be
equally enforced to all the people. It certainly helps to control smuggling of the rare
and endangered plants and their genetic resources and contribute to preserve those
invaluable natural resources from extinction.
4. Awareness Program
Awareness programs need to be conducted to educate the local people for proper
utilization of resources. For this, individuals, community and local agencies should be
mobilized in an integrated manner.
5. Establishment of Nursery
Saplings can be grown in the nursery to increase the population of rare plants. For
this, the number of nurseries need to be increased to protect the plants from being
rare and endangered. This campaign need to be conducted in community level.
6. Proper Collection of Forest Products
People in remote area use forest resources as the major source of fuel. They consume
the forest resources traditionally. It causes destruction of plants and vegetation.
That is why forest products should be collected wisely. In this condition, relative
conservation principles need to be followed by all the concerned stake holders while
utilizing the forest products.
6.4 Adverse Effects of Human Activities on Biodiversity and
Conservation Methods
Relative to its size, Nepal is blessed with rich diversity of flora. Nepal’s biodiversity is
now under threat. Human activities like construction of road, drainage, canal, buildings,
tunnels, unplanned urbanization, unorganized industrialization, unsustainable farming
and over exploitation of natural resources result into adverse effect on biodiversity.
Similarly, the environmental problems like global warming, climate change,
desertification, acid rain, landslide which are induced by human activities also have
adverse impact on biodiversity. So, we need to carry out their mitigating measures on
time. Some of the effects are explained below:
A. Degradation of Ecosystem
Rapid population growth gives more pressure on natural resources. Rapid growth
of population results into more population which means more pressure on existing
resources. Overpopulation needs more land for settlement and other activities.
Which poses deforestation, soil erosion, environmental pollution and many more
ecological problems. Similarly, improper management of solid wastes and drainage
also degrades the ecosystem of those places. Eventually it causes loss of biodiversity.
B. Loss of Habitat
The primary cause of the loss of biodiversity is known as habitat destruction. In many
cases, the factors causing habitat loss are the activities like cattle farming, agriculture,
manufacturing, dam construction with the goal of making profit. In addition, jhum
cultivation (shifting cultivation) and deforestation also cause loss in habitats. After all,
loss of habitats is also a primary cause of loss for biodiversity loss.
C. Loss of Mobility of Animals and Birds
Various human activities may cause loss of mobility of animals and birds. For instance,
deforestation in the name of human settlement, road construction, canals, buildings
and other so called development works eventually cause fragmentation of the habitats
of the wild animals. As a result, they cannot get adequate food to eat and adequate
space to survive and grow. Then eventually they move to the endangered stage.

D. Limitation of Expansion of Vegetation
Human activities gives more pressure on the regeneration process of vegetation.
The human activities for different purposes such as deforestation for cultivation,
industrialization, urbanization and human settlement make encroachment in the
forest, grassland and vegetation. It ultimately creates adverse impact on the total
ecological processes.
6.5 National and Local Level Biodiversity Conservation
Programs
The main programs and efforts to conserve biodiversity are described below:
A. Establishment of In-situs (National Parks, Wildlife Reserves and
Conservation Areas)
To address the threats of biodiversity loss in the country, the government of Nepal
has established In-situs in the various parts of the country. Here, In-situ conservation
means the protection of species and ecosystems in their place of origin as the
primary approach to biodiversity conservation. In other words, In-situ conservation
encompasses “on-site conservation”. It is the process of protecting endangered plant
and animal species in their own natural habitats. One benefit of In-situ conservation
is that it maintains population in the surrounding where they have developed
their distinctive properties. Moreover, this conservation strategy helps ensure the
ongoing process of evolution and adaptation within their natural environment. The
conservation areas like national parks, wildlife reserves and conservation areas are
the examples of the In-situs. 12 National Parks, 1 Wildlife Reserves, 6 Conservation Areas, 13 Buffer Zones
At present, there are __________________________________
10 national parks, 6 conservation areas, 4 wildlife reserves and
________
12 buffer zones in our country. Altogether about 18.5% of the total land area of the
country is covered by such conservation areas. They have made great contribution for
the conservation of biodiversity and ecosystems.
Table 6.3: Status of National Parks in Nepal
Name of Area
National Park Districts Speciality Specific Plants/Animals
(Year estd.) sq.km.
Shey Mugu, 3,555 Ghoral, blue • Pine, Walnut, Oak,
Phoksundo Dolpa km2 sheep, musk Cyprus, Blue Pine,
National Park deer, and Spruce, Juniper, Birds
1984 AD the Shey- • Blue Sheep, Ghoral,
(2041 BS) Phoksundo Musk Deer, Leopard,
lake. Wild Dog, Hare,
Monkey, Langur, etc.

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

Bardiya Bardia 968 Karnali River • Langur, Hyana, Wild
National Park km2 dog, Jakal, Porcupine
1988 AD • Dolphin (30 species of
(2045 BS) mammal, 250 species
of birds)
Makalu Barun Sankhuwasabha, 1,500 Makalu • Snow and Clouded
National Park Solukhumbu km2 Barun River Leopard, Thar, Wild
1991 AD Boar, Musk Deer, Red
(2048 BS) Panda
Shivapuri Kathmandu, 159 Shivapuri • Rhododendron and
Nagarjun Nuwakot, km2 watersheds other various valuable
National Park Sindhupalchowk plant resources
2002 AD • Clouded Leopard, Wild
(2058 BS) Cat, Leopard Cat, Black
Bear, 177 species of
birds, 102 species of
butterflies and 102
species of mushrooms
Banke Banke, Salyan, 550 Famous for • Sal forest
National Park Dang km2 bengal tiger • Bengal tiger
2010 AD and Youngest
(2067 BS) national park
Shuklaphanta Kanchanpur 305 Prime habitat • Bengal Tiger, One-
National Park km2 of around horned Rhino, Swamp
2017 AD 2,000 swamp Deer, Slowth Beer,
(2073 BS) deers including 48 species
mammals, 423 species
of birds, 28 species of
fish
Plan, 2014-2020 (Pg:191/192)
Table 6.4: Status of Wildlife Reserves in Nepal

Name of Area District and
Year estd. Specific Animal
Wildlife Reserve (sq. km.) Speciality
Koshi Tappu 1976 AD 175 km2 (Sunsari, • Wild buffalo, Dolphin.
Wildlife Reserve (2032 BS) Saptari and Crocodile
Udayapur) Wild
buffalo
Parsa Wildlife 1984 AD 499 km2 (Parsa, • Wild elephant, Bengal
Reserve (2041 BS) Bara and tiger, Leopard, Sloth
Makwanpur) beer, One-horned
One-Horned Rhino,Blue bull,
Rhino Barking deer and 300
species of birds
Dhorpatan 1987 AD 1,325 (Baglung, • Leopard cat, Ghoral,
Hunting Reserve (2044 BS) km2 Myagdi, Wild boar, Monkey
Rukum) Ghoral and Barking deer
Plan, 2014-2020 (Pg:192)
Table 6.5: Status of Conservation Areas in Nepal

Name of Conservation Area Area (sq. km.) Estd. date District
Annapurna Conservation 1992 AD Kaski,Lamjung, Manang,
7,629 km2
Area (2049 BS) Mustang, Myagdi
Kanchanjunga Conservation 1997 AD Taplejung
2,035 km2
Area (2054 BS)
Manaslu Conservation Area 1998 AD Gorkha
1,663 km2
(2055 BS)
Krishnasar Conservation 2009 AD Bardia
15.95 km2
Area (2065 BS)
Gaurishankar Conservation 2010 AD Ramechhap, Dolakha,
2,179 km2
Area (2067 BS) Sindhupalchok
Api Nampa Conservation 2010 AD Darchula
1,903 km2
Area (2067 BS)
Plan, 2014-2020 (Pg:193)
Table 6.6: Status of Buffer Zone in Nepal

S.N. Name of the Buffer Zone Date of estd. Area (sq. km)
1. Buffer Zone of Chitwan National Park 1996 AD 7506 km2
2. Buffer Zone of Bardia National Park 1996 AD 327 km2
3. Buffer Zone of Langtang National Park 1998 AD 420 km2
4. Buffer Zone of Shey-phoksundo National Park 1998 AD 1,349 km2
5. Buffer Zone of Makalu Barun National Park 1999 AD 830 km2
6. Buffer Zone of Sagarmatha National Park 2000 AD 275 km2
7. Buffer Zone of Suklaphanta Wildlife Reserve 2004 AD 243.5 km2

8. Buffer Zone of Koshi Tappu Wildlife Reserve 2004 AD 173 km2
9. Buffer Zone of Parsa Wildlife Reserve 2005 AD 298.17 km2
10. Buffer Zone of Rara National Park 2006 AD 198 km2
11. Buffer Zone of Khaptad National Park 2006 AD 216 km2
12. Buffer Zone of Banke National Park 2010 AD 343 km2
Plan, 2014-2020 (Pg:193)
B. Establishment of Ex-situs/Man-made Conservation Areas (Zoo,

Sanctuary, Nursery, Botanical Garden, etc)
The thousands of varieties of species have already been vanished from the Earth
due to unfavourable natural environment. Therefore, people should create artificial
controlled favourable environment for the conservation of endangered species of
plants and animals. It is possible to protect biological resources that are on the verge
of extinction through Ex-situ.
Here, Ex-situ conservation means off-site conservation. In other words, it is the
conservation of genetic resources outside their natural habitat. This conservation
approach can be considered as the process of protecting the endangered species of
plants or animals by removing part of the population from a threatened habitat and
placing it in a new human controlled conservation site.
Protected Areas (National Parks, Wildlife Reserves and Conservation Areas) of Nepal

Nepal botanical garden and central zoo are providing the examples of Ex Situs. In
general practice, Ex-situ helps to provide favourable environment to the animals and
plants in those places for their growth, reproduction, breeding regeneration.
The differences between In-situ and Ex-situ are as follows:
In-situ Ex-situ
Ü In-situ is the conservation of biological Ü Ex-situ is the conservation of
resources within their natural habitat. biological resources outside their
natural habitat.
Ü It is the conservation of animals, and Ü It is the conservation of animals
plants in its parental site. and plants in the human controlled
environment.
Ü It is also called on site conservation. Ü It is also called off site conservation.
Ü National parks, Wildlife reserves and Ü Zoo, Botanical garden and gene
conservation areas are the examples bank are the examples of Ex-situ
of In-situ conservation. conservation.
Ü It is effective for the conservation of Ü It is effective for the conservation
rare species of biological resources. of endangered species of biological
resources.
C. Local Programs for Raising Awareness

Various local level awareness campaigns should be conducted to aware the people
for the conservation and proper management of biodiversity. Government and non-
government organizations can conduct these programs jointly at local or community
level. Such programs should ensure the participation of the community members. It
helps them to realize their responsibility for the conservation of plants and animals
and their habitats. The Ministry of Soil and Forest Conservation is conducting various
programs at different levels for the preservation of biodiversity as well as soil and
forest resources. Other various ministries like Ministry of Agriculture, Ministry of
Industry, Ministry of Science Technology and Environment are also launching various
conservation awareness programs. Such activities certainly contribute for the
conservation of biodiversity.
D. Conservation Programs at National Level
Various organizations are conducting different programs at national and local level
for the conservation of the biodiversity. For instance, National Trust for Natural
Conservation (NTNC) has been conducting different programs for biodiversity
conservation through the participation of community members. Some international
organizations such as The World Conservation Union (IUCN), The World Wildlife Fund
(WWF), the International Centre for Integrated Mountain Development (ICIMOD),
are also conducting different programs for the conservation of biodiversity and
management of habitats and ecology.

Summary
Ü Biodiversity is the richness in variety and variability of species of all living

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

EXE RC IS E
1. Define biodiversity.
2. What is Ex-situ conservation?
3. Write any two importance of Himalayan yew.
4. Mention any two medicinal value of Sarphagandha.
5. Write any two causes of rareness of Asiatic Rock Python.
6. What is Buffer zone?
7. Write any two adverse effect on biodiversity due to human activity.
8. Write down any two conservation measures of biodiversity in your locality.
9. How many species of birds and mammals of Nepal have been included in the
protected list?
10. Write the name of any one endemic fish of Nepal.

1. What is biodiversity? Classify it and explain briefly.
2. What is agricultural biodiversity? Differentiate between species and genetic
diversity.
3. The hilly region of Nepal is rich in biodiversity in comparison to other regions.
Why?
4. List down the measures to preserve endangered plants and animals.
5. “Change in consumption pattern of resources is the best policy to conserve
biodiversity”. Elaborate it.
6. What is climate change? List down any four implications of climate change
on biodiversity.
7. Explain the role of In-situ and Ex-situ for the preservation of biodiversity.
8. What are the challenges for biodiversity conservation? Mention the
mitigating measures.
9. Mention the role of biodiversity in socioeconomic development of the
nation.
10. Proper conservation of habitats is necessary for the promotion of species
richness of biodiversity. Why?

1. Ecosystem diversity and species diversity
2. In-situ and Ex-situ
3. Conservation and preservation of biodiversity
4. Natural biodiversity and agricultural biodiversity

1. Asiatic Elephant
2. Panch Aunle
3. Giant Pied Hornbill
4. Ecosystem diversity
5. Ex-Situ

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

UNIT
ENVIRONMENTAL HEALTH
7 AND DISEASES
Give introduction to disease.
Differentiate between communicable and non-communicable diseases.
Tell the causes, mode of transmission, symptoms and preventive measures of
some major communicable diseases.
Tell the causes, symptoms, prevention and control measures of some major non-
communicable diseases.
7.1 Introduction to Communicable and Non-communicable

Disease
7.1.1 Concept of Disease
The term disease is derived from two words ‘dis’ and ‘ease’. It means lack of ease
or comfort. We do not feel ease or comfort when we get diseased. So, we can say
that disease is a negative condition of the body. In other words, disease is a harmful
departure from the normal state of health. A disease is an abnormal condition that
affects the body of an organism. In general understanding disease refers to any
condition that causes pain, dysfunction, distress, disabilities and infection in the body.
In other words disease can be considered as; A pathological condition of an organ or
system of an organism resulting from various causes, such as infection, genetic defect
or environmental stress and characterized by identifiable signs and symptoms.
According to the Webster dictionary: “Disease is a condition in which bodily health
is seriously attacked, deranged or impaired and departure from a state of health
interrupting the performance of vital functions.” The Oxford English Dictionary defines
“Disease is a condition of the body or some organs of the body in which its functions
are disturbed.”
Furthermore, from the ecological point of view, disease can be defined as: “A mal-
adjustment of the human organism to the environment.” Hence, disease can be
considered as a disorder with a specific cause and recognizable signs and symptoms;
any bodily abnormality or failure to function properly except that resulting directly
from physical injury. The concern of environmental health is the promotion of human
health by maintaining environmental components. It includes the activities like
conservation, management and proper utilization of environmental resources to uplift
human health. According to WHO; “environmental health refers to those aspects of
human health and disease that are determined by the factors in the environment”.
The ultimate goal of environmental health is to control possible negative impact and
maintain healthy environment for qualitative and productive life.
7.1.2 Types of Diseases

There are various types of diseases, but all of them can be classified mainly under two
groups. They are explained below:
A. Communicable Disease
Communicable disease is an illness in the body due to specific infectious agent or its
toxic products. It is directly or indirectly transmitted from an infected person or animal
to a healthy person through various mediums. Air, water, food, soil, dust particles,
insects and animals, are the different medium through which the pathogenic germs
are transmitted from the infected person to a susceptible host. The spread often
happens via airborne viruses or bacteria and also through contaminated blood or
other bodily fluid. Cholera, typhoid, common cold, tuberculosis, hepatitis, syphilis,
etc are the examples of communicable diseases.
According to American Public Health Association: “Communicable disease is an illness
due to a specific infectious agent or its toxic products arising through transmission of
that agent from reservoir to susceptible host either directly from an infected person
or animal or directly through the intermediate host, or vector or the inanimate
environment.” Therefore, we can say that: a disease which tends to spread or transmit
among individuals from infected to healthy persons is called communicable disease.
Though germs enter in to our body, the symptoms are not seen immediately. The
period after the entrance of the germs to the appearance of symptoms of the disease
is known as incubation period. The duration of incubation period varies according to
the nature of the disease. A person generally seems healthy during the incubation
period. We know that communicable disease spreads from one person to another or
from an animal to a person.
According to the nature, communicable disease can be classified into four groups
such as:
Nature by
Types of Communicable Disease Example of Disease
Prevalence
A disease is said to be sporadic when a few Poliomyelitis,
Sporadic
scattered cases occur now and then. Leprosy, etc.

A disease is said to be endemic when it is
Malaria, Typhoid,
Endemic constantly present to a greater or lesser degree
etc.
in any particular geographical area.
Sudden outbreak of infectious disease that
spreads rapidly through the population Bird Flu, Cholera,
Epidemic
affecting a large proportion of people. etc.
A disease is said to be pandemic when a large

number of people in many countries are SARS, Swine Flu,
Pandemic
affecting at the same time. HIV/AIDS, etc.
B. Non-communicable Disease
Disease which is not transmitted from one person to another through any medium
is called a non-communicable disease. Non-communicable diseases are caused due
to various factors like mal-nutrition, heredity, physiological disturbances, lifestyle,
negligence or unhealthy environment. Hypertension, heart disease, stroke, cancer,
diabetes, asthma and osteoporosis are the examples of non-communicable diseases.
The Concept Table of Communicable and Non-communicable Disease
Communicable Disease Non-communicable Disease
• Pathogenic germs and parasites: • Malnutrition
Virus • Unhealthy life style
Causes of Disease
Bacteria • Lack of proper exercise

Protozoa • Intake of tobacco
Fungi products, narcotic drugs
Tick and alcoholism
Lice etc. • Mental tension and
anxiety, fatigue and
workload, heredity
• Germs, etc.
• Direct and indirect contact, with infected • Unhealthy life style such
Mode of Transmission
persons, as:- intake of unbalanced

• Transfusion of contaminated blood and diet, lack of proper
blood products, exercise, mental stress,
• Insect bite or animal bite, heredity, etc.
• Infected utensils, contaminated food and
drinks,
• Infected needles or syringes,
• Sexual contact with infected persons, etc.

Nature of Diseases • Acute (Short Term Nature) • Chronic (Long Term Nature)
eg: Diarrhoea, cholera common cold, etc. • Can be prevented easily but
• Chronic difficult to cure
eg: Tuberculosis, Pneumonia, leprosy, etc. eg: Cancer, Diabetes, Heart
• Incurable and life-threatening disease, etc.
eg: HIV & AIDS.
Causes and Preventive Measures of Communicable and Non-communicable Diseases:

Disease
Causes of Communicable Causes of

Disease Non-communicable Disease
Transfusion of Contaminated Blood Obesity

Contaminated Food, Water and Droplets Mental Tension
Insects and Animal Bite Tobacco and Alcohol
Unsafe Sex Narcotic Drugs
Contaminated Syringe Lack of Physical Exercise
Contaminated Fomites Imbalanced Diet
Direct contact Heredity
Preventive Measures
Communicable Disease Non-communicable Disease
Safe Sexual Contact Balance Diet

Improving Personal Hygiene Adequate Physical Exercise
Immunization and Rest
Use of Safe Drinking Water Avoid Tobacco Products,
Alcohol and Narcotic Drugs
Balance Diet
Sanitation Control Obesity
Avoid Mental Tension
7.2 Some Major Communicable Diseases

7.2.1 Food and Water Borne Diseases
A. Roundworm Infestation
Ascaris Lumbricoides is the giant species of round worm. It is responsible for the disease
Ascariasis in humans. Roundworm lives usually in upper portion of the small intestine

like duodenum. It is cylindrical in shape
and pink in colour. The male roundworm
measures 15-25 cm and the female from
25-30 cm long. The dirty behaviour of the
individual is the main cause of this disease.
The eggs of this parasite released from the
patient’s excreta enter into the healthy
person’s body through faecal oral route.
Round worm
A female roundworm can lay about 1 lakh
eggs in a day which come out with the faeces of patient. These eggs enter into our
mouth by means of food, water or contaminated hands. After it enters into our body,
it gradually develops into adult worms. The incubation period of this diseases lasts for
around 2 months.
M Contaminated food and water
M Unhygienic habits
M Feacal-oral route
M Eating raw food like radish, carrot, green leaf or salads without cleaning
thoroughly
Symptoms
Abdominal pain and disturbance in digestive system
Swelling of the stomach
Cough
Irritation around the anus
Loss of body weight due to malnutrition
Sleeplessness
Nausea and vomiting
Loss of appetite
Constipation
Appearance of worm in stool
Preventive Measures
e Do not defecate near water sources
e Develop the habit of disposing faeces in toilet
e Wash hands before eating and after toilet (use soap for washing)
e Eat well cooked food. The foods that are eaten raw should be well washed and
cleaned
e Protect food from flies and other disease carriers (vectors)
e Spread knowledge about personal hygiene
e If anyone is affected from roundworm infestation, make provision of medical
treatment
B. Diarrhoea
The passing of loose, liquid or watery stool for more than
three times a day is called diarrhoea. Particularly, children
suffer from this disease. Diarrhoea is an intestinal disorder
often accompanied by other clinical signs and symptoms
including vomiting, fever, dehydration and electrolyte
disturbances. The causative agents of diarrhoea are Gartner
Bacillus, E.Coli, Rota virus, Shigella Shiga and Salmonella.
In addition to this, a number of non-infectious medical
conditions like; indigestion, food poisoning, surgery of
intestine, inflammation in the intestine and cold also may
cause diarrhoea. Diarrhoea that comes on suddenly and
lasts for no longer than a couple of days is called ‘acute
Diarrhoea infected child
diarrhoea’ whereas the diarrhoea that lasts for more
than one week is considered as ‘chronic diarrhoea’. This disease transmits from an
infected to another person because of unsanitary practices. The infectious diarrhoea
is transmitted through contaminated food, water and drinks. The incubation period
of diarrhoea ranges from 2 to 4 days.
Symptoms
Abdominal pain and frequent passing of loose stool
Contraction of muscles
Dehydration occurs due to frequent passing of watery stool
Patient feels physically weak, having sunken eyes and hollow cheeks
Loss of appetite
Gradual decrease in body temperature
Less urination than usual
Preventive Measures
e Health Education
e Provision of proper disposal of faeces
e Protection of food and water supplies from contamination by the human excreta
and flies
e Avoiding uncooked food and unwashed vegetables
e Development of hygienic habits
e Eating well cooked food
e Dehydration can be mitigated by giving Oral Rehydration Solution (ORS) like
Jeebanjal, Navajiban, etc.
C. Dysentery
Dysentery is the common infection of gastrointestinal tract. Simply speaking, dysentery
is an intestinal inflammation, especially in the colon that can lead to severe diarrhoea
with mucus or blood in the faeces marked by pain, fever, dehydration and a feeling of
incomplete defecation. It may be caused by the chemical irritants, bacteria, protozoa
or parasites. Dysentery is common in underdeveloped areas with poor sanitary living
conditions. This disease transmits from an infected person to another because of our
unhygienic practices. Dysentery can be classified under two types such as Amoebic
Dysentery and Bacillary Dysentery.
1. Amoebic Dysentery
Amoebic dysentery is also known as an infection of the intestine caused by an amoeba
called Entamoeba Histolytica. If timely treatment is not done, these amoeba are able
to spread through the blood stream to infect other organs such as the liver, lungs
and brain. It is a protozoal disease. The incubation period of Amoebic dysentery is
believed to be ranging between 30 to 90 days.
Symptoms
Abdominal pain and mucus is seen in stool
The patient may feel weak
The eyes seem sunken and the cheeks look hollow
Dehydration occurs
Indigestion occurs
Weight loss
Fatigue
Headache
Muscle cramps
Loss of appetite
In the chronic stage, manifestation of Amoebic hepatitis may occur
2. Bacillary Dysentery
Bacillary dysentery, also known as Shigellosis is a potentially dangerous and
extremely contagious bacterial infection of the colon (large intestine). It is caused by
the bacterium called Shigella Shiga or Flexeneri. The incubation period of bacillary
dysentery is ranging between 2 to 7 days.
Symptoms
Abdominal pain and body ache
Gradually the blood content increases with the faeces
Dehydration occurs and the tongue becomes dry
The patient slightly suffers from fever and chill
Frequent discharge of faeces
Nausea, vomiting and fever
Weakness
Weight loss
Loss of appetite
Preventive Measures
e Health education
e Wash the hands before and after meal and after toilet use
e Food and water should be clean
e Provision of safe drinking water
e Food must be protected from flies
e Proper management of wastes
e Proper disposal for human excreta
e Attention should be given for personal hygiene and environmental sanitation
D. Cholera
Cholera is an acute infectious disease of small intestine that causes severe watery
diarrhoea and effortless vomit which can lead to severe dehydration and even
death if it is not treated on time. It is caused by the bacteria called ‘Vibrio Cholera’
and characterized by continuous profuse of effortless diarrhoea and vomiting. It
is transmitted from the infected person to another very soon. This disease is most
common in the places with poor sanitation, crowding and famine. This disease gets
transmitted by means of contaminated food, drink and vectors. The incubation period
of cholera is very short ranging from few hours to 5 days.
Symptoms
Evacuation of loose watery stool for more than 40 times a day
The stool is soft at first, later it appears starchy fluid (semi-solid)
The patient feels nausea and vomits. Sometimes vomiting and diarrhoea happen
at the same time
Rapid heart beat
Loss of skin elasticity
Urine is suppressed
Dehydration occurs, the patient looks weak and inactive
The patient has sunken eyes and hollow cheeks
Low blood pressure is observed and finally the patient collapses
If the patient is not treated in time, he/she may die
Muscle cramps due to dehydration
Hypoglycemia may occur due to deficiency of glucose in the blood stream
Preventive Measures
e Health education especially in personal hygiene
e Protect food from flies and contamination
e Drink boiled water
e Wash hands after toilet and before eating food
e Wash vegetables and fruits with clean water thoroughly before using
e Dispose excreta properly
e Apply oral rehydration solution to protect from the problem of dehydration
e Do not share the clothes used by the infected person
e Immunization with cholera vaccine (Tetracycline vaccine) during cholera epidemic
7.2.2 Air-borne Disease
A. Common Cold
Common cold is a common disease. It is rapidly
transmitted from one person to another. It is caused
by Rhinu virus (filterable virus). This is the viral
disease of the upper respiratory tract. Common
cold is characterized by the inflammation of mucus
membrane of nose, throat, irritated nasopharynx,
and chilliness lasting for 2-7 days. Common cold is
not a disease to treat; some precautions are enough
for this. It is transmitted directly through air while
sneezing as well as through droplets by exchange of
personal belongings with the infected person.
Symptoms Common cold infected person
Irritation of the nose and sore throat
The patient may feel difficulty while breathing because of the swollen sinuses
The voice of the patient is changed
Running nose and watery eyes
Temperature of the body increases. Little fever is also observed
Congestion and dryness of the nose and throat
Coughing and sneezing
Pain is felt at back, limbs and head
Weakness and loss of weight
Preventive Measures
e Education in personal hygiene
e Use personal handkerchief
e Vitamin C consumption
e Do not come in contact with the infected persons.
e Nasal discharge and phlegm must be properly disposed
e Balance your time for work and rest
e Be careful while working in the dusty environment
e Protect yourself from cold
e Wear clothes according to season
e Adequate sleep
7.2.3 Diseases Transmitted by Contaminated Needles

A. Hepatitis
The word hepatitis is derived from the ancient Greek word ‘hepato’ meaning liver
and the Latin word ‘itis’ meaning inflammation. Hence, etymological meaning of
hepatitis is injury to the liver with inflammation of the liver cells. Hence, Hepatitis
is an inflammatory condition of the liver. There are five types of hepatitis that are
caused by the various types of hepatitis virus A, B, C, D and E plus G. Among them,
some are acute and others are chronic. Hepatitis is acute when it lasts for less than
six months and chronic when it lasts longer than 6 months. Mostly liver damage is
caused by three hepatitis virus called hepatitis A, B and C. Moreover, hepatitis can also
be caused by alcohol and some other toxins and infections as well as from our own
autoimmune process. About 250 million people globally are thought to be affected by
hepatitis C, while 300 million people are thought to be carriers of hepatitis B.
1. Hepatitis - ‘B’
It is a sexually transmitted infection. It is the disease of liver and is caused by Hepatitis
‘B’ virus. It is a DNA virus, which is round in shape and it is about 42 nanometer
long. Symptoms of the acute illness caused by the virus, includes liver inflammation,
vomiting, jaundice, etc. The chronic form is one that develops slowly and remains in
the body for a long time.
In its most chronic stage, hepatitis ‘B’ can become a fatal disease. In this stage,
the virus causes severe scarring of the liver. The scarring process of the liver called
“Cirrhosis”. Cirrhosis damages the liver so badly that it may no longer be able to
function normally, then eventually causes liver cancer which may results into death
of the patient. The infection is preventable by vaccination. The incubation period of
this disease varies from 30 to 180 days.

M Exposure to body fluids containing virus
M Unprotected sexual intercourse
M Transfusion of infected blood
M Sharing of contaminated needles and razor blades
M Transmission from mother to child
M Shared personal care items
M Transplantation of infected organs, etc
Symptoms
Fatigue and tiredness
Diarrhoea
Loss of appetite
Headache and mild fever
Muscle or joint ache
Slight abdominal pain
Light coloured stool
Nausea and vomiting
Itchy skin
Enlarged spleen
Weight loss
Yellow skin, whites of eyes, tongue (jaundice)
Preventive Measures
e Personal hygiene and cleanliness
e Avoiding alcohol, smoking and drug abuse
e Do not share brush, razors, needles or manicure instruments
e Unprotected sexual relationship should be avoided
e Immunization with hepatitis B vaccine
e Avoidance of unscreened blood transfusion
e Proper medical diagnosis and treatment
e Only allow well sterilized skin perforating equipment (tattoo, acupuncture, etc.)
2. Hepatitis - ‘C’
Hepatitis-C is a liver disease. It is usually spread through direct contact with the blood
of a person who has the disease. In this disease, the liver can swell and become
damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increase in people
with cirrhosis and only 20% hepatitis C patient get cirrhosis. Faeces is never a route of
transmission in hepatitis C. It is caused by the hepatitis-‘C’ virus (HCV). It is caused by
RNA virus, which is round in shape and is 60 nanometer long. The high possibility of
transmission of this disease is among the intravenous drug users. Hepatitis C usually
does not demonstrate signs and symptoms in its acute condition but in the chronic
stage this condition can progress to scarring of the liver and advanced scarring
(cirrhosis). In the context of Nepal, this disease is mainly found among intravenous
drug users. In the later stage of Hepatitis C, the infection becomes chronic and slowly
damages the liver and finally it may results into liver cancer. The incubation period of
this disease ranges between 2 weeks to 6 months.
M Blood and blood product transfusion
M Tattooing with contaminated needles
M Sharing of syringes
M Unsafe sexual exposure
M Transplantation of infected organs
M Infected mother to child
Symptoms
Loss of appetite
Nausea and vomiting
Fever and enlargement of liver
Dark urine
Yellowing of skin or eyes (called jaundice) in rare cases
Fatigue or muscular pain
Loss of weight
Preventive Measures
e Care should be given to personal hygiene
e Avoid unsanitary tattoos
e Avoid sharing personal items such as toothbrushes, razors, syringes, etc.
e Avoid sharing of needles and razors
e Avoid unsafe sex
7.3 Non-Communicable Disease
At present, non-communicable diseases have become the leading cause of deaths in
the world except Africa. Nepal is also not remained untouched by this fact, there is
lack and unavailability of such program which may help to control the prevalence of
non-communicable disease. Besides this, due to the unhealthy living style; the onset
of non-communicable diseases is severely affecting the present world. Cancer, heart
attack, stroke and diabetes are the example of non-communicable diseases.
7.3.1 Causes or Risk Factors of Non-communicable Diseases
There are various risk factors of non-communicable diseases. They can be classified
under two groups:
A. Modifiable Risk Factors
The risk factors which can be controlled and changed are called modifiable risk
factors. They are as follows:
Consumption of tobacco and tobacco products
Consumption of alcohol
Lack of physical exercise
Obesity
Increase of glucose and cholesterol level in blood
Unhealthy diet
Mental tension and anxiety
Unhealthy life style
B. Non-modifiable Risk Factors
Non-modifiable risk factors means those risk factors which cannot be changed
or altered by human efforts. They are unavoidable risk factors that lead people
ultimately to non-communicable diseases. Age, Sex and heredity are considered as
non-modifiable risk factors.
1. Age
Age is one of the major non-modifiable risk factors of non-communicable diseases.
Generally, people suffer from non-communicable diseases after the age of 40
years. The common diseases that occur among the people after the age of 40 are
hypertension, diabetes and heart disease.
2. Sex
Sex is also considered as a strong non-modifiable risk factor of non-communicable
disease. Different researches have revealed that males are more vulnerable to non-
communicable diseases in comparison to their female counterparts. The research
reports show that it is because of challenging job and more stressful life of male than
that of female’s life. Because of these reasons, males are vulnerable to the risk of non-
communicable diseases.
3. Genetic or Heredity
The disease which is genetically inherited through the gene is called genetic or
hereditary disease. For example; diabetes and cancer have a greater possibility of
passing through the parents to offspring.

7.3.2 Some Non-communicable Diseases
A. Cancer
Cancer is a diseases in which abnormal cells get divided without control and are able
to invade other normal tissues. Cancer cells can spread to other parts of the body
through the blood and lymphatic system. There are more than 100 different types
of cancer. Most cancers are named for the organ or type of cell in which they start.
For example, cancer that begins in the colon is called colon cancer and the cancer
that begins in melanocytes of the skin is called melanoma. Similarly, bladder cancer,
breast cancer, rectal cancer, endometrial cancer, leukemia, lungs cancer, pancreatic
cancer, prostate cancer, thyroid cancer are named according to their location. WHO
has revealed that nearly 7.6 million people are dying annually in the world due to
cancer, and it is projected that this number will still increase and go beyond 10.14
million by 2030 AD. Cancer type can be grouped into broader categories.
The main categories of cancer include
• Carcinoma: cancer that begins in the skin or in tissues that line or cover internal
organs. There are a number of subtypes of carcinoma, including adenocarcinoma,
basal cell carcinoma and squamous cell carcinoma.
• Sarcoma: cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other
connective tissues.
• Leukemia: cancer that occurs in blood-forming tissue such as the bone marrow
and causes large numbers of abnormal blood cells to be produced and enter into the
blood.
• Lymphoma and myeloma: cancers that begin in the cells of the immune system.
• Central nervous system cancers: cancers that begin in the tissues of the brain and
spinal cord.
Causes of Cancer
(i) Physical Factors:
• X-ray, UV ray, radium, etc.
(ii) Chemical Factors:
• Tobacco products, alcohol, non-edible colours, etc.
(iii) Biological Factors:
• Viral infection
• Hepatitis-B Virus has been accepted to be one of the causes of liver cancer
• Human papilloma virus is believed to be the main cause of cervical cancer
• Bacterial Infection
• The bacteria called, Helicobacter pylori is believed to be the main cause
stomach cancer
Some Warning Signs of Cancer
Change in wart or mole
Persistent cough and change in voice (hoarsness)
Blood loss from any natural orifice (nose, mouth, anus, vagina, etc.)
Unexplained loss of body weight
Change in digestive and bowel habits
Lumps felt in breast which might be painless
Any sore that does not get better
Preventive Measure of Cancer
e More than 40 percent of cancer can be controlled by avoiding tobacco and doing
daily physical exercise
e Use of inedible colours and preservatives in the food substances must be
controlled
e Many cancers are found to be caused by other chronic infections like Hepatitis B,
Human Papiloma Virus and HIV. So, controlling them can be the control of cancer
e Unhealthy food habits should be controlled
e Cancer awareness campaign need to be conducted in massive scale
e Control of environmental poll
e Random use of chemical fertilizer and pesticides in agriculture must be controlled
B. Diseases Related with Heart and Blood Vessels
Among non-communicable diseases, Cardio Vascular Diseases-(CVDs) are one of the
major causes of death. CVDs alone causes more than 30% death out of total deaths by
non-communicable diseases in the world. According to the WHO, around 17 million
people are dying because of cancer every year and it is projected that 25 million
people will be killed by this disease by 2020 AD. Cardiovascular diseases include:
coronary heart disease, cerebrovascular disease (stroke), peripheral arterial disease,
rheumatic heart disease, congenital heart disease and heart failure which are briefly
explained in the following table:
Different form of Cardio Vascular Diseases
Coronary Heart Disease (Heart attack) A disease related to blood vessels which
supply blood to the muscles of the heart
(coronary arteries) e.g. heart attack
Cerebrovascular Disease (Brain Stroke) A disease related to blood vessels which
supply blood to the brain (cerebral
arteries) e.g. brain stroke

Peripheral Arterial Disease A disease related to the blood vessels
that supply blood to legs and arms
(atherosclerosis). e.g Ischemia
Rheumatic Heart Disease A disease related to the valve of the heart
caused by streptococcal infection
Congenital Heart Disease Inborn malformation in heart
1. Heart Attack and Brain Stroke

Heart Attack and Brain Stroke are the most emergent and complex conditions among
the cardio vascular diseases. Heart attack and stroke are mainly caused by the blockage
that prevents blood supply to the heart or the brain. The most common cause is a
buildup of fatty deposits or blood clots on the inner walls of the arteries that supply
blood to the heart or brain. These life threatening conditions eventually results into
cardio vascular accident (stroke) and heart attack.
i. Heart Attack
Heart attack is a serious medical emergency in which the supply of blood to the heart
is suddenly blocked or stopped. In other words, heart attack refers to the damage
of heart muscle due to the lack of blood flow. In this sense, we know that lacking of
blood flow to the heart can seriously damage the heart muscles. Various research
studies revealed that heart attack most often occurs as a result of coronary heart
disease.
Every year, more than 17 million people in the world are dying due to heart diseases.
WHO has estimated that this number will still increase and near about 25 million
people will die by heart disease by 2020 AD.
Symptoms
Chest pain: The chest can feel like it is being pressed by a heavy object
Shortness of breath
Discomfort in the centre or left side of the heart
Pain radiating to the back, jaw, throat and arm
Fullness, indigestion or may feel like heartburn
Sweating, nausea, vomiting or dizziness
Extreme weakness, anxiety or shortness of breath
Rapid irregular heart beat
But in some condition people may have heart attack without having any symptom.
A silent heart attack may occur in any one but it is more common among the people
with diabetes.

Causes of Heart Attack
M High blood pressure
M Over weight
M Development of fatty substance in the vein that supply blood to the heart
M Heredity
M Stress
M Smoking and drinking
M Coronary heart disease and rheumatic heart disease
ii. Brain Stroke
Stroke is the sudden death of brain cells in a localized area due to the inadequate
blood flow. It occurs when blood flow is interrupted to a part or section of the brain
either by blockage or a rupture of blood vessels. Depending on the effect in the brain
a stroke may cause paralysis, speech impairment, loss of memory, coma or death. A
stroke is called a brain attack or cerebrovascular accident (CVA). Much of the time,
stroke affect only one side of the body.
Symptoms
Blurring or darkened vision in one or both of the eyes
Severe headache
Dizziness
Difficulty in walking
Loss of balance and coordination of body
Difficulty in speaking or understanding others who are speaking
Numbness or paralysis in the face, leg or arm, most likely just one side of the
body
Risk factors of Heart Attack and Brain Stroke
Risk factors for stroke and heart attack involve age, sex, heredity, medical conditions,
use of certain medications, and lifestyle choices:
• Age: The risk of stroke and heart attack increases with age.
• Heredity: People with a family history of these diseases are at greater risk.
• Diseases: Risk is increased for people with diabetes, heart disease, high blood
pressure, etc.
• Other medical conditions: Risk increases with obesity, high blood cholesterol level,
or high red blood cell count.
• Lifestyle: Risk increases with cigarette smoking especially if combined with the
use of oral contraceptives, low level of physical activity, alcohol consumption, or
consumption of cocaine or intravenous drugs.
Preventive Measures
e Quit smoking and alcohol
e Eat a diet rich in vegetables and fruits
e Reduce the intake of sweet and salty diet
e Control blood pressure and diabetes
e Get into regular moderate physical exercise for 30 to 45 minutes include: walking,
jogging, yoga, game, etc.
e Maintain a healthy weight
e Reduce mental tension
e Keep life style healthy
2. Rheumatic Fever and Rheumatic Heart Disease

i. Rheumatic Fever
Rheumatic fever is an inflammatory disease that may develop after an infection
with group A streptococcus bacteria. The disease can affect the heart, joints, skin
and brain. Rheumatic fever is responsible for many cases of damaged heart valves. It
mainly affects children between the ages of 3-15 years.
ii. Rheumatic Heart Disease
Rheumatic heart disease is a chronic condition caused by rheumatic fever. This disease
occurs due to group A streptococcal infection. It is the most common acquired heart
disease in children in many countries in the world, especially in developing countries
including Nepal. It generally damages the heart valves. Untreated tonsillitis can later
results in to Rheumatic Heart Disease. This disease mostly attack the children in the
age group 3-15 years. At least 16 million people are estimated to be currently affected
by this disease.
Symptoms of Rheumatic Fever and Rheumatic Heart Disease
Abdominal pain
Heart problem, which may result in shortness of breath or chest pain
Joint pain (mainly in the knees, elbows, ankles and wrists)
Joint swelling with redness and warmth
Skin nodules
Rashes in body parts
Fever
Emotional instability
Rapid jerky movement due to muscle weakness
C. Diabetes
Diabetes is a group of metabolic disease in which a person has high blood sugar.
The high concentration of sugar in the blood produces the symptoms of frequent
urination, increased thirst and increased hunger. Diabetes is also known as sugar
disease. It is the medical condition in which either the pancreas cannot secrete insulin
at all or body cannot use the secreted insulin. The pancreas may secrete insulin for
all the cells of the body, but some cells may not respond to it. Consequently, it causes
extremely high concentration of sugar in the blood. This condition is called diabetes.
Untreated diabetes can cause many long term complications like: heart disease,
kidney failure, damage to the eyes, nerve damage to the feet and other parts of the
body. Depending on the nature, diabetes can be grouped into three types such as
Diabetes Insipidus, Diabetes Mellitus and Gestational Diabetes.
1. Diabetes Insipidus
Diabetes insipidus is a disease characterized by extreme thirst and the passing of
vast amounts of diluted urine. It is caused by insufficient vasopressin (a hormone
produced by pituitary gland of the brain that instructs the kidneys to retain water).
Without enough vasopressin, too much water is lost from the body through urination.
Which urges the affected person to drink large amounts of fluids in an attempt to
maintain their fluid level.
In the severe case diabetes insipidus can cause dehydration and coma due to excessive
concentration of salts in the blood, particularly sodium. Depending on the cause,
diabetes insipidus can be treated with medications, vasopressin replacement and a
low-salt diet.
Symptoms
Excessive thirst
Excessive urine production (polyuria)
Unexplained weakness
Muscle pain
Irritability
Dehydration
Presence of sugar in urine
The colour of urine is crystal and smells nice
2. Diabetes Mellitus (Sugar)

Diabetes Mellitus is one of the most common and serious chronic diseases in the
world including Nepal. Diabetes is a metabolic disease in which the body can not
produce insulin (insulin is a hormone produced by pancreas that is needed to convert
sugar, starche and other food into energy needed for daily life). There are three types
of diabetes mellitus, all of which are characterized by high levels of blood glucose
(sugar).

Diabetes Mellitus (Type I)
It is also called insulin dependent diabetes mellitus or juvenile onset diabetes. It is
characterized by loss of the insulin producing beta cells in the pancreas, leading to
insulin deficiency. The Mellitus Type I diabetes can affect children or adults, but is
traditionally termed as “juvenile diabetes” because a majority of these diabetes cases
are among the children. Generally, the onset of type I diabetes is unrelated to lifestyle.
General characteristics
M Results when the body’s immune system attacks and destroys its own insulin-
producing beta cells in the pancreas
M People with type I diabetes need daily injections of insulin to live a normal life
M Develops most often in children or young adults
M Although risk factors are not well defined, autoimmune, genetic, and
environmental factors are involved in the occurrence of this disease
Diabetes Mellitus (Type II)
It is also called noninsulin dependent diabetes:
General characteristics
M Occurs when the pancreas makes enough insulin but body cannot use it effectively.
M Usually develops in adults over the age of 40
M More common among older; obese people who have a family history of diabetes
and who have had gestational diabetes earlier
Gestational Diabetes Mellitus
Gestational diabetes mellitus resembles type II diabetes in several respects, involving a
combination of relatively inadequate insulin secretion and responsiveness. It occurs in
2–5 percent of the total pregnant women. It may disappear after delivery. Gestational
diabetes is fully treatable, but requires careful medical supervision throughout the
pregnancy period. About 20-25 percent affected women develop type II diabetes in
future.
General Characteristics
M It occurs during pregnancy
M Usually disappears when the pregnancy is over
M Women who have had gestational diabetes have a greater risk of developing type
II diabetes later in life
Causes of Diabetes
Ü Too much carbohydrates in diet
Ü Lack of physical exercise
Ü Obesity
Ü Sitting idly and eating more food
Ü Lack of secretion of insulin by pancreas
Ü Too much worry and idleness
Symptoms of Diabetes
Increased thirst
Extreme hunger
Fatigue
Weight loss in spite of increased appetite
Feeling tired and lethargic
Tongue looks dry
Blurred vision
Slow healing of wounds
Presence of more sugar in urine
Frequent urination and loss of water in the body
Itching and skin infection, particularly around the genitals
Tingling or numbness in legs, feet or fingers
Preventive Measures
e Have a healthy eating plan
e Do regular physical activities and exercise
e Follow healthy lifestyle
e Avoid obesity
e Avoid alcohol and tobacco substances
e Weight management
e Periodic test for the presence of sugar level in urine and blood
D. Chronic Obstructive Pulmonary Disease (COPD)
“The disease which may develop wheezing, breathlessness and mucus due to
the obstruction of bronchi and bronchioles is recognized as chronic obstructive
pulmonary disease.” A chronic obstructive pulmonary disease affects the bronchi and
bronchioles of the lungs. Patient becomes breathless in need of air and also has cough
with excessive sputum production. There is no complete treatment of this disease but
it can be prevented and controlled. This disease if not treated in time, it may develop
into the chronic disease Asthma.
The WHO has estimated that nearly about 80 million world population is suffering
from COPD. A survey shows that about 3 million people died in 2005 AD due to this
disease. Among them, 90 percent were from the developing countries.

Causes
Ü Dust and chemical substances
Ü Smoking and frequent upper respiratory tract infections
Ü Indoor air pollution (i.e. smoke produced by; domestic combustion of coal, wood,
kerosene, etc),
Ü Outdoor air pollution (i.e. harmful gases or smoke produced by the industry and
vehicle)
Symptoms
Heaviness in the chest
Restlessness
Difficulty in respiration during the sleep
Cough with sputum
Wheezy breathing during the work, exercise and running
Fast respiration and pulse rate
In the case of severe COPD, patient may die if he/she does not get oxygen in time.
Prevention and Control
e Keep away from allergens
e Stay in non-polluted environment
e Wear warm clothes to prevent yourself from cold
e Keep away from smoking
e Take medicine according to the doctor’s prescription
e Take oxygen immediately if there is difficulty for respiration
7.4 Environmentally Infectious Diseases
A. Dengue Fever
Dengue fever is a mosquito-borne tropical disease. It is caused by the dengue virus.
Dengue virus is transmitted through Aedes aegypti female mosquitoes that breed in
household water containers and unused materials on the roof and around the houses.
Aedes Aegypti is the vector of Dengue fever. It is a small, black mosquito with white
stripes and is approximately 5 mm in size. Aedes aegypti mosquito breeds in any type
of manmade containers or storage containers having even a small quantity of water.
Drums, jars, pots, buckets, flower vases, plant saucers, tanks, cisterns, bottles, tyres,
roof gutters, cement blocks, bamboo stumps, coconut shells and many more places
where rainwater is stored for long period become suitable breeding habitats for these
mosquitoes. The incubation period of this disease usually lasts for 3-7 days. According
to WHO, around 300 million people are infected and approximately 20,000 persons
die due to this disease each year. In the context of Nepal, this disease infects around
300 persons every year (Department of Health, GoN). The vaccine against dengue
fever was discovered in 2016 AD.
Habitat of the Vector
Ü Water retained ditch
Ü Water retained flower vase
Ü Water retained discarded sinks
Ü Water holding discarded barrels, buckets, drums and jerrican
Ü Water retained discarded tires and other vehicle parts
M Mosquito bite
M Blood transfusion by infected donour
M Infected mother to her foetus
Signs and Symptoms
Sudden high fever and pain behind the eyes
Intense headache and tiredness
Cough and sore throat
Nausea or vomiting
Severe joint and muscle pain
Bleeding from nose and gums
Liver enlargement
Skin rash (appearing between two and five days after the initial fever)
Convulsion
Preventive Measures
e Avoid heavily populated residential areas
e Use mosquito repellent indoors and outdoors
e Wear long-sleeved shirts and pants tucked into socks
e Ensure that window and door screens are secure, and any holes are repaired
e Use mosquito nets if sleeping areas are not screened
Activity
Organize a talk program in your class on the role of school children for the prevention
and control of communicable diseases in community with the epidemiologist and
other stakeholders under the supervision of your subject teacher.

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

Summary
Ü Disease is a pathological condition of an organism resulting from various causes

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

EXE RC IS E
1. Which type of communicable disease is cholera?
2. Which disease is known as silent killer?
3. Mention any two symptoms of dengue fever.
4. What is the causative agent of bacillary dysentery?
5. What can be the main cause of non-communicable disease?
6. Which bacteria causes stomach cancer?
7. Mention any two modifiable risk factors of non-communicable disease.
8. What is the main cause of Rheumatic heart disease?
9. Write any two symptoms of stroke.

1. “Diarrhoea is a common disease of Nepali children”. Justify the statement.
2. What is cancer? What are the causes and preventive measures of cancer?
3. Mention the causative agent, signs/symptoms and preventive measures of
Round Worm infestation.
4. Mention the causative agent, mode of transmissions and preventive
measures of common cold.
5. What is disease? Explain the types of disease.
6. What is heart attack? Write its signs and symptoms.
7. What is Dengue fever? Mention its causative agent, signs/symptoms and
mode of transmission.

1. Heart attack and stroke
2. Amoebic dysentery and bacillary dysentery
3. Diabetes insipidus and diabetes mellitus

1. COPD
2. Gestational Diabetes
3. Rheumatic Fever

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

IV. Findings, Conclusion and Recommendation

UNIT
ADOLESCENCE, SEXUAL AND
8 REPRODUCTIVE HEALTH EDUCATION
Give introduction to Sexually Transmitted Diseases.
Introduce HIV and AIDS and identify causes, symptoms, and prevention and
control measures.
Introduce syphilis, gonorrhea and chanchroid and identify their causes, symptoms,
and prevention and control measures.
Give introduction to Safe Motherhood.
Explain the education and health service for Safe Motherhood.
Tell the signs and symptoms of pregnancy.
Identify risky conditions of pregnancy.
Identify the minor and major problems of pregnancy.
Tell the need and importance of Maternal and Child Health Care.
Illustrate the measures of Maternal and Child Health Care.
Mention about proper breast feeding and supplementary food to the baby.
Tell immunization schedule to the newborn baby.
8.1 Some Major Sexually Transmitted Infections (STIs)

The infection transmitted from one individual to another through the unprotected
sexual contact is called sexually transmitted infection. The sexual intercourse before
marriage is illegal and is not acceptable in our society. Multiple partners for sexual
intercourse leads to various sexually transmitted infections. The common sexually
transmitted infections are Syphilis, Gonorrhea, HIV and AIDS, etc.
8.1.1 HIV and AIDS
Human Immuno Deficiency Virus or ‘HIV’ is the virus that causes AIDS. HIV attacks and
destroys a type of white blood cell called a CD4 cell, commonly called the T-cell. This
cell’s main function is to fight against disease. When a person’s CD4 cell count gets
low, s/he is more susceptible to illnesses. AIDS is a life threatening disease caused by
the Retro virus known as (HIV). As soon as retrovirus gets into the body, HIV infection
begins and it starts invading CD4 (T-lymphocytes). Then the immunity power of the

infected person starts decreasing. Following infection by HIV, within 3 weeks to 3
months, many patients develop some symptoms such as fever, sweats, fatigue, muscle
and joint ache, sore throat, diarrhoea, skin rash and swollen lymph nodes. But within
one to three weeks, these symptoms disappear as the immune system responds
to the HIV by producing antibodies that kill HIV infected cells. Having HIV does not
always mean that the person has AIDS. It can take many years for people with the
virus to develop AIDS. Hence, HIV and AIDS is often called the “silent epidemic” due
to its very long incubation period, meaning that a person can be infected for many
years without showing any symptoms. AIDS cannot be cured however, with the Anti
Retro Viral Drugs available today, it is possible to have a normal life span with little or
minimal interruption in quality of life. There are ways to help people stay healthy and
live longer.
UNAIDS has estimated that there are about 35 million people who have been living
with HIV in the world. Although the disease appeared late in Asia it has exceeded
other continents in the number of AIDS patients. The first case of HIV and AIDS was
found in the USA in 1981 AD. Similarly, the first case of AIDS in Nepal was identified in
1988 AD. According to the National Centre for AIDS and STD control (NCASC), the total
number of people living with HIV for 2012 AD was estimated 50,000 in the country.
In Nepal, HIV epidemic is largely concentrated among the intravenous drug users, sex
workers, male labour migrants and Trans genders.
Normally, approximately 1,200 CD4 cells are present per cubic millimeter of blood.
An HIV-infected person is considered to have AIDS when one or more of the following
conditions appear: such as the CD4+T cell count falls below 200 cells/mm3 and
opportunistic infection like; T.B., Syphills, Persistent diarrhoea or Kaposis sarcoma
(cancer of skin, lymph nodes) develops. Then, the AIDS patient dies within 6 months
OF T
R
A
E
N
D
SM
O
M
Unsafe sex IS
SI
Trans fusion of O HIV- Infection
N
infected blood
Sharing of infected S Window Period
(3-12 months)
needles T
A HIV Positive
G Healthy Carrier Stage
(Some months to many years)
E
S AIDS
(Attack with multiple opportunistic diseases)
Different stages of HIV & AIDS

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

Major Symptoms
Loss of weight for more than ten percent of the body weight
Being tired all the time
Continuous fever for more than one month
Continuous diarrhoea for more than one month
Abnormal discomfort, headache
Opportunistic diseases of various kinds
Preventive Measures
e Be away from prostitution
e Public awareness about reproductive and sexual health should be increased
e Do not involve in the unsafe sexual activities
e Use sterilized or disposable syringe
e Blood should not be used without screening
e Proper use of condom can control HIV infection
e Have anti- retroviral therapy by infected mother if she is pregnant
e Avoid body piercing and tattooing
Reasons of Prevalence of HIV/AIDS in Nepal
1. Poverty and Unemployment
A large number of Nepalese youths emigrated to different foreign countries including
India. During the long time stay outside in those places some persons happen to
establish promiscuities sexual relation with the sex workers over there. If they
establish unsafe sexual relation, they get infected with HIV/AIDS and return back
to the country. If they have sexual relation with their sexual partner again then this
disease transmits to the partners also.
2. Human Trafficking from Nepal

The smuggler’s groups are involved in human trafficking. They trap people in different
name and traffic them to India and other countries. In those places, they are compelled
to involve in sex work. Because of such work, they get HIV infection. When they return
to the country, they cannot get support, protection and rehabilitation service. As a
result, they become the medium of prevalence of this disease.
3. Sex Trade in Rural and Urban Area

Sex trade is illegal in Nepal. However, some people are involved in this illegal activity.
In this context, they can spread HIV/AIDS to a large population if they establish unsafe
sex.

4. Ignorance about Sex Education
In our society, there are many social taboos against open discussion about the sexual
issues. So, there is no open discussion about sexuality, sexually transmitted diseases
and other sexual issues even between husband and wife. Eventually people become
ignorant about sexual issues and responsibilities. Hence, they become totally ignorant
about AIDS related issues. For instance, they do not know What is AIDS? How does it
transmit? How can it be prevented? It is necessary to understand that there should be
equal treatment to the HIV infected persons also and there should be rehabilitation
services and facilities to the HIV/AIDS victims.
5. Social Taboos About Open Discussion on STDs

The STD infected person should openly explain their problems to the doctor or
authorized health worker at the health organization. In our society, we cannot openly
discuss about sexual issues and STDs yet. It is still believed that to talk about the
sexuality is to cross the limitation of moral and social ethics. This factor also becomes
one reason of high prevalence of the STDs including HIV/AIDS.
Activity
Divide the class in different groups and conduct a sample survey on endemic diseases
of your locality and examine the causes, mode of transmission, signs and symptoms
including their preventive and control measures. Then present the report in your class
for discussion.
8.1.2 Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium called
Treponema Pallidum. The primary mode of transmission of this disease is unsafe sexual
contact. It may also be transmitted from mother to foetus during pregnancy or birth
resulting in congenital syphilis. If left untreated, syphilis typically progresses through
three stages: Primary, Secondary and Tertiary stage. The primary stage normally
begins with a single chancre (a firm, painless, non-itchy skin ulceration), secondary
syphilis with a diffuse rash which frequently involves the palms of the hands and
soles of the feet and tertiary syphilis with insanity, blindness or heart damage. Its
diagnosis is usually made by using blood tests. Syphilis can be effectively treated with
antibiotics. It is believed that this disease has infected about 12 million people in the
world in 2013 AD, with greater than 90 percent of cases in the developing world.
During 2010 AD, Syphilis alone caused about 130 thousand deaths in the world. The
incubation period ranges from 10 to 90 days.

M Unprotected sexual contact
M Transfusion of contaminated blood
M Infected mother to the foetus
M Use of contaminated syringes and needles
Symptoms
Primary Stage
Primary stage of Syphilis develops approximately 10 to 90 days after the initial
exposure. As the earliest sign of syphilis in its primary stage, a skin lesion called
chancre appears in the genitals or tip of the finger in male and on vulva and anal area
in female. The chancre is a single, painless, non-itchy skin ulceration but occasionally
multiple chancres may be present. The lesion may appear for 3 to 6 weeks without
treatment then it disappears leaving scars. Eventually, lymph node enlargement
occurs around the area of infection, generally 7 to 10 days after the formation of
chancre.
Secondary Stage
Secondary syphilis occurs approximately 4 to 10 weeks after the primary infection.
In this stage, skin rashes appear. At the same time hair falls, swelling of joints and
symptoms of common cold occur. There may be enlargement of liver, spleen and lymph
glands. Other symptoms may include fever, sore throat, weight loss and headache.
The acute symptoms usually resolve after three to six weeks. If the treatment is not
done in time, the third stage begins after some years later.
Third Stage (Tertiary Stage)
Tertiary Syphilis may occur between 3 to 15 years after the initial infection and may
develop the following health problems:
Gummatous Syphilis: Formation of gummas occurs (tumour like masses),
typically affect the skin, bone, liver, etc.
Neurosyphilis: Development of maningo vascular syphilis resulting in to
blindness, general paralysis and insanity.
Cardiovascular Syphilis: The most common complications of cardiovascular syphilis
are serious damage to heart and blood vessels.
Preventive Measures
e Early diagnosis of the cases
e Sexual health education at home, school and community
e Unprotected sexual activities must be discouraged
e Wash and sterilize clothes and pots before using them
e Avoid personal belongings of infected persons
8.1.3 Gonorrhoea
Gonorrhoea is a contagious disease. It is transmitted through sexual contact with an
infected person. It may also be spread by contact with body fluid so that mother can
pass on the infection to her newly born. The infection is easily spread and occurs most
often in people who have multiple sex partners. It is caused by the bacterium called
Neisseria Gonorrhoeae that can grow and multiply easily in mucus membrane of the
body. This bacteria can grow in the reproductive tract including the cervix, uterus,
fallopian tube in women and in urethra in both men and women. The bacteria can
also grow in the mouth, throats and anus. The germs come out with the pus from the
genitals. The average incubation period of this disease ranges between 3 to 9 days.
Symptoms
Burning sensation and difficulties in urination, frequent occurrence of urination
Thick greenish yellow or white discharge flows out form the vagina or penis
Genitals and urethra are swollen
Red spots appear around the genitals
Bleeding may occur between periods in women
Painful or swollen testicles appear in men
Eyes are affected to the newly born baby
Swelling of vulva
Burning sensation when urinating
In women, lower abdomen or pelvic pain
M Unsafe sexual contact
M Sharing clothes and handkerchief used by the patients
M Transfusion of contaminated blood
M Use of infected needles and syringe
M Infected mother to child
Preventive Measures
e Sexual relation between husband and wife only
e Girls’ trafficking and prostitution must be banned
e If a husband or wife is infected from it, both of them should be treated in time
e The patient’s clothes and other belongings should be washed properly
e It is needed to keep the genitals neat and clean
e Education on sexual hygiene
e Early diagnosis and treatment

8.1.4 Chanchroid
Chanchroid is a sexually transmitted disease caused by the bacterium called
Haemophilus. It causes open sores around the genitals and also causes ulceration
of the lymph nodes in the groin. The infection begins with the appearance of painful
open sores on the genitals and swollen lymph nodes in the groin. Symptoms in women
are often less noticeable and may be limited to painful urination or defecation,
painful intercourse or vaginal discharge. These symptoms appear within a week
after exposure. The common locations for chanchroid sores in men are the penis and
scrotum. In women, the common locations are labia majora, labia minora and inner
thighs. Its incubation period falls between 3-7 days.
M Having unprotected sex
M Wearing contaminated fomites
M Skin-to-skin contact with an infected person
Symptoms
Presence of painful ulcer on and around the genitals
Draining of grey or yellowish pus from the ulcers
Swelling in the groin may occur
Bleeding from the ulcers
Painful urination
Vaginal discharge
Prevention
e Awaking the community through Practicing safe sex
e Consistent use of condom during sexual intercourse
e Limiting the number of sexual partners
e Promoting abstinence from drugs and alcohol
e Avoiding high-risk sex partners
Activity
Divide the class into different groups. Then discuss about the causes, mode of
transmission, signs and symptoms and prevention methods of various kinds of
sexually transmitted diseases. Afterwards, present the conclusion in your class.
8.2 Safe Motherhood

8.2.1 Introduction to Safe Motherhood
Safe motherhood is considered as one of the important components of reproductive
health. It refers to the protection of health of the mother and foetus during prenatal,
natal and post natal period through safe motherhood initiatives. The ultimate goal
of prenatal care is to detect any potential complication of pregnancy. Postnatal care
includes the concerns about the newborn baby care, mother’s nutrition, breast-
feeding, and family planning. The overall goal of safe motherhood initiative program
(SMI) is to reduce maternal and neonatal morbidity and mortality rate through
intensive maternal and child health care.
It is estimated that about half a million women from around the world are dying each
year because of complication in pregnancy and delivery. Among them, more than
90 percent of the maternal deaths occur in the developing countries. Every minute,
somewhere in the world and most often in a developing country, a woman dies from
complications related to pregnancy or childbirth. Furthermore, the maternal mortality
rate of our country is still 239 according to Nepal Demographic Health Survey,
2016 AD. Safe motherhood includes the following information and services:
i. Pregnancy at appropriate age
ii. Appropriate prenatal care
iii. Proper care of pregnant women
iv. Effective postnatal care and service
v. Identify complications promptly and referring to nearby health institution
vi. Provide high quality antenatal and postpartum care, post abortion care
vii. Provide quality family planning service and treatment of STIs
viii. Appropriate age of women for safe conception
ix. Ensure all delivery service hygienically and according to accepted medical
practices.
8.2.2 Education and Health Service Related to Safe Motherhood

There is still a tendency of early marriage in Nepal. It is not considered good from the
perspective of reproductive health. From the perspective of reproductive health, an
ideal age of conception for the female is after 20 years. Early conception may create
many health related complications. It is necessary to aware the people about the
pregnancy only after the physical maturity for the good health of mother and infant.
There should be limited number of babies with proper birth spacing. Begetting a large
number of babies may spoil the health of the mother. There should be birth spacing
of 4/5 years so that the first baby can get proper care from the family. People need
to get safe motherhood education and serves in time for productive and healthy life.
A. Pregnant Woman and Awareness Generation
A healthy mother can give birth to a healthy baby. Today’s healthy baby becomes
healthy human resource in the future. Prenatal care is essential for the health and
proper development of the growing foetus. In this context, the strategy of nutrition,

care and service carried for the Sunaulo Hazar Din is very effective to promote the
health condition of the mother and the baby. The necessary health care during the
prenatal period are mentioned below:
i. Conventionally, a pregnant woman should go for prenatal check up as per the
schedule given below:
First antenatal check up Right after conception
Monthly antenatal check up From the first month till seven months of
conception
Fortnightly antenatal check up From 8 months to 9 months of conception
Weekly antenatal check up After 9 months of conception until delivery
Any time emergency antenatal check up is required in the case of complication
ii. In the case of first pregnancy, tetanus toxoid injection should be given two doses
intramuscularly. The first dose should be given anytime in the first seventh month of
pregnancy and the second dose should be given after one month of the first dose.
iii. Once the woman is pregnant, she should increase her food intake as the foetus
grows. She must take adequate food that is rich in carbohydrate, fats, proteins, iron,
calcium, iodine, etc. The foods such as cereals, beans, nuts, milk, egg, meat, green
leafy vegetables and fruits should be there in her daily meal.
iv. Women should not carry heavy load during the pregnancy period.
v. Attention should be given in personal hygiene.
vi. Pregnant women should not consume alcohol, tobacco substance, drugs and
should not eat soil and ash as well.
vii. Family member should give proper care and support to the pregnant woman.
B. Some Risky Factors of Pregnancy
Pregnancy may be risky in the following conditions; if
a. The woman’s age is less than 18 years and above 35 years old.
b. The woman’s weight is less than 40 kg and above 80 kg; height below 145 cm.
c. The Woman diseased by HIV and AIDS, Cancer, Diabetes, and other chronic
diseases.
d. The Woman is malnourished and she already has more number of children.
e. The Woman had given birth to twins in her previous pregnancy.
f. The Woman’s last baby was born dead or died soon after birth.
g. The Woman’s last baby was born less than two years ago.
h. The Woman is having the medicines that are harmful to the foetus.

C. Problems of Pregnancy
The period between conception and birth is called pregnancy. The pregnancy period
generally lasts for 9 months and 7 days. During this period, some health problems are
observed. They can be studied as minor problems and major problems.
1. Minor Problems of Pregnancy
• Nausea and vomiting • Anaemia
• Constipation • Tiredness
• Chest pain • Hyper acidity
• Piles • Itching in the body
• Muscle cramps • Numbness in feet
• Backache • Gingivitis (swelling of gums)
• Swelling of veins in legs (varicose of veins)
2. Major Problems of Pregnancy

In some situation, major problems may occur during pregnancy. In the case of major
problems; appropriate care and medical treatment are essential. The major problems
of pregnancy are as follows:
i. Abortion
Abortion refers to the removal of immature foetus before 24 weeks of pregnancy. If
the pregnancy date is unknown, the expulsion of foetus with less than 500 gram is
also considered as abortion. Abortion can be defined as the termination of pregnancy
before the foetus gains survival qualities. There are two types of abortion i.e.
spontaneous abortion and induced abortion.
a. Spontaneous Abortion
The abortion, which takes place without human enforcement is called spontaneous
abortion. It is also called a miscarriage. Some of the reasons of spontaneous abortion
are as follows:
M Abnormal size of Uterus
M Chronic infections during pregnancy
M Chronic malnutrition
M Excessive mental tension and anxiety during pregnancy
M RH negative factor in the mother’s blood
M Injury in Uterus during the pregnancy period
M Toxemia
b. Induced Abortion
Induced abortion refers to the deliberate termination of pregnancy by using medicine
or with the help of trained and authorized health personnel. The main reason of
induced abortion is unwanted pregnancy. Usually, the pregnancy of unmarried girls,
widows, sex workers are found aborted.
At present, there is provision of legal abortion in our country in certain conditions.
According to this provision (Abortion Act, 2058 BS), women can abort their pregnancy
before 12 weeks. At present, safe abortion service is being provided by maternity
hospital, Thapathali (Kathmandu), Marie Stope clinics of different districts and Family
Planning Clinics. It is hoped that people will be encouraged for safe abortion services
from authorized abortion centers and authorized medical personnel’s only. The main
reasons of induced abortion are mentioned below:
M Unwanted pregnancy
M Sex preference (son/daughter)
M Health complication of mother
M Abnormality or deformity of foetus
M Premarital and or extramarital pregnancy
M Pregnancy resulted by rape, incest relation, etc.
ii. Toxemia
Toxemia refers to the illness during pregnancy due to the concentration of toxic
substances in the blood. It is also called as pre-eclampsia or eclampsia. This kind of
illness is observed in very few pregnant women. Some symptoms of toxemia are as
given below:
Ü Severe headache
Ü High blood pressure
Ü Excessive weight gain
Ü Swelling of ankles
Ü Presence of protein in the urine
Ü Blurred vision
Ü Abdominal pain
Ü Oedema
iii. Ectopic Pregnancy

The implantation of fertilized zygote at any place other than in the Uterus is called
ectopic pregnancy. In other words, the development of foetus at a site other than
in the womb is called ectopic pregnancy. Generally, ectopic pregnancy occurs at the
site of Fallopian Tube, abdomen and ovary. Obstruction in Fallopian Tubes, improper
use of IUD and endometrial tumors are considered as the main reasons of ectopic
pregnancy.

iv. Hypertension
The normal blood pressure of an adult person has 120/80 mm of Hg. Hypertension
refers to the blood pressure which is higher than normal level of blood pressure.
Hypertension is also one of the major problems of pregnancy. It is believed that
hypertension is resulted by anxiety, tension, toxemia, etc. Some of the symptoms of
hypertension are given below:
Ü Headache
Ü Nausea and vomiting
Ü Dizziness
Ü Blurred vision
v. RH Incompatibility
RH incompatibility is a condition that occurs during pregnancy if a woman has RH
negative blood and her baby has RH positive blood. “RH negative” and “RH positive”
refer to whether the blood has RH factor or not. RH factor is a protein on red blood
cells. If the woman is RH negative and her baby is RH positive, her body will react to
the baby’s blood as a foreign substance. In this condition, the RH antibodies may cross
the placenta and attack the baby’s red blood cells. This can lead to hemolytic anemia
in the growing foetus (Hemolytic anemia is a condition in which red blood cells are
destroyed faster than the body can replace them). As a result, severe anemia, brain
damage, or even death occurs in foetus.
8.3 Maternal and Child Health Care and its Measures
8.3.1 Introduction and Importance of Maternal and Child Health Care
Maternal and child health care refers to the health services provided to the pregnant,
postnatal and breast-feeding mother and children under five years. It includes
preventive, promotive and curative health services of the mother and the children.
In the absence of effective and adequate maternal and child health care, maternal
mortality rate and child mortality rate are extremely high. For instance, every year
more than half a million women die as a result of complication during antenatal,
natal and postnatal period. At the same time, it is estimated that about 4 million
babies are dying before reaching one month of age in the world. Furthermore, in
Nepal about 12 thousand children are dying by gastro-intestinal diseases every
year. Similarly, maternal mortality rate is still 239. Actually, this is the great loss to
the family, community and nation. Thus, there must be provision of effective and
adequate maternal and child health care services in the community and nation.
Importance of Maternal and Child Health Care
MCH care is essential to have safe pregnancy
It helps to prevent the different complications during antenatal, natal and
postnatal period
It provides knowledge and skills to protect and to promote the health status of
mother and newly born baby
With the assistance of skilled birth attendants, we can protect the health of the
mother and child
Special attention on immunization, balanced diet, maintenance of hygiene during
pregnancy increase the chance of birth of the healthy baby
It promotes the status of reproductive health
It protects the women from high risk pregnancy and unsafe abortion
8.3.2 Maternal Child Health Care

The measures that are related natal care, postnatal care and neonatal care are
explained below:
A. Care of Pregnant Woman (Prenatal care)
Prenatal care is the care to the women during the pregnancy period. It is also called
as antenatal care. It plays an important role to protect and promote the health of the
mother and foetus as well during pregnancy period. The following aspects are to be
considered well during the pregnancy period.
1. Personal Hygiene
Cleanliness is very essential during pregnancy and postnatal period. Most of the
diseases and infestation can be prevented through cleanliness. It protects pregnant
and breast feeding women from Diarrhoea, Cholera, Typhoid, Jaundice, Dysentery,
Worm Infestation, etc. So, to maintain personal hygiene, they should take regular
bath, clean their genitals well, wear clean and comfortable clothes. At the same
time, living rooms, kitchen, courtyard and surrounding should be clean. Besides this,
pregnant women should follow the rules of hygiene to keep themselves healthy.
2. Nutritious Food
A pregnant woman should take balanced diet. She should eat for herself as well as
for her foetus. Once the woman is pregnant, she should increase her food intake as
the foetus grows. She must take adequate food which are rich in carbohydrate, fats,
proteins, iron, calcium, iodine, etc. In our context, attention is not given on food for the
pregnant and breast feeding mother. Therefore, the maternal and child mortality rate
is very high in our country. If we can supply foods such as cereals, beans, nuts, green
leafy vegetables and fruits adequately; the health of the mother can be promoted. At
the same time, she should drink adequate water for sound health. In addition to this,
she must not consume tobacco, alcohol and drugs. If necessary, medicine has to be
taken only under the consultation with the medical personnels.

3. Light Exercise and Rest
Rest and exercise are essential aspects of the pregnant women. The pregnant women
can do light exercise and normal household activities. Morning walk in the open air
is good for their health. However, heavy and stressful exercise is harmful for them. It
may result into miscarriage too. Long journey in the first three months and at least
the last first three months of pregnancy period should be avoided. In addition to this,
adequate rest and sleep is also equally important in this period. For this, the pregnant
women should take rest for 2 hours after lunch and 8 hours sleep for good health.
4. Health Checkup
In the context of our country, health examination is a new concept among the
pregnant and breast feeding women. Due to lack of Health Education and lack of
health care facilities health examination during prenatal and postnatal period is not
common among them. Regular health examination is mandatory during pregnancy,
delivery and postnatal period.
Regular health checkup provides information about the status of mother and foetus.
If certain complications are noticed they can be immediately treated. Normally, a
pregnant woman should attend the health centre once a month during the first seven
months, twice a month during the eighth month and once a week during the last
month.
5. Use of Medicine
There should not be practice of self medication during the pregnancy period. If needed
they should be taken only with the recommendation and prescription of the doctor or
authorized health personnel. The intake of drugs without the recommendation of the
doctor can adversely affect the health of the mother. Similarly, it may also hamper the
health and development process of the foetus.
6. Vaccine/Immunization
The pregnant mother and infant should be prevented from the infection of Tetanus.
For this, Tetanus Toxoid injection should be given intramuscularly in seven months
of pregnancy or two weeks before birth. In the case of first pregnancy, she should
be given two doses. The first dose should be given in the first seventh month of
pregnancy and the second dose should be given after one month of the first dose.
If the woman is already immunized in the past, a booster dose is given in the last
trimester of pregnancy period.
B. Safe Delivery and Natal Care
Labour starts at the last stage of pregnancy. The woman should be especially cared
during this period. Labour can be defined as the physiological process by which the

foetus, placenta and membranes are expelled throughout the birth canal after the
full term of pregnancy (38 to 42 weeks). The whole process of labour can be divided
into three phases. Normally, the total process of labour lasts for 8 to 24 hours. The
duration of labour depends on the various factors like birth parity, physical strength,
structure of pelvic bone, height and weight of pregnant woman.
1. First phase of Labour
It starts from onset of regular uterine contraction to full dilation of cervical os. This
phase generally lasts for 6 to 20 hours.
Signs and Symptoms
Painful contraction of the Uterus occurs at every 10 or 15 minutes
Progressive dilation of the cervical os is observed
Amniotic membrane ruptures
Vaginal discharges show (i.e. blood mixed mucus)
Mother feels to urinate frequently
She feels pain at the bottom of her back and abdomen
The Cervix softens and fully dilates (cervical os measures 10 cm diameter)
Care During the First Phase of Labour
Ü Skilled Birth Attendants should be present
Ü Encourage the mother to pass urine and faeces
Ü Pubic hair should be removed and body should be cleaned
Ü Serve her liquid food like juice, milk, soup, sugar water, etc.
Ü Ask her to take a deep breath during the painful contraction of the Uterus
Ü Do not allow her to push down the baby during this phase
2. Second Phase of Labour

The second phase starts from the full dilation of cervical os and ends after the
complete expulsion of the baby. This phase lasts for 30 minutes to 1 hour.
Signs and Symptoms
Expulsive and painful contraction of the Uterus occurs at every 5 minutes
Sweating, vomiting and opening of the vagina occurs
Mother feels urge to push down the baby
Rupture of the membrane occurs
At the end, the foetus is expelled out from the Uterus
Care During the Second Phase of Labour
Ü The mother should be kept in comfortable posture for delivery
Ü She should be encouraged to bear down the baby
Ü Vital signs like blood pressure, pulse rate should be examined in every 10 minutes
Ü Sweats on her body should be wiped out
Ü Separate the baby safely from the umbilical cord after the birth of the baby
3. Third Phase
This phase begins after the expulsion of the baby and ends after the placenta,
membrane, umbilical cord and little amount of blood come out from the birth canal.
It lasts for 5 minutes to ½ hour.
Signs and Symptoms
The mother feels relaxed and all the vital signs become normal
Loss of about 100 ml fresh blood occurs
Placenta and membranes are expelled out
The mother’s womb becomes hard
Care During the Third Phase of Labour
Ü Let the placenta, cord and mucus be discharge. Do not pull on the cord
Ü The mother should be cleaned, made comfortable and allowed to rest
Ü Ask her to urinate and clear her bowl
Ü The placenta and cord should be disposed properly
Ü She should be provided hot soup
Ü Baby should be cleaned with soft cotton cloth and wrapped with the warm cotton
clothes
Ü Stitch the perineum if it is torn out
C. Care of Postnatal Mother

Care of the mother approximately for two months (specifically for 42 days) after
delivery is called postnatal care. Postnatal care helps to keep mother and the infant
fit and healthy. The following points have to be considered in postnatal care:
e The postnatal mother should be given comparatively more nutritious foods like
milk, fish, meat, eggs, beans, vegetables, fruits etc than the normal period
e She should get adequate time for rest and sleep
e She should clean her genital organs with soap and clean water after each toilet
use
e She should breast feed her baby as soon as possible
e Baby should be wrapped with warm cotton clothes
e She should get regular health checkup during this period
e She should keep her body warm with cotton clothes
e She should not do heavy work and carry heavy load

e She should walk slowly every day for half an hour inside the house; it helps in
blood circulation process
e She should pay attention in breast hygiene
e She should be explained about Sunaulo Hajar Din
8.3.3 Infant and Child Health Care

A baby is more safe in the mother’s
uterus but not as much safe in the
external environment. S/he has to
face various challenges and problems
after birth. A normal new born infant
should have 3 kg body weight and 50
cm height. When it is less than 2.5 kg,
the infant is considered as low weight.
After one year of birth, generally the
weight of the baby reaches three
times and height reaches around 75 Polio Immunization
cm. The first Sunaulo Hajar Din plays
an important role for the overall development of the baby. Proper attention should be
given for the health and nutrition of the baby during this period. The following points
should be considered while providing infant health care:
Ü As soon as the baby is expelled out, it should be held upside down so that the
mucus and water in the nose and mouth can easily come out there will be easy
respiration
Ü The baby should be kept at a little low position than the mother’s uterus until the
umbilical cord is separated from the baby so that there will be adequate passage
of blood from the placenta to the baby
Ü Remove the mucus from the nose, mouth and ears of the baby
Ü Wrap the baby with warm cotton cloths
Ü Umbilical cord should be cut with a sterilized razor or blade
Ü The baby should be breast fed as soon as possible
Ü Feed colostrums (the first milk of the mother) to the baby instead of throwing it
out
Ü Periodic health check-up and immunization of the baby should be managed on
regular basis
A. Breast Feeding and Supplementary Food
Breast milk is the ideal food for the infant. There is no alternative food for the breast
milk to the infant up to 5 months. It means no other food is required for the baby

till 5 months after birth. Prolonged
breast feeding prevents the infants
from malnutrition and some infectious
diseases.
Generally, after 5 months of birth, breast
milk is not sufficient for the baby. Hence,
after five months, the infant can be
given supplementary foods like cow’s
milk, fresh fruit’s juice, lentil, crossed
vegetables, porridge, lito, etc. Providing
Breast Feeding
supplementary food along with breast-
feeding up to two years of age is called weaning. Weaning, if not done properly may
cause malnutrition to the baby. In our culture, there is a weaning practice called ‘Pasni’
(Rice feeding ceremony). It is celebrated after 5/6 months of birth. The following table
illustrates rules for the management of food for the children from birth to two years
of age.
Table 8.1: A Diet Chart of the Children from the Birth till Two Years of Age
Age Provision of Food
0-6 months Mother’s milk only
6-7 months Mother’s milk, lito, well cooked soft mixed vegetables
7-9 months Mother’s milk, lito, mixed vegetables and soft fruits
9-12 months Mother’s milk, lito, soft food, pulse, vegetables, eggs, etc.
1-2 years Mother’s milk, cereals, beans, soft food, pulses, rice, vegetables,
eggs, fish, meat, curd, etc.
Advantages of Breast Feeding

Breast milk is a complete diet for a child
The first breast milk (colostrums) supplies immunity to the child
Creates mutual relationship between mother and the child
Prevents mother from the risk of breast cancer
Helps to shaping Uterus in the normal size
Helps to postpone next pregnancy (postpartum amenorrhea)
It works as a natural means of contraception for few months
No tension for food preparation for the baby
B. Immunization
Immunization refers to the development of immunity in the body by artificial means
such as vaccines against particular diseases. It can prevent us from many infectious
diseases. Various research studies revealed that the people who had a complete dose
of vaccines in childhood is better in health compared to those who are not immunized.
The unimmunized children have high risk of diseases like Measles, Whooping Cough,
TB, Pneumonia, Tetanus, Poliomyelitis, etc. The immunization schedule is given in the
following table:
Table 8.2: The Immunization Chart for the Child
Age of Route of Against the
Name of Vaccine Doses
Administration Administration Diseases
BCG(Bacillus- 1 (0.05ml) At birth Intradermal Tuberculosis
Calmette-Guerin)
DPT-HepB-HiB 3 (0.5ml) 6, 10, 14 weeks Intramuscular Pertusis, Tetanus,
Hepatitis B and
Hemophilus
Influenza B
OPV (Oral Polio 3 (0.5ml) 6, 10, 14 weeks Oral Poliomalities
Vaccine)
PCV 3 (0.5ml) 6, 10 weeks Intramuscular Pneumonia
(Pneumococcal and 9 months
Conjugate Vaccine)
IPV (Injectable 1 (0.05ml) 14 weeks (Add Intramuscular Poliomalities
Polio Vaccine) on to OPV)
MR (Measles- 2 (0.5ml) 9 and 15 Subcutaneous Measles-Rubella
Rubella) months
JE(Japanese 1 (0.05ml) 12 months Subcutaneous Japanese
Encephalitis) Encephalitis
Td (Tetanus 2 (0.5ml) [1st dose] Intramuscular Tetanus and
Diphtheria) As soon as Diphtheria
[For women] pregnancy is
known
[2nd dose] One
month apart
Activity
Prepare a neat and clean immunization table for newly born babies on a chart paper
and discuss the relation between immunization and child health with friends in the
class.

Summary
Ü An HIV-infected person is considered to have AIDS when one or more of the

following conditions appear: such as the CD4+T cell count falls below 200 cells/
mm3 and opportunistic infection like; T.B., Syphills, Persistent diarrhoea or
Kaposis sarcoma (cancer of skin, lymph nodes) develops. Then, the AIDS patient
dies within 6 months to 2 years due to the attack of opportunistic diseases.
Ü Syphilis is a sexually transmitted infection caused by the bacterium called
Treponema Palladium. The primary mode of transmission of this disease is
unsafe sexual contact.
Ü Gonorrhoea is caused by the bacterium called Neisseria Gonorrhoeae that can
grow and multiply easily in mucus membrane of the body. This bacteria can grow
in the reproductive tract including the cervix, uterus, fallopian tube in women
and in urethra in both men and women.
Ü Safe motherhood refers to the protection of health of the mother and foetus
during prenatal, natal and post natal period through safe motherhood initiatives.
Ü Conception is the sum process of development of the fertilized zygote into a
blastocyst and its embedment on the uterine wall. Normally, conception occurs
at the fallopian tube and lasts for 8-10 days.
Ü Ectopic pregnancy refers to the development of a foetus at any place other than
the Uterus, usually at fallopian tube, abdomen and ovary.
Ü Safe motherhood is the protection of health of the mother and foetus during
antenatal, natal and postnatal period through safe motherhood initiatives like
prenatal care, safe delivery service and postnatal care.
Ü Maternal and child health care refers to the health services provided to the
pregnant, postnatal and breast-feeding mother and children under five years. It
includes preventive, promotive and curative health services of the mother and
the children.
Ü RH incompatibility is a condition that occurs during pregnancy if a woman has RH
negative blood and her baby has RH positive blood.
Ü Abortion can be defined as the termination of pregnancy before the foetus gains
its survival quality.
Ü The wishful or deliberate termination of pregnancy by using medicine or with the
help of authorized health personnel is called induced abortion.
Ü Labour is the physiological process in which foetus, placenta, and membrane are
expelled throughout the birth canal after the full term of pregnancy.
Ü Immunization refers to the development of immunity in the body by artificial
means such as vaccines against particular diseases. It can prevent us from many
infectious diseases.

EXE RC IS E
1. What is sexually transmitted disease?
2. Mention any two reasons of high prevalence of HIV and AIDS in Nepal.
3. What is safe motherhood?
4. List down any two signs/symptoms of the 2nd phase of labour.
5. Mention the appropriate food for the child of 6 to 9 month age.
6. What is RH factor?
7. Which diseases are prevented by DPT vaccine?
8. Mention any two symptoms of Chanchroid.

1. Why should a child be properly breast fed till the age of two years?
2. Mention the symptoms and care of the first phase of labour.
3. Explain the role of cleanliness and regular health check up in prenatal care.
4. List down the minor and major problems of pregnancy.
5. Explain the reasons of high prevalence of HIV and AIDS with reference to
Nepal.
6. Mention the signs and symptoms of pregnancy.
7. What is Safe Motherhood? Mention any three importance of maternal and
child health care.
8. Draw the immunization chart for the children.
9. What is Syphilis? Mention its symptoms and modes of transmission.
10. Give an introduction to first phase of labour and mention its signs and
symptoms.

1. Ectopic pregnancy
2. Toxemia
3. Natality
4. Third phase of labour
5. Supplementary food to the Child
D. Write difference between:

1. Prenatal and postnatal care
2. Spontaneous abortion and induced abortion
3. Gonorrhoea and Syphilis
4. Breast-feeding period and weaning period

1. Why is Gonorrhoea called a sexually transmitted infection? Critically examine
the causes, mode of transmission, symptoms and preventive measures of
Gonorrhoea.
2. Explain the measures that are undertaken natal care, postnatal care and
neonatal care.
3. Classify different phases of labour with their specific signs/symptoms and
give your suggestions for the care during the first, second and third phase of
labour for safe delivery.
Project Work
Conduct a small sample survey among 20 currently married women with children
ever born of your locality and prepare a report analyzing the following aspects:
S.N. Indicators Population (%)
Below Above 35
1. Age at marriage 18 - 35 years
18 years years
Below Above 35
2. Age at first pregnancy 20 - 35 years
20 years years
3. Number of children ever born <2 2-3 >3
4. Birth spacing (in years) <4 4-5 >5
Access to hospital for regular

5. <4 times 4 -7 times >7 times
antenatal care
Below Above 35
6. Age at first delivery 20 - 35 years
20 years years
Mother’s weight gain at the
7. <9 kg 9-12 kg >12 kg
last month of pregnancy
On the way to Hospital/
8. Place at delivery Home
hospital Health Center
Weight of the children at the
9. < 2.5 kg 2.5-4 kg > 4 kg
birth time
10. Case of miscarriage if any Yes No Don’t know

UNIT
CONSUMER HEALTH AND
9 COMMUNITY HEALTH
Introduce community health with its importance.
Tell the scope of community health.
Explain the health service providing agencies at different level and their activities.
Mention the role of individual, family and community in addressing major health
problems.
Mention the activities of voluntary health agencies.
Explain the major health problems of Nepal.
Evaluate the policies and program of health sector in Nepal.
9.1 Concept of Community Health

9.1.1 Introduction to Community Health
The term “Community Health
and Community Medicine” are
being used in an interchangeable
manner. In the beginning; when
this approach was introduced as
Public Health, it gave priority on
sanitation and hygiene. Since this
health approach precisely accepted
as Community Health its scope
has been increased largely beyond
sanitation and hygiene. Hence,
at present it incorporates various
Community members are busy at discussion
aspects of health services including
preventive, curative, promotive and rehabilitative health services.
Community Health is the justice based innovative health approach over the traditional
health program. It gives emphasis on organized joint effort of individuals, community
and the state to uplift health condition of community people through integrated health
programs. Moreover, Community Health programs are based on public participation
and mobilization of local resources and expertise for maximization of available
health services. The strength and effectiveness of Community Health depends on the
role of individuals, community and the government. For instance, individual effort
will be in vain if the community and the government do not support an individual.
Similarly, certain community health problems cannot be solved only from the level
of community and individual alone. In this condition, the presence of government is
also mandatory.
Community health includes preventive, curative promotive and rehabilitative health
services through the joint effort and coordination between individual, community
and the state. Many scholars have defined Community Health in different ways. Some
of them are as follows:
According to Winslow “Community Health is the science and art of preventing
disease, prolonging life and promoting health and efficiency through the organized
community efforts.”
Similarly, Kasturi Sundar Rao opined that “Community Health is a joint effort of an
individual, community and the state in promoting health and maintaining it in the
individual and in the community people.”
As mentioned above, we can conclude that there must be proper coordination and
involvement of statisticians, health experts, sociologists, researchers and paramedics
and community members not merely the doctors and epidemiologists to promote
the Community Health Programs. Furthermore, all the possible efforts need to be
maintained to provide effective and affordable health services at people’s door to
materialize the principle of community health. The concept of community health
developed in England at the beginning of 19th century. It incorporates the following
areas of health services:
e Balance diet
e Safe drinking water
e Good occupation
e Safe environment
e Safe disposal of wastes
e Good education
e Acceptable and affordable health services
e Good Shelter

Aspect of Community
Health
Preventive Aspect Curative Aspect Promotive Aspect Rehabilitation Aspect
Safe environment Conciliation and

Safe disposal of wastes and accommodation in the family,
human excreta community and society after
the recovery of health.
Vaccination
Affordable and sufficient Small family

health services:
(diagnosis, medication, Good occupation
surgery, treatment) Safe housing
Balanced diet
Various aspects of community health
9.1.2 Importance of Community Health

It is obvious that community health is the art and science of promoting health,
preventing and curing diseases by means of joint effort of individual, community and
the government. Hence, it is almost impossible to promote the status of community
health until and unless there is combined efforts of individual, community and the
state. Community health encourages people to lead a healthy life. In addition to
this, it motivates people for efficient use of health services, adopt self-care practices
and participate actively in the design and implementation of health programs.
Moreover, community health helps to address public health issues like prevention
of STI’s including HIV and AIDS maternal and child health, mental health, nutrition,
prevention of cancer and other non-communicable diseases and other many more
issues. The importance of community health are described below:
A. Environmental Sanitation
Environmental Sanitation is an
important area of community health.
The goal set forth by community
health cannot be fulfilled until
sanitation is maintained properly.
Environmental sanitation denotes
clean and safe home, courtyard,
surrounding, market, workplace and
so on. Community health encourages
the people to adopt the healthy habits Bagmati cleaning campaign

and to maintain sanitation of the surroundings. The environment should be clean and
free from hazards for safe and productive life. In this sense, environmental sanitation
is essential for healthy living.
B. Production of Healthy Human Resource
Community health educates people about different problems related to health
and sanitation and it also teaches people about hygiene and various measures to
maintain good health. It eventually helps to acquire physical, mental and spiritual
health. At the same time, community health gives emphasis on the preventive,
promotive, rehabilitative, and curative health services that helps to produce healthy
and productive manpower.
C. Excess to health service and Facilities
Community health is based on the philosophy of decentralization of health care, which
gives emphasis on the availability, accessibility, and acceptability of health services
and facilities within the accessibility of community. We know that many people in
Nepal are ignorant and are suffering from different health problems. Community
health provides health education and services to those marginalized people. It gives
priority to establish health service centers at the local level for the benefit of the
people by their quick and reliable services. It always get priority to make possible for
at least basic health facilities within the reach of the people.
D. Feeling of Social Responsibility
The ultimate goal of community health is to make community members responsible
towards their own health. It makes the community realize that joint effort makes it
possible to meet the objective of community health. At the same time, community
health makes community responsible to solve the health hazards including endemic
and epidemic diseases of the country. When everyone becomes responsible, healthy
community is possible. Various organizations like Nepal Paropakar Association,
Nepal Red Cross, Family Planning
Association of Nepal are conducting
various community level programs
to promote the health of community
people.
E. Decentralization of
Health Services
Community health motivates and
prepares different agencies to
operate local health camps that
provide free or low cost health Getting benefits from health service

services to the community members. Furthermore, it may run door-to-door health
programs in villages and also may establish rehabilitation centers for the people who
are addicted to drugs or alcohol including people suffering from chronic diseases
like HIV and AIDS, Leprosy, etc. When the health services are made available at the
grass root level, it helps to promote health condition of the community and increase
the number of health users in the rural area too. At the same time, it also provides
health services in affordable cost within the reach of the people at grass root level.
Eventually, it helps to create productive and healthy society.
Activity
Divide the class into different groups and involve in environmental sanitation campaign
of the public places as per the need and prepare a report on the impact of those
sanitation campaigns on public health.
9.1.3 Scope of Community Health

All the subject matters and issues included by community health is considered as
the scope of community health. Usually, the activities related to the health of the
community are associated in community health. The scope of community is explained
below:
A. Examination of Foodstuffs, Milk, Water, etc in the Community
The articles like food, water, milk, etc are the basic needs of the people. Healthy
food, safe drinking water and good environment play important role to protect and
promote the health condition of the community people. Shopkeepers may sell sub
standard goods and adulterated foodstuffs in the market to make more profit. We
know that there is scarcity of water and the water available to us is not free from
pollution. Similarly, milk and milk products that are available in the urban area are
also contaminated with germs. The quality of these articles must be examined in
advance before consumption. It is necessary to check the quality of the goods by
the community. Since these aspects are directly associated with public health, it is
considered as the scope of public health.
B. Prevention and Control of Communicable and Epidemic Diseases
Epidemic diseases refer to those diseases, which are prevalent in particular geographical
areas within the country. For instance, malaria, kalazar, Japanese encephalitis,
diarrhoea, dysentery, cholera, typhoid, common cold, pneumonia, measles, etc are
considered as the epidemic diseases of Nepal. There must be prevention and control
of such diseases on time to promote the health status of people.
These diseases transfer from the infected persons to another through various
mediums. It is caused by human’s unhealthy habits, polluted environment, ignorance,
and sanitation problem.
Since most of the people are suffering from these diseases, they should be educated
for the importance of safe drinking water, personal hygiene, proper use of latrine
and sanitation of the surrounding. In fact, prevention and control of communicable
disease helps to promote the status of community health.
C. Environmental Health and Sanitation
Environmental health and sanitation is also considered as one of the major aspects of
community health. There must be adequate supply of safe drinking water to ensure
hygiene and sanitation of the people. The adequate provision of safe drinking water
and sanitation protect people from various infectious diseases like typhoid, jaundice,
diarrhoea, cholera, tuberculosis, etc. It is essential for the attainment of quality of life.
D. Immunization Program
The process of producing immunity to an infectious disease in an individual through
vaccination is called immunization. In other words, immunization is the process
whereby a person is made immune or resistant to an infectious disease, typically
by the administration of a vaccine. Vaccines stimulate the body’s own immune
system to protect the person against the particular diseases. There is provision of
comprehensive immunization program for the children and pregnant women to
protect from various kinds of targeted infectious diseases. Implementation of such
comprehensive immunization program plays an important role in the promotion of
community health.
E. Prevention of Malnutrition
Malnutrition is the condition resulted by lack of balanced diet. Malnutrition among
children causes different diseases like rickets, marasmus, kwashiorkor, scurvy, anemia,
etc. Small children and pregnant women are more vulnerable to malnutrition in the
developing countries like Nepal. Malnutrition problem can be prevented with the
joint effort of family, community and the government. Hence, it is considered as one
of the scopes of community health.
F. Prevention of Accidents and Injures
It is also one of the major aspects of community health. Along with the pace of economic
and physical development, the rate of accidents and injuries are also increasing side
by side. A large number of people are meeting the incidence of accidents like burn,
wound, cut, fracture, road accident, drowning, electric shock, etc. People should be
provided education and training to prevent them from accidents and injuries.
G. Health Education
Health education is also one of the most important scopes of community health.
Indeed, health education gives insight experiences about the health related issues

and helps to change attitudes and behaviour accordingly. It also makes individuals to
be responsible in health related matters. Health Education aware people about the
need and importance of personal hygiene, environmental sanitation, regular health
checkup, proper nutrition, etc. It also motivates them in shaping their attitude, life
skills and behaviour for better health.
H. Prevention of Drug Abuse
Drug abuse also creates adverse impact on public health. Specifically, the youths and
adolescents have ruined their health and precious life due to drug addiction. Today’s
youths and adolescents are the back bone for the development in the future. So, it
is necessary to educate them for different measures to prevent from drug abuse and
addiction.
Activity
Prepare a chart paper of scope of community health and discuss with your friends in
the class.
9.2 Health Service Providing Agencies and their Activities

9.2.1 Introduction
The condition of health in our country is not so good. Most of the people in Nepal
are deprived of health facilities and services. In other words, we can say that health
facilities are inadequate for the growing population. Majority of the people are
suffering from poverty, illiteracy and malnutrition. They have poor knowledge of
health and sanitation. It is found that prevalence rate of disease is higher in Nepal
than other South Asian countries. The disease and illness including diarrhoea,
gastrointestinal disorders, tuberculosis, pneumonia, bronchial, asthma, etc are
common in our country. People still believe in ‘Dhami’ and ‘Jhankri’ instead of medical
doctors. Every-year thousands of people are vulnerable to premature death due
to minor diseases like cholera, dysentery, diarrhoea, pneumonia, typhoid, etc. The
government agencies and other different national and international organizations are
trying their best to upgrade health facilities in the country but their effort is not in
the level of satisfaction. Some available health services in our country are described
below:
A. Preventive Health Service
Preventive Health service encompass a variety of interventions that can be undertaken
to prevent or delay the occurrence of disease or reduce further transmission or
exposure to disease. Preventive care can include immunizations, lab tests, physical
exams and prescriptions. Diagnostic services help your doctor understand your
symptoms or diagnose your illness. Routine health care that includes check-ups,

patient counseling and screenings to prevent illness, disease and other health-related
problems. Preventive health services are intended to help people remain healthy and
to detect any health-related problems early while there is a better chance of recovery.
The preventive health services include the following aspects:
Family planning and MCH program
National Immunization program
National T.B. control program
Education about STIs
Leprosy control program
Malaria and Kalazar control program
AIDS and STD control program
Health Education
B. Promotive Health Service
Promotive health service is defined as “The process of enabling people to increase
control over their health and its determinants, and thereby improve their health”.
To reach a state of complete physical, mental and social well-being, an individual or
group must be able to identify and to realize aspirations, to satisfy needs, and to
change or cope with the environment. Health promotion involves public policy that
addresses health determinants such as income, housing, food security, employment,
and quality working conditions. Health promotion is aligned with health equity and
can be a focus of NGOs dedicated to social justice or human rights. Health literacy can
be developed in schools, while aspects of health promotion such as breast feeding
promotion can depend on laws and rules of public spaces. The promotive health
services include the following aspects:
Ü Pre-and post-natal health checkup
Ü Proper spacing of children
Ü Good nutrition practice
Ü Personal hygiene
Ü Use of boiled drinking water
Ü Proper disposal of human waste
Ü Anti-smoking campaign
Ü Breast feeding counseling
Ü Domestic violence counseling
C. Curative Health Service

Curative health service refers to a medical treatment and therapies provided to a
patient to cure the patient’s overall medical problems. In other words, curative health

service restores and maintains health by treating people after they fall ill. Curative
services are provided by various categories of health institutions. There are general
hospitals, special hospitals, teaching hospitals, regional hospitals, district hospitals,
community hospitals. Curative services are providing comprehensive health care
services. The curative health services includes the following aspects:
Ü Proper diagnosis
Ü Proper treatment
Ü Cure of the disease
D. Rehabilitative Health Service

Special healthcare services that help a person regain physical, mental and cognitive
(thinking and learning) abilities that have been lost or impaired as a result of disease,
injury, or treatment can be considered as rehabilitative health services. Rehabilitation
services help people return to daily life and live in a normal or near-normal way. The
rehabilitative health services include the following aspects:
Ü Rehabilitation of drug addicts and alcoholic persons
Ü Psychiatric rehabilitation for restoration of mental health
Ü Rehabilitation of criminal behaviour
Ü Rehabilitation of AIDS and Leprosy patients
9.2.2 Health Service Providing Agencies of Nepal

A. Hospital
A hospital is a health care institution
providing treatment to patients by
specialized staff and equipment. Hospitals
are usually funded by the public sector for
profit or nonprofit. They are largely staffed
by professional physicians, surgeons,
nurses and other supporting staff. In a
hospital, more specialized health services
are available with advanced equipment,
sophisticated laboratories and the team of
specialists. There is provision of outdoor TU Teaching Hospital, Maharajgunj
and indoor service. Patients are sent to
their houses after the diagnosis and treatment of the disease in outdoor service.
On the other hand patients are admitted in the hospital and treatment is done with
special care in the case of indoor service. Besides this, 24 hours emergency service is
also available in hospital. The emergency department provides services to casualties
and patients in critical condition.

There are 104 government hospitals in Nepal according to the data of CBS (Nepal
in figure, 2016 AD). The recent, involvement of private sectors in health sectors is
increasing. At present, there are 413 hospitals in Nepal including government, private,
community and cooperative hospitals.
Classifications of Hospitals
Hospitals can be classified into two types. One is on the basis of service nature and
another is on the basis of region. Service oriented hospitals are classified as general,
special and teaching hospitals. There is provision of treatment of all kinds of diseases
in general hospital. On the other hand, there is the provision of treatment of particular
diseases in the special hospital. TB Hospital, Cancer hospital, Orthopedic hospital, etc
are the example of special hospital. In teaching hospital different types of treatment
is also provided and medical students are also produced from that institution.
1. Description of hospitals according to service
i. General Hospital
This type of hospital provides treatment of all sorts of diseases. In other words, this
hospital provides secondary level of health services. This type of hospital such as
Mahendra Adarsha Chikitsalaya are established in different districts.
ii. Specialized Hospital
This kind of hospital provides specialized health services. In other words, this hospitals
render all kinds of health services to the particular group of people. Maternity hospital,
Kanti Bal hospital, etc are the examples of this type of hospitals.
iii. Special Hospital
This type of hospital provides specialized services to specific disease. Eye Hospital, TB
Hospital, Cancer Hospital, etc are the example of this type of hospital.
2. Health Service Providing Agencies in Vertical Structure

There are various health service providing agencies in Nepal. There is the development
of the structure of the health service providing agencies from the central level up to
the grass root level. They are explained below:
i. Central Level
There is the Ministry of Health and Population to systematize the health service
providing agencies at the central level. Other health agencies are established under
this ministry. Some hospitals are established at the central level to deliver government
health services.
The hospitals that are located in the national level are called central hospitals. These
hospitals are highly sophisticated hospitals. There is provision of more specialized
and special treatment of the diseases by the team of specialists. The services like

CT scan, ECG, EEG, Organ Transplantation, Ultrasonography (USG), Surgery, Pediatric,
Gynecology, Cardiac, ENT services are available in the central hospitals. There are
generally more than 400 beds in the central hospitals. Some of the government
hospitals at the central level are mentioned below:
1. Patan Hospital, Lalitpur
2. Bir hospital, Kathmandu
3. Mental Hospital, Lagankhel Lalitpur
4. Maternity Hospital, Thapathali, Kathmandu
5. B.P. Koirala Cancer Hospital Kathmandu
6. Kanti Bal Hospital, Maharajgung, Kathmandu
7. B.P. Koirala Institute of Health Science, Dharan
8. Sahid Sukraraj Tropical Hospital,Teku Kathmandu
9. Sahid Gangalal National Heart Center, Bansabari Kathmandu
10. Karnali Institute of Health Science, Karnali
ii. Regional Level
There is the provision of one regional health directorate in each development region.
There are five regional health directorates altogether in the country. The regional
hospitals and sub regional training centers fall under the regional health directorate.
There are only two regional hospitals in Nepal at present. They are Western Regional
Hospital (Gandaki Hospital) and Eastern Regional Hospital. The Eastern Regional
Hospital is known as B.P. Koirala Institute of Health Science which is situated in
Dharan. There is provision of more than 200 beds in regional hospital. The functions
of the regional level health service agencies are as follows:
M Top execute the policy and guidelines of the Ministry of Health and Population.
M To make planning, monitoring and supervision of health program
M To make coordination between district and zonal level health institutions
M To provide specialized health services at the regional and sub-regional health
institutions
M To provide laboratory service and the general surgery service
M To refer the patients of critical condition to the central hospitals
iii. Zonal Level
Zonal hospitals are situated in different zones of the country. They are more facilitated
than district hospitals. Generally, they are established in zone’s headquarter. There are
50-200 beds in such hospitals. At present, there are 10 zonal hospitals in the country.
Similarly, there are some Zonal Ayurved Chikitsalaya and Zonal Ayurved Ausadhalaya
also. Some of the functions of the zonal level hospitals are as follows:

M To follow the policy and directions from the central and regional offices
M To provide specialized health service
M To provide treatment to the patients referred from the district hospital and other
lower level health service institutions
M To refer the complicated cases to the regional and central hospital
M To conduct various preventive and promotive health program
iv. District Level
There is District Health Office in each district. The District Hospitals come under
the District Health Office. There are altogether 60 district hospitals in Nepal. These
hospitals provide both indoor and outdoor health services along with diagnostic and
emergency services. There is the provision of 25 to 50 beds in district hospitals. In
addition, there are also 15 District Public Health Offices in the country. The district
hospitals have their own laboratories, X-ray machine, and pharmacy. Some of the
functions of the district hospitals are as follows:
M To follow the policy and directions from the central and regional offices
M To do monitoring and evaluation of the health institutions within the district
M To conduct training, workshop and seminar programs
M To control infectious and epidemic disease in the district
M To execute school health education program effectively
M To provide general medicine care through the physicians
M To conduct OPD Service, Emergency Service and indoor Service
M To provide X- Ray service and Lab Service
3. A brief description of basic health service agencies in vertical structure

i. Electro Constituency Level
Primary health centers are more facilitated than health posts. The government has
aimed to convert the health post into primary health centers. Furthermore, the
government has a policy to establish one primary health centre in each electoral
constituency. The Constitution of Nepal 2072 BS has made provision of 165 electoral
constituencies. At present there are 201 Primary Health Centers in the country. The
Primary Health Center is headed by a medical officer. The PHC provides treatment to
the common minor diseases and maternity health services. There is the provision of
three beds in the PHC.
Manpower of the Primary Health Centre
Medical Officer (MBBS Doctor) 1
Staff Nurse 1
Health Assistant or Senior Auxiliary Health Workers (HA/SAHW) 1

Auxiliary Health Workers (AHW) 2
Lab Assistant 1
Auxiliary Nurse and Midwives 2
Assistant Accountant 1
Village Health Workers (VHW) 2
Peon 1
Total 12
Health Services of Primary Health Centre (Electro Constituency Level)

Health centre provides better quality services than health posts. There are three
beds, one for maternal service and two other beds are for other emergency service.
The primary health centers provide the health services that follows:
• Maternal and child health care service
• Family planning service
• Maternity service
• Nutrition awareness program
• Assists, evaluate and monitor the health post and sub-health post
• Controls the prevalence of communicable disease
• Provides treatment to the patients and minor injuries
• Refers the complicated cases to the hospital
ii. Ilaka Level
In Nepal, there are seventy five districts and those districts are again divided into
many sub-units like Illakas. The government has formulated the policy to establish
one Health Post in each Ilaka (Generally, 5 VDCs makes one Ilaka). Health Post is one-
step higher level basic health institution compared to Sub-health Post.
The number of health workers in health post is confirmed according to geographical
region. There are seven staff members in Terai region whereas six health workers are
mobilized in Himalayan and Hilly region. Health Post provides basic health services.
At present, there are 3,808 Health Posts in Nepal. The government is planning to
promote Sub-health Post into Health Post.
Manpower of Health Post
Assistant /Senior Auxiliary Health worker 1
Auxiliary Health Worker (AHW) 1
Auxiliary Nurse and Midwife (ANM) 1
Maternal and Child Health Worker (MCHW) 1

Office Assistant 1
Village Health Worker 1
Peon 1
Total 7
Health Services of Health Post (Illaka Level)

Health post provides the different types of basic health services that include:
• To provide door to door maternal health care service
• To conduct vasectomy, minilap and eye camps
• To provide school health service to the school children
• Diagnosis and treatment of the minor diseases
• Treatment of minor injuries and wounds
• To provide preventive health services
iii. Village Council Level (Sub Health Post)
The government has adopted the health policy to establish at least one sub-health
post in each village council (Gaun Palika). Sub-health post is a bottom level health
service institution. It provides basic health services to the people. There are altogether
4 staff in a Sub-health Post. It is headed by Auxiliary Health Worker (AHW). At present,
there are 3,176 Sub-health Posts in Nepal. The Sub-health Post provides the following
health services:
• Sub-health Post provides the different types of basic health services that include
• To create public awareness about the preventive measures against the
communicable diseases
• To conduct awareness campaign about the environmental sanitation in the
community
• To provide treatment to the minor wounds and injuries
• To provide First Aid to the victim or casualties
• To mobilize mothers’ group, women health volunteers, birth attendants and NGO
activists in health service programs
Comparison between Health Post and Primary Health Centre
Health Post Primary Health Centre
1. Health post is the bottom level 1. Health centre is one step higher
health service centre. level health service centre.
2. Minimum health facilities are 2. Little more health facilities are
available. available compared to health post.

3. It provides health services 10-4 3. It provides 10-4 hours OPD service
hours during the day and 24 hours emergency service.
4. There is no bed facility. 4. There is provision of 3 bed facility.
5. It provides outdoor services only. 5. It provides both indoor and
outdoor service.
6. It is headed by Health Assistant (HA). 6. It is headed by MBBS doctor.
7. There are 6 or 7 staff members. 7. There are 12 staff members.
4. Community and Ward Level

Immunization clinics and community clinics are run in each village council to make the
primary health service reachable to the grass root level people. Moreover, at least one
woman health volunteer is working in each ward of the village council. The woman
health volunteer can provide family planning, immunization, nutrition education,
contraceptive services, etc.
9.2.3 Voluntary Health Agencies

Health problems is not only the problem of community or a country but it is the
concern of the entire world. In this context, the solution of these problems cannot be
solved through the government effort only. Hence, there are many nongovernmental
organizations putting hands together to solve health problems in Nepal. Among them
some of the important organizations are discussed below:
A. Nepal Red-Cross Society
Nepal Red Cross Society came into being
on 4th September 1963 AD. (2020 BS) Nepal
Red Cross society became the member of
International Committee of Red Cross formally
on 1st October 1964 AD. Humanity, freedom,
unity, neutrality, voluntary services, worldwide
service and nonalignment are the motto of this
Rally of Junior red cross circle
society. Nepal Red Cross Society is the largest
humanitarian NGO in Nepal. It has its district committees in all districts of the country.
Objectives
M to serve war victims both civilians and army personnel in the time of arm conflict,
M to contribute in promoting and improving health condition, preventing diseases
and reducing suffering,
M to arrange for emergency relief service for disaster victims,
M to perform community development and public welfare programs,
M to ensure respect for the international humanitarian law.

Programs
a. Service oriented activities
To provide immediate help to the persons affected by natural calamities
Primary health care
Environment sanitation
First Aid programs
Information, Education and Communication Program
b. Health service activities
Blood transfusion and blood donation
Eye camps
Water Project
Ambulance service
School based HIV Peer Education
Safe motherhood
Reproductive and family health programs
c. Organizational activities
Trainings
Workshops
Seminars
Camps
Awareness program
Activity
Prepare a report on the activities conducted by junior Red Cross Circle or Scout of
your school to manage minor health problems, injuries and emergency care to the
students of your school.
B. Nepal Paropakar Association

Nepal Paropakar Association (Paropakar
Sanstha) is the first and the oldest non-profit
making social organization of Nepal. It was
founded by Dayabir Singh Kansakar in 1947 AD
10th Aswin 2004 BS. Its central office is located
at Bhimsensthan, Kathmandu. Primarily
this organization was established to provide
medicine facilities to the poor people suffering Paropakar Adarsha School

from Malaria, Dysentery, Cholera and Typhoid. Now it has expanded its service in
different sectors of social welfare.
Objectives
M To provide maternity service.
M To provide free medicine to poor and disable people.
M To provide rehabilitation.
M To provide free education to orphans.
M To encourage the youths to involve in volunteer service.
Programs
Ambulance service in Kathmandu
Blood donation program
Distribution of free medicine
Establishment of Maternity hospital at Thapathali, Kathmandu in 1959 AD
Establishment of Paropakar Adarsha Madhyamik School for orphans in 1955 AD
Provision of health service to orphans
C. Family Planning Association of Nepal (FPAN)
Family planning association of Nepal was established in
1959 AD (2016 BS). It became an associate member of
International Planned Parenthood Federation (IPPF) in
1960 AD and full-fledged member in 1969 AD. It is a leading
national NGO in the field of reproductive and sexual health
program. FPAN’s current programs are focused on five areas
Logo of FPAN
including: adolescent, abortion, HIV and AIDS, advocacy
and access. Annually it provides family planning services to 2,10,000 persons, MCH
education and service to 1.4 million, STIS and HIV counseling, diagnosis and treatment
service to about 1,00,000 and safe abortion counseling and services to more than
50,000 women. Moreover, it had provided integrated services related to reproductive
health. It has launched its projects only in three districts in the beginning, but now, it
has expanded its service in thirty-two districts.
Objectives
M To increase public participation in family planning programs,
M To manage safe abortion and to reduce high unsafe abortion rate and maternal
mortality rate,
M To run family planning clinics in different places,
M To help in promotion of safe motherhood,
M To encourage the couple to make the family size small.
D. Nepal Heart Foundation
Nepal Heart Foundation was established in
2045 BS. Its central office is located in Kathmandu
and branches have been established in the different
parts of the country. Its main objective is to minimize
the patients of heart disease which is globally
increasing. Nepal Heart Foundation has run the
services of diagnosis and treatment of heart disease.
This organization is also working in non-medical
field, like raising awareness about the heart related
Logo of Nepal Heart Foundation
disease, encouraging people for healthy and active
lifestyle, helping poor heart patients for the treatment, etc. Sahid Gangalal Heart
Centre in Kathmandu has been established with the initiation of this organization in
1995 AD. It has started treatment of rheumatic under the initiation of Nepal. Fever
and rheumatic heart disease since 2064 BS.
Objectives
M Treatment and diagnosis of heart diseases
M To conduct awareness programs
M To minimize the patients of heart diseases
M To help the poor people who are victims of heart disease
Programs
Public awareness programs through Radio and Television
Organizes heart camps in different parts of the country
Awareness in school children about the importance of heart
Carry out heart camps and curative service through heart clinics
Screening of Rheumatic heart disease and education about it to the school
students
E. Nepal Cancer Relief Society (NCRS)
Nepal Cancer Relief Society is a non-profit community-
based nationwide social organization founded in 2039 BS
(1982 AD) with the aim of fighting against the spread of
cancer in Nepal. The organization has now established its
branches in 42 districts of Nepal and has been mobilizing
10,000 volunteers nationwide. NCRS is a pioneer
organization for tobacco control in Nepal. NCRS works in
both cancer prevention and its cure. Tobacco control is
the major preventive activity done by NCRS because it is a Logo of NCRS

sole preventable risk factor for several types of cancer. Nepal cancer relief society is
playing a leading role in both preventive and curative programs against cancer.
Objectives
M To control, prevent and cure cancer
M To detect the cancer early for prevention
M To support the curative aspects of the cancer sufferer
M To provide rehabilitative services to those suffering from cancer
Programs
Conducts cancer awareness classes, workshops, seminars, interaction programs
and conferences.
Conducts cancer and tobacco awareness classes in schools, colleges, communities,
hospitals and rehabilitation centers.
Conducts rallies on world no tobacco day, world cancer day for mass public
awareness.
Several cancer awareness documentaries have been made by NCRS for public
awareness.
Distributes brochures and posters to most part of the country for raising cancer
awareness for prevention.
Conducts conferences targeting policy makers for the provision of best cancer
control health policies in Nepal.
F. Nepal Anti-Tuberculosis Association (NATA)
Nepal Anti-Tuberculosis Association is a non-governmental, nonprofit making voluntary
organization. It is the second oldest social organization of Nepal. It was established in
Kathmandu in 1953 AD, (2010 BS) with a view to raising public awareness about TB.
It had run TB Control Project in joint collaboration with Government of Nepal, (WHO)
and UNICEF in 1965 AD.
NATA has started German Nepal Tuberculosis Project (GENETUP) which has launched
Direct Observed Treatment Short Course (DOTS) for the treatment of TB It is a method
of treatment of TB by direct observation of medical personnel. It helps to reduce
the relapse of disease caused by irregular intake of drug. Since the establishment of
NATA, it has formed 32 branches in the country and working for BCG Vaccination, case
finding and distribution of medicines.
Objectives
M To coordinate with government TB Control Program
M To study about the problems of TB
M To create public awareness about Tuberculosis
M To help the victims of TB and lungs disease
M To help in DOTS program
Programs
Provision of BCG vaccine
Community based health education program
It has started DOTS very effectively
Exchange of ideas through workshop, seminars and trainings
It has launched different awareness programs
Activities
Visit any one health institution available in your community. Prepare a report including
the following chapters:
1. Name of the Institution:
2. Objective of the Institution:
3. Activities or Functions of the Institution:
4. Problems and Challenges Faced by the Institution:
5. Measures of Mitigating the Problems and Challenges:
6. Benefits to the Community People:
7. Conclusion:
9.2.4 Major Health Problems of Nepal

Nepal is the country recognized with the poor economy, low life expectancy, high infant
mortality rate and so on. Many people are uneducated and most of the parts of the
country have become remote from the capital city Kathmandu. Poor infrastructure,
lack of health facility, ignorance, superstition and difficult topographical structure
are other factors leading to various forms of health problems in Nepal. Every year
many people are losing their life even from minor diseases like diarrhoea, dysentery,
common cold, cholera, pneumonia, etc. Some of the major health problems of Nepal
are discussed below:
A. Prevalence of Communicable Disease
Communicable disease is such a disease which transfers from an infected person to
another healthy person through any kind of medium. It is mainly caused by human’s
unhealthy habits and polluted environment. Due to ignorance and sanitation problem,
thousands of people are at the risk and hundreds of them die from communicable
diseases. It is experienced that communicable diseases are the major part of health
burden in our country due to poor environmental sanitation, lack of safe drinking
water, poor personal hygiene, superstition and poor diet. In Nepal, gastro-intestinal
diseases have covered more than 80% prevalence rate of communicable diseases and
it can be easily prevented through health education and improvement in sanitation.
The diseases like diarrhea, dysentery, cholera, typhoid, common cold, pneumonia,
measles, etc are the examples of some common communicable diseases prevailed
in Nepal. Since most of the people are suffering from gastro-intestinal diseases they
should be educated for the importance of safe drinking water, domestic and personal
hygiene, proper use of latrine and sanitation of the surrounding as well.
B. Malnutrition
Malnutrition is the condition resulted by an improper diet. We know that malnutrition
is caused not only due to under nutrition but it is also resulted by over nutrition.
Proper nutrition is a prerequisite for the normal health and well being of individuals.
Poor nutrition creates problem to the entire population in general and Women and
children are more vulnerable in particular. Malnutrition among women results in
to anemia, having baby with low birth weight and vulnerable to various nutrient
deficiency diseases like night blindness, scurvy rickets, etc.
According to the Nepal Demographic and Health Survey 2011 AD;
• 29 percent of children under 5 years of age are under weight
• 46 percent of children are anemic
• 18 percent of women are malnourished by under nutrition and 14 percent are
obese
• 35 percent of women of the age group 15-49 are anemic
Under nutrition has become a great challenge in Nepal than other type of nutritional
health problems due to poverty, ignorance, unequal distribution of productive land,
lack of hygiene and sanitation.
C. High Infant Mortality Rate
Child mortality rate in general and infant mortality rate in particular are often used
as indicators of social development and as specific indicators of health status. In this
context, high Infant Mortality Rate is also one of the major health problems of Nepal.
Infant Mortality Rate of Nepal is 44 as per the data of Demographic Health Survey,
2011 AD. The real picture of infant mortality rate of the SAARC countries is shown in
the table given below:
Table 9.1: Trend of IMR in SAARC Countries, 1994 - 2016 AD
Countries 1994 2006 2016
Nepal 90 64 33
India 79 58 40

Pakistan -- 78 67
Sri Lanka 19 11 8
Maldives 38 15 8
Bangladesh 116 65 38
Bhutan -- 40 44
Afghanistan -- -- 68
Sources: World Population Data Sheet, 1994-2016 AD
The table shows that the infant mortality rate of SAARC Countries is not at satisfactory
level except Maldives and Sri Lanka. Infant mortality rate is the broad indicator of
the health and development status of the society and of the nation. In the context
of Nepal, infant mortality rate were 90 and 64 in 1994 and 2006 AD respectively and
it was decreased to 33 in 2016 AD. It reveals that there is a little progress in social,
economical and health aspects of the country. However, Nepal is still having high
infant mortality rate compared to other SAARC countries.
D. Maternal Mortality Rate
Maternal mortality rate of Nepal is high in comparison to the other countries. It is
obvious that the causes of high maternal mortality rate in Nepal are low living status,
poverty, illiteracy, lack of health services, lack of safe motherhood initiatives, gender
discrimination, etc.
The maternal mortality rate of Nepal according to the Demographic Health Survey
2011, AD has been recorded 229. The three year interim plan (2068-70 BS) has set the
target to reduce maternal mortality rate to 192. It shows that maternal mortality rate
is still high in comparison to other developed and neighboring countries.
E. Poverty
Poverty is one of the major health problems of Nepal. We know that most of the
people of our country are still living in poor condition of life. According to the Nepal
living standard, survey 2011 AD more than 24%, people in Nepal are living below
absolute poverty line. Because of poverty, people cannot manage balance diet,
proper shelter, proper clothes according to season and cannot visit health institutions
for regular check-up. As a result, they suffer from various kinds of health problems
and are supposed to live poor quality of life. It is needless to say that poverty is the
root cause of other various problems prevailed in the society.
The per capita income (PCI) of Nepal is in 2016 AD US$ 766 only. It means economic
condition of the people in Nepal is not satisfactory. To eliminate absolute poverty and
to raise the living standard of the people, it is necessary to create environment for
the generation of employment opportunity and income generating activities. These
activities should focus the people at grass-root level.
F. Lack of Health Education
Majority of Nepali people are deprived of health education. In this situation,
people are either ignorant or indifferent towards sanitation, hygiene, balanced diet,
immunization including many more health issues. They do not have clear concept on
health. Conservative belief is deep rooted in Nepalese society. Most of the people
still believe in faith healer instead of medical doctor. They believe that all types of
sickness is caused due to super natural power or due to the curse of god and evil
spirit. Therefore, a large number of people are losing their lives by very easily curable
diseases too. The ultimate solution to solve this problem is to make the people believe
in rationality and remove misconception regarding health. Moreover, it is necessary
to give education about sanitation, personal hygiene and other healthy habits for
healthy life.
G. Lack of Health Services
It is another major health problem of Nepal because there is no adequate and quality
health services as per the need of the people. Many people are losing their life
untimely due to lack of quality health services. Health services are expanding in slow
pace but the population is increasing rapidly. So, the available health service centers
have become out of reach to common people. Furthermore, established health posts
and health centers are facing lack of human power and inadequate supply of essential
medicines. To solve the existing health problems, health facilities and services should
be decentralized and reach the people’s door. The following table shows the present
condition of health services in Nepal:
Table 9.2: Status of Health Services in Nepal, 2015/2016 AD
Health Services Number Health professionals Number
Hospitals (Private, 405**
Government, Community (govt. - 104) Doctors 16,854*
and Teaching: All Types) (pvt. - 301)
Primary Health Centers 202** Senior A.H.W/HA 9,500

Health Posts 3,803** AHW (Auxiliary Health Worker) 19,098
Sub-Health Posts 3,176 Nurses 38,759**
ANM (Auxiliary Nursing and
Ayurvedic Services Centres 305 25,398**
Mid wife)
Village Health Worker 7,175 Kaviraj/Vaidhya 741
Source: CBS, Nepal in figures, 2015 AD, ** CBS, Nepal in figures, 2016 AD , *Nepal Medical Council

H. Rapid Population Growth
Rapid population growth is another major health problem of Nepal. It has resulted
into various problems like lack of food, lack of health facilities and services, lack of
employment opportunity, malnutrition, sanitation problem, environment degradation
including other many more socioeconomic and environmental problems. Similarly, it
has expanded slum areas in the towns and cities and consequently resulted in to the
prevalence of communicable disease and poor quality of life.
Population growth rate of Nepal is always high since 1941 AD. For instance population
growth rate of Nepal in 1952/54 AD was 2.27% and it increased to 2.25% in
2001 AD. If it is not controlled in time there will be severe problem in education,
drinking water, cultivable land, residence, etc. It also creates wide gap between rich
and poor which will be sufficient cause to create conflict in the society. So, we should
put all the possible efforts to control the rapid population growth with effective plans
and programs to ensure sustainable living.
I. Unhealthy Life Style
One of the major causes of bringing health problem in Nepal is the typical Nepalese life
style. It denotes the food habits, tobacco chewing, smoking, alcoholism hard physical
work with little rest of majority of the people. WHO has explained these things as the
causative factors for non-communicable diseases. In Nepalese meal, high content of
carbohydrate, spicy food, fried and instant food with low nutritive value are included.
They may cause diabetes and heart disease.
There is a wrong perception among the common people that is quality of life is to
pass the time luxuriously without physical work. It results into obesity which is the
cause of many non-communicable diseases.
Activity
Identify the major health problems of your community. Examine the causes of
these health problems? Collect the opinion of the community members about the
prevention measures of those diseases. Prepare a report and present it in the class.
9.3 Policies and Programs of Health Sector

9.3.1 Policies of Health Sector
Planned development in Nepal has been initiated since 1956 AD. It has already
completed more than 5 decade but the government is found far behind in introducing
national health policy and programs in its periodic plans. The organized national health
program can only be seen from the 5th five year plan (1975-80 AD) onwards. Nepal
adopted National Health Policy in 1991 AD to show its commitment and concern to
promote health condition of its citizen.
After the WHO’s declaration “Health for All by 2000 AD” and various promises made
in different international conferences, Nepal government has become very responsive
and sensitive towards the health issues for the common citizens.
In the 11th Three Year Interim Plan, government gave priority on preventive, promotive
and curative health services by upgrading sub-health post into the Health post
and Primary Health Centers. Similarly, it also concentrated its priority in increasing
number of hospital beds, health workers, Ayurvedic dispensaries and improvement
of quality health services. In addition, Family Planning, Reproductive health as well
as massive immunization program including respiratory disease control program and
communicable disease control program are also in priority of this interim plan. The
main objective of the 12th three year interim plan was to increase the access to quality
health services to citizens of all the geographical regions, class, gender and ethnicity.
While analyzing this Interim Plan, there has been a considerable improvement on
mortality rates of infants, children and mothers. All the services provided by health
posts and sub-health posts and basic health services provided by the district hospitals
to the poor and backward communities have been made free. Moreover family
planning and safe abortion services are available in all districts.
Even though the overall health system has improved there has not been expected
improvement in remote districts. Health condition of backward societies and people
below poverty line has not been improved as expected. It can be observed that there
is lacking of effective co-ordination among the plan implementing and monitoring
agencies. We know that 14th Three Year Interim Plan is formulated incorporating
health, as a fundamental right of all citizens. The quantitative targets of the 14th Three
Year Interim Plan have been illustrated in the following table:
Table 9.3: Quantitative Targets of 14th Three Year Interim Plan (2072/73 - 2074/75 BS)
13th Interim 14th Interim
Health Indicators
Plan (Status) Plan (Target)
Population with excess to essential health service (%) 79 90
Prenatal service at least 4 times before delivery (%) 35 65
Delivery attended by Trained Birth
29 40
Attendants (TBAs) (%)
Contraceptive Prevalence Rate (%) 49 57
Total Fertility Rate 2.6 2.3
Maternal Mortality Rate 229 134
Infant Mortality Rate 46 38
Child Mortality Rate 54 47
Life expectancy at birth(years) 69 71

Population with access to drinking water (%) 85 96.3
Population with access to sanitation (%) 62 90.5
Source: NPC, GoN: Fourteenth Three Year Interim Plan, (2072/73 – 2074/75 BS)
The 14th three year interim plan has adopted the following health objective and
policies to achieve the set targets:
Objective
To ensure that all citizens have equitable access to basic and good-quality health
services.
Health Policies
a. Upgrade local health institutions and manage physical and human resources
accordingly.
b. Make service delivery effective by improving capacity, skill and standard of health
service provider organizations, employees and also prepare and implement
special encouragement program for the health workers and those working in
remote and backward areas.
c. Upgrade district hospitals with necessary expert services.
d. Monitor the quality of medicine and make its management effective.
e. Make health services easily available to all the citizens by increasing the
investment in health service organizations.
f. Improve the effectiveness and access to reproductive health, infant health and
family planning services by operating new program as well as by providing regular
and mobile services to the women suffering from Uterus collapse.
g. Increase the awareness among the people through education with the partnership
of governmental, private and non-governmental organizations.
h. Make effective arrangements to prevent and control serious noncommunicable
diseases.
i. Make effective arrangements for the promotion, regulation and monitoring of
the private health service providers.
j. Make the referral system to higher level health organization more organized.
k. Develop monitoring system with proper representation of relevant stakeholders
to make the service delivery of local and district level health organizations more
effective.
l. Expand free and safe maternal services, encourage to get health services
before and after child birth and make 24 hour arrangement of minimum basic
infrastructure to provide maternal services from primary health centers and
health posts.

m. Establish insuring mechanism of health service targeted to the poor, senior
citizen, freed Kamaiya, Adivasi, Janajati, Dalit and disabled community.
n. Expand services and program of mobile camps including special service package,
outreach clinic and telemedicine.
o. Recognize the interrelationship between Ayurvedic and alternative medical
system which includes, natural treatment, yoga, Homeopathy, Yunani, Amchi and
Acupuncture to ensure services in an integrated approach.
Activity
Prepare a chart paper by writing objectives, quantitative targets and working policies
of health sector from the 13th interim plan of Nepal (2072/73-2074/75 BS). Cling the
chart paper on the magazine wall of your school.
9.3.2 Major Programs in Health Sector

A. Expanded Immunization Program
In Nepal, Expanded Immunization Program was started after the eradication of
Smallpox in 2034 BS (1975 AD). Currently eleven antigens are provided through the
routine immunization under National Immunization Program of Nepal. World Health
organization established a program called Expanded Program on Immunization
in 1974 AD and many countries started implementing EPI. Expanded program on
Immunization including BCG, and DPT vaccines started in Nepal in 1979 AD in three
districts. However, EPI including BCG, DPT, Oral Polio Vaccine, and Measles was
expanded to all 75 districts by 1989 AD only. Since then, government of Nepal is
providing free immunization services to everyone. It is one of the accessible services
of Nepal and has reached to the 97% of its target population. Nepal is believed to be
one of the countries recognized for the well functioning immunization system. This is
also considered as the most cost effective public health program.
Objectives of Expanded Immunization Program
• To protect the children from infectious diseases like Pertusis, Tetanus, Hepatitis B,
Hemophilus, Influenza B, Tuberculosis, Measles, Rubella, Japanese Encephalitis,
etc.
• To immunize every child through complete doses.
• To immunize every pregnant woman with TT vaccine.
• To provide vaccine against the prevalence of epidemic diseases such as
Encephalitis, Viral Influenza, etc.
B. Community Based Integrated Management of Childhood Illness
(CB-IMCI)
WHO and UNICEF jointly formulated the IMCI strategy in mid 1990s in an effort to
provide a more integrated approach for addressing the main causes of childhood
morbidity and mortality associated with five major childhood illnesses such as
diarrhea, ARI, measles, malnutrition and malaria which accounts for about 70% of
child death in developing countries and for improving child growth and development.
CB-IMCI program in Nepal developed through the year with preceding program such
as; control of diarrheal diseases, a program initiated 1982 AD and acute respiratory
infection program initiated in 1987 AD. Emphasis on community level involvement in
Nepal started with strengthening program in 1995 AD and for CDD in 1996 AD.
The government introduced Community Based Integrated Management of Childhood
Illness (CB-IMCI) in 1999 AD. CB-IMCI included the major childhood killer diseases
like pneumonia, diarrhea, malaria, measles, and malnutrition. The strategies adopted
in IMCI were improving knowledge and case management skills of health service
providers, overall health systems strengthening and improving community and
household level care practices. CB-IMNCI Program also focuses on identifying malaria,
malnutrition, measles, and other common illnesses among children.
Objectives
M To reduce the morbidity and mortality among children under five due to
pneumonia, diarrhea, malnutrition, measles, and malaria.
M To promote healthy growth and development of children.
M To reduce neonatal morbidity and mortality by promoting essential newborn
care services.
M To reduce neonatal morbidity and mortality by managing major causes of illness.
M To reduce morbidity and mortality by managing major causes of illness among
under 5 years children.
M Contribute to survival, healthy growth and development of under five years
children of Nepal.
M Improve newborn and child survival and healthy growth and development.
Activities
CB-IMCI training in 8 districts (Nuwakot, Nawalparasi, Mugu, Kalikot, Jajarkot, Rukum,
Surkhet and Dadeldhura)
e CB-IMCI training by the government with the support of UNICEF and WHO
e Progress analysis and improvement of CB-IMCI program
e Community care of preterm and low birth weight babies born at home using foot
length card in Nuwakot and Rasuwa
e Supervision and monitoring of CB-IMCI program

C. Family Planning and Maternal Child Health
In Nepal, family planning related activities are being conducted by various organizations
and agencies. The family planning program in Nepal was for the first time carried out
by Nepal Family Planning Association. After that Nepal Family Planning and Maternal
Child Health Project was established under the Department of Health Service. It
is taking a leadership role to revitalize the family planning program in Nepal. The
program also seeks to expand and sustain quality family planning services throughout
the health service network, including hospitals, primary health care centers, health
posts, sub-health posts, primary health care outreach clinics and mobile voluntary
surgical contraception camps. The Family Health Division has initiated satellite clinics
in all 75 districts.
Objectives
M To examination of health of the mother and child
M To provide nutritious food to the babies
M To educate about maternal and child health
M To provide delivery service
M To support family for the prosperous future of the family member
Activities
e Counselling about the temporary contraceptive measures to the concerned
stakeholders
e Providing permanent contraception method to the couples having desired
number of children
e Supporting the married couple to make their conjugal life happy and prosperous
e Health examination of mother and child
e Provision of antenatal, natal and post natal service
D. Vitamin A Deficiency and Blindness Control Project
In our country, deficiency of Vitamin A has been considered as a health problem of
the children below five years. Vitamin A deficiency weakens the immune system. It
is the most common cause of blindness among children in developing countries. It
also impairs individuals’ physical and mental development process. The Vitamin ‘A’
Defence Control Project was established in 2046 BS with the joint initiation of the
Government of Nepal and Food and Agricultural Organization.
Objectives
M To improve the nutrition status of the people through training and campaign
M To reduce child mortality rate
M To decrease the prevalence rate of Vitamin ‘A’ deficiency disease

Activities
e Enhancement of the effectiveness and sustainability of supplementation
programs
e Sound planning, implementation, and quality control of fortification programs
e Inclusion of other food-based approaches in programs
e Application of appropriate economic analysis to guide the evolution of country
programs
e Use of monitoring and evaluation to improve program operations
e Development of public and private sector alliances to enhance the effectiveness
of interventions
E. HIV and AIDS Control Program
HIV and AIDS is a life threatening disease caused by the Retro virus known as (HIV).
It is a sexually transmitted disease. It is spread all over the world and is called as
a pandemic disease. It can take many years for people with the virus to develop
AIDS. Hence, HIV and AIDS is often called the “silent epidemic” due to its very long
incubation period, meaning that a person can be infected for many years without
showing any symptoms. AIDS cannot be cured however; it is possible to live a long life
with the anti retroviral drugs.
The first case of HIV and AIDS was found in the USA in 1981 AD and the first case
of AIDS in Nepal was identified in 1988 AD. In the context of Nepal, HIV epidemic is
largely concentrated among the intravenous drug users, sex workers, male labour
migrants and Trans genders. Prevention is the best policy since it is an incurable
disease. The National Centre for AIDS and STD control (NCASC), has been established
for the prevention and control of HIV and AIDS in Nepal.
Objectives
M To aware people about STDs and HIV/ AIDS
M To rehabilitate AIDS patients effectively
M To give counselling service for condom promotion
Activities
e Diagnosis of STDs including HIV and AIDS through blood screening
e Disseminate awareness about STDs through public campaign
e Formulating national policy to control STDs and HIV/AIDS
e Carry out activities for the rehabilitation of AIDS patients
e Condom promotion counselling service for the prevention of STDs and HIV/AIDS

F. National Malaria Control Program
Malaria is still a public health problem of
Nepal where around 84 percent of the
population is at risk. Malaria cases are
being reported from 65 districts. Out of 65
malaria prone districts, 13 districts have
been classified as high risk of malaria (i.e.
Ilam, Jhapa, Morang, Dhanusha, Mahottari,
Kavre, Sindhuli , Nawalparashi, Banke,
Bardiya, Kailali, Kanchanpur, Dadeldhura).
The government of Nepal started its Anopheles Mosquito
activities in this area by establishing
Malaria Eradication Association in 2015 BS
(1958 AD). The government has made a
significant progress in controlling malaria
transmission over the past decades through
the activities of National Malaria Control
Program. For instance, total confirmed
malaria cases were 42,342 and 2,750 in
1985 AD and 2002 AD respectively whereas
this number was decreased to 2,092 in
2012 AD. In recent years, malaria control DDT Spread to Control Malaria
activities have been carried out in 65
districts. The government has been distributing medicated mosquito nets free of cost
in those 13 high-risk malaria prone districts.
Objectives
M To achieve effective treatment of all confirmed malaria cases
M To respond early to new malaria cases and outbreaks
M To encourage general population to adopt malaria healthy behaviour
M To provide free, efficient and quality preventive and curative service against
malaria
Activities
e Surveillance of malaria cases
e Early warning and reporting system
e Indoor house and surrounding spraying against malaria
e Awareness and health education about the prevention and control of malaria
e Vaccination against malaria
e Timely treatment of the malaria patients
G. National Health Education Information and Communication Centre
(NHEICC)
The National Health Education Information and Communication Centre (NHEICC)
was established under the Ministry of Health and population in 1993 AD, with the
mandate to give high priority to information, education and communication in the
health sector. This centre is responsible for developing, producing and disseminating
messages to promote and supports specific all health-related programs and services
in an integrated manner. For this purpose, health education, information and
communication programs have been carried out in all 75 districts since 1993 AD. The
NHEICC implements health education and communication activities utilizing various
media and methods according to the needs of the local people in the region, district
and community. Local media and languages are used in the district and community
for the dissemination of health messages so that people can understand health
messages clearly in their local context and language.
Objectives
M Increase positive attitudes towards health care
M Increase awareness and knowledge of the people on health issues
M Increase access to new information and technology on the health programs for
the people
M Promote environment health, hygiene and increase healthy behaviour
M Increase participation of the people in the health intervention programs at all
levels of health services
Activities
e Establishing national resource centre for proper management and dissemination
of information education and communication materials and message
e Implementing information education and communication interventions in an
effective manner at the national, regional, district and community level
e Distributing information education and communication materials about the
communicable diseases, non-communicable diseases and reproductive health
through private and government sectors
e Ensuring and mobilizing the participation of community, INGOs, NGOs, local bodies,
social workers and individuals in information Education and communication
program
e Disseminating accurate, appropriate and adequate health information using
multi-media approaches to people of community level

Activities
Prepare a proposal based on any one health program that has been conducted in your
community on the basis of the following sub-headings:
Name of the health program:
Objectives of the Program:
Scope of the Program:
Target Group of the Program:
Budget of the Program:
Program Activities:
Expected Outcome of the Program:
9.4 Bad Habit, Its Consequences and Preventive Measures

9.4.1 Introduction
A bad habit is a patterned habitual behaviour regarded as detrimental to one’s physical
or mental health and often linked to a lack of self-control. Alcoholism, drug abuse,
consumption of tobacco in any form, over eating, regular junk food consumption,
gambling, swearing, sexual addiction, etc are the examples of bad habits. Bad habits
adversely affect the physical, mental, emotional, social, economic and spiritual aspects
of individuals. If it is not possible to control such bad habits on time, it may aggravate
health and well-being of an individual. Hence,
we should always be away from the bad habits.
Some of the bad habits are explained below:
A. Habitual on Junk Food
To develop habit on junk food and fast food
instead of eating homemade food is also
considered as a bad habit. Usually, fast
food contains trans fat, spices and artificial
preservatives. As fast food is rich in bad fat,
it raises the bad cholesterol in the body which may
further cause obesity, diabetes and cardio vascular
diseases.
B. Gambling and Play Cards
Gambling and playing cards is very bad habits. Playing
cards and gambling just for fun becomes habit in the
long run. People play gambling to make fast money
without hard work, which is wrong. A large number of

people become homeless because of such bad habit. Hence, we need to stay away
from such bad habits.
C. Watching too Much TV and Internet
Watching television and internet for
hours can put your health at risk.
Watching too much television and
computer can put you at an increased
risk of eye strain, heart attack, stroke
and obesity. The more you are glued to
the TV, mobile and computer the more
immobile life will affect your levels of fat
and sugar in your blood. It also strains
your eyes.
D. Sexual Addiction
Engaging in persistent and escalating patterns of sexual behaviour acted out despite
increasing negative consequences to self and others is called sexual addiction. A sex
addict will continue to engage in certain sexual behaviours despite facing potential
health risks, financial problems and broken relationships.
9.4.2 Consequences of Bad Habit

Ü There is negative effect on the physical, mental and social aspects of the individual
Ü Bad habit spoil the health and property
Ü There is loss of potential active life due to bad habits
Ü Bad habit causes conflict and misunderstanding in the family
Ü Bad habit may cause various kinds of sexually transmitted diseases
Ü Some kinds of bad habits escalate crimes in the society (i.e. theft, robbery,
buglary, pick pocketing, cyber crime, looting, gang fights, etc.)
9.4.3 Preventive Measures from Bad Habit

Bad habits interrupt our life and prevent us from accomplishing our goals. They
jeopardize our health both mentally and physically. In addition, they waste our time
and energy also. Some of the preventive measures of bad habits are as follows:
Ü Do not accompany the persons with bad habits
Ü Parents should understand the feeling of their children and should observe their
friend circle
Ü Do not engage in television, mobile and internet unnecessarily
Ü Engage the persons with bad habits with income generating creative activities
Ü Dare to say no against the bad habits
Ü Establishment of pressure groups like mothers’ group, youth club and bal
samuha to avoid and discourage bad habits from the society
Ü To report to the police if anybody is involved in criminal activities indulging in
bad habits
Activities
You can see some persons indulged in the bad habits in your community. What sorts
of efforts can be applied to make them quit those bad habits? Discuss this issue with
your friends and present the conclusion in the class.
9.5 Smoking, Drugs and Alcoholism

9.5.1 Smoking
Tobacco is the dry leaves of the plants of Nicotiana
Tobaccum. All species of tobacco plants contain
the recreational drug called nicotine, in all parts
of plants except the seeds. It is a powerful poison.
Tobacco products can generally be divided into two
types: smoked tobacco and smokeless tobacco.
Tobacco smoking directly affects the lungs, heart
and brain. In addition to the risk of heart disease,
smoking increases the risk of chronic bronchitis,
respiratory disorders, retarded fetal development
and so on. The smoke includes vaporized chemicals, gases, particles of tar, nicotine
and hundreds of cancer causing substances. All these are harmful substances to
health. Among them, carcinogens cause cancer and other fatal diseases too.
A. Causes of Smoking
It is found that smokers fall sub consciously in a habit by imitating the smokers in the
society. The smokers give different answers if they are asked the reason of smoking.
People start smoking due to multiple physiological, psychological and social factors.
However, the main causes for smoking are listed below:
Sometimes as a matter of entertainment and fun and under the pressure of their
bad company.
If all senior members at home have the habit of smoking, the children also imitate
such habit.
Some people begin to smoke by the influence of smokers in their society and
working places.
Some people start smoking for a status symbol.
Children being curious about its taste start smoking.
Some young persons begin to smoke as a fashion.
Many others imitate smoking under the impression of various advertisements.
They fall under the false impression that smoking increases their thinking power
and it also stops their worries and anxieties.
B. Effects of Smoking
In the following section, we shall study about immediate effects and long-term effects
of smoking on our health.
1. Immediate Effects
M Coughing is often the result of smoking
M Smoking causes headache, vomiting
and stomach pain
M Bad breathing
M Giddiness and nausea
M It causes heart beating faster
2. Long-term Effects
Smoking for a long period of time results into some effects known as long-term
effects. They are as follows:
M Teeth, skin and fingers become pale because of the direct effect of nicotine
M Nicotine is stored in different sensitive organs of our body
M Heart beating becomes faster, blood-
pressure increases and often the
smoker feels irritated
M Social prestige is damaged
M Wounds may appear in the gums and
in the mouth
M There is a possibility of heart attack Healthy Lungs Smoker’s Lungs
and lungs-cancer
M Sometimes incidence of miscarriage and still birth may happen as a direct effect
of smoking
M Smoking may affect the movement of heart leading to death
M Women may become sterile due to smoking
3. Preventive Measures
M Avoid the company of bad friends and smokers.
M Family members must be aware about the bad effects of smoking.
M Efforts should be made to declare certain areas as smoke prohibited areas.

M At present, Government of Nepal
has banned the advertisement of
smoking and other intoxicating NO
things from radio, TV and other
electronic means. The advertisement
of smoking from other sources too
should be restricted.
M Parents should practice healthy
habits. If they have smoking habit
it should not be in front of the
children.
M Increment in the tax of tobacco.
M Youngsters should be encouraged for other recreational activities.
9.5.2 Alcohol
An alcoholic beverage is a drink that
contains ethanol. It is believed that the
alcoholic beverages have been consumed
by humans since the beginning. The use
of alcohol has been a traditional practice
in all most all human societies. Different
people use it in different manner for
different purposes. Some people use it as
a form of religious rituals. Some consume
it in some special ceremonies and others consume it to entertain themselves at party
and meeting with friends and family.
Alcoholic beverages are divided into three general classes such as beer, wine, and
distilled beverages (liquors). A distilled alcohol or liquor is an alcoholic beverage
produced by distilling ethanol by means of fermenting grains, fruits or vegetables.
For the most common distilled beverages: such as in whiskey and vodka, the alcohol
content is around 40 percent. Vodka, gin, whiskey, brandy, etc are the examples
of distilled beverage. On the other hand, wine and beer are fermented beverages
produced from grapes and food grains. In which, wine involves a longer fermentation
process than beer (months or years), resulting in an alcohol content of 9 percent to 16
percent. Similarly alcohol content in beer is 5-7% in average. In the context of Nepal
along with those wine, beer and liquors the local alcohol like jad, raksi, chhyang,
aaila, nigar and tongba are commonly available in the market.
Alcohol is legally consumed in most of the countries around the world. So, selling
and drinking wine is not an illegal practice in most of the society. However, alcohol
consumption is injurious to our health. It is said that a glass of pure alcohol once at a
time is a fatal dose to human body.
A. Reasons for Drinking Alcohol
The reasons for drinking alcohol may differ from person to person and culture to
culture. However, some reasons are listed as follows:
Due to the assumption of reducing tension.
In getting together with friends as a recreational purpose.
Some have logic that alcohol helps in digesting food.
Some are attracted by advertisements.
Some use it as beverage which gives energy to them.
Some use alcohol under the pressure of his circle.
Some people have tradition to drink.
Due to lack of proper guidance.
Broken environment at home.
In some ethnic communities, alcohol is used in social rites and rituals.
Young people are curious towards its taste and start drinking.
B. Effects of Alcohol
1. Immediate Effects
M Alcohol acts as both a
‘stimulant’ and a ‘depressant’.
M Decrease in thinking capacity.
M Results in uncontrolled
activities.
M Body becomes imbalance and
passive.
M Family life and personal
relationship are disturbed.
M It reduces the eye muscle’s
ability and causes poor focus,
double vision and reduction
in night vision.
M Impairs memory and
judgment.
Healthy Liver Liver after
2. Long-term Effects
alcoholic cirrhosis
M Overuse makes the drinker
vulnerable to peptic ulcers, cirrhosis, pancreatitis, gastritis and heart disease.

M The gastrointestinal tract is usually affected and digestion becomes worse.
M The liver is the principal engine, adversely affected by alcohol.
M Alcoholism leads to infertility.
M It adversely affects the social prestige of the individual.
M Increases the risk of heart failure and stroke.
C. Prevention of Alcoholism
M One must avoid the company of the friends who have already formed the habit
of drinking alcohol.
M If there is a culture to drink wine, it must gradually be reduced. Family members
should be educated about its hazards.
M Drinking alcohol should be prohibited in public places.
M Health education must be extended to make aware of the adverse effects of
drinking alcohol.
M Advertisement of alcohol must be banned.
M Increment in the alcohol taxation.
M Self control.
9.5.3 Drugs
A drug is a substance which may have medicinal and intoxicating performance when
taken into a human body and is not considered as food. According to WHO, “A drug
is any substance that when taken into the living organism may modify one or more
of its functions.” In other words, drug is a substance that affects the structure and
functioning of a living organism. The term medicine is sometimes preferred for
therapeutic drugs in order to distinguish them from narcotics and other addictive
drugs which are used illegally. In other words, drug is “a chemical substance used
in the treatment, cure, prevention, and diagnosis of disease.” When properly used,
therapeutic drugs relieve pain and suffering, cure disease and maintain good health.
If abused, they can severely damage health and well-being.
While talking about the narcotic drugs, some drugs stimulates the body, some of
them are proved to be depressant, while some of them hallucinate the user. Cocaine,
Brown Sugar, Heroin, Opium and Hasis are the example of some common narcotic
drugs. Such drugs can cause addiction and habituation. Recreational substance use is
the use of psychoactive substances to have fun for the experience. Many recreational
drugs are legal and culturally accepted. These recreational substances include alcohol,
tobacco, and betel nut products. Although many recreational drug use is controversial.
Moreover, cigarettes and alcohol can be perceived as legal drugs.
Lysergic acid diethylamide (LSD), is an illegal recreational drug derived from a parasitic
fungus. LSD is the most well-known hallucinogenic drug. Illegal drugs aren’t good
Opium Plants Heroin Marijuana
for anyone particularly for kids and teens whose body is still growing. Narcotic or
illicit drugs can damage the brain, heart, and other important organs. Cocaine, for
instance, can cause heart attack. While using drugs, people are also less able to do
well in school, sports, and other activities. Addiction of these illicit drugs may even
ruin the precious life. Strictly speaking, all medicines are drugs, but not all drugs are
medicines. For example, the articles such as plastic glue, paint thinners and removers,
brown sugar, dendrite, heroin, cocaine, etc are drug but they cannot be considered
as medicine.
Difference between Drug Abuse and Addiction
Drug Abuse Drug Addiction
Ü Drug abuse is persistent or Ü Drug addiction is a condition in
excessive intake of drugs for which the addict is committed
reasons other than medical, in an to the drug physically and
amount, frequency and manner psychologically.
that damage the physical and
mental functioning of an individual.
Ü In simple term, it can be said as the Ü In simple term, it can be said
repeated misuse of drugs. as physical and psychological
dependency on drugs.
Ü Drug abuse may result into drug Ü Drug addiction results into
addiction. tolerance ladder (dose needs to be
increased to get the same level of
satisfaction and functioning).
Ü It does not develop withdrawal Ü It develops withdrawal symptoms
symptoms over the abuser. among the addicts.
Ü In this condition, it is easy to rescue Ü In this condition, it is a little bit
the hooked persons. difficult to rescue the addicted
persons.

A. Reasons for Drug Abuse
Drugs are taken to forget discomfort and frustrations of life.
The addicted friends usually influence their friends to this habit.
In Nepal, some people use drugs to worship and please Lord Shiva.
Drift towards western culture, sense of pseudo freedom and urbanization.
Personality problem also makes a person more prone to drug addiction.
The smugglers may trap the persons in drug abuse.
Imitating elders and celebrities.
B. Effects of Drug Abuse
Memory power becomes weak.
There is disharmony between thinking and activities.
Change in facial appearance and looking intoxicated all the time.
Increase in heart beat and blood pressure.
Loss of appetite and the body becomes exhausted.
Vomiting and the feeling of nausea.
Social reputation of an individual gets degraded.
Injecting drug with an unsterilized syringe may cause STIs like AIDS, Hepatitis ‘B’
and ‘C’.
Reduction in reproductive performance.
Drug addiction leads to social disorder and criminal activities.
Immunity power weakens, which leads to ill health.
C. Way to Control and Prevent Drug Abuse
We must aware the people of the harmful effects of drug addiction through
community participation.
There must be effective control mechanism against smuggling of narcotic drugs
in the society.
There should be management of sports and other recreational programs so that
in leisure time, young people will involve themselves in such activities.
There should be discussion on the adverse effects of drug addiction among family
members and neighbors.
There must be a good relationship among the family members.
Laws against smuggling of illicit drugs must be implemented strictly.
Encouraging the child to believe in himself.
Advising addicts to seek treatment from hospitals and counselling from
rehabilitation centres.

Summary
Ü The concept of community health developed in England at the beginning of the

19th century as public health.
Ü Community health is the science and art of the preventing disease, prolonging
life, and promoting health and efficiency through the joint effort of individuals,
community and the state.
Ü It is a justice based innovative health approach, which provides preventive,
curative, promotive and rehabilitative health services.
Ü The strength of the community health depends upon the role of individuals,
community, and the government.
Ü There must be proper coordination and involvement of statistician, health experts,
sociologists, researchers, and the community members not only between doctors
and between epidemiologists to promote community health programs.
Ü Preventive Health service encompass a variety of interventions that can be
undertaken to prevent or delay the occurrence of disease or reduce further
transmission or exposure to disease.
Ü Preventive care can include immunizations, lab tests, physical exams and
prescriptions. Diagnostic services help your doctor understand your symptoms
or diagnose your illness.
Ü The process of producing immunity to an infectious disease in an individual
through vaccination is called immunization. Health promotion involves public
policy that addresses health determinants such as income, housing, food security,
employment, and quality working conditions.
Ü Health promotion is aligned with health equity and can be a focus of NGOs
dedicated to social justice or human rights.
Ü In Nepal, Expanded Immunization Program was started after the eradication of
Smallpox in 2034 BS (1975 AD).
Ü Expanded program on Immunization including BCG, DPT, Oral Polio Vaccine, and
Measles was expanded to all 75 districts by 1989 AD.
Ü Currently eleven antigens are provided through the routine immunization under
National Immunization Program of Nepal.
Ü Drug is a chemical substance used in the treatment, cure, prevention, and
diagnosis of disease, hence when properly used therapeutic drugs relieve pain,
suffering and cure disease. If abused, they can severely damage health and well-
being.
Ü Cocaine, Brown Sugar, Heroin, Opium and Hasis are the example of narcotic
drugs. Such drugs can cause addiction and habituation.
Ü Recreational drugs are the psychoactive substances that have been used to have
drugs fun.
Ü Many recreational drugs are legal and culturally accepted. These recreational
substances include alcohol, tobacco, and betel nut products.
Ü Lysergic acid diethylamide (LSD), is an illegal recreational drug derived from a
parasitic fungus. LSD is the most well-known hallucinogenic drug.
EXE RC IS E
1. What do you mean by community health?
2. When was expanded immunization started in Nepal?
3. What is promotive health service?
4. Name any two health services that fall under preventive health service.
5. Mention any two functions of regional level health service delivering
agencies.
6. Write any two roles of health post in preventing health problems.
7. Mention any two long term effects of alcoholism.
8. How many beds are there in a primary health center?
9. Mention any two objectives of NHEICC.
10. Name any two chemicals found in tobacco which are injurious to health.
11. What is the target of 13th three year interim plan for Infant Mortality Rate?
12. Write the full form of DOTS.

1. Explain any two major health problems of Nepal?
2. Write any five policies formulated by the 13th Three Years Interim plan of
Nepal.
3. Write any five differences between primary health centre and health post.
4. Describe briefly the reason behind inadequate health services in Nepal.
5. Why is malnutrition considered as one of the major health problems of
Nepal? Give reasons.
6. “Life style of Nepali people is the major health problem of Nepal.” Justify.
7. Give introduction to Nepal Heart Foundation and elaborate its activities.
8. What contribution is made by the establishment of primary health center in
promoting community health? Explain.
9. Mention the objectives and programs of Nepal Anti-Tuberculosis Association.
10. “Prevention is better than cure”. Justify the statement.
11. Explain various kinds of bad habits with suitable examples.
12. Why is lack of health education considered as a major health problem in the
context of Nepal?

1. District hospital and central level hospital
2. Drug abuse and drug addiction
3. Preventive and curative aspect of health service
4. Health post and primary health centre
1. Family Planning Association of Nepal
2. Role of family for community health
3. Nepal Leprosy Relief Association
4. Zonal hospital
5. Expanded Immunization Program
1. What is community health? Analyze the scope of community health.
2. Critically examine the various aspects of health services with suitable examples.
3. Elucidate the role of individuals and community to solve the community
health problems.
4. You can see some people smoking even in public places. Mention the
reasons of smoking and suggest the possible measures to minimize this
social problem.
5. Give introduction to CB-IMCI. Mention the objectives and functions of CB-
IMCI.
6. Critically evaluate the activities undertaken by some non-profit making
organizations such as FPAN, NATA, NLRA of Nepal in terms of their contribution
in the health sector.
7. Mention the recent health policy of Nepal. Is this policy strong enough to
promote the health status of the people in the country?
Project Work
Conduct a case study about the organizational structure and service delivery system
of a health post or community hospital of your locality under the sub-titles that are
given below:
I. Introduction
a. Background of the Study
b. Objective of the study
c. Significance of the Study
d. Limitation of the Study
II. Methodology
a. Study Area
b. Sources of Data
c. Method of Data Collection
III. Findings
IV. Conclusion and Recommendation

UNIT PRIMARY HEALTH CARE,
10
PRECAUTIONS AND SECURITY
ON RISK
Tell the meaning and importance of First Aid.
Elaborate the important points to be considered while providing First Aid.
Tell the essential articles to be available in the First Aid box.
Explain the process of Expired Air Resuscitation-EAR and External Cardiac
Compression.
Tell the process of First Aid of wound, choking, snake bite, allergy, high altitude
sickness, frostbite, drowning, sprain, etc.
Explain the ways to keep sound human health and safe life style.
10. 1 Methods and Procedure of First Aid

10.1.1 Meaning of First Aid
First aid is the immediate care given to someone
suffering from an injury or illness until the arrival
of a doctor or admission to hospital. In other
words, First aid is the help given to someone
who is injured or ill, to keep them safe until
they can get more advanced medical treatment
by seeing a doctor, health professional or go to
hospital. It can be considered as the assistance
provided to the casualty or ill patient at the
time of emergency with such materials as may
be available there. First Aid is not a medical
treatment so the responsibility of a First Aider
ends as soon as medical treatment begins.
First Aid can be defined as an immediate care provided to the casualty or ill person
during the incident of accident before the arrival of medical treatment. If we get the
skills of first aid, we can prevent the casualty from untimely death. For the effective
First Aid, s/he should be resourceful, tactful, courageous, kind and skilful. The aim of
first aid is to prevent a deterioration of the victim’s situation, to aid recovery, and to
preserve life. In serious cases, first aid may be necessary to keep the victim alive.
Objectives
M To save life
M To minimize injuries
M To hasten healing
M To prevent illness from becoming worse
M To prevent the casualty’s condition from deteriorating any further.
10.1.2 Importance of First Aid

e First Aid can reduce the physical and mental stress of the patient
e It can save the condition of casualty from worsening
e It helps to save the life of casualty
e It helps to inform the doctors about the previous condition of the patient
e It helps to develop confidence in the victim
e It is possible to carry the casualty to the hospital safely from the accident spot
10.1.3 Points to be Considered by the First Aider

e Reach the accident spot as soon as possible
e Assess the situation quickly and calmly
e Ask for the permission to the casualty’s relatives or the persons at the accident
spot to begin with the First Aid
e Sympathy should be given to the casualty to promote their confidence level
e Make sure whether the respiration has stopped or not. If casualty cannot breathe
begin artificial respiration right away
e Never give an unconscious person anything by mouth
e If there are more than one casualty prioritize the most life-threatening conditions
e Always protect yourself and the casualty from danger
e Don’t touch an open wound without gloves
e Call for the doctor, police and ambulance immediately if the case is serious
10.1.4 First Aid Box

The box where we keep various kinds of
articles that are essential during the First Aid
to the casualty during the accident is called
First Aid Box. The First Aid Box should be
available at school, club, office, play ground,
vehicles, police post, fair, etc. The First Aid
Box should be belonged to the First Aider.
The following articles should be there in a
First Aid Box: A Set of First Aid Items

1. Plasters of different sizes 2. Gauze dressings
3. Sterile eye dressings 4. Triangular bandages
5. Crêpe rolled bandages 6. Safety pins
7. Disposable sterile gloves 8. Tweezers
9. Tourniquet 10. Adhesive tape
First Aid Items

11. Cotton swab 12. Thermometer
13. Safety pins 14. Small note book
15. Dettol 16. Tincture benzene
17. Tincture Iodine 18. Brufen
19. Paracetamol 20. Jeevanjal
21. Spirit 22. Blade
23. Scissors 24. Soap
25. Clean hanky 26. Torch light
10.1.5 Major Methods of First Aid

The condition of casualty should be identified by observing the nature of incidence of
accident. Then First Aid should be provided as per the priority basis. The First Aider
need to have the knowledge and skill of ABC. The person having the knowledge of
ABC can safeguard the life of the victim. The term ABC stands for Airway, Breathing,
and Circulation. The following activities fall under the ABC method:
Opening Airway
The first aider needs to make sure the casualty’s airway
is clear. Let the casualty lie on their back, and then to
place one hand on his/her forehead and place two
finger from the other hand on the casualty’s chin and
gently tilt the head back while slightly raising the chin
further upwards. Any obstructions need to be removed
from the casualty’s mouth, including dentures.
Adequate Breathing
With victim’s airway open, look, listen, and feel for breathing for 5-10 seconds by
placing your cheek near victim’s mouth and watching for chest to rise and fall. When
the first aider has determined that the airways are not obstructed, he/she must
determine the casualty’s adequacy of breathing, and if necessary provide artificial
respiration.
Sufficient Blood Circulation

If the casualty is not breathing and no pulse the first aider should go straight for chest
compressions and artificial respiration. The chest compressions will help to resume
circulation of blood.

A. Artificial Respiration (Expired Air Resuscitation-EAR)
Artificial respiration is a First Aid provided to
the casualty to restore breathing. It is required
to the casualties of heart attack, poisoning,
drowning, stroke, choking, electric shock, etc.
Some procedures of mouth to mouth
respiration are mentioned below:
M Place the victim on his/her back laying
face upward (supine position)
M Clear the mouth for easy passage of air
M Press the head backward by keeping one hand firmly on the forehead of victim
and another hand at the chin of the victim to maintain upward position
M Then close the nostrils of the victim with the hand that was used to press the
forehead
M Take a deep breath and place the mouth over the victim’s mouth firmly and blow
air into the casualty’s lungs until the chest rises
M Blow air into the lungs in every 4 to 5 seconds until the victim starts breathing
again or medical help arrives
B. Cardiac Massage (External Cardiac Compression-ECC)
The process of saving the life of victims through
artificial respiration and cardiac massage is
called cardiopulmonary resuscitation (CPR).
So, to save the life of the victim, First Aid
provider should give cardiac massage and
artificial respiration simultaneously. We have
to provide cardiac massage to the victim
when heart beat stops within 3 to 5 minutes
otherwise s/he cannot be revived. Heart beat
stops due to shock, accident, heart attack, etc.
Among them heart attack is the common cause of stoppage of heart beat. In this
situation, the victim is unconscious and heart beat is absent. The procedure of cardiac
massage is Mentioned Below:
Ü Place the victim in head up position on a firm surface
Ü The First Aid provider should kneel down at the right side of the victim nearby his
shoulder
Ü Then the First Aid provider should overlap the left palm with the right palm and
the fingers of both hands should be interlocked to one another

Ü Gentle pressure should be given on the sternum for 4/5 times. Then Artificial
Respiration should be given after each cardiac massage
Ü Cardiac Massage should be continued till the start of heart beat again or till the
medical help arrives
Activities
Arrange an orientation class of First Aid through the coordination with a First Aid
Trainer. Give demonstration of Expired Air Resuscitation and External Cardiac
Compression under the instruction of the trainer.
10.1.6 Some Accidents and its First Aid Methods

A. Wounds
Wound is an injury which causes damage
in the structure of the underlying tissues
or organs by an external agent or force.
In other words, wound is the loss of
continuity of tissues following an injury
or operation. Wound can be classified as
open wound and closed wound. In open
wound, the skin structure is broken and
external bleeding is observed whereas in
the closed wound, only the subcutaneous tissues or internal organs are damaged and
external bleeding is absent. The wound may vary from the simple peeling off of skin
to deep cut with heavy bleeding.
1. Classification of Open Wound
i. Incisions (Incised wound)
The wound caused by a clean, sharp-edged object such as a knife, razor, glass or
splinter is called incised wound.
ii. Lacerations (Irregular tear-like wounds)
The wound caused by some blunt objects is called lacerated wound. Lacerated wound
usually may appear in irregular cut.
iii. Abrasion
Superficial wound in which the topmost layer of the skin (epidermis) is scraped off.
Abrasion is often caused by a sliding fall onto a rough surface.
iv. Avulsion
An injury in which a body structure is forcibly detached from its normal point of
insertion is called avulsion.

v. Puncture wound
The wound caused by an object puncturing the skin such as a splinter, nail or needle
is called puncture wound.
vi. Gunshot wound
The wound caused by a bullet or similar object through the body is called gunshot
wound. There may be two wounds, one at the site of entry and one at the site of exit,
generally referred to as a “through-and-through”.
2. Classification of Closed Wound

i. Hematoma
This wound is also called a blood tumor. It is caused by damage to blood vessels that
in turn causes blood to collect under the skin.
ii. Crush Injury
This kind of wound is caused by an extreme amount of force applied over a long
period. It also damages blood vessels, which in turn causes blood to collect under the
skin in large scale.
First Aid to simple wound is mentioned below:

i. Stop Bleeding
To stop the bleeding from the wound is the very first duty of the First Aider. Heavy
bleeding may lead the casualty to death within 15 to 30 minutes.
Bleeding Control Procedure
• Press the bleeding area with clean cloth, pad or handkerchief
• Elevate the bleeding area slightly above the chest level
• Add more clean clothes on top of wet cloths and keep on pressing until the
bleeding stops
• In the case of limbs, use big handkerchief, scarf, shawl or tie and tourniquet to
control bleeding
Points to be consider while using tourniquet
• Tie with tourniquet just 2/3 inches above the wound firmly (neither too loose nor
too tight)
• Never use wire, thread and rope as tourniquet
• The tourniquet should be loosen in every 10/25 minutes for few seconds to let
the blood pass to all tissues
ii. Cleaning the Wound
We should clean the wound with antiseptic solution. It can protect the wound from
infection. We should clean the wound with antiseptic solution like Savlon, Dettol,
Betadin, etc. During this process, all kinds of
foreign objects like Splinters, Nails, broken
glasses, etc should be taken out properly.
iii. Wound Closure
When bleeding stops, the wound should
be closed if the skin is broken widely. If
necessary, the wound should be closed
as soon as possible. It helps to recover the
wound soon and leaves a small scar.
Cleaning Wound
B. Burn
Burn is the tissue damage due to heat,
electricity, sunlight, chemical or nuclear
radiation. Similarly, the tissues damaged by
moist heat like hot water and steam is called
scalding. Burn can be generally classified
into three types depending on the degree
of skin and tissue damage. They are first
degree, second degree and the third degree
burn.
1. First Degree Burn
In first degree burn, there is damage of superficial skin (i.e. epidermis). It occurs due
to the sunlight, scalding by boiling water and steam. The signs like redness on skin,
mild swelling and minor pain are present. It gets healed without leaving any scar.
2. Second Degree Burn

In the second degree burn, there is damage of both dermis and epidermis (i.e. deep
structure of the skin). In this type of burn, the symptoms like blisters, pain, swelling
and white discharge are observed from the burn site.
3. Third Degree Burn

In the third degree burn, there is the damage of the skin to its full depth and damage
the tissues beneath the skin such as fat, nerve cells and bone also. In this type of burn,
the symptoms like complete damage of all layers of skin, white liquid discharge and
destruction of subcutaneous tissues are observed.
The First Aid to the Burn are Mentioned Below:
e Victim should be separated from the fire or hot objects
e Blanket or any thick cloth should be used to put out the fire if the cloth of victim
is burning
e Immerse the burnt part in cold water in the case of first and second degree burn
e Do not destroy the blisters
e Do not apply any cream or ointment on the burnt site
e Burnt part should be covered with clean cloth to keep it safe
e Victim should be provided with adequate liquid to drink
e Do not remove the burnt clothes if they are very much attached to the body parts
e Take victim to the nearby hospital as soon as possible
C. Snake Bite
The incidents of snake bites are generally observed during the summer season.
Terai region of Nepal is highly affected area for snake bite because various types of
poisonous snakes are found there. Poisonous snake bites, leaves the mark of two long
teeth (i.e. fangs). On the other hand, if the snake is not poisonous it leaves the mark
of several small teeth at that place. Kraits, Banded Krait, Lesser Black Krait, Greater
Black Krait, Coral Snake (Naag), Vipers and King Cobra are some highly poisonous
snakes available in the Terai and Hilly region of Nepal.
Poisonous snake Marks of poisonous snake bite
Poison sac
Fangs
Non-poisonous snake Marks of non-poisonous snake bite
Signs and Symptoms of Poisonous Snake Bite

M Colour of the skin gets changed
M Mark of teeth can be observed at the site of the snake bite
M Victim feels difficulty in breathing
M S/he feels nausea and vomiting
M Froth can be seen in victim’s mouth
M Dimness in eye sight is observed
M Blood is seen in urine, sputum and vomit
M The victim becomes unconscious in the advanced stage
First Aid
M Keep the victim calm and still
M Confirm the bitten area and scratch it with a sterilized blade or knife to let the
poison flow out with blood. Do not elevate the bitten part from the level of the
heart
M Use tourniquet just two inches above the bitten area. (i.e. it should be loosened
in every 15 minutes for few seconds)
M Do not let victim sleep and take him/her to the nearest hospital or health centre
as soon as possible
D. Electric Shock
Electric shock is a state caused by the sudden
discharge of electric current through a part of
the body. When we come to contact with a naked
electric wire or electric devices with flow of
electric current, we get electric shock. In minor
electric shock, it may burn the outer layer of the
skin (epidermis) or damage subcutaneous tissues
too. In severe electric shock, muscle contraction,
paralysis and sudden death may happen. Electric
shock is always fatal.
Symptoms of Electric Shock

M The victim may become unconscious.
M Disorder of heart beat.
M There will be burnt mark at the site of electric shock.
First Aid
M Do not touch victim if s/he is still in contact with the current flowing naked electric
wire or devices
M Turn of the main switch using bad conductor in the case of low voltage electric
shock
M In the case of high voltage electric shock, call for emergency help to the authority
M If the accident has occurred at the place where there is no switch to put it off,
separate the victim from the electric current with the help of bad conductor like
dry bamboo, dry wood, etc.
M Provide artificial respiration if the victim is unconscious
M Place the victim in rest condition by covering him with warm cloth
M Provide plenty of water to drink and liquid food if s/he is conscious
M Take the victim to the hospital as soon as possible if necessary
E. Frostbite
Frostbite is an injury that is caused
by exposure of parts of our body to
temperatures below freezing point. The cold
causes freezing of our skin and underlying
tissues. The fingers, toes and feet are most
commonly affected but other extremities,
including the nose, ears and cheeks, can
also develop frostbite. Frostbite occurs
when tissues are damaged due to freezing
temperatures. Frostbite is most common on the. Exposed skin including fingers, toes,
nose, ears, cheeks and chin are most susceptible to frostbite. There are different
degrees of frostbite. They are mentioned below:
First-degree frostbite just affects the epidermis
Second-degree frostbite may affect the epidermis and part of the dermis
Third-degree frostbite affects the epidermis, the dermis and the fatty tissue
beneath the dermis
Fourth-degree frostbite affects the full thickness of the skin, the tissues that lie
underneath the skin, and also deeper structures such as muscles, tendons and
bone
Symptoms
M Skin that feels hard and waxy with a white or grayish yellow color
M In superficial frostbite: aching pain, numbness, at affected area most often on
hands, feet, face, and ears
M In deep frostbite: there is loss of sensation at the affected part and may even
appear blackened and dead tissues.
M Significant pain as the areas are rewarmed and blood flow reestablished.
First Aid
M Assess for any hypothermia
M Remove any rings, watches or constricting items from the affected limbs
M Replace the wet clothes with dry clothing
M Keep hands under the armpits
M Do not rub the affected area, as this can cause further tissue damage

M Do not walk on toes or feet which are affected by frostbite
M If a hand or a foot is affected by frostbite, wrap it in a blanket for protection If
possible, avoid walking on frostbitten feet, as fractures can occur
M Protect the casualty from any possible re-freezing
M Provide warm drinks to the casualty to prevent dehydration
M Place the affected body part in warm (not hot) water at around 40°C and be
careful not to put it near direct heat as this can cause more damage
M Then take them to hospital keeping their limb raised.
F. High Altitude Sickness
Altitude sickness is an illness that is caused by ascent
to high altitude characterized by nausea, short
breathing, rapid heartbeat, mental confusion and
headache resulting from the shortage of oxygen.
This type of illness takes place at the place above
2,500 meters altitude. In this condition brain and
lungs are badly affected.
Symptoms
M Headache, nausea and vomiting
M Short breathing and rapid heart beat
M Fatigue and insomnia
M Deterioration of neuro-muscular coordination
M Fainting and convulsion may occur
M In severe condition, bleeding occurs from nose, ears and eyes
First Aid
M If the person gets headache and dizziness while climbing on uphill, lower the
victim at least 500 m downward
M Oxygen should be given to him/her if available
M Let the victim rest completely
M Hot drink can be given to the victim
M Carry to the nearby health clinic or hospital in
the case of severe condition
G. Heat Stroke
Heatstroke is a condition that causes overheating of
body as a result of prolonged exposure to physical
exertion in high temperature. The heat stroke
can occur if our body temperature rises to 104° F
(104° F) or higher. Heatstroke requires emergency treatment. The cause of heat stroke
is an elevation in body temperature, often accompanied by dehydration. Heat stroke
is a medical emergency and can be fatal if not promptly and properly treat.
Symptoms
M Body temperature above 104° F
M Dizziness and headache
M Lack of sweating despite the heat
M Red, hot, and dry skin
M Muscle weakness or cramps
M Nausea and vomiting
M Rapid heartbeat
M Rapid shallow breathing
M Confusion, disorientation
M Unconsciousness
M Seizure
First Aid
M Move the person to a cool, shady area
M Fan air over the patient
M Apply ice packs to the patient’s armpits, groin, neck, and back
M Immerse the patient in a shower or tub of cool water
M Provide cold water or fruit juice
H. Drowning
Drowning is defined as respiratory impairment
from being in or under water. In other words,
drowning is the process of experiencing
respiratory impairment from submersion/
immersion in liquid. Drowning generally occurs
when someone is unable to breathe because
his/her nose and mouth are submerged in
water. People get drowned accidentally into the
water bodies like swimming pool, pond, river, lake, well, etc.
Symptoms
M Head tilted back with mouth open
M Floating face down
M Gasping for air
M Trouble breathing

M Coughing
M Chest pain
M Vomiting
M Sleepiness due to lack of oxygen to the brain
First Aid
M Take the casualty out of the water
M As soon as the casualty has been rescued from the water, check if s/he is breathing
M If the person is not breathing, check pulse
M If there is no pulse and breathing, start artificial resuscitation and chest
compression
M Repeat it until the victim begins breathing
M Replace their wet clothes with dry ones
M If they start breathing again protect them for hypothermia by covering with warm
blankets
I. Choking
The state of preventing from breathing by constricting
or obstructing the throat due to the foreign objects
like bones, coin, marble, lapsi, toy piece, etc is called
choking. Besides this, sometime, swallowed food may
get stuck at the windpipe. It also causes choking.
Symptoms
M Suffocation, cough, struggling to breath
M Pale and bluish face due to lack of oxygen
M Victim cannot speak
M Victim may become unconscious
Prevention
M Keep the objects like coins, buttons , marbles, pen , marker caps etc away from
the children
M Cut meat into small pieces chew your food thoroughly
M Do not give popcorn, nuts, or hard candy to children younger than 4 years
M Keep balloons and plastic bags away from any child who may put them in his or
her mouth
M Chewing and swallowing carefully and quietly without talking
M Never hold pen caps, bottle caps etc in mouth
M Never try to swallow a handful of nuts or any other food once at a time

First Aid
M Keep the victim in comfortable position
M Ask the victim to cough loudly
M Sometimes, the foreign object can be removed from the throat by hitting slightly
on the back by the palm of hand
M If the foreign object cannot come out by the above technique, give 2 to 3 inward
and upward thrusts against the abdomen by placing the arms around the victim’s
waist from behind with the help of enclosed hands till the objects come out from
mouth
M Once, the foreign object is out, give artificial respiration if necessary
M If the foreign object does not come out even after applying all the techniques
mentioned above, take the victim to the nearest health centre or hospital as soon
as possible
J. Poisoning
A poison is a substance which taken into the body may damage the health or even kill
a person. There are three basic routes of poisoning such as ingestion, inhalation and
injection.
Symptoms
M Burning sensation in the mouth, pharynx and stomach
M Nausea and vomiting
M Excessive salivation
M Breathlessness
M Abdominal pain and diarrhoea
M Excessive sweating
M Dilation of eye pupil
M Blurred vision
M Loss of muscle control
M Confusion and convulsion
First Aid
M Place the victim in a comfortable position
M If the person vomits, clear the airway
M Provide water for drinking if the victim is able to drink
M Ask for vomiting to the victim if s/ he is conscious
M Clean the mouth and throat properly after vomiting
M If the person vomits, turn his or her head to the side to prevent choking
M Vomit sample should be carried to the hospital for examination

M Allow gastric lavage if the victim cannot vomit
M Do not allow vomiting in the case of kerosene, petrol or acid poising
M If the poison has spilled on clothes, remove the clothing and flush the skin with
water
M If the person starts having convulsions, give convulsion First Aid
M Remove any poison tinged clothing from the body using gloves
M In the case of inhaled poison, get the person into fresh air as soon as possible
M Begin CPR if the person shows no signs of breathing and circulation
K. Sprain
Sprain is an injury due to wrenching and
tearing of ligaments and tissues violently so
as to cause pain and swelling at an ankle,
wrist or other joints. It is an injury to the
ligament caused by sudden over stretching.
It occurs due to sudden twist or stretch
(wrench) of the joints beyond their normal
range of motion.
Symptoms
M Swelling, pain, tenderness at the site of sprain
M Discoloration of surrounding skin
M It is difficult to move the swelling part
First Aid
M Keep the victim calm
M Put bandage at the sprain area
M Ice bag can be applied to reduce swelling
M Do not allow victim walk with or move injured part
M Carry the victim to nearby hospital for further check up.
Activities
Invite a First Aid trainer in your school and manage First Aid training to the selected
students with the coordination of school administration.
10.2 Human Health and Safe Lifestyle

10.2.1 Human Health
Human health is the condition of a person having complete health and fitness.
According to WHO, ‘Health is a state of complete physical, mental and social wellbeing

and not merely the absence of disease and infirmity’. This definition emphasizes the
importance of wellbeing of people in physical, mental and social state besides being
free from disease and infirmity. Physical health means physical development and
fitness whereas healthy thinking and mental development is related to mental health.
Social behaviour of an individual is related with social health. The abilities of a person
like co-operation, friendship, leadership infers social health. Sound health is the
integration of physical, mental and social and spirituals qualities of a person. Health
of the individuals may feel better in one aspect whereas s/he may feel worse in other
aspects. Some characteristics of a healthy person are illustrated by the diagram that
is given below:
A. Balanced Diet
A balanced diet means getting the right
type and amount of food to supply
energy for maintaining body cells,
tissues, and organs, and for supporting
normal growth and development of
the body. In other words, the diet
which contains all the nutrients in
right quantity and proportion keeping
our body healthy and productive is called balanced diet. The term “balanced” diet
simply means that a diet meets nutritional needs of a person while not providing too
much of any nutrients. A balanced diet is essential for our good health. There are
different kinds of foods available in our surrounding. Indeed, balance diet makes our
body healthy and strong. A balanced diet contains 50-60% carbohydrates, 20-30%
fats and 15 to 20% proteins with sufficient quantity of vitamins and minerals. In order
to have a balanced diet, we must eat at least one foodstuff in required quantity from
the following groups. For this, we also should have knowledge of how many calories
we need to consume every day. The foods that are found in our locality can be divided
into different groups as given in the table given below:
Group of Foods Name of the Foods
Milk products: milk, ghee, curd, cheese, butter, etc.
Animal Sources
Meat, fish, egg, etc.
Plant sources
Cereals Rice, wheat, maize, corn, millet, buckwheat, etc.
Pulses and legumes Gram, cow pea, peas, mung dal, beans, rajmah, etc.
Oil Almond, mustard, coconut, sunflower, soyabean, etc.
Green leafy vegetables Spinach, cabbage, lettuce, mustard leaves, kurilo, etc.
Fruits Mango, guava, banana, apple, grapes, pomegranates, etc.
We can have balanced diet from the foods that are available in our locality. Vegetables
and fruit are important part of balanced meal. Fruits and vegetables are the vital source
of vitamins and minerals. They supply vitamins and minerals to keep our immune
system strong. There is evidence that people who eat fruits and vegetables everyday
are at lower risk of heart disease, stroke, and cancer. Meat, fish, legumes, and eggs
are all good sources of protein and minerals. They are essential for growth, and repair
of the body. Legumes include beans, peas, lentils, groundnuts, and soybeans. Milk
and dairy foods such as cheese and yoghurt are good sources of protein. They also
contain calcium, which helps to keep our bones healthy. Fat is also the good sources
of energy for the body but too much consumption can lead to obesity.
Some of the importance of balanced diet is mentioned in the following points:
M Supplies energy for all the cells in the body adequately,
M Helps in the physical and mental development,
M Increases immunity power in the body,
M Protects from nutrient deficiency diseases,
M Provides support to vital organs like heart, kidney, intestine, etc.,
M Helps in the synthesis of essential antibodies, enzymes and hormones.
Activities
Prepare a balanced diet chart in a chart paper and discuss about its role, need and
importance in the maintenance of physical, mental and spiritual health of human
being.
B. Healthy Environment
Healthy environment is an important
aspect of human health. The various
activities of physical, biological
and social aspects of environment
directly and indirectly affect human
health. There is interaction between
environment and man. Positive
interaction between human and
environment ensures healthy
environment and sustainable living
and quality of life. On the other hand,
negative interaction between human and environment results into environmental
degradation, loss of biological resources, poor sanitation, energy crisis, social
disintegration and ultimately low quality of life.

Healthy environment plays an important role for the attainment of quality of life.
Different aspects of human life such as healthy residence, balanced and safe food,
safe drinking water, fresh air, culture and tradition play important role to make people
healthy and productive. We need to keep our home, surrounding, neighbourhood and
community always clean. There should be proper management of solid wastes and
sewage at our home, neighbourhood and community to ensure healthy environment.
We can enjoy sound health in healthy environment. Healthy environment ultimately
brings positive impact on mental, social, spiritual, emotional aspect of health of the
people. Some of the importance of healthy environment is mentioned below:
It helps to maintain physical and mental health
It helps to prevent from pollution borne diseases
It helps to maintain quality of life
It helps to ensure sustainable living
C. Physical Dynamics
The process of making our body
active and dynamic through
physical exercise, yoga, pranayam,
meditation, etc is known as physical
dynamics. The different parts and
organs of our body become active
due to the physiological dynamics.
It helps to maintain sound health.
Human health and physical dynamics
are the two inseparable parts. At present, a large number of people are dying from
non-communicable diseases in comparison to the communicable diseases. Some
common diseases are cardio vascular diseases, cancer, diabetes, hypertension, etc.
Regular physical exercise, yoga, pranayam and meditation increase immunity power
of the individual. At the same time, it also makes our body active and healthy. In
addition, it also boosts up the self-esteem. However, the wrong way of yoga, byayam
and physical exercise may hamper the health and physical fitness of the individuals.
There will be unnecessary weight gain and the body systems may not perform their
functions properly. Physical dynamics more than necessity is also injurious to health.
The following rules should be followed while doing pranayam and byayam:
As much as possible pranayam and byayam should be practiced in the open
space
The physical exercise which gives more physical exertion should not be practiced
It better to eat food only after two hours of physical exercise. Physical exercise
should not be practiced right after eating food

Physical exercise should not be practiced with the intension of merely the
development of a particular part of the body
Pranayam can be done at any condition but byayam can be practiced only on the
basis of physical condition of the individual
Activities
Organize a talk program on physical fitness and healthy life style inviting epidemiologist,
dietician, physician and yoga guru in your school under the supervision of your subject
teacher.
10.2.2 Safe Life Style

We need to follow health rule to keep ourselves healthy. We can enjoy a healthy life if
we follow health rule in our daily life. The act of translating healthy behaviour in daily
life to keep healthy, safe and prosperous living is called safe life style. The activities
like consumption of balanced diet regularly, practice of appropriate pranayam, proper
rest and sleep, personal hygiene, etc are the examples of the safe life style. Each
individual should make such a life style so that he/she can be away from the bad habit
such as smoking, alcoholism. Health status of an individual is determined by the life
style s/he follows.
Healthy life style gives us, happiness, good health and long life. So, we need to develop
the habit of wake up before the sun rise, regular bowl clearing, regular bathing and
proper care of hygiene. At the same time, we need to do pranayam and physical
exercise daily in the open space and should take breakfast and meal at proper time.
We have to respect our seniors and love and care our juniors.
Good nutrition, physical dynamics, adequate rest and sleep and adoption of safety
measures for safe and prosperous life are foundation of safe life style. Moreover, eating
healthy food, proper management of mental stress, keeping away from alcoholism,
smoking and drug abuse should be adopted as healthy life style in our daily life. Some
of the tips for healthy life style are mentioned below:
e Eat safe, healthy and nutritious balanced diet regularly
e Do pranayam and physical exercise regularly
e Adopt safety measures to prevent ourselves and our family
e Proper management of mental stress
e Establish mutual relation with family and friend circle
e Keep away from smoking, alcoholism and other bad habits
e Take care of personal hygiene
e Do not make company with the persons with bad habit
e Be informed and show readiness to adopt safe life style
Summary
Ü First Aid is an immediate care provided to casualty or ill person during the time of
incidence of accident before the arrival of medical treatment.
Ü The box where we keep various kinds of articles that are essential during the First
Aid to the casualty during the accident is called First Aid Box.
Ü The process of saving the life of victims through artificial respiration and cardiac
massage is called cardiopulmonary resuscitation (CPR).
Ü Wound can be defined as the damage in the structure of the underlying tissues
or organs and loss of continuity of tissue by an external force or agent.
Ü Burn is the damage of tissues by the dry heat like electricity, sunlight, chemical or
nuclear radiation. Similarly, the tissues damaged by moist heat like hot water and
steam is called scalding.
Ü The state of preventing from breathing by constricting or obstructing the throat
due to the foreign objects like bones, coin, marble, lapsi, toy piece etc is called
choking.
Ü Poisonous snakebite leaves the mark of fangs (front two long teeth). On the other
hand, non-poisonous snake leaves the mark of several small teeth at the bitten
site.
Ü Electric shock is a state resulted by the sudden discharge of electric current
through a part of the body. In severe electric shock, muscle contraction, paralysis,
and sudden death may happen.
Ü High altitude sickness is an illness resulted by ascending high altitude. Nausea,
short breathing, rapid heartbeat, headache, fatigue, bleeding and mental
confusion characterize it.
Ü Choking is the state of preventing from breathing by constricting or obstructing
the throat due to the foreign objects like coin, marble, bone piece, etc.
Ü An injury due to wrenching and tearing of ligaments and tissues violently to cause
pain and swelling at ankle, wrist or other joints is called sprain.
Ü Frostbite is an injury that is caused by exposure of parts of our body to
temperatures below freezing point.
Ü Altitude sickness is an illness that is caused by ascent to high altitude characterized
by nausea, short breathing, rapid heartbeat, mental confusion and headache
resulting from the shortage of oxygen.
Ü Heatstroke is a condition that causes overheating of body as a result of prolonged
exposure to physical exertion in high temperature. The heat stroke can occur if
our body temperature rises to 104° F (104° F) or higher.
Ü The process of making our body active dynamic through physical exercise, yoga,
pranayam, meditation, etc is known as physical dynamics.
Ü The act of translating healthy behaviour in daily life to keep healthy, safe and
prosperous living is called safe life style.
Ü Good nutrition, physical dynamics, adequate rest and sleep and adoption of
safety measures for safe and prosperous life are foundation of safe life style.
Ü Moreover, eating healthy food, proper management of mental stress, keeping
away from alcoholism, smoking and drug abuse should be adopted as healthy life
style in our daily life.
EXE RC IS E
1. What is First Aid?
2. Illustrate any one aim of ABC rule.
3. Mention any two techniques to stop external bleeding.
4. Write any two symptoms of drowning.
5. What is physical dynamics?
6. Why do you need healthy life style?
7. Mention any two measures of keeping healthy environment.
8. What is CPR?

1. Mention the objectives and importance of First Aid.
2. Elaborate the First Aid procedure of open wound.
3. How do you control external bleeding from the wound as a First Aider?
4. What is poisoning? Mention the symptoms and First Aid of poisoning.
5. Illustrate the points that are to be considered by First Aider.
6. What is balanced diet? What are the importance of balanced diet?
7. Make the list of essential articles that should be available in a First Aid Box.

1. Open wound and Closed wound
2. High altitude sickness and Frostbite

1. Artificial resuscitation
2. First Aid to snake bite
3. Heat Stroke and its First Aid

1. What is choking? Explain the symptoms, prevention and First Aid of choking.
2. What is burn? Explain the types of burn and their First Aid procedure.
3. Terai Region is highly prone to snake bite during the summer season. If you
were a First Aider, how would you distinguish whether the casualty has been
bitten by a poisonous snake or non-poisonous snake before you start First
Aid procedure?
Project Work
Invite a First Aid trainer and make the arrangement of medicines, stretchers and other
essential materials for the First Aid in your school with the coordination of the school
management. Give mock demonstration of First Aid to other students according to
the instruction of the First Aider.

282
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Health, Population and Environment Education-10

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(Types of questions) (Total no. of questions) (Time allocation) (Full Marks)
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(Very short questions) 22 mins
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9 9 9 x 4 = 36
(Short questions) 63 mins
nfdf] pQ/ cfpg] k|Zg 4 questons x 12.5 mins =
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50 mins
Health, Population and Environment Education-10

(Long questions)
24 24 135 mins 75
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283
A Set of Model Question
“Group A”
(Very short answer questions)
Attempt all the questions from this group. (11x 1 = 11)
1. What is meant by physical aspect of environment?
2. How do you calculate midyear population?
3. What is the ultimate goal of development?
4. Mention the sub-division of Mountain region.
5. Name any two conditions of quality of life.
6. What is Buffer zone?
7. Mention any two symptoms of dengue fever.
8. What is RH incompatibility? Evaluate in a sentence.
9. Write a difference between preventive health services curative health service.
10. What is external cardiac compression?
11. Illustrate any one aim of ABC rule.
“Group B”
(Short answer questions)
Attempt all the questions from this group. (9 x 4 = 36)
12. Describe the relation of science and technology with health, population and
environment education with suitable example.
13. Define Infant Mortality Rate. Suppose, 2100 live births were recorded in Itahari
Sub-metropolitan City in 2016 AD. Among them, 162 infants died before
completing one year of age. Find Infant Mortality Rate of that place.
OR
Define Rate of Natural Increase. According to the census of 2001 AD, the CBR and
CDR of Nepal were recorded 33.1 and 9.6 respectively. Find RNI of that country.
14. Examine the role of agriculture in the development of the nation.
15. What types of human activities deteriorate the ecosystem of Terai region? Analyze
with appropriate examples.
16. What is gender equality? Mention the role of women empowerment for quality
of life.

17. Justify the role of In-situ and Ex-situ for the preservation of biodiversity.
OR
‘Proper conservation of habitat is necessary for the promotion of species richness
of biodiversity’. Justify the statement.
18. How can you identify a person infected by Dangue fever? Illustrate its mode of
transmission preventive measures.
19. How can you identify the second phase of labour? What sorts of care are required
during this phase?
20. Write the differences between primary health centre and health post.
OR
Write the differences between drug abuse and drug addiction.
“Group C”
(Long answer questions)
Attempt all the questions from this group. (4 x 7 = 28)
21. Give an introduction to permanent contraception and compare the male
sterilization with female sterilization.
22. What is quality of life? How can you measure quality of life of the people through
Physical Quality of Life Index and Human Development Index?
23. What is rare plant? Mention the medicinal and other importance of the following
plants:
a. Golden Michelia b. Spikenard
c. Serpentina d. Himalayan Yew
e. Panch Aunle f. Yarshagumba
24. Give a brief introduction to NGO and evaluate the objectives and programs
undertaken by Family Planning Association of Nepal, Nepal Red Cross Society
and Nepal Heart Foundation to promote the health status of the people.

A Sample of Project Work
Situation Analysis on Access to Drinking Water Among the Residents
(A Case Study of Teku, Kathmandu)
A project work for Health, Population and Environment Education
Prepared by: .............................................. (Student’s name)
Submitted to:
The Faculty of Health, Population, and Environment Education
Name of the School

Address
Month, Year

Chapter - 1
(Introduction)
1.1 Background of the Study

There are various types of solid wastes including municipal, agricultural, and special
(health care wastes, household hazardous wastes, sewage sludge) waste. Unmanaged
solid waste disposal is one of the main causes of environmental degradation in the
urban areas of the developing countries including Nepal. In this context, solid waste
refers to low liquid content waste materials, which includes municipal garbage,
industrial wastes, sewage sludge, agriculture waste, etc. The waste management
problem is increasing especially in the urban area. Therefore, solid waste management
is accepted as a growing issue that has caused environmental pollution especially
in the urban area. According to the report of IUCN Nepal, (1997 AD) solid waste
generation per head per day in Kathmandu city was 0.56 kg. At the same time, solid
waste generation for all municipalities in average was estimated to be 0.25 kg per day
per head. According to this estimation, the total daily generation of the solid wastes
at present is more than 225 metric tons daily from the urban areas of our country.
According to the Municipal Act, 1989, AD, the respective municipality is the main
responsible institution for the cleaning locality and management of solid wastes.
Safe‐drinking water and safe disposal of the wastes are considered as the most vital
components for reduction of disease burden of the people. Solid waste management
is the process of treating solid wastes and offers variety of solutions for recycling
items that do not belong to trash. Waste management is the generation, prevention,
characterization, monitoring, treatment, handling, reuse, and residual disposition of
solid wastes. Safe drinking water and waste management are the basic areas of the
sanitation.
Safe drinking water and sanitation is the prime foundation of human development.
Because of high priority accorded to this sector and involvement of various agencies
in it, about 80 percent people have the facility of drinking water and about 43% have
been provided with sanitation service, at present. However, the disparity between
urban and rural areas in the availability of water and sanitation service, lack of
coordination in the activities of various agencies, and maintenance of quality and
sustainability of the service are appeared as major challenges of this sector. Lack of
supply of expected quantity of drinking water and government’s inability to provide
adequate qualitative drinking water and sanitation service according to the demand
of rural and urban people are the main problems of this sector.

1.2 Objective of the Study
General Objective
The general objective of the study is to assess the knowledge of the respondents about
the current situation of drinking water and sanitation in the study area. Moreover, it
also assesses the impact of unsafe drinking water and lack of sanitation on the health
of the people of that area.
Specific Objectives
M To know the level of knowledge of the respondents about safe drinking water
and solid waste management practice in the study area.
M To know the perception of the respondents about the situation of drinking water
in the study area.
M To know the knowledge of the respondents on impact of unsafe drinking water
on the health of the people in the study area.
1.3 Significance of the Study
Safe drinking water and sanitation is the prime foundation of public health. Lack of
supply of expected quantity of drinking water and government’s inability to provide
adequate qualitative drinking water and sanitation service according to the demand
of people have worsen the urban life. At the same time, solid waste management is
accepted as a growing issue that has caused environmental pollution especially in
the urban area. Safe-drinking water and safe disposal of the wastes are considered
as the most vital components for reduction of health problems of the people. In this
context, the people residing in the study area also have not remained untouched by
these problems but we do not have actual information about it. Therefore, we believe
that the present study on this sub-population would definitely provide baseline
information about the level of knowledge and practice on sanitation.
1.4 Limitation of the Study
This study has been conducted to know the situation of drinking water at Teku,
Kathmandu. However all possible efforts have been made to make this research work
reliable, the following are the limitations, which may be acceptable to this study:
This study is limited within Teku Kathmandu.
The result of this study may not be generalized for other places.
This study does not use any statistical tools for the selection of sample population
and data analysis.
Being a student there is budget limitation too so that we cannot spend too much
of money for this study

Chapter - 2
(Methodology)
This Study was conducted to obtain information about the current situation of
drinking water and practice in solid waste management in the study area. This chapter
elaborates the methods that are applied to accomplish the study objectives.
2.1 Study Area
This Study was conducted in Teku, Kathmandu. This is the densely populated urban
area. People from different parts of the country have been settled down in this
place. Though a very large number of households are observed in this place, only 25
households were randomly selected in our convenience as sample population.
2.2 Sources of Data
Two types of data have been used in this research study. They are primary and
secondary in nature.
Primary Source of Data
The first hand data for the study was obtained from the field survey conducted in the
study area. We did not know the total number of households of that place. In this
situation, we selected 25 households from the locality of Teku in our convenience for
the purpose of collection of the primary data.
Secondary Source of Data

We have made citation of different books, magazines, journals, and internet websites
as the secondary sources of information in this research work. This source has been
used while writing background of the study.
2.3 Method of Data Collection
First, 25 households were randomly selected altogether from the study area to make
the study convenient. Then the head of the household were selected as respondents
from the study area in view of keeping the gender balance among them. Similarly,
education as being one of the important factors in comprehending the meaning
of questions, a balance was tried to achieve respondents with different levels of
educational attainments. The primary data was collected by face-to-face interview
method with the help of questionnaire. The already prepared questions were directly
asked to the respondents. A set of questionnaire was developed as a tool for interview
to collect the data about the sanitation and socio-demographic characteristics. Along
with questionnaire and interview, observation was also done to know the existing
situation of the drinking water and sanitation of that area.

Chapter - 3
(Data Analysis and Presentation)
3.1 Distribution of Population by Sex and Educational Status

Education is an important indicator of the social status of an individual and a
fundamental factor of personality development. Hence, we felt that education
information is inevitable and the respondents were asked about their educational
status. At the same time, it is said that sex is also an important demographic factor
in the analysis of research work. It helps us to the variation in the level of knowledge
about sanitation and their sensitivity towards it. The distribution of the respondents
by sex and education is illustrated in the table given below:
Table 1: Distribution of Respondents by Sex and Education Status
Sex Population Percentage
Male 12 48.0
Female 13 52.0
Education Status Population Percentage
University 2 8.0
Higher Secondary 3 12.0
Secondary 4 16.0
Lower Secondary 6 24.0
Primary 10 40
Illiterate NA 0.0
Total 25 100.0
NA: Not Available Source: Field Survey, 2072 BS
The above table revealed that out of the total number of respondents, 48 percent
was female and 52 percent were the male respondents. Similarly, amongst the
respondents 8% were university graduates, (12%) higher secondary, (16%) secondary
and 40% of them had primary level education.
3.2 Distribution of Population by the Source of Drinking Water
The quality of drinking water is precisely determined by its sources. Therefore, the
respondents were asked about the sources of drinking water that they were using for
the drinking purpose. The following table reveals the status of the respondents by the
access to the sources of drinking water:

Table 2: Distribution of Respondents by the Source of Drinking Water
Sources of drinking water Population Percentage
Public Tap 11 44.0
Well 4 16.0
Pump 2 8.0
Tanker 5 20.0
Jar/Bottle 3 12.0
Total 25 100.0
NA: Not Available Source: Field Survey, 2072 BS
The above table revealed that (44%) of the respondents were found to be having
access to public tap for drinking water followed by tanker and well (20% and 16%)
respectively. At the same time, (12%) of them were found to be using jar and bottled
water and (8%) were found using pump water as the source of drinking water.
3.3 Distribution of Population by Reasons of Water Pollution
During the time of interview, the respondents were asked to give opinion about the
reasons of pollution in water. They gave different reasons for water pollution. The
following table reveals the status of the respondent’s response towards this query.
Table 3: Distribution of Respondents by Reasons of Water Pollution
Reason of Water Pollution Population Percentage
Rapid population growth 6 24.0
Pollution in the water sources 2 8.0
Lack of replacement of old pipes 8 32.0
Lack of water treatment plants 3 12.0
Improper distribution 5 20.0
Don’t know 1 4.0
Total 25 100.0
Source: Field Survey, 2072 BS
The above table revealed that 24 percent of the respondents opined that water
pollution occurs due to rapidly increasing population. Similarly, (32%) of them said
that it is due to lack of timely replacement of the old pipes. At the same time, (20%)
of them said that the cause of water pollution is improper distribution system. Among
them (4%) respondent could not say the reason of water pollution.

3.4 Distribution of population by Purification Method of Drinking water
During the time of interview, the respondents were asked about the methods they
were applying to purify drinking water at home. They gave different versions about the
purification method of drinking water, they have been doing at home. The following
table illustrates the distribution of the respondents by the method of purification.
Table 4: Distribution of population by Purification Method of Drinking water
Method Population Percentage
Filtration 15 60.0
Boiling 3 12.0
Chemical use 4 16.0
Euroguard 1 4.0
Doing nothing 2 8.0
Total 25 100.0
The above table reveled that out of the total respondents, (60%) of them do filtration,
and (12%) do boiling and (16%) use chemical substances in the drinking water before
use. At the same time, (4%) of them are using water of euro guard while (8%) of them
are using directly without any kind of filtration.
3.5 Distribution of Respondents by the Place of Disposal of Solid Wastes
Waste should be managed at the place from where it generates. More disposable
waste is produced in the city area due to the high density of population in comparison
to the rural area. The respondents were asked that where did they dispose the
refused wastes. The distribution of the respondents is revealed by the table that is
given below:
Table 5: Distribution of Respondents, by the Place of Disposal of Solid Wastes
Place of Disposal of Solid Wastes Population Percentage
Water sources 2 8.0
Public container 8 32.0
Open field 1 4.0
Along the road side 6 24.0
Municipal vehicle 8 32.0
Total 25 100.0

The above table revealed that the solid waste management practice was varied among
the respondents. During the survey, it was found that majority of the respondent
disposed the solid wastes in the public waste container and municipal vehicle
(37.78%) respectively. At the same time, (26%) of them found to be refusing them
along the roadside and (4%) of them were found to be disposed it in the open field.
In fact, place of disposal of solid waste in this study area or place depends on facilities
available nearer to respondents’ house and their attitude.
Chapter - 4
(Finding, Conclusion and Recommendation)
4.1 Findings
Out of the total number of respondents, 48 percent was female and 52 percent
were the male respondents.
Amongst the respondents (8%) were university graduates, (12%) higher secondary,
(16%) secondary and (40%) of them had primary level education.
(44%) of the respondents were found to be having access to public tap for drinking
water followed by tanker and well (20% and 16%) respectively.
At the same time, (12%) of them were found to be using jar and bottled water
and 8% were found using pump water as the source of drinking water.
(24%) of the respondents opined that water pollution occurs due to rapidly
increasing population.
(20%) respondents said that the cause of water pollution is improper distribution
system.
(60%) respondents were found doing filtration, and (12%) do boiling and (16%)
use chemical substances to purify the drinking water.
(8%) respondents were found to be drinking water directly without any kind of
purification process.
(37.78%) of the respondents were found disposing the refuses into the public
container and municipal vehicle.
(26%) of them were found to be refusing the waste along the roadside while (4%)
of them were found to be disposed it in the open field.
4.2 Conclusion
Male respondent’s population had outnumbered the female population.
Only (44%) of the populations had access to the public tap water.

Majority of the population opined that drinking water is polluted due to lack of
timely replacement of the old pipes.
Majority of the population was found using filtered water for drinking but still
(8%) population were drinking water directly without any kind of purification
process.
About a quarter of the population (26%) were found to be refusing the waste
along the roadside.
4.3 Recommendation
The government and the concerned authority need to increase their capacity in
the supply of clean and safe drinking water through public tap.
Public awareness need to be increased for public sanitation and sewage
management.
The government and the municipality need to be more accountable for all
possible measures over water pollution.
Provision of awareness campaign and strict punishment should be carried out
without any delay.

Appendix
References:
Bedi Yas Pal, 1997, “A Handbook of Preventive and Social Medicine”,
(Delhi: Anand Publishing Co).
Pande, B.D et. al., 2000, “Environment Education Source Book for
Bachelor’s Program”. (Kathmandu:IUCN Nepal).
Sharma, P.D., 2007, “Ecology and Environment”, (Meerut,India: Rastogi

Publication).
(A Set of Model Questionnaire)
Part - I: Household Related Questionnaire

1. Age : ...............
2. Sex: a. Male ( )
b. Female ( )
3. Type of family : a. Joint ( )
b. Nuclear ( )
4. Education: .............................
[Part- II: Sanitation Related Questionnaire]

3. Which of the following are the sources of drinking water at
your house?
a. Public Tap
b. Well
c. Pump
d. Tanker
e. Others
4. Do you think that the water you are drinking at your home is
clean and safe?
a. Yes ( ) b. No ( )
5. If No, which of the following reasons are strongly related with
not having drinking water clean and safe?
a. Rapid population growth
b. Pollution in the water sources
c. Lack of replacement of old pipes
d. Improper distribution of water
e. Lack of water treatment plants
6. Have you applied any methods to purify water before drinking?
a. Yes ( ) b. No ( )
7. If Yes, Which of the following methods have you applied?
a. Filtration
b. Boiling
c. Using chemicals
d. Euro guard
8. Where do you dispose the refuse waste generated from your
home and workplace?
a. Water sources
b. Public container
c. Open field
d. Along the roadside
e. Municipal vehicle
*******

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UNIT 2 DEMOGRAPHY, POPULATION CHANGE AND MANAGEMENT......................................15

UNIT 3 POPULATION, ENVIRONMENT AND DEVELOPMENT..................................................68

UNIT 4 POPULATION AND ENVIRONMENTAL STATUS OF NEPAL..........................................82

UNIT 5 FAMILY LIFE EDUCATION AND QUALITY OF LIFE......................................................105

UNIT 6 NATURAL RESOURCES AND BIODIVERSITY..............................................................125

UNIT 8 ADOLESCENCE, SEXUAL AND REPRODUCTIVE HEALTH EDUCATION........................194

UNIT 9 CONSUMER HEALTH AND COMMUNITY HEALTH........................................................217

UNIT 10 PRIMARY HEALTH CARE, PRECAUTION AND SECURITY ON RISK.............................261

PsfO * S of}ghGo /f]ux¿ (Sexually transmitted diseases): !&

1.1 Various Aspects of Health, Population and Environment

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Fig- 1: Interrelationship of Health, Population and Environment Education in terms of

A. Relation of Physical Aspect with other Aspects

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Ü Health, Population and Environment Education is a multidisciplinary subject. Due

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2.1 Demographic Components, Process and Measurements

2.1.2 Demographic Components

2.1.3 Demographic Process

2.1.4 Demographic Measurements

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2. General Fertility Rate (GFR)

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3. Age Specific Fertility Rate (ASFR)

Number of Women Number of Live (Ba)

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4. Total Fertility Rate (TFR)

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3. Infant Mortality Rate (IMR)

4. Under 5 Child Mortality Rate (U5MR)

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5. Maternal Mortality Ratio (MMR)

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2. Out-Migration Rate (O-MR)

3. Net Migration Rate (NMR)

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4. Gross Migration Rate (GMR)

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3. Population Doubling Time (PDT)

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Popn(15-59) Ü The independent population, between the age of 15-59 years

(a) Dependency Ratio:

(c) Old Dependency Ratio:

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2.2.2 Consequences of RPG on Socio-economic Aspect

Primary Health Centers 202** Senior A.H.W/HA 9,500

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C. Culture and Cultural Heritages

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