Health, Population and Environment Education 10

Modes of Transmission
i. Through contaminated blood transfusion Do You Know
ii. Unsafe sexual intercourse with the infected There are different types of
partner viruses that cause hepatitis.
iii. Use of unsterilized syringe, needle, etc. and They are A, B, C, D, E and G.
other surgical instruments Among them, three Hepatitis
iv. Piercing ears and making tattoos with viruses, viz A, B and C cause
unsterilized tools severe liver damage.
v. Through kissing with the infected partner
vi. Sharing toothbrush, towel, shaving blade, etc. with the patient
vii. Through mother to her unborn or newly born baby

viii. Through organ transplantation

Major Symptoms
i. Tiredness
ii. Abdominal pain Do You Know
iii. Loss of appetite Hepatitis B causes cancer of
iv. Yellow skin liver. It is the main cause of
v. Yellow eyes death of the patient suffering
vi. Light colourd stool from Hepatitis B.
vii. Long lasting infection of liver
viii. Cancer of liver
ix. Dark urine progression to jaundice

Prevention and Control Measures
i. Personal cleanliness should be maintained.
ii. We should avoid the use of unsterilized blade, razor, needle, syringe, etc.
iii. We should not pierce tattoos in the body.
iv. We should not take drugs.
v. We should not share blade, razor, toothbrush, handkerchief, etc.
vi. The needles used for piercing nose, ears, etc. and injecting medicines should be
disposed properly.
vii. Sterilized instruments should be used for acupuncture, surgery and treatment of
teeth.
viii. Unsafe sexual intercourse should be avoided.
ix. Anti Hepatitis B vaccine should be given to the baby born from infected mother.
x. Anti Hepatitis B vaccine should be given to all children.


GREEN Health, Population and Environment Education Book-10 151

2. Hepatitis C
The liver infection which is caused due to Hepatitis C virus is called Hepatitis C.

Modes of Transmission
i. Through contaminated blood transfusion
ii. Unsafe sexual intercourse with the infected partner
iii. Use of unsterilized syringe, needle, etc. and other surgical instruments
iv. Piercing ears and making tattoos with unsterilized tools
v. Through kissing with the infected partner
vi. Sharing toothbrush, towel, shaving blade, etc. with the patient
vii. Through mother to her unborn or newly born baby
viii. Through organ transplantation

Major Symptoms
i. Tiredness
ii. Abdominal pain
iii. Loss of appetite
iv. Yellow skin
v. Yellow eyes
vi. Light colourd stool
vii. Longlasting infection of liver
viii. Cancer of liver occurs which causes the death of the patient.

Prevention and Control Measures
i. Personal cleanliness should be maintained.
ii. We should avoid the use of unsterilized blade, razor, needle, syringe, etc.

iii. We should not pierce tattoos in the body.
iv. We should not take drugs.
v. We should not share blade, razor, toothbrush, handkerchief, etc.
vi. The needles used for piercing nose, ears, etc. and injecting medicines should be
disposed properly.
vii. Sterilized instruments should be used for acupuncture,
surgery and treatment of teeth.
viii. Unsafe sexual intercourse should be avoided.
ix. Anti Hepatitis C vaccine should be given to the baby
born from infected mother.
x. Anti Hepatitis C vaccine should be given to all children.
Fig: 11 Hepatitis C virus
152 GREEN Health, Population and Environment Education Book-10

However, Hepatitis B and C, do not transmit in following conditions.
i. Hugging
ii. Sitting together
iii. Shaking hands
iv. Coughing
v. Sneezing


7.9 non-Communicable Diseases

The diseases which are not transmitted from one person to another are called non-
communicable diseases. Heart diseases, diabetes, haemophilia, colour blindness, asthma,
brain stroke, peripheral arterial disease, rheumatic fever, etc. are some examples of non-
communicable diseases.












Fig: 12
Suffering from diabetes Heart attack

Some non-communicable diseases like heart diseases, diabetes, etc. transmit from
parents to their offspring. So these diseases are also called genetic diseases. Most of the
communicable diseases can be cured. But some non-communicable diseases cannot be
cured. Therefore, non-communicable diseases are life threatening and hence considered
more dangerous than communicable diseases.


7.10 Major Causes of non-Communicable Diseases

The major causes of non-communicable diseases can be divided into following two groups:


a. Causes that can be changed or modified
The causes of non-communicable diseases that can be changed or modified include:

i. Consumption of tobacco and products of tobacco
ii. Drinking alcohol
iii. Obesity
iv. Lack of physical exercise
v. Unhealthy lifestyle
vi. Unbalanced diet
GREEN Health, Population and Environment Education Book-10 153

vii. Unhealthy diet
viii. Mental tension
ix. High blood pressure
x. Increase in blood sugar level
xi. Increase in blood cholesterol

b. Causes that Cannot be Changed or Modified

The causes of non-communicable diseases that cannot be modified include:
i. Genetic causes or heredity
ii. Age
iii. Sex

Differences Between Communicable and Non-communicable Diseases

Parameters Communicable diseases Non-communicable diseases
Causes of • Get transmitted through • Unhealthy lifestyle
diseases germs and parasites from • Lack of physical exercise
infected person to a healthy • Smoking
person
• Chewing tobacco and
products of tobacco
• Drinking alcohol
• Mental tension
• Heredity or genetic cause
• Due to complication of
communicable diseases
Modes of • Direct contact with the • Genetically transmit from
transmission infected person/animal parents to their offspring
• Using articles used by the
patient
• Through vectors
• Droplet transmission
• From infected mother to her
baby
• Through contaminated
syringe, needle, blade, etc.
• Through animal bite/insect
bite






154 GREEN Health, Population and Environment Education Book-10

Nature or • Acute diseases (Short-term • Chronic or long term
characteristics of disease) Examples: Cholera, diseases
disease common cold, diarrhoea, • Can be prevented easily but
dsentery, typhoid, etc. difficult to cure

• Life-threatening and
incurable diseases
Examples: AIDS, Hepatitis
B, etc.





7.11 Some non-communicable Diseases


A. Cancer
Cancer is a non-communicable disease. It is a group of diseases involving abnormal cell
growth with the potential to spread or invade to other parts of the body. Cancer may
occur in any organ of the body.

Cancer generally occurs in uterus and breasts of females and mouth, throat, testes, urethra
and penis of males. More than 100 types of cancers are known so far.










Fig: 13
Mouth cancer Lung cancer Throat cancer Uterus cancer

Cancer is one of the major causes of death of human Do You Know
beings throughout the world. Twenty percent of
cancer patients die of smoking. In developing • The branch of Biology that
countries, about 70% of people die of cancer. About deals with cancer is called
76 lakh people die of cancer throughout the world oncology.
every year. It is estimated that about 1 crore 14 lakh • In 2015 AD, 8.8 million
people will die of cancer every year till 2030 AD.
people died of cancer while
The growth of tumour in the body is simply 90.5 million people had
considered as cancer. However, not all tumours cancer.
are cancerous. Benign tumours do not spread to
other parts of the body. Possible signs and symptoms include a lump, abnormal bleeding,
prolonged cough, unexplained weightloss, and a change in bowel movements.





GREEN Health, Population and Environment Education Book-10 155

Causes of Cancer
About 90-95% of cancer cases occur due to environmental factors and the remaining
5-10% are due to inherited genetics. Common environmental causes that contribute to
cancer death include tobacco (25-30%), unhealthy diet and obesity (30-35%), infections
(15-20%) stress, lack of physical activity and pollution.

The major causes of cancer are classified as follows:
1. Physical Factors Do You Know
Physical factors that cause cancer include exposure
to harmful radiation like UV-rays, x-rays, etc. • Tobacco smoke causes 90%
of lung cancer. It contains
2. Chemical Factors over fifty carcinogens.
Chemical factors that cause cancer include • Tobacco is responsible for
consumption of tobacco, tobacco products, alcohol about one in five cancer
and long term exposure to smoke, harmful colours, deaths worldwide.
etc.

3. Biological Factors
Biological factors that cause cancer include infection of bacteria and viruses. For example,
human papilloma virus causes cervical cancer in females. Hepatitis B virus causes liver
cancer. Similarly, Helicobacter pylori causes cancer of intestine.













Fig: 14
Human papilloma virus Hepatitis B virus Helicobacter pylori


Major Symptoms of Cancer
1. Sore does not get better for a long time.

2. The size of wart or mole increases gradually.
3. Painless lumps in breast can be noticed.
4. Blood is seen in the stool in intestinal cancer.
5. Persistent cough

6. Hoarseness of voice
7. Bleeding from nose, mouth, anus, vagina, etc.

156 GREEN Health, Population and Environment Education Book-10

8. Loss of body weight
9. Occurrence of sore in penis in case of prostate cancer and in the cervix in cervical
cancer.

Preventive and Control Measures of Cancer
1. Healthy lifestyle should be adopted.
2. Balanced diet should be taken.
3. Consumption of tobacco and products of tobacco should be avoided.
4. Consumption of alcohol should be avoided.
5. Sores and boils should be treated on time.
6. Personal hygiene should be maintained.
7. Hepatitis B should be controlled.
8. Warts should be treated on time.
9. Proper health education should be given.

B. Diseases of Heart and Blood Vessels

Heart diseases are the major causes of human death throughout the world. Heart diseases
and diseases of blood vessels are the major causes of death worldwide. About 1 crore 75
lakh people die of heart diseases every year in the world. According to WHO, about 2
crore 50 lakh people will die of heart diseases till 2020 AD. At that time, heart diseases will
be common in South-East Asia.

The common diseases of heart and blood vessels are given below:
S.No. Diseases Causes
1. Heart attack or coronary heart Blocking of coronary artery that supplies pure
disease blood to the muscles of the heart
2. Brain stroke Problem in blood vessels that supply pure
blood to the brain
3. Rheumatic heart disease Due to throat infection caused by bacteria
4. Peripheral arterial disease Problem in peripheral arteries that supply
blood to fore limbs and hind limbs
5. Different types of heart Due to defect in heart by birth or genetic cause
diseases (Congenital heart
diseases)


1. Heart Attack and Brain Stroke
Among different types of cardiovascular diseases, heart attack and brain stroke are
emergent and complex conditions. Heart attack and brain stroke are the life-threatening
conditions. Heart attack mainly occurs due to blockage of the coronary artery. The
coronary artery supplies pure (oxygenated) blood to the heart muscles. This artery gets


GREEN Health, Population and Environment Education Book-10 157

blocked due to deposition of cholesterol in the inner wall of the artery. It prevents the
circulation of blood to the heart muscles. It results in heart attack.












Fig: 15
Coronary artery Blocked coronary artery Heart attack

Similarly, brain stroke occurs due to blockage of cerebral arteries that supply pure blood
to the different parts of the brain.

A brief description of heart attack and brain stroke is given below:

a. Heart Attack
Heart attack is a life-threatening disease. It is a serious medical emergency which occurs
due to sudden stop in the supply of blood to the heart. Actually, heart attack is the damage
in the heart muscles due to lack of blood flow. This condition occurs when coronary artery
gets blocked.

Symptoms of Heart Attack
The major symptoms of heart attack are given below:
1. Severe chest pain as if hit with a sword
2. Sweating
3. Dizziness
4. Shortness of breath
5. Pain in the left side of the chest
6. Feeling of heartburn
7. Nausea
8. Vomiting
9. Weakness
10. Irregular heartbeat
11. Faint pulse
12. Unconsciousness

Causes of Heart Attack

The major causes of heart attack include:
1. Deposition of cholesterol in the inner wall of coronary artery
158 GREEN Health, Population and Environment Education Book-10

2. High blood pressure
3. Stress and hypertension
4. Coronary heart disease

5. Rheumatic heart disease
6. Obesity
7. Smoking tobacco and products of tobacco

8. Drinking alcohol
9. Prolonged consumption of fatty and oily foods

b. Brain Stroke
Brain stroke can be defined as the sudden death of brain cells due to poor supply of blood.
A person suffers from brain stroke when continuous flow of blood is interrupted to the
entire brain or its part. It occurs due to rupture or blockage of cerebral arteries that supply
pure blood to the brain. Generally, brain stroke occurs only one side of the brain. Brain
stroke may cause loss of memory, paralysis, speech impairment, etc. Brain stroke may
result in coma or death of the victim.


Causes of Brain Stroke
Various risk factors are responsible for brain stroke. Among them, the major causes of
brain stroke are given below:
i. When the age of a person increases, the risk of brain stroke also increases.
ii. Patients of diabetes, high blood pressure and heart diseases have increased risk of
brain stroke.
iii. Risk of brain stroke increases with high RBC count, obesity and high blood cholesterol.

iv. Persons with family history of brain stroke are at risk of brains stroke.
v. Risk of brain stroke increases with smoking, drinking alcohol, use of oral contraceptive
along with smoking, lack of physical exercise, consumption of intravenous drugs, etc.


Major Symptoms of Brain Stroke
The major symptoms of brain stroke are as follows:
i. Paralysis occurs in facial region or any part of the body.

ii. Weakness of limbs
iii. Paralysis of legs or arms
iv. Difficulty in speaking or no speech
v. Headache
vi. Loss of body balance


GREEN Health, Population and Environment Education Book-10 159

vii. Hearing disorders
viii. Unconsciousness


Preventive and Control Measures
i. Smoking and drinking alcohol should be avoided.
ii. Obesity should be reduced.

iii. Balanced diet should be taken regularly.
iv. Physical exercise should be done regularly.
v. We should be free from mental tension.

vi. Consumption of fatty, oily and spicy foods should be avoided.
vii. Fruits and vegetables should be consumed regularly.
viii. Blood pressure should be tested regularly and should be kept under normal condition.
ix. Use of drugs or narcotics should be avoided.


2. Rheumatic Fever and Rheumatic Heart Disease
Rheumatic fever is a disease associated with sore throat. It
is a serious illness that can cause stroke, permanent damage
to the heart and death of the victim if left untreated.
Children between the ages of 5 and 15 usually suffer from
rheumatic fever, however, it may attack older children and
adults, too.

Rheumatic fever affects the heart, joints and brain. Swelling
of the heart may cause chest pain and if severe, there may be
signs of heart failure. Rheumatic heart disease is a chronic Fig: 16 Rheumatic fever
condition caused by rheumatic fever.


Causes of Rheumatic Fever Do You Know
Rheumatic fever is caused by Group A of • Rheumatic fever is
Streptococcus bacterium. This bacterium is common in places like
commonly known as Beta-hemolytic streptococcus. Sub-Saharan Africa, South
This bacterium causes sore throat or scarlet fever Central Asia and Certain
which is an inflammatory disorder. populations in Australia
and New Zealand.
Major Symptoms of Rheumatic Fever
i. Sore throat with tender and swollen lymph nodes

ii. Red rashes in the skin
iii. Difficulty in swallowing
iv. Thick bloody discharge from nose

160 GREEN Health, Population and Environment Education Book-10

v. Body temperature about 101°F or more
vi. Red and swollen tonsils
vii. Tonsils with white patches or pus

viii. Headache
ix. Nausea
x. Vomiting

xi. Small painless nodules or bumps under the skin
xii. Chest pain and stomach pain
xiii. Fatigue or lethargy
xiv. Sweating, shortness of breath

xv. Pain in one joint that moves to another joint
xvi. Red, hot swollen joints
xvii. Jerky, uncontrollable movements of hands, feet and face


Risk Factors of Rheumatic Fever
Factors that increase the chances of developing rheumatic fever are as follows:
i. A family history because certain genes make more likely to develop rheumatic fever
ii. The type of streptococcus bacteria

iii. Environmental factors like poor sanitation, overcrowding and contaminated water

Preventive and Control Measures of Rheumatic Fever
i. Mouth and nose should be covered with a handkerchief while coughing and sneezing.
ii. Direct contact with the patient should be avoided.

iii. Personal articles of the patient should not be used.
iv. Hands should be washed with soap and water after taking care of the patient.
v. The patient should be treated quickly and thoroughly.

3. Diabetes

Diabetes mellitus, commonly referred as diabetes, is a group of metabolic disorder in
which there is high blood sugar levels over a prolonged period. Symptoms of high blood
sugar include frequent urination, increased thirst and increased hunger. If left untreated
diabetes can cause various complications like stroke, cardiovascular disease, eye-damage,
kidney disease, foot ulcers, etc.
Diabetes occurs due to lack of insulin hormone secreted by pancreas or the cells of the
body not responding properly to the insulin produced by pancreas. There are three main
types of diabetes mellitus. They are as follows:

GREEN Health, Population and Environment Education Book-10 161

i. Type 1 Diabetes Mellitus
It occurs when pancreas cannot secrete enough insulin. Its cause is unknown.

ii. Type 2 Diabetes Mellitus
It begins with insulin resistance, a condition in which cells fail to respond insulin properly.
As the disease progresses a lack of insulin may also develop. The major cause of type 2
diabetes is excessive body weight and lack of physical exercise.


iii. Gestational Diabetes
It occurs after 40 years. However, many people suffer from diabetes before the age of
40 years. In our body, pancreas secretes a hormone called insulin which regulates the
conversion of extra glucose in the form of glycogen. When the secretion of insulin
decreases extra glucose cannot be converted into glycogen. As a result, the amount of
sugar increases in blood and urine. This condition is commonly known as diabetes or
sugar disease.
Do You Know
• As of 2015, an estimated 415 million people
had diabetes worldwide with type 2 diabetes
making up about 90% of the cases.
• Diabetes at least doubles a person’s risk of early
death.
• From 2012 to 2015 AD, 1.5 million to 5 million
deaths each year resulted from diabetes.
Fig: 17 Obesity causes diabetes


Major Symptoms of Diabetes
1. Frequent urination
2. Extreme thirst
3. Extreme hunger
4. Increased amount of sugar in blood and urine
5. Weakness

6. Delay in wound healing
7. Fatigue
8. Tiredness and lethargy
9. Ulcers in feet
10. Blurry vision
11. Itchy skin
12. Prolonged diabetes may damage the eyes, kidneys and nerves



162 GREEN Health, Population and Environment Education Book-10

Preventive and Control Measures
1. Healthy and balanced diet should be consumed.
2. Physical exercise should be done regularly.
3. Obesity should be reduced.

4. Consumption of tobacco and tobacco products should be avoided.
5. Smoking and drinking alcohol should be avoided.
6. Too much consumption of carbohydrate should be reduced.

7. The patient of diabetes should always keep ID card with him/her.
8. The diabetes patient should protect him/her from accidents, cuts, etc.
9. The diabetes patient should take medicine or insulin injection after consulting the
doctor.
10. Consumption of fatty, oily and spicy foods should be avoided.


4. Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a disorder which occurs due to the
obstruction of bronchi and bronchioles. It causes difficulty in breathing and continuous
coughing. This disease is commonly known as asthma (dam/khoki).
Chronic obstructive pulmonary disease occurs due to cold, dust, smoke, allergy,
pneumonia, roundworm infection, etc. This disease cannot be cured completely but can
be prevented. According to WHO, about 8 crore people have been suffering from chronic
obstructive pulmonary disease. This disease is common in children and old persons.
However, young persons also suffer from this disease.


Major causes of COPD
i. Smoking
ii. Dust particles
iii. Harmful chemicals

iv. Smoke released from firewood while cooking food
v. Smoke released from vehicles and industries
vi. Genetic Fig: 18

Major symptoms of COPD
i. Difficulty in breathing while sleeping
ii. Heaviness in the chest
iii. Coughing
iv. Restlessness
v. Wheezing breathing while climbing slopes, running, working, etc.

GREEN Health, Population and Environment Education Book-10 163

vi. The rate of pulse and breathing increases.
vii. The patient may die in case of severe COPD if s/he does not get oxygen in time.

Preventive and Control Measures
i. Smoking should be avoided.

ii. We should stay away from the allergy.
iii. The patient should stay in a clean environment having fresh air.
iv. Sufficient hot liquid should be taken.
v. Oxygen should be given immediately if there is difficulty in breathing.

vi. Medicine should be taken according to doctor’s advice.
vii. Warm clothes should be worn to avoid cold.



7.12 Environmentally infectious Diseases

1. Cholera
Cholera is an infection of small intestine. It is caused by
some strains of bacterium Vibrio cholerae. This disease
is transmitted easily from unhealthy and polluted
environment. Cholera spreads mostly by unsafe water and
unsafe food that has been contaminated with human faeces
containing the bacteria. Humans are the only animals that
suffer from cholera. The major risk factors of this disease
include poor sanitation, not enough clean drinking water
and poverty. Fig: 19 Vibrio cholerae
Cholera affects an estimated 3 – 5 million people worldwide and causes 28800-130000
deaths a year. So cholera is classified as a pandemic disease. Areas with an ongoing risk of
disease include Africa and South-East-Asia. While the risk of death among those affected
is usually less than 5%, it may be as high as 50% among some groups who do not have
access to treatment.


Causative Agent Do You Know
The causative agent of cholera is a • In 1883 AD, Robert Cock discovered
bacterium called Vibrio cholerae. the causative agent of cholera, i.e. Vibrio
cholerae.
Modes of Transmission
i. Through contaminated food and water
ii. By means of flies

iii. Through the articles used by the patient


164 GREEN Health, Population and Environment Education Book-10

iv. Consumption of fruits and vegetables washed with contaminated water
v. Direct contact with the patient


Major Symptoms
i. Abdominal pain
ii. Passing out of profuse loose watery stool more than 40 times a day
iii. Vomiting

iv. Sunken eyes
v. Dry eyes, mouth and lips
vi. Decrease in body temperature

vii. Muscle cramping
viii. Dehydration
ix. Shrinking of skin
x. Sunken palate Fig: 20 Patient suffering from cholera


Preventive and Control Measures
i. The patient should be isolated.
ii. Consumption of contaminated food and water should be avoided.
iii. Patient should be rushed to the hospital for treatment.
iv. We should drink boiled water.
v. Defecation should be done only in the toilet.
vi. Vomit and faeces of the patient should be disposed properly.
vii. Anti cholera vaccine should be given.
viii. Flies should be controlled.

ix. Consumption of stale foods and raw foods should be avoided.
x. Food items should be covered properly.
xi. Hands should be washed properly with soap-water before taking food and after
visiting toilet.
xii. Raw foods and salads should be washed properly with pure water.

xiii. Personal hygiene should be maintained.
xiv. Proper health education should be given to generate awareness.

2. Dengue Fever

Dengue fever is a communicable disease caused by a virus. This disease is transmitted
due to the bite of infected female mosquito called Aedes aegyptii. Dengue virus is found in
the blood of the infected person.
GREEN Health, Population and Environment Education Book-10 165

About 3 crore people get infected with dengue fever annually. This disease is very
common in warm climates. However, this disease is found worldwide. For the first time,
the vaccine against dengue fever was discovered in 2016 AD.













Fig: 21
Aedes aegyptii mosquito Eggs of Aedes aegyptii


Habit of the mosquito that transmits dengue fever
i. Aedes mosquito (female) lays eggs in clean water.
ii. It lays eggs in clean water, in the water stored, in empty tin cans, containers of paint,
drums, old tyres, tubes, etc. during rainy season.
iii. It lays eggs in water stored in vases, air conditioner, cooler, etc.

Major Symptoms

1. Sudden high fever
2. Fever remains for 5-7 days
3. Severe headache
4. Pain in the pupil and backside of head

5. Rashes in the body
6. Bleeding from the nose and gums
7. Pain in joints, bones and muscles Fig: 22

8. Nausea
9. Vomiting
10. Pain in abdomen
11. Tiredness

12. Unconsciousness

Preventive and Control Measures
1. Mosquito-bite should be avoided.
2. Mosquitoes should be controlled.


166 GREEN Health, Population and Environment Education Book-10

3. We should use mosquito repellants.
4. We should sleep inside the mosquito net.
5. Anti-mosquito cream should be applied on exposed parts of body.

6. Full-sleeved clothes should be worn to avoid mosquito bite.
7. Puddles should be either drained or filled with sand to control mosquito breeding.
8. The surroundings of the house should be cleaned.

9. Windows and doors should be screened.
10. Kerosene or paraffin should be sprayed on the surface of ditches, puddle, ponds, etc.
11. Larvicidal fishes should be introduced in ponds, lakes, etc.


3. Viral Influenza

Viral influenza is a disease of respiratory system caused
by influenza virus of maxovirus group. This disease is
commonly known as flu. It is a pandemic disease. This
disease spreads very fast in a wide range and affects
a large number of population within a short period of
time.

Viral influenza can spread at any time, place and Person suffering from viral
population within a short period of time. Therefore, it is influenza
also called an international disease. The person of any Fig: 23
age can suffer from this disease. This disease get transmitted easily in schools, colleges,
factories, supermarkets, refugee camps, rallies and other crowded areas.

Causes
Viral influenza is caused by three types of influenza viruses. They are:

i. Influenza A ii. Influenza B iii. Influenza C
Among them, the influenza caused by influenza A virus is more dangerous and spreads
fast as compared to the influenza caused by B and C.

Modes of Transmission
Various modes of transmission of viral influenza virus are given below:


1. Direct contact with the patient
When a healthy person comes in close contact of the patient suffering from viral influenza,
s/he will gets infected. It is transmitted by shaking hands and hugging with the patient.

2. Droplet infection
Viral influenza is transmitted trough droplets of the patient while coughing, sneezing,
talking, etc.
GREEN Health, Population and Environment Education Book-10 167

3. Through the materials produced by the patient
Viral influenza is transmitted through cough, urine and stool of the patient.

4. Through the materials used by the patient
Viral influenza is also transmitted through the personal materials of the patient such as
tooth brush, spoon, handkerchief, towel, clothes, etc.

Major symptoms
i. Runny nose
ii. Fever
iii. Headache
iv. Feeling of cold
v. Throat pain
vi. Pain in muscles
vii. Itchy eyes
viii. Eyes become red
ix. Stuffy nose
x. Hoarseness of sound
xi. Body ache
xii. Joint pain and back pain
xiii. Abdominal pain in children
xiv. Diarrhoea

Preventive and Control Measures
i. The patient should be taken to the hospital immediately for treatment.
ii. The patient should be isolated.

iii. The use of personal articles of the patient should be avoided.
iv. The patient should cover his/her nose and mouth with a handkerchief while coughing
and sneezing.

v. The cough, urine and stool of the patient should be disposed properly.
vi. The patient should be kept in clean and bright place having fresh air.
vii. Direct contact with the patient should be avoided.
viii. We should not go to the places having crowd.

ix. We should use mask while going into crowd.
x. Hands should be washed properly with soap and water after taking care of the
patient.
xi. The materials used by the patient should be sterilized.

168 GREEN Health, Population and Environment Education Book-10

Activity

• Visit in your locality and prepare a list of communicable and non-communicable
diseases from which the local people are suffering.
• Suggest preventive and control measures of those diseases to the local people.
• Prepare a project work on non-communicable diseases in Nepal.

Summary

1. A disease is an illness affecting humans, animals or plants, often caused by infection.
2. The word disease is made up of two words, viz. ‘dis’ and ‘ease’ which simply
means lack of easiness or lack of comfort.
3. Those diseases which transmit from infected person to another are called
communicable diseases.
4. Communicable diseases are mainly caused due to infection of micro organisms.
5. The diseases which do not transmit from one person to another are called non-
communicable diseases.
6. Non-communicable diseases mainly occur due to malfunction of body parts,
unhealthy lifestyle, mental stress, lack of physical exercise, smoking, drinking
alcohol, etc.
7. When the immune system of the body connot fight against disease causing germs,
symptoms of the disease are seen and the person becomes the source of infection.
8. The diseases which are transmitted through air are called air-borne diseases.
9. The diseases which are transmitted through contaminated food and water are
called food and water-bone disease.
10. Cancer is a non-communicable disease. It is a group of diseases involving abnormal
cell growth with the potential to spread or invade to other parts of the body.
11. Heart attack and brain stroke are the life-threatening conditions. Heart attack
mainly occurs due to blockage of the coronary artery.
12. Heart attack is a life-threatening disease. It is a serious medical emergency which
occurs due to sudden stop in the supply of blood to the heart.
13. Brain stroke can be defined as the sudden death of brain cells due to poor supply of
blood.
14. Rheumatic fever is a disease associated with strep throat.
15. Children between the ages of 5 and 15 usually suffer from rheumatic fever, however,
it may attack older children and adults, too.
16. Diabetes mellitus, commonly referred as diabetes, is a group of metabolic disorder
in which there is high blood sugar levels over a prolonged period.
17. Chronic obstructive pulmonary disease (COPD) is a disorder which occurs due to
the obstruction of bronchi and bronchioles. It causes difficulty in breathing and
continuous coughing.
18. Cholera is an infection of small intestine. It is caused by some strains of bacterium
Vibrio cholerae.


GREEN Health, Population and Environment Education Book-10 169

19. Cholera spreads mostly by unsafe water and unsafe food that has been contaminated
with human faeces containing the bacteria.
20. Dengue fever is a communicable disease caused by a virus. The disease is transmitted
due to the bite of infected female mosquito called Aedes aegyptii.
21. Viral influenza is a disease of respiratory system caused by influenza virus of
maxovirus group. This disease is commonly known as flu.



Exercise

A. Write very short answer to the following questions.
1. What is a disease?
2. What are two types of diseases? Name them.

3. What are communicable diseases?
4. Give any two examples of communicable diseases.
5. What are non-communicable diseases?
6. Name any two non-communicable diseases.
7. Name any two diseases that are transmitted through air.
8. Name any two diseases that are transmitted through contaminated food and
water.
9. Write any two symptoms of round worm infection.
10. What is diarrhoea?
11. Write any two symptoms of diarrhoea.
12. What is dysentery?
13. Name two types of dysentery.
14. What is the causative agent of amoebic dysentery?
15. Write any two symptoms of common cold.
16. What is hepatitis B?
17. Write any two causes of non-communicable diseases.

18. Write any two symptoms of cancer.
19. Write any two preventive and control measures of cancer.
20. What is heart attack?
21. Write any two symptoms of rheumatic fever.
22. What is diabetes?
23. Write any two symptoms of diabetes.
24. Write down the full form of COPD.
25. Write down the causative agent of cholera.

170 GREEN Health, Population and Environment Education Book-10

26. Name the vector of dengue fever.
27. What is the causative agent of viral influenza?
28. Write any two symptoms of viral influenza.


B. Write short answer to the following questions
1. What is meant by disease? How is it defined? Describe in brief.
2. What are communicable and non-communicable diseases? Write with examples.
3. Non-communicable diseases are more dangerous than communicable diseases.
Justify this statement.
4. Differentiate between communicable and non-communicable diseases.
5. Write any four modes of transmission of communicable diseases.
6. Write down the major symptoms of roundworm infection.
7. Write down the major symptoms of Bacillary dysentery.
8. Write down the modes of transmission of Hepatitis B.
9. Write down the preventive and control measures of Hepatitis C.
10. Write down the major causes of cancer.
11. Write down the preventive and control measures of heart attack and brain stroke.
12. Write down the major symptoms of diabetes.
13. Write down the major symptoms of COPD.
14. Write down the modes of transmission of cholera.
15. Write down the major symptoms of dengue fever.


C. Write long answer to the following questions
1. Explain the concept of ‘disease’.
2. Write down the causes, modes of transmission, and major symptoms of Bacillary
dysentery.
3. Write down the causes, modes of transmission and major symptoms of common
cold.
4. Explain the causes and preventive majors of non-communicable diseases.
5. Explain in short about diseases of heart and blood vessels.
6. Write down the causes, major symptoms and control measures of diabetes.
7. Explain in brief about chronic obstructive pulmonary disease.
8. Write down the causes, and major symptoms of cholera.
9. Write down the causes, modes of transmission of dengue fever.
10. Write down the causes, modes of transmission and major symptoms of viral
influenza.






GREEN Health, Population and Environment Education Book-10 171

unit Adolescence, Sexual
8 and Reproductive Health




Education



Estimated Teaching Periods: 16



Learning Outcomes
Learning Objectives
After completing the study of this unit, students will be able to:
i. introduce sexually transmitted diseases with examples.
ii. describe the causative agent, modes of transmission, major symptoms and preventive measures of
some sexually transmitted diseases.
iii. introduce safe motherhood.
iv. explain the problems and complications that occur during pregnancy.
v. explain maternal and child health care and its measures.
vi. explain safe delivery and natal care.



Course Outline

8.1 Sexually Transmitted Diseases
8.2 Safe Motherhood
8.3 Maternal and Child Health care and Its Measures


Glossary

adolescence : the period of life when a child develops into an adult
parasite : an animal or plant that lives in or on another animal or plant and gets food
or protection from it
antibiotic : a drug that is used to kill harmful bacterial and to cure infections
susceptibility : the state of being easily affected, influenced, or harmed by something
prostitution : the work of a prostitute: the act of having sex in exchange for money
diagnosis : the act of identifying a disease, illness or problem by examining someone
or something
chancre : a primary sore or ulcer at the site of entry of a pathogen
dysuria : difficult or painful discharge of urine





172 GREEN Health, Population and Environment Education Book-10

8.1 Sexually transmitted Diseases
Sexually transmitted diseases (STDs) are infections that are passed from one person to
another through sexual contact. The causes of sexually transmitted diseases are bacteria,
parasites, yeast and viruses. They are transmitted from infected person to a healthy person
through unsafe sexual contact. Unsafe sexual contact refers to the sexual contact before
maturity of sex organs, sexual contact with multiple partners, sexual contact without
using condoms and unnatural sexual activities.
There are more than 20 types of sexually transmitted diseases. Among them, the major
STDs are HIV/AIDS, Syphilis, Chlamydia, Genital herpes, Trichomoniasis, Gonorrhoea,
Chancroid, etc. Most STDs affect both men and women, but in most cases the health
problems they cause can be more severe for women. If a pregnant woman has an STD, it
can cause serious health problems for the baby.
STDs caused by bacteria, yeast or parasites can be treated by antibiotics. But there is no
cure for STDs caused by viruses. However medicines can often help with the symptoms
and keep the disease under control. Correct usage of latex condoms greatly reduces, but
does not completely eliminate, the risk of catching or spreading STDs.













Fig: 1
Person suffering from AIDs Person having syphilis Person having gonorrhoea

The most effective way of preventing STDs is to stay far from having sex. Some vaccinations
may also decrease the risk of certain infections including Hepatitis B and some types
of HPV. Safer sex practices such as use of condoms, having only one sex partner. Most
STDs are curable. Of the most common infections syphilis, gonorrhoea, chlamydia and
trichomoniasis are treatable and curable, while herpes, hepatitis B, HIV/AIDS and HPV
are treatable but not curable.
In this unit, we will study in detail about HIV/AIDS, syphilis, gonorrhoea, chancroid, etc.

Some Major Sexually Transmitted Diseases (STDs)

HIV/AIDS
AIDS (Acquired Immuno Deficiency Syndrome) is a syndrome caused by a virus called
HIV (Human Immunodeficiency Virus). The disease alters the immune system, making
people much more vulnerable to infections and diseases. This susceptibility worsens as
the syndrome progresses.



GREEN Health, Population and Environment Education Book-10 173

Fig: 2
HIV virus AIDS patient

Do You Know
HIV is found throughout all tissues
of the body but is transmitted via • HIV is the virus that destroys the body’s
the body fluids of an infected immune system while AIDS is a medical
person such as semen, vaginal condition in which a person suffers from
fluids, blood and breast milk. multiple infections.
HIV is the virus that attacks the T-cells in the immune system. AIDS is the syndrome,
which appears in the advanced stage of HIV infection.
HIV infection can cause AIDS to develop. However, it is possible to be infected with
HIV without developing AIDS. Without treatment the HIV infection can progress and
eventually it will develop into AIDS in the vast majority of the cases. Once someone has
received an AIDS diagnosis, it will always carry over with them in their medical history.

Causes of HIV and AIDS
HIV can be passed from one person to another through blood to blood and sexual contact.
HIV is a retrovirus that infects the vital organs and cells of human immune system.

The virus progresses in the absence of antiretroviral therapy (ART) a drug therapy that
slows or prevents the growth of new HIV viruses. The rate of virus progression varies
widely between individuals and depends on many factors. These factors include the age
of the patient, the body’s ability to defend against HIV, access to health care, existence of
other infections, the infected person’s genetic inheritance, resistance to certain strains of
HIV and so on.

How is HIV transmitted?

1. Sexual Transmission

It happens when there is contact with infected sexual fluids genital, rectal or oral mucous
membranes. This can happen while having unprotected sex, including vaginal, oral and
anal sex or sharing sex toys with someone infected with HIV.


2. Blood Transmission
The risk of transmitting HIV through blood transfusion is now-a-days extremely low in

174 GREEN Health, Population and Environment Education Book-10

developed countries. However, among injections or intravenous drug users, sharing and
reusing syringes contaminated with HIV-infected blood is extremely hazardous.

HIV Symptoms
For the most part, the symptoms of HIV are the result of infections caused by bacteria,
viruses, fungi or other parasites.

These conditions do not normally develop in individuals with healthy immune systems
which protect the body against infection.


Symptoms of Early HIV Infection
Many people with HIV have no symptoms for several months to even years after having
infection. Others may develop symptoms similar to flu, usually 2-6 weeks after catching
the virus.
The symptoms of early HIV infection may include:
i. Fever
ii. Chills
iii. Joint pain
iv. Sore throat
v. Muscle aches
vi. Sweating at night
vii. Tiredness
viii. Enlarged glands
ix. Red rashes
x. Unintentional weightloss

Asymptomatic HIV
In many cases, after the initial infection, there will not be any further symptoms for many
years. During this time, the virus carries on developing and damaging the immune system
and organs. Without being on medications to stop HIV’s replication, this process can take
upto 10 years on average. The infected person often experiences no symptoms, feels well
and appears healthy.

Late-stage HIV Infection
If left untreated, HIV weakens the ability to fight infection. The person becomes vulnerable
to serious illness. This stage of infection is known as AIDs.
The major symptoms of late-stage HIV infection may include.
i. Blurred vision

ii. Dry cough
iii. Persistent or chromic diarrhoea


GREEN Health, Population and Environment Education Book-10 175

iv. Fever (above 100°F) lasting for two weeks
v. Sweating at night
vi. Permanent tiredness

vii. Shortness of breath
viii. Swollen glands
ix. White spots on the tongue or mouth

x. Unintentional weightloss
xi. Skin infection
xii. Pneumonia
xiii. Developmnent of multiple cancers

xiv. Death of the patient
During the late-stage of HIV infection, the risk of developing a life threatening illness is
much greater. Life threatening illness may be controlled, avoided, and or treated with
proper medications, often including HIV treatment.


HIV and AIDS Myths and Facts
There are many misconceptions about HIV and AIDS. The virus cannot be transmitted
from:

i. shaking hand.
ii. hugging.
iii. casual kissing.
iv. sneezing.

v. touching unbroken skin.
vi. using the same toilet.
vii. sharing cutlery.
viii. mouth-to-mouth resuscitation.


Prevention and Control Measures
Following measures should be adopted to prevent being infected with HIV:
1. Unsafe sexual intercourse with the infected partner should be avoided.
2. Sexual intercourse wit multiple partners should be avoided.

3. Prostitution should be avoided.
4. Women trafficking should be controlled.
5. Blood should be screened before transfusion.


176 GREEN Health, Population and Environment Education Book-10

6. Sterilized or disposable syringe should be used.
7. Use of contaminated needle, syringe, blade, Do You Know
etc. should be avoided. • The time period that it
8. Condom should be used during sexual takes for the HIV blood
intercourse. test to give positive result
after getting infected with
9. Sex trade in rural and urban areas should be HIV (retro virus) is called
controlled.
window period.
10. Poverty and unemployment should be • During window period
reduced. the blood of the person

11. Body piercing and making tattoos should be infected with HIV shows
avoided. HIV negative test but s/he

12. Pregnancy should be avoided if the mother is may transmit HIV to other
HIV-positive. healthy persons.
13. Anti-retroviral therapy (ART) should be taken • Window period lasts for 3
by HIV-positive persons. weeks to 12 months.
14. Proper health education should be given to develop awareness.

15. Sexual intercourse before maturity of sex organs should be avoided.

Causes of Prevalence of HIV/AIDS in Nepal
The major causes of prevalence of HIV/AIDS in Nepal are described below:


1. Illegal Sex Trade in Rural and Urban Areas of Nepal
In our country, sex trade is illegal. But some people are involved in illegal sex trade. When
people involve in unsafe sexual activity, they transmit HIV/AIDS to their sex partners.


2. Human Trafficking from Nepal
In Nepal, some people are involved in
human trafficking. The smugglers lure
poor and needy people (mainly girls and
women) and sell them in India and other
countries. These girls and women are
compelled to have sex with many partners.
If they practice unsafe sexual intercourse,
they transmit HIV/AIDS to their sex
partners. When these sex workers return
back to Nepal, they may also transmit
HIV/AIDS to their sex partners.
Fig: 3





GREEN Health, Population and Environment Education Book-10 177

3. Poverty and Unemployment
Poverty and unemployment is another major cause of prevalence of HIV/AIDS in Nepal.
Many people go to India and other countries for employment. When they stay outside
home for a long period of time they may involve in sexual relationship with prostitutes
or sex workers. If they establish unsafe sexual relation with infected sex workers, they
get infected with HIV/AIDS. When they return to their home, they transmit HIV/AIDS to
their sex-partner.


4. Lack of Sex Education or Lack of Awareness
In Nepal, many people are totally ignorant about sex, sexual intercourse and sexually
transmitted diseases are not discussed openly in our society. Even husband and wife do
not discuss openly in our society regarding sex issues. So they do not know about HIV/
AIDS, its transmission and preventive and control measures. They involve in unsafe
sexual activities due to ignorance and hence may get HIV infection.


5. Social Taboos About Open Discussion on STDs
Due to social taboos, we do not discuss openly about sexually transmitted diseases. Many
people do not talk about STDs and hide their disease. They do not share their problems
related to STDs even to the doctor. Many people still believe that to talk about STDs is
against the social norms and values. This is another reason of prevalence of HIV/AIDS in
Nepal.

Syphilis

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.
The signs and symptoms of syphilis vary depending in which of the four stages it presents
viz. primary, secondary, latent and tertiary.
The primary stage of syphilis classically presents with a single chancre (a firm, painless and
non-itchy ulceration) but there may be multiple sores. In secondary syphilis, a diffuse rash
occurs, which frequently involves the palms of the hands and soles of the feet. There may
also be sores in mouth or vagina. In latent syphilis, there are few or no symptoms. In tertiary
syphilis, there are gummas (soft non-cancerous growths), neurological or heart symptoms.





Do You Know
• Syphilis has been known as the great
imitator as it may cause symptoms
similar to many other diseases.

Fig: 4
Electron micrograph of
Treponema pallidum



178 GREEN Health, Population and Environment Education Book-10

Syphilis is generally transmitted through unsafe sexual intercourse. This commonly
occurs in young people as they have a high frequency of sexual activities. This disease
can be cured if treated in its early stage. But, most people hide this disease and do not go
for treatment. If not treated on time, this disease may damage various vital organs of the
body such as brain, liver, heart, etc. which may cause the death of the patient.


Modes of Transmission
i. Syphilis is transmitted through the unsafe sexual intercourse with the infected
partner.

ii. It is transmitted from pregnant mother to her unborn baby.
iii. It is also transmitted through contaminated blood transfusion.

Major Symptoms
Syphilis infection occurs in three distinct stages. They are as follows:


Early or Primary Symptoms
People with primary syphilis will develop one or
more sores. The sores are usually small painless
ulcers. They occur on the genitals or around the
mouth between 10-19 days of infection. Then the
sores spread to anus, lips, tongue, breast, fingers, etc.
Even without treatment the sores heal without a scar
within six weeks.

The secondary stage may last one to three months
and begins within six weeks to six months after
exposure. People with secondary syphilis experience
a rosy “copper penny” rash typically on the palms of Fig: 5 Sores of primary syphilis
the hands and soles of the feet. However, rashes with
a different appearance may occur on other parts of the body. They may also experience
moist warts in the groin, white patches on the inside of mouth, swollen lymph glands
fever and weight loss. Like primary syphilis, secondary will resolve without treatment.


Latent Syphilis
Latent syphilis is the infection that lies dormant (inactive) without causing symptoms.


Tertiary Syphilis
If the syphilis is not treated, it may then progress to a stage characterized by severe
problems with the heart, brain and nerves that can result in paralysis, blindness, dementia,
deafness, impotance and even death if it is not treated.





GREEN Health, Population and Environment Education Book-10 179

Fig: 6
Secondary syphilis Tertiary syphilis


Preventive and Control Measures
i. Unsafe sexual intercourse with the infected partner should be avoided.

ii. Condom should be used during sexual intercourse.
iii. Prostitution should be stopped.
iv. Blood should be screened before transfusion.

v. Intimate contact with the infected person should be avoided.
vi. Infected person should be treated in the early stage of infection.
vii. Proper health education should be given to develop awareness.
viii. Personal belongings of the infected person should not be used.

xi. The patient should be isolated.

Gonorrhoea
Gonorrhoea is a sexually transmitted infection (STI) caused by the bacterium Neisseria
gonorrhoea. Many people have no symptoms. Men may have burning with urination,
discharge from penis or testicular pain. Women may have burning with urination, vaginal
discharge, vaginal bleeding between periods or pelvic pain. Complications in women
include pelvic inflammatory disease and in men include inflammation of the epididymis.
If untreated gonorrhoea can spread joints or heart valves.












Fig: 7
Neisseria gonorrhoea Gonococcal lesion on the skin




180 GREEN Health, Population and Environment Education Book-10

Gonorrhoea : At a glance
Speciality : Infectious disease
Causative agent : Neisseria gonorrhoea
Modes of transmission : Unsafe sexual contact with the infected partner
Symptoms : None, burning with urination, vaginal discharge, discharge
from the penis, pelvic pain, testicular pain
Diagnosis : Testing with urine, urethra in males or cervix in females
Prevention : Condoms, having sex with only one partner who is
uninfected, not having sex with infected partner
Treatment : Ceftriaxone by injection and azithromycin by mouth

Gonorrhoea is spread through sexual contact with an infected person. This includes oral,
anal and vaginal sex. It can also spread from a mother to a child during birth.

Gonorrhoea affects about 0.8% of women and 0.6% of men. An estimated 33 to 106 million
new cases occur each year, out of the 498 million new cases curable STI- which also
includes Syphilis, Chlamydia and Trichomoniasis. Infections in women most commonly
occur when they are young adults.
Gonorrhoea affects both males and females. This disease infects urethra, rectum, eyes,
throat, etc. It produces lesions around urethra. It may also affect epididymis and inner
part of uterus. The person having gonorrhoea has an increased risk of getting infected
with syphilis and other STI’s.


Modes of Transmission
i. Through unsafe sexual intercourse with the infected partner

ii. Contact with the materials used by the patient
iii. Through contaminated blood transfusion
iv. Through contaminated needle, razor, blade, syringe, etc.

v. From infected mother to her unborn child

Major Symptoms
i. Frequent urination
ii. Burning sensation while urinating

iii. Vaginal discharge
iv. Discharge from penis
v. Swelling of urethra and difficulty in urination
vi. Oozing of grey or yellowish pus from the ulcers Fig: 8
Ulcer gonorrhoea
vii. Bleeding from the ulcers
viii. Vaginal bleeding

GREEN Health, Population and Environment Education Book-10 181

ix. Pelvic pain
x. Bleeding between periods in females
xi. Appearance of open sores on penis and around vagina


Preventive and Control Measures
i. Unsafe sexual intercourse with the infected partner should be avoided.
ii. Condom should be used during sexual intercourse.
iii. Prostitution should be stopped.

iv. Blood should be screened before transfusion.
v. Intimate contact with the infected person should be avoided.
vi. Infected person should be treated in the early stage of infection.

vii. Proper health education should be given to develop awareness.
viii. Personal belongings of the infected person should not be used.
xi. The patient should be isolated.


Chancroid
Chancroid is a bacterial sexually transmitted infection characterized by painful sores on
the genitalia. It is transmitted from infected person to another by sexual contact. However,
it spreads less as compared to HIV/AIDS, syphilis and gonorrhoea.












Fig: 9
Chancre sore Chancroid

Chancroid is a bacterial infection caused by the
fastidious gram negative streptobacillus Haemophilus
ducreyi. It is a disease found primarily in developing
countries, most prevalent in low socioeconomic
groups, associated with commercial sex workers.
Chancroid is a risk factor for contracting HIV, due to
shared risk of exposure and biologically facilitated
transmission of one infection by another.
Chancroid has been known to humans since time of Fig: 10
ancient Greeks.
Haemophilus
182 GREEN Health, Population and Environment Education Book-10

Modes of Transmission
i. Through unsafe sexual intercourse with the infected partner.
ii. Use of the personal materials of the patient like clothes, towel, etc.
iii. Intimate contact with the infected person Do You Know

• The initial ulcer may be
Signs and Symptoms mistaken as a hard chancre,
i. Painful ulcers in and around genitalia the typical sore of primary
ii. Pain with urination (dysuria) syphilis as opposed to the
iii. Swelling of glands in the groin soft chancre of chancroid.

iv. Vaginal discharge
v. Bleeding from the ulcers
vi. Oozing of grey or yellowish pus from the ulcers.

vii. Enlargement of the inguinal lymph nodes, the nodes located in the fold between the
leg and the lower abdomen
viii. Painful lymphadenopathy


Preventive and Control Measures
i. Unsafe sexual intercourse with the infected partner should be avoided.
ii. Condom should be used during sexual intercourse.
iii. Prostitution should be stopped.

iv. Blood should be screened before transfusion.
v. Intimate contact with the infected person should be avoided.
vi. Infected person should be treated in the early stage of infection.
vii. Proper health education should be given to develop awareness.

viii. Personal belongings of the infected person should not be used.
ix. The patient should be isolated.



8.2 Safe Motherhood
Safe motherhood is one of the important areas of
reproductive health. Safe motherhood encompasses
a series of initiatives, practices, protocols and service
delivery guidelines designed to ensure that women
receive a high quality gynecological, family planning,
prenatal, delivery and postpartum care, in order to
achieve optimal health for the mother, foetus and Fig: 11
infant during pregnancy. Safe motherhood

GREEN Health, Population and Environment Education Book-10 183

Unsafe motherhood consists of maternal mortality and morbidity due to preventable
pregnancy and child birth related causes. On other hand, safe motherhood decreases the
maternal and infant mortality and morbidity. Although, most maternal and infant deaths
can be prevented through safe motherhood practices, millions of women worldwide are
affected by maternal mortality and morbidity from preventable causes.
All women should receive timely and high quality maternal care including antenatal and
postpartum care, assistance by a skilled birth attendant during delivery and emergency obstetric
care. Similarly, women should receive adequate nutrition during pregnancy and lactation.
Safe motherhood also encompasses the right of a woman to decide herself to be pregnant
or not. It also emphasizes to be healthy during pregnancy. Similarly, safe motherhood also
includes keeping pregnant mother and newborn healthy. A healthy woman can give birth
to a healthy baby. Many woman die throughout the world due to the complications related
to pregnancy and motherhood. The health of mother and newborn become healthy only if
the mother remains healthy during pregnancy. For a woman, pregnancy is a complicated
and risky stage. The stage from conception to child birth remain very complicated and
risky for a woman. Therefore, the family members and guardians should take care of
a pregnant woman. The services and information included in safe motherhood are
mentioned below:
i. To be pregnant at appropriate age.

ii. Proper care of the pregnant woman.
iii. Proper management of breast feeding, nutrition, rest and family planning.
iv. Proper plant for delivery and developing awareness against risk factors during
pregnancy.
v. Safe delivery by a trained health personnel using delivery kit.
vi. Finding the complexity of pregnant woman and admit to nearby health institution
for proper treatment.
vii. Proper management to prevent the infant from cold and immediate breast feeding.


Education and Health Services Related to Safe Motherhood

In rural areas of Nepal, child marriage is still in practice. Early marriage is not appropriate
to be pregnant in the prospective of health science. A woman becomes mature to be
pregnant only after 20 years of age. Many complications may arise in pregnant woman
before the age of 20 years. We should develop awareness to be pregnant only after maturity
for good health of mother and the new born. A woman should produce less babies and
there should be appropriate birth spacing. Producing a large number of children spoils
the heath of the mother. A woman should produce maximum two babies and the birth
spacing between them should be 4 to 5 years. It helps in proper care and nourishment of
the first child.






184 GREEN Health, Population and Environment Education Book-10

Fig: 12
Stop child marriage in Nepal Safe motherhood

Similarly, we should not discriminate between son and daughter. The status of safe
motherhood can be improved by disseminating safe motherhood education to people.
Following points should be kept in mind to improve the condition of safe motherhood in
Nepal.

1. Pregnant Woman and Awareness Programme
A healthy woman can give birth to a healthy baby. That healthy baby is a healthy
manpower for the future. We should take proper care of maternal health and the health
of the foetus. It helps in proper growth and development of the foetus. Proper prenatal
care results in the birth of a healthy baby. For this purpose, the strategy of nutrition, care
and service carried by ‘Golden Thousand Days’ or ‘Sunaula Hajar Din’ becomes much
effective for promoting health condition of both mother and child.












Fig: 13

Pregnant woman Healthy baby

The necessary health care that a woman requires during pregnancy are given below:
1. A woman should go for health check up right from conception to delivery as given
below:
i. First ANC (antenatal checkup): Right after knowing of conception
ii. Monthly antenatal check up (ANC): From the first month upto seven months of
pregnancy.
iii. Fifteen days antenatal check up (ANC): From 8th month to 9th months of
pregnancy
iv. Weekly antenatal check up: From 9th months till delivery

GREEN Health, Population and Environment Education Book-10 185

v. Immediate check up: At the time of emergency in the case of complication
2. To be safe from tetanus, two dose of TT (Tetanus toxoid) injection should be
administrated to the pregnant woman.
The first dose should be given at the time of the first check up and the second dose
should be administrated between the first month to the ninth month of pregnancy.
3. Nutritious diet should be taken by the pregnant woman. She should increase the
amount as the foetus grows. A pregnant woman should take the foods rich in
carbohydrates, protein, fat, vitamins and minerals. She should consume more fruits
and vegetables, milk, meat, fish, eggs, etc.
4. A pregnant woman should not carry heavy loads.
5. A pregnant woman should not consume tobacco, alcohol and other narcotics.

6. A pregnant woman should maintain personal hygiene.
7. A pregnant mother should not consume junk foods and stale foods.
8. A pregnant woman should not eat too much food and have an adequate sleep.
9. Family members should take proper care of a pregnant woman.


Risk Factors of Pregnancy
The pregnancy of a woman becomes risky under the following conditions.

1. If the age of the pregnant woman is less than 18 years and more than 35 years

Females need to conceive at the appropriate age. They can become more fertile from
20 years to 30 years. It is better to conceive at the age of (20 to 30) years. There is no
proper development of reproductive organs below 18 years of age in females. There can
be improper development of foetus as well as several health consequences might take
place in females., After 35 years of age, there is retardation in physical activity and power
of females. Pregnancy after 35 years might cause various healh complications for both
mother and child. Hence, females need to avoid pregnancy before 18 years and after 35
years.

2. If the weight of the pregnant woman is less than 40 kg and height less than 145 cm
Females should be healthy enough to bear a child and should gain optimum weight
during pregnancy. Females are not said to be healthy when their weight is below 40
kg. Generally, females having weight below 40 kg are malnourished and the growing
foetus can not have proper nutrition from them. In that condition, foetus has several
abnormalities and other health consequences. Similarly, females having height less than
145 cm have improper development of reproductive organs like uterus, vagina, etc. even
they are small in size as well. There can be several complications during pregnancy and
delivery time. Hence, such females can not deliver a healthy baby and their pregnancy
becomes very risky.



186 GREEN Health, Population and Environment Education Book-10

3. If the female suffers from HIV/AIDS or chronic diseases
Being pregnant while suffering from HIV/AIDS and other STIs might be dangerous for
both mother and child. There is chance of transmission of HIV/AIDS and other STIs from
mother to child. Similarly, when a female suffers from chronic diseases like cancer, heart
disease, kidney problems, diabetes, etc. pregnancy may be critical. There is improper
growth of foetus in such condition.


4. If the woman has already given birth to many babies
After the delivery of a baby, the health of mother becomes weak. It takes some time to
resettle the reproductive organs. If she wishes to bear more than one child, she should
strictly follow at least 2 years of birth spacing. When she continuously bears children,
there is high chance of infection in reproductive parts, excessive bleeding and various
other health consequences on mother. Hence, females should be encouraged not to bear
more than 2 children.


5. If the woman is having medicines
If the woman is under medication for particular health problems for long period of time,
the pregnancy can become critical. The use of medicine can cause defirmity or improper
growth of foetus and there is high chance of birth of abnormal baby. Hence, females under
medication are not suggested to become pregnant.

Activity: 1
Pay a visit to your locality and meet any ten women and collect data to prepare a report
on the basis of following points.
1. Age at marriage

2. Name of the health institution visited during pregnancy and the frequency.
3. Age of the mother while giving birth to first child
4. Total number of children produced so far

5. Conclusion
6. Suggestions

Problems During Pregnancy
The health problems that occur during pregnancy are called problems during pregnancy
and the period between the conception and delivery is called pregnancy. The average
period of pregnancy lasts for 280 days. During this period, many health problems occur in
a pregnant woman. Among these problems, many problems may be minor and some may
be major and life threatening. These problems can involve mother’s health, the baby’s
health or both. Some women have health problems before they become pregnant. Other
problems arise during pregnancy.

The problems during pregnancy can be discussed under two heading.

GREEN Health, Population and Environment Education Book-10 187

Minor Problems During Pregnancy
• Anaemia
• Nausea
• Vomiting
• Tiredness
• Chest pain
• Backache
• Hyper-acidity
• Swelling of veins in legs
• Swelling of gums Fig: 14
• Muscular cramps
• Sleeplessness
• Constipation
• Numbness in feet and hands
• Piles
• Itching in the body
• Difficulty in sleeping
• Passing out of white fluid from the vagina
• Increase in the size of lower abdomen
• Abdominal pain
• Depression


Major Problems During Pregnancy
In some conditions, major health problems during pregnancy may occur which may be
fatal for the mother, or foetus or both. The major problems during pregnancy are described
below:
i. Swelling of hands, legs and face
ii. Frequent vomiting
iii. High fever
iv. High blood pressure
v. Severe pain in lower abdomen
vi. Chill and unconsciousness
vii. Bleeding from vagina
viii. Fowl smell in the vaginal fluid
ix. No movement of the foetus
x. Yellowish tongue and nails
If any of the above mentioned problems occur in a pregnant woman, she should be rushed
to the health post/hospital for immediate treatment treatment.

188 GREEN Health, Population and Environment Education Book-10

Activity: 2

Visit your locality and take interview with some females who have already born children
regularly and he problems they have faced during pregnancy time. Note them down
and later on present in your class.

Activity: 3

Prepare a project work on safe motherhood.

2. Abortion
Abortion can be defined as the ending of
pregnancy by removing a foetus or embryo
before it can survive outside the uterus.
An abortion that occurs spontaneously is
also called a miscarriage. An abortion may
be caused purposely and is then called an
induced abortion. It is also called induced
miscarriage. When allowed by law, abortion
in the developed countries is one of the safest
procedures in medicine.
Fig: 15
Modern methods use medication or surgery Safe abortion
for abortions. The drug mifepristone in
combination with misoprostol appears to be as safe and effective as surgery during the first
and second trimester of pregnancy. Birth control, such as the pill or intrauterine devices
can be used immediately following abortion. When performed legally and safely, induced
abortions do not increase the risk of long term mental or physical problems. In contrast,
unsafe abortions (those performed by unskilled individuals with hazardous equipment,
or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each
year through out the world. The World Health Organization recommends safe and legal
abortions to be available to all women. Around 56 million abortions are performed each
year in the world with a little under half done unsafely.
Since ancient times, abortions have been done using herbal medicines, sharp tools with
force or through other traditional methods. Abortion laws and cultural or religious views
of abortions are different around the world. In some areas, abortion is legal only in specific
cases such as rape, poverty, problems with the foetus, risk to a woman’s health or incest.
In many places, there is much debate, over the moral, ethical and legal issues of abortion.
Those who oppose abortion often maintain that an embryo or fetus is a human with a
right to life and many compare abortion to murder. Those who favor legally of abortion
often hold that a woman has a right to make decisions about her own body.
In Nepal, there is a provision of legal abortion in certain conditions. According to Abortion
Act, 2058, women can abort their pregnancy before 12 weeks without screening the gender
of the foetus. Now-a-days, safe abortion service is available at Paropkar Maternity Hospital,
Thapathali, Kathmandu, District Hospitals, Family Planning Centres and Marie Stops Centres
in different places in the country. These institutions provide the facility of safe abortion. On

GREEN Health, Population and Environment Education Book-10 189

the other hand, unsafe abortion may be risky for the pregnant woman. It may cause infection,
continuous bleeding, damage in the uterus, unconsciousness and death of the victim.
Therefore, unsafe abortion should be discouraged providing proper health education.

Types of Abortion
Abortions are mainly of two types. They are as follows:

1. Spontaneous abortion
2. Induced abortion


1. Spontaneous Abortion
Spontaneous abortion is defined as the unintentional expulsion of an embryo or foetus
before the 24th week of gestation. Pregnancy that ends before 37 weeks of gestation
resulting in a live born infant is called a premature birth or a preterm birth. When a foetus
dies in uterus after viability or during delivery, it is usually termed stillborn. Premature
births and stillbirths are generally not considered to be miscarriages.


2. Induced Abortion
The intentional termination of pregnancy by using medicine or with the help of skilled
health personnel is called induced abortion. Approximately, 205 million pregnancies
occur each year throughout the world. Over a third are intended and about a fifth end in
induced abortion. A pregnancy can be intentionally aborted in several ways. The manner
selected often depends upon the gestational age of the embryo or foetus, which increases
in size as the pregnancy progresses. Specific procedures may also be selected due to
legally, regional availability and a doctor or woman’s personal preference.
Reasons for procuring induced abortions are typically characterized as either therapeutic
or elective. An abortion is medically referred to as a therapeutic abortion when it is
performed to save the life of the pregnant woman, prevent harm to the woman’s physical
or mental health; terminate a pregnancy where indications are that the child will have
a significantly increased chance of premature morbidity or mortality or be otherwise
disabled or to selectively reduce the number of foetus to reduce health risks associated
with multiple pregnancy.

An abortion is referred to as an elective or voluntary abortion when it is preformed at the
request of the woman for non-medical reasons.

The main causes of induced abortion are as follows:
i. Unwanted pregnancy
ii. Pregnancy resulted by rape, incest sex or illegal relation, etc.
iii. Preference to son/daughter
iv. Deformity or abnormality of foetus
v. Premarital pregnancy
vi. Extramarital pregnancy
vii. Poor health conditions of the pregnant woman
190 GREEN Health, Population and Environment Education Book-10

In Nepal, there are legal conditions under which abortion service can be obtained.
Abortion is legal in Nepal on the following conditions:
i. Upto 12 weeks of gestation for any woman
ii. Upto 18 weeks of gestation if the pregnancy results from rape or incest, and
iii. At any time during pregnancy with the advice of a medical practitioner or if the
physical or mental health or life of the pregnant woman is at risk or if the foetus is
deformed and incompatible with life.

Abortion is punishable under the following conditions:
i. Sex selective abortion and
ii. Abortion without the consent of the pregnant woman.



8.3 Maternal and Child Health Care and its Measures
Maternal health is the health of a woman
during pregnancy, childbirth and the
postpartum period. Maternal and child
health care encompasses the health care
provided to the pregnant woman, post-
natal, breast feeding mother and children.
The main objective of maternal and child
health care is to improve maternal and
newborn health by raising the level of
motivation of health care workers to provide
high quality maternal and newborn care is Fig: 16
essential to detect high risk cases of mother
and child and give them special care, to identify complications and prevent them to educate
the mother and to promote, protect and maintain health of both mother and child.

In developing countries the maternal and child morality rates are very high due to lack of
effective and adequate maternal and child health care. An effective and adequate maternal
and child health care services helps to reduce maternal and child mortality.
The United Nations Population Fund (UNFPA) estimated that 289,000 women died of
pregnancy or childbirth related causes in 2013. These causes range from severe bleeding
to abstracted labour all of which have highly effective interventions. As women have
gained access to family planning and skilled birth attendance with back up emergency
obstetric care, the global maternal motility ratio has fallen from 380 maternal deaths per
100,000 live births in 1990 to 210 deaths per 1,00,000 live births in 2013.
Four elements are essential to maternal death prevention. The first one is prenatal care. It
is recommended that expectant mothers receive at least four antenatal visits to check and
monitor the health of mother and foetus. The second one is skilled birth attendance with
emergency back up such as doctors, nurses and midwives who have the skills to manage
normal deliveries and recognize the onset of complications. The third one is emergency
obstetric care to address the major causes of maternal death which are haemorrhage,
sepsis, unsafe abortion, hypertensive disorders and obstructed labour. The last one is
GREEN Health, Population and Environment Education Book-10 191

postnatal care, which is the six weeks following delivery. During this time bleeding,
sepsis and hypertensive disorders can occur and newborns are extremely vulnerable in
the immediate aftermath of birth. Therefore, follow up visits by a health worker to assess
the health of both mother and child in the postnatal period is strongly recommended.
Due to lack of proper and adequate maternal and child health care, many mothers and
infants die. The motility rate of mother and infant can be reduced by proper maternal and
child health care services. The satus of maternal and child health is very poor in developing
countries as compared to that in developed countries. The mortality rate of women is very
high in developing countries due to complications related to pregnancy. Similarly, many
women lose their lives due to lack of safe delivery services and proper care after delivery.
The health status of developing countries is very poor due to high mortality rate of mother
and the child. In order to raise the standard of the health of the people living in a country,
we should improve the condition of maternal and child health care.

Importance of Maternal and Child Health Care

1. Maternal and child health care helps to keep the pregnant women safe.
2. Maternal and child health care helps to have safe pregnancy. It helps to protect the
health of mother and new born.
3. It helps to protect the mother and child from various complications during antenatal,
natal and post natal periods.
4. It helps to protect the women from high risk of pregnancy and unsafe abortion.
5. It helps to pay attention on balanced diet, immunization, maintenance and hygiene of
mother and child.
6. It provides knowledge to protect and promote the health status of mother and the
new born.
7. Mother and child health care protects the reproductive right and helps to make life
happy.
The pregnancy period of a woman is about 40 weeks or 280 days. This period is considered
as a sensitive and risky period for a woman. We should take extra care of a pregnant
woman. The family members should help the pregnant woman in various ways, like
nutritious diet, physical exercise, hygiene, etc. It helps to keep the maternal and child
health in good condition. If there is no proper co-ordination among family members,
there will be adverse effect on the health of the mother and child. Therefore, there is a
great role of family members for safe motherhood. The lives of mother and child can be
saved with the help of contribution of family members.
Maternal Child Health Care
The health care services that are included under maternal child health care are described
below:
1. Care of Pregnant Woman or Prenatal Care or Antenatal Care
It is a type of preventive health care, with the goal of providing regular check ups that
allows doctors or midwives to treat and prevent potential health problems during
192 GREEN Health, Population and Environment Education Book-10

pregnancy. During health check ups, pregnant woman will receive medical information
over maternal physiological change in pregnancy, biological changes and prenatal
nutrition including prenatal vitamins.
A healthy woman can give birth to a healthy child.
So, a pregnant woman should take care of her
health right from the time of conception. Similarly,
family members should take care of the health
of the pregnant woman. In rural areas of Nepal,
less care is being paid to pregnant woman due to
poverty, ignorance, lack of proper health eduction
and superstitions.

Pregnancy of a woman is a very sensitive and risky Fig: 17
period. Therefore, extra care should be given to the
pregnant woman. The pregnant woman should take nutritious foods and go to hospital
regularly for check up. Many women suffer from various problems due to lack of proper
care during pregnancy. The care that a pregnant woman should get can be presented as
follows:
a. Personal hygiene b. Nutritious food
c. Light exercise and rest d. Health check up
e. Use of medicine f. Immunization/vaccination


a. Personal Hygiene
Every individual must maintain personal hygiene
and sanitation so as to remain healthy and free
from diseases. Pregnant woman should strictly
maintain personal hygiene. During pregnancy,
there is discharge of vaginal fluid more than in
normal condition which may cause infection in
reproductive parts. Even it creates bad smelling as
well. Hence, she must maintain personal hygiene.
She must bathe and change clothes regularly. Fig: 18


b. Nutritious Food
During pregnancy time, a growing foetus gets nutrition
and oxygen from mother’s body. If a pregnant woman
is given nutritious food, there can be proper physical
and mental growth of foetus. Hence, pregnant woman
should be given nutritious food containing green leafy
vegetables, fish, meat, egg, milk and milk products,
legumes as well as iron and calcium rich substances.
She should be given soft, easily digestible and liquid
containing food. She must drink sufficient amount
of water so as to avoid constipation. If she does not
Fig: 19
GREEN Health, Population and Environment Education Book-10 193

consume nutritious food, there is improper growth of foetus and foetus may suffer from
malnutrition. Moreover, she must avoid smoking, drinking alcohol and taking drugs
during pregnancy period.

c. Light Exercises and Rest
People should do physical exercise daily. Physical
exercise supports in proper functioning of body
organs and makes us healthy. Pregnant woman
should remain active and do physical exercises
daily. It is beneficial for her to do physical exercises.
She can have morning or evening walk as well as
do normal day to day activities. However, she
should not lift heavy loads and do heavy works
in agriculture land. She should be careful while
walking on slopy roads and unlabelled roads so Fig: 20
as to avoid jerking. Above all, family members
should pay attention and take care of proper rest of pregnant woman. They should not
give stress and tensions to pregnant woman. She must have sufficient sleep. The lack of
sleep and more stressful situation can cause miscarriage. Hence, pregnant woman should
be made happy as far as possible.


d. Health Checkup
Pregnancy time is crucial period. The pregnant
woman should have regular health checkups.
She should have at least 4 times health checkup
in nearest hospital or health centre or health post
by a medical person. With the regular health
checkups, she can know about the condition of
foetus, anaemia, bleeding as well as other health
complication on her body and on foetus. Moreover,
she can have necessary health counselling on
safemotherhood, maternal care, infant care, Fig: 21
nutrition and immunization by regular health checkups. In the 9th month of pregnancy,
she should visit the health centre in every week interval.

e. Use of Medicine
During pregnancy, a female should be careful
regarding infection. She must pay attention in
cleanliness and personal hygiene. Even if she has
any major or minor health problem, she should
not use any medicines randomly. She must have
medical consultation before using the medicines.
The random use of medicine can have serious
health complications on her and adverse impacts
in the proper development of foetus. Fig: 22

194 GREEN Health, Population and Environment Education Book-10

f. Immunization/Vaccination
Immunization is given to prevent various
types of diseases. A female should have timely
immunization against tetanus during pregnancy
so as to prevent female and growing foetus from
tetanus. She should be immunized against tetanus
from 7 month of pregnancy till 2 weeks before
th
delivery. In case of first pregnancy, 2 dose of
tetanus injection should be given in 7 and 8th
th
month of pregnancy.
Fig: 23
2. Safe Delivery and Natal Care
Natal care is the care taken to the woman during the delivery period. It includes the
health care services and assistance for the safe delivery. As pregnancy and delivery period
are crucial and critical for females, the pregnant female should not be left alone in home
in the late stage. The labour pain can start at any time during the late stage. Once, there is
discharge of amniotic fluid during late stage, a pregnant female should be rushed to the
hospital. There is presence of trained medical people and other health equipments in the
hospital. So, the delivery becomes quite safe in the hospital. Even she can have assistance
from medical people in case of any complications. In case the hospital or health centres
are far from home, the midwife should be pre-informed about late pregnancy before
hand. In case, if there is no midwife in the nearby places, then people must arrange for
money and the vehicle to take pregnant woman in the concerned hospital or then people
can arrange for delivery in home. In that case, people can take help from the experienced
family members, relatives or neighbours. The following things should be considered
during delivery.

a. A pregnant woman should be rushed immediately to hospital when the symptoms of
labour pain appear or the midwife should be immediately informed.

b. The pregnant female should be given energetic liquid, fruit juices as well as glucose
water.
c. She should be encouraged for defecation and urination.

d. The pregnant woman should be consolled with love, affection, sympathy and security.
e. The room in which delivery is going to be performed should be clean, warm and
sunlight coming.
f. The female assisting for delivery of the child should clean and cut nails, sterilize the
equipments to cut umblical cord as well as the string to tie umblical cord.

g. There should be arrangement of delivery kit. If not, there should be availability of
blade, string, handkerchief, soap and boiled water.


3. Care for Postnatal Mother
The period of two months after delivery is regarded as maternity period or post natal
period. Actually, it is the responsibility of family members to take care of mother and
GREEN Health, Population and Environment Education Book-10 195

child. The mother as well as child should be given special care and attention so as to
protect them from various complications and infections. The following things should be
considered during maternity period.
a. The mother should be given sufficient amount of nutrition like meat, egg, fish, milk,
legumes, etc. more than the normal time.
b. Mother should pay attention in cleaning her breast. She should clean her breast before
feeding her baby.
c. Infants should be bathed within few days of delivery.
d. It is better to wipe the infants with wet clothes in the first week.

e. Mother should be made to walk around for better circulation.
f. The baby should be breast fed on the same day of delivery.
g. The baby should be given first milk (yellow milk called colustrum) rather than
throwing it out.
h. Mother needs to evacuate breast while breast feeding a baby. She should breast feed
her baby from both the breast sufficiently.
i. The postnatal mother should not be allowed to lift heavy loads and do difficult tasks.
She may develop prolapse if she does difficult works or carries heavy loads.
j. People should be aware about golden 1000 days.
Activity: 4

Ask your grandfather or mother regarding caring of postnatal mother. Make a list to
take care of postnatal mother. Later on present in your class.

Infant and Child Health Care

During pregnancy period, foetus gets blood supply,
oxygen and nutrients from mother’s body. Foetus
gets protected from mother’s immunity power and
is safe inside mother’s uterus. After delivery, a baby
needs to survive on his/her own and cope with the
external environment. Hence, the health of infant/
baby becomes critical for certain months after
delivery. The infant may have several infections
and other health consequences. The normal weight
of baby at the time of birth should be (2.7-3.4) kg Fig: 24
and height 50 cm. The baby grows upto 75 cm and its weight increases 3 times within 1
year of age. Early 1000 days which are regarded as the golden 1000 days are very important
for overall development of child. People need to take care of health and nutrition of baby.
Generally, the following things are considered to care infants:
a. Nose and mouth of baby should be cleaned properly for making easy respiration.
After that, baby should be made to sleep by lowering the head.

196 GREEN Health, Population and Environment Education Book-10

b. The body of newly born baby should be wiped by warm clothes.
c. The baby should be kept below the uterus before umblical cord is cut and tied up so
as to ensure blood flow from mother.
d. Umblical cord should be cut by sterilized equipments about 2 cm above the naval
region.
e. The baby must be kept at the chest of mother immediately after birth by which mother
can have psychological and emotional satisfaction.
f. Baby should be breast fed within few hours of delivery. Once the baby sucks mothers’s
breast milk, it helps to discharge placenta and control bleeding.

g. People should take the baby immediately to hospital or medical centre if the baby
does not cry, has difficulty in breathing, does not move or the baby turns to be blue.

h. The infant should have regular health checkups.
Activity: 5

Vist your locality, find out the mother/s during maternity period. Discuss with them
about care of infants and share youir information with your friends in the class.


A. Breast Feeding and Nutrition
The act of feeding breast milk to the baby is known
as breast feeding. There is production of milk from
the breast after delivery of baby. Mother’s milk is
the best nutrition for a baby. It contains all the
required nutrients for a baby as well as it helps to
protect a baby from various diseases. If the health
of mother is good, she can breast feed her baby
within few hours of delivery. Initially, she needs
to clean her breast properly before feeding the Fig: 25
baby. The first milk produced immediately after
delivery is yellow in colour which is called colustrum. It is highly nutritious. Mother
needs to feed colustrum rather than throwing it. Many illiterate and ignorant mothers
think milk is white in colour and hence throw the yellow milk, colustrum considering it
as impure. She needs to allow her baby to suck her breast even if there is no production of
milk. Once the baby sucks breast, then there is gradual production of milk. Mother needs
to feed her breast milk in every 2 hours interval from both the breasts equally.
Breast feeding increases very harmonious and close relationship between baby and
mother. For early six months, mother should feed only breast milk to the baby. Actually,
only the mother’s breast milk is sufficient enough for early six months, for the proper
growth, development and optimum health of a baby. She should avoid milk of other
animals, powder milk or can milk. Use of those milk can affect the health of baby. After

GREEN Health, Population and Environment Education Book-10 197

six months, only mother’s milk is not sufficient for a baby. Hence, the baby should be
provided with supplementary food along with mother’s milk. She must feed her breast
milk at least 2 years of age. Once the child is of 2 years, he/she can have normal food like
that of other family members. The following chart shows the nutrition required for a baby
since birth till 2 years of age.

Age Food
(0 – 6)months Mother’s milk

(6 – 7) months Mother’s milk, lito, mashed curry
(7 – 9) months Mother’s milk, lito, mashed, curry and soft fruits

(9 – 12) months Mother’s milk, lito, soft pulse, rice, curry and soft fruits.
(1 – 2) years Mother’s milk, cereals, legumes, lito, soft pulse, rice, green leafy
vegetables, fish, meat, eggs, milk and milk products, etc.


B. Supplementary Food
The extra food provided to baby except mother’s milk is called as supplementary food.
After 6 months, only mother’s milk is not sufficient for the optimum health and proper
development of baby. Hence, the baby should be given supplementary food along with
the mother’s milk. Initially, the baby can be fed with liquid and solid diet. He/she can be
given lito. In the rural areas, lito is prepared by mixing various cereals and legumes like
rice, wheat, maize, soyabeans, gram, etc. They are mixed in certain proportion and later
on grinded as powder. Then such lito is provided to baby based on requirement. But, in
the urban areas, there is availability of instant food like cerelac, lactogen, etc. which can
be given to baby based on requirement as supplementary food. With the growing age,
baby should be given various types of fruits, vegetables, meat, egg, fish, milk and milk
products along with the mother’s milk. The supplementary food should be added along
with the weight and age of a baby.


C. Immunization
Every child is a valuable property of family. It is very important for every parent that a child
becomes healthy and free from diseases. The health of infant is critical as immune system
is under developed and weak. Hence, infant can suffer from various types of diseases like
tuberculosis, polio, diptheria, pertusis, tetanus, hepatitis, measles, etc. There has been
invention of vaccines to protect against all those diseases. Vaccines act as protecting shield
against several diseases. They are given by injection. Some are given orally as well. Polio
is given orally in the form of drops. It is most essential to immunize children timely. It has
been observed that children who are vaccinated have proper development of body and
optimum health than the children who are not immunized. Immunization should be given
in a given schedule. The government of Nepal has made provision of free immunization
from concerned hospitals, health centres, health posts etc. through out Nepal.

198 GREEN Health, Population and Environment Education Book-10

The immunization schedule for children is presented below:

Times Age of Name of vaccine Against
of visit immunizations
First Immediately after B.C.G Tuberculosis
birth
Second 6 weeks Diptheria, Pertusis, Tetanus,
DPT, HPB, HIB HepatitisB, Haemophilus
polio, P.C.V. First dose Influenza B, Polio and
Pneumonia
Third 10 weeks Diptheria, Pertusis, Tetanus,
DPT, HPB, HIB Second HepatitisB, Haemophilus
polio, P.C.V. dose Influenza B, Polio and
Pneumonia
Fourth 14 weeks DPT, HPB, HIB Diptheria, Pertusis, Tetanus,
polio Third dose HepatitisB, Haemophilus
I.P.V. Influenza B, Polio
Fifth 9 months P.C.V. } third dose Pneumonia, Measles and
Measles, Rubella
Rubella First dose
Sixth 12 months Japanese Japanese Encephalitis
Encephalitis (J.E.)
Seventh 15 months Measles, Measles and Rubella
Rubella Second dose


Summary
1. Sexually transmitted diseases (STDs) are infections that are passed from one person
to another through sexual contact.
2. STDs caused by bacteria, yeast or parasites can be treated by antibiotics. But there
is no cure for STDs caused by viruses.
3. AIDS (Acquired Immuno Deficiency Syndrome) is a syndrome caused by a virus
called HIV (Human Immunodeficiency Virus).
4. HIV is found throughout all tissues of the body but is transmitted via the body
fluids of an infected person such as semen, vaginal fluids, blood and breast milk.
5. HIV can be passed from one person to another through blood to blood and sexual
contact. HIV is a retrovirus that infects the vital organs and cells of human immune
system.
6. The time period that it takes for the HIV blood test to give positive result after
getting infected with HIV (retro virus) is called window period.
7. Syphilis is a sexually transmitted infection caused by the bacterium Treponema
pallidum.


GREEN Health, Population and Environment Education Book-10 199

8. Syphilis is generally transmitted through unsafe sexual intercourse. This commonly
occurs in young people as they have a high frequency of sexual activities.
9. If the syphilis is not treated, it may then progress to a stage characterized by severe
problems with the heart, brain and nerves that can result in paralysis, blindness,
dementia, deafness, impotance and even death if it is not treated.
10. Gonorrhoea is a sexually transmitted infection (STI) caused by the bacterium
Neisseria gonorrhoea.

11. Gonorrhoea is spread through sexual contact with an infected person. This includes
oral, anal and vaginal sex. It can also spread from a mother to a child during birth.

12. Chancroid is a bacterial sexually transmitted infection characterized by painful sores
on the genitalia. It is transmitted from infected person to another by sexual contact.
13. Safe motherhood encompasses a series of initiatives, practices, protocols and
service delivery guidelines designed to ensure that women receive a high quality
gynecological, family planning, prenatal, delivery and postpartum care, in order to
achieve optimal health for the mother, foetus and infant during pregnancy.
14. All women should receive timely and high quality maternal care including antenatal and
postpartum care, assistance by a skilled birth attendant during delivery and emergency
obstetric care.
15. The stage from conception to child birth remain very complicated and risky for
a woman. Therefore, the family members and guardians should take care of a
pregnant woman.
16. A woman should produce maximum two babies and the birth spacing between
them should be 4 to 5 years. It helps in proper care and nourishment of the first
child.

17. The status of safe motherhood can be improved by disseminating safe motherhood
education to people.
18. A pregnant woman should take the foods rich in carbohydrates, protein, fat,
vitamins and minerals. She should consume more fruits and vegetables, milk, meat,
fish, eggs, etc.
19. Females should be healthy enough to bear a child and should gain optimum weight
during pregnancy. Females are not said to be healthy when their weight is below 40
kg.
20. The health problems that occur during pregnancy are called problems during
pregnancy and the period between the conception and delivery is called pregnancy.
21. Abortion can be defined as the ending of pregnancy by removing a foetus or embryo
before it can survive outside the uterus.
22. The World Health Organization recommends safe and legal abortions be available
to all woman. Around 56 million abortions are performed each year in the world
with a little under half done unsafely.


200 GREEN Health, Population and Environment Education Book-10