HEALTH POST- TANKISUNWARI,MORANG,NEPAL

MANAGEMENT SKILLS FOR HEALTH SERVICES

PRESENTED BY- PRADEEP PARAJULI(MBBS)

INTRODUCTION
Total (health post in nepal):- 677
Each 5-6 village development committee (25,000-29,000 Population), there should be one health post.
On the VDC where health post is present, there is no SHP(sub health post).
OUR VISIT
LOCATION: TANKISUNWARI VDC-MORANG
It SUPERVISES -3 SHP
COVERS-4 VDCs
OFFICE TIME= 10-5 pm
INFRASTRUCTURE
It has a building with three rooms.
-OPD
-Drug distribution
-ANC/PNC check up
STAFFING PATTERN
1.In charge- HA(health assistant)-1
2.AHW(auxiliary health worker)-3
3.ANM(auxiliary nurse midwife)-1
4.KHARDAR-1
5.KARYALAYA SAHAYOGI-1
6.EXTRA BY HEALTH POST DEVELOPMENT COMMITTEE- 3 trained ANM
HEALTH POST DEVELOPMENT COMMITTEE
 chairman- executive head of VDC
 Member secretary-HP in charge
 Members-
WARD CHAIRMAN
DALIT
FCHV(FEMALE AND CHILD HEALTH VOLUNTEER)
Teacher
Social worker-2
VDC nominated

FUNCTIONS
`OPD(OUTPATIENT DEPARTMENT)
 10-2 PM
 Ticket free
 30-35 patient per day
 Most common disease-diarrhea , ARI , skin diseases
FAMILY PLANING
>through ANM staff
1.Depo
2.pills
3.IUD
4.Copper-T
5. Norplant
6.Condom
ANC/PNC(antenatal/postnatal checkup)
EPI(expanded programme on immunization)
Every month vaccination for infants- on6,7,8,9,10th day of month in Immunization centers.
Vaccines-BCG, DPT, OPV, Hep. B, JE, Measles & TT, from DPHO (district public health office)
Storage of vaccine- permanent vaccine carrier.
DISEASE CONTROL PROGRAM
 DIARRHEA
 ARI
NUTRITIONAL PROGRAM
 VHW and FCHV conduct nutritional programs
 Monitoring height & weight- std. growth chart(Road to health chart)
 Poor growth rate, severe malnutrition- referred to koshi zonal hospital
 >6 months – vit.A capsule
 Awareness about sarbottam pitho
 Pitho distributed from ‘posan shakha’ in Biratnagar.
TUBERCULOSIS AND LEPROSY CONTROL PROGRAM
 HP act as DOTS sub center and provides ATT drugs
 All suspected TB cases referred to NATA
 ATT Regimens-8 month regime replaced by 6 month (since Chaitra 2065)
 2 months-intensive
 4 months – continuation phase
Leprosy:
 No facility for diagnosis
 Referred to Netherlands Leprosy Relief(NLR) in Biratnagar for diagnosis
 Anti leprosy drugs provided as under MDT regimen for both PB & MB free of cost.
MALARIA AND KALA-AZAR CONTROL PROGRAM
 MALARIA:
 free drugs available
 Blood smear of suspected cases are sent to higher center for diagnosis
 Kala-azar :
 diagnosis not done. suspected cases sent to Koshi zonal hospital.
Free drugs(SAG) given
HEALTH EDUCATION
 Given by ANM, AHW, HA 4 times/yr according to directives of DPHO on HIV- AIDS, seasonal diseases, viral, malaria, Kala-azar
 School health program on LEPROSY,TB,HIV
OUT REACH CLINIC
 Health services to community people who reside away from these facilities
 21,22 and 23rd of every month
 Involved health workers-AHW, VHW, ANM
 Services provided-ANC, PNC, family planning, counseling, health education ,
Vitamin A, iron, Albendazole distribution
FCHV PROGRAMME
 Backbone of health delivery system
 Volunteers from Aama Samuha- who can read & write
 Initial training for 18 days (9 +9)
 Then refresher trainings as new programs launched
 Rs.200/training
 Ideally 1 FCHV/600 population, but here 1 FCHV/ward
 FCHV kit :
• drugs- cotrimoxazol, gentamycin, ORS, tetracycline as eye ointment
• Timer, thermometer
• Weighing machine
• Condoms, pills, iron tablets
• Manuals, flip charts, IEC material, record books
 FCHV kit :
• drugs- cotrimoxazol, gentamycin, ORS, tetracycline as eye ointment
• Timer, thermometer
• Weighing machine
• Condoms, pills, iron tablets
• Manuals, flip charts, IEC material, record books

FINANCIAL RESOURCES
 Rs. 5 per OPD patient given by Nepal govt
 Government provides salary via DPHO
Report and reporting
Through HMIS-32(health management information system). They get reporting from 3 sub- health post by 4th of the next month and they send the report of every month by 7TH of the next month to the DPHO
WASTE MANAGEMENT
 sharp waste in safety box given by DPHO
 No color coding for wastes
 No Incinerator provided
LIMITATIONS
 No laboratory facilities available
 No proper waste disposal
 Under free drug program- Patients come even for minor ailments
 Limited drugs, not available for STIs
 Infrequent meetings of Development Committee
 Shortage of manpower
RECOMMENDATIONS
 Improvement in laboratory facilities
 Autoclave should be present
 Improvement in methods of waste disposal
 Awareness about free drug program
 Proper co-ordination between VDC & HP

THANK YOU

INTRODUCTION:

A seizure is any clinical event caused by an abnormal electrical discharge in the brain and epilepsy is the tendency to have recurrent seizure.Major seizure cause loss of consciousness ,with patient falling to the ground and presenting with a history of ‘blackouts’.Minor seizure causing alteration of consciousness,without the patient falling to the ground ,may also be described by the patient as ‘blackouts’.¹

^{pathoPHYSIOLOGY AND CLASSIFICATION:}

‘Epileptic’ cerebral cortex exhibits hypersynchronus repetitive discharge involving large group of neurons,which in normal brain is inhibited by inhibitory neurotransmitter like GABA.Trans membrane potential in the neurons is decreased and it is postulated that both under activity of the inhibitory neurotransmitter and over activity of the excitatory one is responsible for that due to which the neurons are prone to repetitive and synchronous fire.If the seizure activity is restricted to a particular area of a single hemisphere it is called partial seizure and if it involves both the hemisphere simultaneously and synchronously, it is called generalized seizure.In absence seizure the conscious is lost but the patient remains standing or sitting.²

^{CLINICAL ASSESSMENT:}

In generalized tonic clonic seizure the patient becomes unconscious and fall down heavily if standing and often sustaining injury.Respiration is arrested and central cyanosis may be witnessed.This tonic phase is followed by a clonic jerks or just be replaced by a flaccid state of deep coma.urinary incontinence and tongue bite may occur during the attack.A period of post-ictal confusion or headache and a period of subsequent malaise and/or confusion are usually seen.Many trigger factors are identified for initiation of the seizure activity like sleep deprivation, alcohol withdrawal,recreational drug misuse,physical and mental exhaustion,flickering light including TV/computer screens,inter current infection and metabolic disturbance,loud noise music etc.¹

^{CAUSES AND DIAGNOSIS:}

The cause of the epilepsy may be idiopathic or many other pathological cause like genetic ,developmental,tumours ,trauma,vascular,infections,inflammation,metabolic ,drugs,alcohols,toxins or degenerative conditions.To establish the diagnosis of epilepsy ambulatory EEG and videotelemetry are useful and to define its type standard EEG ,sleep EEG and EEG with special electrode are useful.To find out structural lesion in the brain CT and MRI are useful and if metabolic cause is suspected urea,electrolytes,blood glucose,LFTS,serum calcium/ magnicium etc should be done.If inflammatory or infective nature of the disease is suspected full blood count,ESR,CRP,CXR,serology for syphillis,HIV,collagen disease and CSF examination should be done.¹

^{IMMEDIATE MANAGEMENT:}

First aid of the patient who has an episode of seizure includes moving away of the person away from danger like fire water,machinery ,furniture etc.After convulsion ceases, the patient should be turned to semi prone position and a clear airway should be ensured.Nothing should be inserted into the mouth and if the convulsion persists for more than 5 minute or recur without person regaining consciousness,urgent medical attention should be summoned.The person may be drowsy and confused for some 30-60 minutes and should not be left alone until fully recovered.The immediate medical attention includes ensuring the patient airway and giving oxygen to offset cerebral hypoxia.Intravenous anticonvulsant like diazepam 10 mg should be given only if the convulsion are continuous or repeated.if the patient is a known case of epilepsy blood should be taken for anticonvulsant level.The cause should be investigated.¹

^{LONG TERM MANAGEMENT:}

Epilepsy is a chronic condition requiring careful long-term management. The treatment is complex, involving classification and diagnosis, selection and monitoring of the appropriate antiepileptic agent, and evaluation of the chosen drug’s side effects and drug interactions. Because these side effects increase when drugs are combined, mono therapy is recommended. Long-term management issues and optimal drug selection differ from patient to patient. If seizures are not controlled by medication, the patient may have been misdiagnosed or misclassified. Noncompliance, a major cause of apparent unresponsiveness to treatment, should also be ruled out.  The long term management includes the treatment of the patient with anticonvulsant drugs, of which the patient treatment should be started with the first line drug,which should be started with low dose and gradually the dose should be increased to effective control of seizure or until side effects.compliance should be checked and if the first line therapy fails treatment with the second-line drug should be started gradually withdrawing the first one.Three agents should be tried singly before trying combination therapy.More than two drugs in combination at one time should not be considered.If all the above majors fails occult structural or metabolic lesion should be considered or whether the seizure are truly epileptic.For GTCS first line therapy is carbamazepine and the second line are lamotrigine,sodium valporate,topiramate etc. For many patients, a therapy that brings the seizures under control is initiated soon after diagnosis. For these patients, long-term management consists of monitoring for the long-term adverse effects of medication; providing psychological, career, and social assistance, if necessary; and, ultimately, determining whether medication should be discontinued.

For a second group of patients, medication substantially reduces seizure frequency, but seizures will not be completely eliminated. For this group, long-term management consists of determining the risk–benefit ratio of changing to new therapies, making sure that each therapy is used to its maximum benefit, and keeping side effects to a minimum.

Finally, a group of patients exists who do not respond to any standard therapy. The first step in managing these patients is to determine whether continued seizures are actually due to treatment failure or whether there is another explanation, such as misclassification, noncompliance with medication regimen, or the presence of no epileptic (pseudo epileptic, psychogenic) seizures. If failure is due to seizure intractability, long-term management for these, the most difficult patients, consists of a rational approach to choosing successive drug regimens. If conventional medications fail, the next step is to consider alternative medications or surgical intervention. These patients also need substantial emotional, psychological, and vocational support. ⁴

SOCIAL ASPECT:

Since the treatment has a long course ,it cause a lot of the financial burden to the patient as well as some side effect are inevitable.To moniter the compliance and the side-effect profile the plasma level of some of the drugs has to be measured occasionally like of cabamazepine and phenoytin⁵.Another problem with the epilepsy is that the patient has to restrict himself from some of the activities which are dangerous for them like for a vehicle driver.If a person has been in such type of job then it is mandatory that he refrain from such job, and involve himself in a less risky jobs at least for two year after the effective control of disease.Patient education and education of the caretaker of the patient is of prime importance.They should be told about the nature of the disease,the risk of the complications, treatment modalities, outcome of the treatment,side effect of the drugs and the prognosis of the patient.If the patient is getting married ,the other party should also be told of the disease and that he can have normal marital and sexual life and can have normal children.³

Resource:

1. Principle and practice of medicine by Davidson;20th edition,page no.1167
2. Essentials of medical pharmacology by KD Tripathi;5th edition,page no. 369
3. MURTAGH’S general practice 4th edition,page no.1292
4. The long term management of Epilepsy byjacqualine french;march 1,1994 vol 120,on internet
5. www.wickipedia.com-from internet.

It is disease caused due to acute inflammation of the appendix characterized by acute abdominal pain of sudden onset ,nausea , fever and some episodes of vomiting.
it is of two type , one is obstructive type caused due to the obstruction of the appendix by worm ,its eggs ,cyst etc and the fecal matter, the other type is catteral or infectious type in which the organism like escherechia coli are responsible for the inflammation. The obstructive type is more severe.
several other cause are attributed but the dietary factor ,socioeconomic factor and the genetic factor are attributed as the major risk factor viz high socioeconomic status, female sex, low fiber diet and familial.
clinically it is diagnosed by acute colicy(constricting) pain begining around the umbillicus and later shifting to fight lower abdomen ,nausea and some episode of vomitting and fever, this classic triad is called MORPHYS triad.
As soon as the patient has the following stated symptoms he should be rushed to the hospital so that immediate surgery(APPENDECTOMY) can be done otherwise the patient may suffer from the complication like rupture of the appendix, perforation septisemia, appendicular mass etc
The best treatment ever is the emergency APPENDECTOMY if the patient arrives with in 48 hours of the onset of the symptom. If the patient comes later he should be put in the OCHNER SERRENS regimn in the hospital and eletive surgery is done after 6 weeks. surgical modalities are open and laporoscopic method however lap surgery has many advantage over open surgery.

STUDY OF KNOWLEDGE ATTITUDE AND PRACTICE OF A SEXUAL BEHAVIOUR IN ADOLESCENT
MBBS-2007 Batch.
Sah R.B., Parajuli P., Haldar N., Shah P., Kumar P., Deo N.B. , Shah P.M., Karki P., Bista N., Rani N., Shahi P., Jain P.

Abstract
Introduction: Many adolescents of NEPAl are having different sex related problems and indulging in unsafe sexual practice and consequently having risk of transmission of sexually transmitted diseases .To understand their attitude and practice better, we decided to conduct this research.
Objectives: To identify the level of sexual knowledge in adolescent. To determine the knowledge of adolescent regarding sexually transmitted infections (STI) especially HIV/AIDS and To determine the role of school in providing sex education

Materials and methods: This cross-sectional study was conducted at different government and private school of Hile bazzar of Dhankutta District involving 200 school adolescent of class nine and ten. The data collected was entered in Microsoft excel and analysed.
Results: only 60% of the students thought that teaching reproductive system, sexual changes and family planning as sex education.34% of the students said that they are not interested in talking about sex and 44% feel free.73% of them thought that appropriate age for marriage is 21 to 25 years. Most of the student responded that they get knowledge about sex from TV/Radio and teachers.74% of the students responded that they don’t want to have sex before marriage, and 3% of them already have sex.66% of the student don’t about the masturbation and 72 % of them don’t know about its effect on health.24 % of them thought that mosquito bite also transfers HIV/AIDS.84 % of the student think that sex education should be provided in the school.
Conclusion: More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Less students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems
INTRODUCTION
Sex education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy.
It is also about developing young people’s skills so that they can make informed choices about their behavior, and feel confident and competent about acting on these choices.
With increasing prevalence of sexually transmitted diseases, sex education is of prime importance in the adolescents of today. Young people often lack the knowledge, experience and maturity regarding health issues such as STDs, HIV/AIDS and to avoid the grave consequences that confronts them. Adolescent comprises of 20% of the total world population and 80% of them living in developing countries. Despite high chances of indulging into sexual activity, adolescent often lack due knowledge about the human body and reproduction especially in developing countries.
Teenage sexual activity and pregnancy has emerged as a major social problem in Nepal where more than 60% of its total population is living under poverty line. Poverty, illiteracy and lack of awareness are some of the crucial factors are the root cause for various type of psycho-social crimes ranging from sex abuse, rape, unwanted pregnancies, illegal abortions, suicides, commercial prostitution, human trafficking, etc.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.

OPERATIONAL DEFINITIONS
ADOLESCENTS:
All students aged between 13 to 20 years studying in class nine and ten.

REPRODUCTIVE HEALTH:
It is a state in which people have the ability to reproduce and regulate their fertility and are able to go through pregnancy and child birth safely. Hence the outcome of pregnancy is successful and the couples are able to have sexual relations free of the fear of pregnancy and contracting disease.

KNOWLEDGE ABOUT REPRODUCTIVE HEALTH:
This term refers to an awareness of high school adolescent about reproductive health that has been measured by the knowledge part of research instrument designed for this study purpose.

ATTITUDE TOWARD REPRODUCTIVE HEALTH:
This term refers to the opinion about reproductive health given by school adolescent which includes pubertal changes, reproduction, sexuality, safe sexual practices, family planning and STDs and HIV-AIDS.

Methods & Methodology
• Study design: Descriptive ,cross sectional study.
• Duration of study: from 23th May to 4th June
• Study area: Hile, Dhankuta ( Hille Secondary School, Nilgiri Don Bosco English Boarding School, Mother Land Secondary English Boarding School.)
• Study population: adolescent students from 13 – 20 yrs
• Sample size:200 students
• Sampling technique:
Convenient purposive sampling.
This research is based on random selection of the study area of Hile bazaar of Dhankuta district of which schools were randomly selected and they are stratified into government and private schools. After that the students of class 9 and 10 aged between 13 to 20 were separated in to male and female.
This is a descriptive , cross-sectional study, done at Hile secondary school, Nilgiri Donbosco English

METHODS OF DATA COLLECTION:
Questionnaire was prepared and they are folded and stapled individually. The students of class 9 and 10 are grouped in to male and female and the four groups were put in to separate classes as one student per bench. The questioners were distributed to each individual and the name and answers to the questions are kept confidential. Those not understanding the questions and their options are explained individually. After completing the answer the questionnaires are collected separately in a box so that the answers of each student is confidential.
Ethical consideration:Request letters to the school principal was given in each school and due consent was taken.Verbal consent was taken from the each participants.Those who didn’t want to participate were not forced.Confidentiality was maintained.

Result:
Sex education
Teaching how to perform sexual activity 18.5%
Teaching reproductive system,sexual changes,family planning and STDs 50.5%
Not appropriate for my age 15.5%
Don’t know 15.5%

What is sex education? a) teaching how to perform sexual activity 37
b) teaching reproductive system, sexual changes, family planning and STD’s 101
c) not appropriate for my age 31
d) don’t know 31

What is the effect of masturbation on health? a) It is a healthy practice 25
b) It is a sign of mental illness 2
c) It causes weakness 17
d) It causes disease 13
e) Don’t know 143
Should school provide sex education a) YES 169
b) NO 19
c) Don’t know 12
What is Safe sex? a) sex with single partner 52
b) sexual intercourse after appropriate age 45
c) using condoms 27
d) all of the above 53
e) no idea 26
Do you want to have sex with more than one partner? a) YES 27
b) NO 150
c) Already have 8
d) Don’t know 15

HIV/AIDS transmission
Question YES (%) NO (%) Don’t Know (%)
a) Unsafe sexual contact 94 3 3
b) Mosquito bite 24 66 10
c) From mother having AIDS to child 93 5 3
d) Blood donation 87 6 7
e) Shaking hands 9 83 8
f) Shaving razors 46 33 25
g) Social kissing 11 70 19
h) Drug addiction 66 17 17

Preventing HIV/AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Avoiding sex with multiple partners 93 4 3
b) Using condoms 88 9 3
c) Using mosquito nets 35 52 13
d) Avoid sharing same dish with person having AIDS 26 60 14
e) Using sterilized disposable needles 82 6 12
What should be done with a person having AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Admit him/her to hospital 87 7 6
b) Reject him/her 7 87 6
c) Provide love and sympathy 90 5 5
d) Continue sex 6 84 10

Discussion

Findings from studies which have investigated premarital sexual behavior among high school and college students have found rates of activity to vary from 11 per cent among students in Pokhara to 14 per cent among Kathmandu students 1 and 16 per cent among students in Palpa District (Limbu 2001; Prasai 1999). Among young unmarried men and women aged 14 to 19 years working in factories in the Kathmandu Valley, 20 per cent and 12 per cent of the men and women respectively reported having experienced sex (Puri 2002). Further, studies of single men in the border towns of Nepal found activity rates of 10 per cent among a sample aged 15 to 19 years and about 50 per cent among a slightly older sample aged 18 to 24 years (Mehta 1998; Tamang and others 2001).Data collected during the demographic and health surveys as well as from small-scale surveys indicate that awareness of condoms, HIV/AIDS and other STIs appears to be rising among the general population, mainly owing to extensive media campaigns (NDHS 1996 and 2001; Mehta 1998; Pradhan and others 1997).

Conclusion
More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Fewer students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems

Recommendations
• Sex education should carry a major credit in curriculum of secondary schools.
• Text books should have an extensive coverage in this topic.
• Teachers play a role model in providing education to the adolescents, thus, they need to emphasize on this agenda.
• Parents should be more like friends: this prevents hazards.

Bias:
• As participants of research are likely to recall some events Recall bias may play a factor.
• Site selection bias may be there.
• Data entry and analysis bias in another possibility.
• As sex is still the subject which people cannot talk about freely, topic selection has further biased our study.

Limitations:
• A set of questions in questionnaire may not measure the actual level of knowledge regarding the topic.
• Though we tried our best to explain the student regarding the questionnaire, still, some mistakes were inevitable.
• Time allotted to conduct the research was not adequate which limited our study.

Bibliography
1. Kothari CR, interpretation and report writing: research methodology, 2nd edition 2004, page 345-347.
2. K. Park, Demography on family planning, community medicine, 18th edition 2005, page 361-376.
3. K. Park, sexually transmitted disease, community medicine, 18th edition 2005, page 265-279
4. Pramod Singh, Surya Niraula, Kavita Verma; sexual behaviour, knowledge and attitude to sexuality among adolescent of Dharan Municipality. Published 2000. rep.139, BPKISH library.
5. B. Singh and N. thakur; research on knowledge, attitude about reproductive health among female adolescent in high school in Dharan. Published 2004, Rep.84 BPKISH library.
6. William F Ganong: physiology of male and female, reproductive system, review of medical physiology , 20th edition , page 410-433.
7. Reproductive care ,KAP among adolescents: PLAN international.

STUDY OF KNOWLEDGE ATTITUDE AND PRACTICE OF A SEXUAL BEHAVIOUR IN ADOLESCENT
MBBS-2007 Batch.
Sah R.B., Parajuli P., Haldar N., Shah P., Kumar P., Deo N.B. , Shah P.M., Karki P., Bista N., Rani N., Shahi P., Jain P.

Abstract
Introduction: Many adolescents of NEPAl are having different sex related problems and indulging in unsafe sexual practice and consequently having risk of transmission of sexually transmitted diseases .To understand their attitude and practice better, we decided to conduct this research.
Objectives: To identify the level of sexual knowledge in adolescent. To determine the knowledge of adolescent regarding sexually transmitted infections (STI) especially HIV/AIDS and To determine the role of school in providing sex education

Materials and methods: This cross-sectional study was conducted at different government and private school of Hile bazzar of Dhankutta District involving 200 school adolescent of class nine and ten. The data collected was entered in Microsoft excel and analysed.
Results: only 60% of the students thought that teaching reproductive system, sexual changes and family planning as sex education.34% of the students said that they are not interested in talking about sex and 44% feel free.73% of them thought that appropriate age for marriage is 21 to 25 years. Most of the student responded that they get knowledge about sex from TV/Radio and teachers.74% of the students responded that they don’t want to have sex before marriage, and 3% of them already have sex.66% of the student don’t about the masturbation and 72 % of them don’t know about its effect on health.24 % of them thought that mosquito bite also transfers HIV/AIDS.84 % of the student think that sex education should be provided in the school.
Conclusion: More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Less students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems
INTRODUCTION
Sex education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy.
It is also about developing young people’s skills so that they can make informed choices about their behavior, and feel confident and competent about acting on these choices.
With increasing prevalence of sexually transmitted diseases, sex education is of prime importance in the adolescents of today. Young people often lack the knowledge, experience and maturity regarding health issues such as STDs, HIV/AIDS and to avoid the grave consequences that confronts them. Adolescent comprises of 20% of the total world population and 80% of them living in developing countries. Despite high chances of indulging into sexual activity, adolescent often lack due knowledge about the human body and reproduction especially in developing countries.
Teenage sexual activity and pregnancy has emerged as a major social problem in Nepal where more than 60% of its total population is living under poverty line. Poverty, illiteracy and lack of awareness are some of the crucial factors are the root cause for various type of psycho-social crimes ranging from sex abuse, rape, unwanted pregnancies, illegal abortions, suicides, commercial prostitution, human trafficking, etc.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.

OPERATIONAL DEFINITIONS
ADOLESCENTS:
All students aged between 13 to 20 years studying in class nine and ten.

REPRODUCTIVE HEALTH:
It is a state in which people have the ability to reproduce and regulate their fertility and are able to go through pregnancy and child birth safely. Hence the outcome of pregnancy is successful and the couples are able to have sexual relations free of the fear of pregnancy and contracting disease.

KNOWLEDGE ABOUT REPRODUCTIVE HEALTH:
This term refers to an awareness of high school adolescent about reproductive health that has been measured by the knowledge part of research instrument designed for this study purpose.

ATTITUDE TOWARD REPRODUCTIVE HEALTH:
This term refers to the opinion about reproductive health given by school adolescent which includes pubertal changes, reproduction, sexuality, safe sexual practices, family planning and STDs and HIV-AIDS.

Methods & Methodology
• Study design: Descriptive ,cross sectional study.
• Duration of study: from 23th May to 4th June
• Study area: Hile, Dhankuta ( Hille Secondary School, Nilgiri Don Bosco English Boarding School, Mother Land Secondary English Boarding School.)
• Study population: adolescent students from 13 – 20 yrs
• Sample size:200 students
• Sampling technique:
Convenient purposive sampling.
This research is based on random selection of the study area of Hile bazaar of Dhankuta district of which schools were randomly selected and they are stratified into government and private schools. After that the students of class 9 and 10 aged between 13 to 20 were separated in to male and female.
This is a descriptive , cross-sectional study, done at Hile secondary school, Nilgiri Donbosco English

METHODS OF DATA COLLECTION:
Questionnaire was prepared and they are folded and stapled individually. The students of class 9 and 10 are grouped in to male and female and the four groups were put in to separate classes as one student per bench. The questioners were distributed to each individual and the name and answers to the questions are kept confidential. Those not understanding the questions and their options are explained individually. After completing the answer the questionnaires are collected separately in a box so that the answers of each student is confidential.
Ethical consideration:Request letters to the school principal was given in each school and due consent was taken.Verbal consent was taken from the each participants.Those who didn’t want to participate were not forced.Confidentiality was maintained.

Result:
Sex education
Teaching how to perform sexual activity 18.5%
Teaching reproductive system,sexual changes,family planning and STDs 50.5%
Not appropriate for my age 15.5%
Don’t know 15.5%

What is sex education? a) teaching how to perform sexual activity 37
b) teaching reproductive system, sexual changes, family planning and STD’s 101
c) not appropriate for my age 31
d) don’t know 31

What is the effect of masturbation on health? a) It is a healthy practice 25
b) It is a sign of mental illness 2
c) It causes weakness 17
d) It causes disease 13
e) Don’t know 143
Should school provide sex education a) YES 169
b) NO 19
c) Don’t know 12
What is Safe sex? a) sex with single partner 52
b) sexual intercourse after appropriate age 45
c) using condoms 27
d) all of the above 53
e) no idea 26
Do you want to have sex with more than one partner? a) YES 27
b) NO 150
c) Already have 8
d) Don’t know 15

HIV/AIDS transmission
Question YES (%) NO (%) Don’t Know (%)
a) Unsafe sexual contact 94 3 3
b) Mosquito bite 24 66 10
c) From mother having AIDS to child 93 5 3
d) Blood donation 87 6 7
e) Shaking hands 9 83 8
f) Shaving razors 46 33 25
g) Social kissing 11 70 19
h) Drug addiction 66 17 17

Preventing HIV/AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Avoiding sex with multiple partners 93 4 3
b) Using condoms 88 9 3
c) Using mosquito nets 35 52 13
d) Avoid sharing same dish with person having AIDS 26 60 14
e) Using sterilized disposable needles 82 6 12
What should be done with a person having AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Admit him/her to hospital 87 7 6
b) Reject him/her 7 87 6
c) Provide love and sympathy 90 5 5
d) Continue sex 6 84 10

Discussion

Findings from studies which have investigated premarital sexual behavior among high school and college students have found rates of activity to vary from 11 per cent among students in Pokhara to 14 per cent among Kathmandu students 1 and 16 per cent among students in Palpa District (Limbu 2001; Prasai 1999). Among young unmarried men and women aged 14 to 19 years working in factories in the Kathmandu Valley, 20 per cent and 12 per cent of the men and women respectively reported having experienced sex (Puri 2002). Further, studies of single men in the border towns of Nepal found activity rates of 10 per cent among a sample aged 15 to 19 years and about 50 per cent among a slightly older sample aged 18 to 24 years (Mehta 1998; Tamang and others 2001).Data collected during the demographic and health surveys as well as from small-scale surveys indicate that awareness of condoms, HIV/AIDS and other STIs appears to be rising among the general population, mainly owing to extensive media campaigns (NDHS 1996 and 2001; Mehta 1998; Pradhan and others 1997).

Conclusion
More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Fewer students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems

Recommendations
• Sex education should carry a major credit in curriculum of secondary schools.
• Text books should have an extensive coverage in this topic.
• Teachers play a role model in providing education to the adolescents, thus, they need to emphasize on this agenda.
• Parents should be more like friends: this prevents hazards.

Bias:
• As participants of research are likely to recall some events Recall bias may play a factor.
• Site selection bias may be there.
• Data entry and analysis bias in another possibility.
• As sex is still the subject which people cannot talk about freely, topic selection has further biased our study.

Limitations:
• A set of questions in questionnaire may not measure the actual level of knowledge regarding the topic.
• Though we tried our best to explain the student regarding the questionnaire, still, some mistakes were inevitable.
• Time allotted to conduct the research was not adequate which limited our study.

Bibliography
1. Kothari CR, interpretation and report writing: research methodology, 2nd edition 2004, page 345-347.
2. K. Park, Demography on family planning, community medicine, 18th edition 2005, page 361-376.
3. K. Park, sexually transmitted disease, community medicine, 18th edition 2005, page 265-279
4. Pramod Singh, Surya Niraula, Kavita Verma; sexual behaviour, knowledge and attitude to sexuality among adolescent of Dharan Municipality. Published 2000. rep.139, BPKISH library.
5. B. Singh and N. thakur; research on knowledge, attitude about reproductive health among female adolescent in high school in Dharan. Published 2004, Rep.84 BPKISH library.
6. William F Ganong: physiology of male and female, reproductive system, review of medical physiology , 20th edition , page 410-433.
7. Reproductive care ,KAP among adolescents: PLAN international.

STUDY OF KNOWLEDGE ATTITUDE AND PRACTICE OF A SEXUAL BEHAVIOUR IN ADOLESCENT
MBBS-2007 Batch.
Sah R.B., Parajuli P., Haldar N., Shah P., Kumar P., Deo N.B. , Shah P.M., Karki P., Bista N., Rani N., Shahi P., Jain P.

Abstract
Introduction: Many adolescents of NEPAl are having different sex related problems and indulging in unsafe sexual practice and consequently having risk of transmission of sexually transmitted diseases .To understand their attitude and practice better, we decided to conduct this research.
Objectives: To identify the level of sexual knowledge in adolescent. To determine the knowledge of adolescent regarding sexually transmitted infections (STI) especially HIV/AIDS and To determine the role of school in providing sex education

Materials and methods: This cross-sectional study was conducted at different government and private school of Hile bazzar of Dhankutta District involving 200 school adolescent of class nine and ten. The data collected was entered in Microsoft excel and analysed.
Results: only 60% of the students thought that teaching reproductive system, sexual changes and family planning as sex education.34% of the students said that they are not interested in talking about sex and 44% feel free.73% of them thought that appropriate age for marriage is 21 to 25 years. Most of the student responded that they get knowledge about sex from TV/Radio and teachers.74% of the students responded that they don’t want to have sex before marriage, and 3% of them already have sex.66% of the student don’t about the masturbation and 72 % of them don’t know about its effect on health.24 % of them thought that mosquito bite also transfers HIV/AIDS.84 % of the student think that sex education should be provided in the school.
Conclusion: More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Less students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems
INTRODUCTION
Sex education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy.
It is also about developing young people’s skills so that they can make informed choices about their behavior, and feel confident and competent about acting on these choices.
With increasing prevalence of sexually transmitted diseases, sex education is of prime importance in the adolescents of today. Young people often lack the knowledge, experience and maturity regarding health issues such as STDs, HIV/AIDS and to avoid the grave consequences that confronts them. Adolescent comprises of 20% of the total world population and 80% of them living in developing countries. Despite high chances of indulging into sexual activity, adolescent often lack due knowledge about the human body and reproduction especially in developing countries.
Teenage sexual activity and pregnancy has emerged as a major social problem in Nepal where more than 60% of its total population is living under poverty line. Poverty, illiteracy and lack of awareness are some of the crucial factors are the root cause for various type of psycho-social crimes ranging from sex abuse, rape, unwanted pregnancies, illegal abortions, suicides, commercial prostitution, human trafficking, etc.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.
Lack of proper sex education, practices of unsafe sexual activities, poor knowledge about ovulation, menstrual cycle and conception among female partners and lack of awareness about STDs and HIV/AIDS have contributed a lot not only to increase teenage pregnancy but also for high fertility rate, population growth and poverty in the country. It has also become a major factor to push our young generation into the danger of HIV /AIDS progressively.

OPERATIONAL DEFINITIONS
ADOLESCENTS:
All students aged between 13 to 20 years studying in class nine and ten.

REPRODUCTIVE HEALTH:
It is a state in which people have the ability to reproduce and regulate their fertility and are able to go through pregnancy and child birth safely. Hence the outcome of pregnancy is successful and the couples are able to have sexual relations free of the fear of pregnancy and contracting disease.

KNOWLEDGE ABOUT REPRODUCTIVE HEALTH:
This term refers to an awareness of high school adolescent about reproductive health that has been measured by the knowledge part of research instrument designed for this study purpose.

ATTITUDE TOWARD REPRODUCTIVE HEALTH:
This term refers to the opinion about reproductive health given by school adolescent which includes pubertal changes, reproduction, sexuality, safe sexual practices, family planning and STDs and HIV-AIDS.

Methods & Methodology
• Study design: Descriptive ,cross sectional study.
• Duration of study: from 23th May to 4th June
• Study area: Hile, Dhankuta ( Hille Secondary School, Nilgiri Don Bosco English Boarding School, Mother Land Secondary English Boarding School.)
• Study population: adolescent students from 13 – 20 yrs
• Sample size:200 students
• Sampling technique:
Convenient purposive sampling.
This research is based on random selection of the study area of Hile bazaar of Dhankuta district of which schools were randomly selected and they are stratified into government and private schools. After that the students of class 9 and 10 aged between 13 to 20 were separated in to male and female.
This is a descriptive , cross-sectional study, done at Hile secondary school, Nilgiri Donbosco English

METHODS OF DATA COLLECTION:
Questionnaire was prepared and they are folded and stapled individually. The students of class 9 and 10 are grouped in to male and female and the four groups were put in to separate classes as one student per bench. The questioners were distributed to each individual and the name and answers to the questions are kept confidential. Those not understanding the questions and their options are explained individually. After completing the answer the questionnaires are collected separately in a box so that the answers of each student is confidential.
Ethical consideration:Request letters to the school principal was given in each school and due consent was taken.Verbal consent was taken from the each participants.Those who didn’t want to participate were not forced.Confidentiality was maintained.

Result:
Sex education
Teaching how to perform sexual activity 18.5%
Teaching reproductive system,sexual changes,family planning and STDs 50.5%
Not appropriate for my age 15.5%
Don’t know 15.5%

What is sex education? a) teaching how to perform sexual activity 37
b) teaching reproductive system, sexual changes, family planning and STD’s 101
c) not appropriate for my age 31
d) don’t know 31

What is the effect of masturbation on health? a) It is a healthy practice 25
b) It is a sign of mental illness 2
c) It causes weakness 17
d) It causes disease 13
e) Don’t know 143
Should school provide sex education a) YES 169
b) NO 19
c) Don’t know 12
What is Safe sex? a) sex with single partner 52
b) sexual intercourse after appropriate age 45
c) using condoms 27
d) all of the above 53
e) no idea 26
Do you want to have sex with more than one partner? a) YES 27
b) NO 150
c) Already have 8
d) Don’t know 15

HIV/AIDS transmission
Question YES (%) NO (%) Don’t Know (%)
a) Unsafe sexual contact 94 3 3
b) Mosquito bite 24 66 10
c) From mother having AIDS to child 93 5 3
d) Blood donation 87 6 7
e) Shaking hands 9 83 8
f) Shaving razors 46 33 25
g) Social kissing 11 70 19
h) Drug addiction 66 17 17

Preventing HIV/AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Avoiding sex with multiple partners 93 4 3
b) Using condoms 88 9 3
c) Using mosquito nets 35 52 13
d) Avoid sharing same dish with person having AIDS 26 60 14
e) Using sterilized disposable needles 82 6 12
What should be done with a person having AIDS
Question YES (%) NO (%) Don’t Know (%)
a) Admit him/her to hospital 87 7 6
b) Reject him/her 7 87 6
c) Provide love and sympathy 90 5 5
d) Continue sex 6 84 10

Discussion

Findings from studies which have investigated premarital sexual behavior among high school and college students have found rates of activity to vary from 11 per cent among students in Pokhara to 14 per cent among Kathmandu students 1 and 16 per cent among students in Palpa District (Limbu 2001; Prasai 1999). Among young unmarried men and women aged 14 to 19 years working in factories in the Kathmandu Valley, 20 per cent and 12 per cent of the men and women respectively reported having experienced sex (Puri 2002). Further, studies of single men in the border towns of Nepal found activity rates of 10 per cent among a sample aged 15 to 19 years and about 50 per cent among a slightly older sample aged 18 to 24 years (Mehta 1998; Tamang and others 2001).Data collected during the demographic and health surveys as well as from small-scale surveys indicate that awareness of condoms, HIV/AIDS and other STIs appears to be rising among the general population, mainly owing to extensive media campaigns (NDHS 1996 and 2001; Mehta 1998; Pradhan and others 1997).

Conclusion
More students feel free talking about sex. Most of the students think that appropriate age for marriage is 21 to 25 years. Most of the students responded that they get knowledge about sex from TV/ Radio. Majority of students don’t want to have sex before marriage. Most of the responders don’t want to have sex with more than one person. Most think that school should provide sex education. About half of the responders think that they are not provided with adequate knowledge about sex in the school. Fewer students discuss their queries related to sex with their teachers. Most of them consult with healthcare personnel and with their friends when they have sex related problems

Recommendations
• Sex education should carry a major credit in curriculum of secondary schools.
• Text books should have an extensive coverage in this topic.
• Teachers play a role model in providing education to the adolescents, thus, they need to emphasize on this agenda.
• Parents should be more like friends: this prevents hazards.

Bias:
• As participants of research are likely to recall some events Recall bias may play a factor.
• Site selection bias may be there.
• Data entry and analysis bias in another possibility.
• As sex is still the subject which people cannot talk about freely, topic selection has further biased our study.

Limitations:
• A set of questions in questionnaire may not measure the actual level of knowledge regarding the topic.
• Though we tried our best to explain the student regarding the questionnaire, still, some mistakes were inevitable.
• Time allotted to conduct the research was not adequate which limited our study.

Bibliography
1. Kothari CR, interpretation and report writing: research methodology, 2nd edition 2004, page 345-347.
2. K. Park, Demography on family planning, community medicine, 18th edition 2005, page 361-376.
3. K. Park, sexually transmitted disease, community medicine, 18th edition 2005, page 265-279
4. Pramod Singh, Surya Niraula, Kavita Verma; sexual behaviour, knowledge and attitude to sexuality among adolescent of Dharan Municipality. Published 2000. rep.139, BPKISH library.
5. B. Singh and N. thakur; research on knowledge, attitude about reproductive health among female adolescent in high school in Dharan. Published 2004, Rep.84 BPKISH library.
6. William F Ganong: physiology of male and female, reproductive system, review of medical physiology , 20th edition , page 410-433.
7. Reproductive care ,KAP among adolescents: PLAN international.