1

MAKERERE UNIVERSITY

COLLEGE OF HEALTHSCIENCES

COMMUNITY DIAGNOSIS REPORT FOR NAKASONGOLA

SUBCOUNTY,NAKASONGOLA DISTRICT.

APRIL/MAY 2013

BY

AKELLO FAITH 11/U/334

BALUKU ANDREW 11/U/15559/PS

KALUNGI JONATHAN 11/U/1021

KUNIHIRA CATHERINE 11/U/1127

MUGALU DENIS EDWARD 11/U/1007

NABUKALU SSENTONGO ANGELA 11/U/1044

NDAGIRE REGINA NABIKINDU 11/U/1137

ORIBA DAN LANGOYA 11/U/1019

TUMWESIGIRE SAMUEL 11/U/47

A REPORTFOR COMMUNITY DIAGNOSIS SUBMITTED TOTHE COLLEGE OF

HEALTH SCIENCES, MAKERERE UNIVERSITY.

DECLARATION

We hereby declare the originality and authenticity of this report. The views expressed herein

are mostly ours though other people’s works have been cited and referenced.

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ACKNOWLEDGEMENT

We are thankful to the Almighty for the wisdom, courage and determination he has granted us

throughout our stay in Nakasongola and as we accomplished this piece of work.

Our sincere thanks also go out to our site supervisor; Dr. Nakku Edith, site tutor; Dr. John

Kamulegeya, Mr. Kirunda Dan and the entire staff at Nakasongola Health Centre IV for their

ever present guidance during our stay at the facility.

Special thanks go to the local leaders in Nakasongola Sub County and the villages therein

for their hospitality and assistance in our community work. It made this work a great success.

Every slight effort rendered by every group member is highly appreciated too.

We cannot go without thanking Dr. Dhabangi Aggrey, the course coordinator, for the formal and

informal skills, and knowledge we acquired from him before we went to the community. We are

very grateful.

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LIST OF ABBREVIATIONS.

AIDS : Acquired Immunodeficiency Syndrome.

HIV : Human immune virus.

MMR : Maternal Mortality Rate.

TFR : Total Fertility Rate.

UDHS : Uganda Demographic and Health Survey.

WHO : World Health Organization.

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TABLE OFCONTENTS

DECLARATION.................................................................................................................................i

ACKNOWLEDGEMENT..................................................................................................................ii

LIST OF ABBREVIATIONS...........................................................................................................iii

TABLE OFCONTENTS....................................................................................................................iv

ABSTRACT.......................................................................................................................................vi

CHAPTER ONE.................................................................................................................................1

1.0 INTRODUCTION........................................................................................................................1

1.1 BACKGROUND......................................................................................................................1

1.2 Statement of the problem..............................................................................................................2

1.3 Broad objective.........................................................................................................................3

1.4 Specific objectives....................................................................................................................3

1.5 Scope of the study.....................................................................................................................3

CHAPTER TWO................................................................................................................................4

2.0 LITERATURE REVIEW.............................................................................................................4

2.1 Defining health..............................................................................................................................4

2.2 Health status of the people of........................................................................................................4

CHAPTER THREE.............................................................................................................................8

3.0 METHODOLOGY........................................................................................................................8

3.1 STUDY AREA.............................................................................................................................8

3.2 STUDY DESIGN..........................................................................................................................8

3.3 STUDY POPULATION...............................................................................................................8

3.4 Sample size...................................................................................................................................8

3.5 Sampling techniques.....................................................................................................................8

3.6 Data collection techniques............................................................................................................9

3.7 Data processing and analysis........................................................................................................9

3.8 Ethical consideration.....................................................................................................................9

3.9 Quality assurance........................................................................................................................9

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3.10. The activities carried out at the site:..........................................................................................9

CHAPTER FOUR.............................................................................................................................13

4.0 RESULTS...................................................................................................................................13

4.3. Sanitation and Hygiene..............................................................................................................17

4.4. Health seeking behavior.............................................................................................................20

4.5. DISEASE BURDEN..................................................................................................................21

4.6. IMMUNIZATION COVERAGE..............................................................................................24

4.7. CHECKLIST..............................................................................................................................26

CHAPTER FIVE...............................................................................................................................27

5.0 DISCUSSION.............................................................................................................................27

5.1 Socio-demographic characteristics.............................................................................................27

5.2 NUTRITION...............................................................................................................................28

5.3 SANITATION AND HYGIENE................................................................................................28

4 HEALTH SEEKINGBEHAVIOUR..............................................................................................29

CHAPTER SIX.................................................................................................................................30

6.0 CONCLUSION AND RECOMMENDATIONS.......................................................................30

6.1 CONCLUSION......................................................................................................................30

6.2 RECOMMENDATIONS..........................................................................................................30

REFERENCES..................................................................................................................................31

ANNEX.............................................................................................................................................32

Annex1. Questionnaire.....................................................................................................................32

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ABSTRACT.

Community diagnosis is the comprehensive assessment of the health state of an entire community

in relation to its social, physical and biological environment. It involves identification and

quantification of health problems in a Community as whole. We study the morbidity, mortality

rates and identify their causes for the purpose of identification of those at risk.

The study was carried out in Nakasongola Subcounty, Nakasongola District.

During this community diagnosis, we used questionnaires and checklist to obtain information on

the socio-demographic factors, Nutrition, Hygiene, Health seeking behavior, and maternal and

Child Health. The collected data was then analyzed to come up with this report.

The study was Non-intervention descriptive cross-section survey research. It involved the

community and the local leaders in the villages of Kalubanga, Matuugo and Buruuli.

Generally the biggest health challenges of Nakasongola Sub County were found to be malaria,

upper respiratory infections especially cough and diarrheal diseases. these were mainly due to

the bushes around people’s homes, congestion within the homes, poor sanitation to some

extent, and the way of life of these people especially in Buruuli where there is communal

alcohol drinking.

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CHAPTER ONE

1.0 INTRODUCTION

Community diagnosis is a process by which the health management committee members and

health staff begin to learn about the community health problems, needs and concerns as well as the

d e t e r m i n a n t s of these problems. Every individual needs a family and every family needs a

community to cling to. Health professionals serve so as to satisfy their needs. The greatest

resource available for this is the community which is considered to be the foundation of the health

system.

Prevention has to be done by the people themselves with the help of health workers who have the

knowledge about preventive measures. The presence of a health unit nearby does not itself reduce

the amount of preventable illness until the people have a positive attitude towards their own health

both in their homes and the surrounding environment.

Our goal in the community was to build our capacity and assess local concerns that determine the

health status of local residents, establish priorities of improving their health, use the data for public

health program planning and policy making, develop effective interventions and evaluate the

impact of public health programs and policies.

1.1 BACKGROUND

Community diagnosis involves comprehensive assessment of social, physical, cultural, economic,

psychological, environmental and biological status of community in order to identify problems

regarding health and set priorities for program development.

This report has the community diagnosis of Nakasongola Sub County. Nakasongola Sub County

is found in Nakasongola County, Nakasongola district. The district has 2 counties; Budyebo

county and Nakasongola county. Nakasongola County in turn has many sub counties including

Nakasongola, Wabinyonyi, Kakooge, Kalungi, Kalongo sub counties. Nakasongola Sub County,

our catchment area has many villages but we covered only three: Matuugo, Kalubanga and Buruuli

villages. There are 30 health centers in the district, 27 of which are government owned, and 3 are

private.

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Despite the government and ministry of health’s initiative program to increase the utilization of

health services, there is still high prevalence of diseases like Malaria, diarrhea and new HIV

infections emerging.

Most people are peasants with low-income and low standards of living.

Community diagnosis has acquired three levels; Descriptive, analytical and healthy action

programs. It is usually a slow and gradual process based on information continuously collected in

the clinical situation, supplemented from time to time by surveys performed outside this situation.

For small populations, it may be necessary to cumulate several years` experience before

satisfactory data can be got. This should be done to get her with the inhabitants of the community

to evaluate any variations.

1.2 Statement of the problem.

There are bushes around many of the homes we visited. These become breeding places for

mosquitoes, which spread malaria, the most prevalent disease in our catchment area. Another

contributing factor to this is the low income of most of the people in Nakasongola. Most are just

peasant farmers who can’t afford to buy mosquito nets. They therefore wait for the free packs

given out in government facilities and these can never be enough for the entire community and as a

result, they are defenseless against malaria. There is also poor sanitation in homes and the biggest

contributing factor is the high population in the homes. Being crowded in a limited space makes it

hard to clean up and as result, much community members report with diarrheal conditions. Being

crowded in homes also contributes to the high number of people reporting with upper respiratory

tract infections like cough and others, many of which are communicable.

The following is the summary of the possible factors contributing to the health status and health of

the people living in Nakasongola Sub County:

Distance from health unit: Long distance from the health unit might affect the turn up.

Cultural beliefs: Due to the cultural beliefs, people may not seek preventive and

curative health services.

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Level of education: The literates will easily perceive the importance of health services

provided than the illiterates.

Attitude of health workers: The conduct of health workers while delivering the

Services may encourage or discourage the clients’ turn up.

Inadequate health education: People may not be well versed with some of the

provided health services.

Economic status: Income of the may influence the type of health facility he/she will use.

Poor housing facilities.

1.3 Broad objective.

The aim of the study is to carry out community diagnosis of Nakasongola

Sub County.

1.4 Specific objectives.

The study was guided by the following objectives:

To determine the demographic characteristics of the community of Nakasongola.

To assess the nutritional status and hygiene of the community.

To assess the common diseases and health seeking behavior.

To assess the health service delivery system in this community

1.5 Scope of the study.

The study was carried out in Nakasongola sub county, Nakasongola county, Nakasongola district.

The researchers covered 3 villages in the subcounty; Kalubanga, Matuugo and buruuli villages. It

focused on community diagnosis.

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CHAPTER TWO

2.0 LITERATURE REVIEW

This chapter contains the literature on the definition of health, health status of people of

Nakasongola district, and determinants of their health.

2.1 Defining health

According to the Constitution of the World Health Organization 1948,health is defined as a state

of complete physical, mental, emotional, intellectual, environmental, spiritual health, and social

well-being and not merely the absence of disease or infirmity.

(WHO,2004).

2.2 Health status of the people of

Nakasongola district.

The health status of the people of Nakasongola district as a whole is indicated by many factors, a

few of which are discussed below.

As of 2008, their life expectancy was 48 years which is a bit low in comparison to the national life

expectancy of 52 years.

A Total Fertility Rate (TFR) of 6.7birth/woman and a contraceptive prevalence rate of

24% both contribute significantly to the increase in Nakasongola’s population. The maternal

mortality rate was recorded to be 506 deaths per 100000 live births; the infant mortality rate was

88 deaths per 1000 live births. Teenage pregnancy estimated at 25%in2006significantly

contributes to overall maternal mortality rate (MMR)

Malaria, respiratory tract infections especially pneumonia, skin diseases, diarrheal

diseases, physical trauma/accidents, intestinal worms, STIs, AIDS, and maternal

complications remain the leading causes of morbidity and mortality. Malaria is the

disease affecting people the most in Nakasongola, contributing 48% to the disease

burden, pneumonia 30%,skin diseases 5.3%, diarrheal diseases 4.6%, physical trauma

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2.5%, intestinal worms 2.2%, STIs contributing 2.1%,maternal complications 1.6% the

rest of the percentage being contributed by AIDS.

Non-Communicable Diseases (NCDs) are an emerging problem due to multiple factors

such as adoption of unhealthy lifestyles, metabolic side effects resulting from lifelong

antiretroviral (ARV) treatment.

Neglected Tropical Diseases (NTDs), including those targeted for eradication, are

Still occurring in Uganda. Gender inequalities including sexual and gender-based

violence remain a major hindrance to improvement of health outcomes (UBOS, 2007).

Seventy five percent of the disease burden in Uganda however is still preventable

through health promotion and disease prevention

As recoded from DMO’s office.

2.3 Determinants of health

Determinant is defined as any factor, whether event, characteristic, or other definable entity that

brings about change in a health condition or other defined characteristic. These are the causes

and other factors that influence the occurrence of disease and other health-related events. (Olsen et

al 2000)

Many factors combine together to affect the health of individuals and communities. Whether

people are healthy or not, is determined by their circumstances and environment. To a large

extent, factors such as where we live, the state of our environment, genetics, our income and

education level, and our relationships with friends and family all have considerable impacts on

health. According to WHO, the determinants of health include;

Income and social status-

Higher income and social status are linked to better health. The greater the gap between the richest

and poorest people, the greater the differences in health.

Employment and working conditions–

People in employment are generally healthier, particularly those who have more control over their

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working conditions. A direct relationship exists between poverty and prevalence of diseases such

as malaria, malnutrition and diarrhea as they are more prevalent among the poor than the rich

households (UBOS2007)

Physical environment–

Safe water and clean air, healthy work places, safe houses, communities and roads all contribute to

good health. People who live in environments with pollution, high rates of joblessness, inadequate

access to healthy and affordable food, few opportunities for physical activity, or that are targeted

by corporations pushing unhealthy products such as alcohol, cigarettes and fast food, tend to

experience adverse health outcomes.

Culture-

Customs, traditions and the beliefs of the family and community all affect health. The cultural and

socio-economic context within which women in Uganda live has inherent limiting factors that

have a bearing on their health. The rural women have been most disadvantaged as the socio-

cultural environment is still tightening its prohibitions on nutrition and other health-seeking

behavior (FPAU1998). .

Behavioral factors-

How and what people eat, their level of alcohol consumption, their engagement in physical

activity, or their propensity for violence are all affected by the environment around them. The

combination of environmental and behavioral factors contributes to an increased number of people

getting sick and injured who then require medical services (MC Ginn 1993)

Food safety;

Unsafe food causes many acute and life-long diseases, ranging from diarrheal diseases to various

forms of cancer. WHO estimates that food borne and water borne diarrheal diseases taken together

kill about 2.2 million people annually, 1.9 million of them children. Food borne diseases and

threats to food safety constitute a growing public health problem and WHO's mission is to assist

Member States to strengthen their programmes for improving the safety of food all the way from

production to final consumption.6

Water supply, sanitation and hygiene.

Around1.1billion people globally do not have access to improved water supply sources whereas

2.4 billion people do not have access to any type of improved sanitation facility. About 2 million

people die every year due to diarrheal diseases; most of them are children less than 5 years of age.

The most affected are the populations in developing countries, living in extreme conditions of

poverty, normally peri-urban dwellers or rural inhabitants. (WHO, 2004).

Education–low education levels are linked with poor health, more stress and lower self-

confidence .Education has profound health effects. More education makes an individual more

aware of healthy and unhealthy choices and makes it easier to make healthy choices

Other determinants of health as outlined by WHO are; Transport, Food and Agriculture, Housing,

Waste, Energy, Industrial, Urbanization. Water, Radiation, Nutrition and health. Genetics-inheritance

plays a part in determining life span and the likelihood of developing certain illnesses. Personal

behavior and coping skills–balanced diet, keeping active, smoking, drinking, and how we deal

with life’s stresses and challenges all affect health services-access and use of services that prevent

and treat disease influences health. Gender: Men and women suffer from different types of

diseases at different ages (WHO 2002)

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CHAPTER THREE

3.0 METHODOLOGY.

3.1 STUDY AREA.

The study was conducted in Nakasongola sub county, Nakasongola County, Nakasongola

district. The district covers an area of 3509 sq.km. It is occupied by swamps (wetlands) and part

of the Lake Kyoga the study was carried out in 3 of the villages in Nakasongola Sub County:

kalubanga, Matuugo, buruuli.

Most of the occupants go for low income generating activities like peasant farming whereby they

rear cattle and grow food especially root tubers, and selling food items in their local market

places. The common health problems encountered in the area include; malaria, HIV/AIDS,

diarrheal diseases, upper respiratory tract infections. The RTIs are also prevalent among the

drunkards found in buruuli village.

3.2 STUDY DESIGN.

The study was a Non-intervention descriptive cross-section survey research. It involved

the community and their local leaders in Nakasongola sub county.

3.3 STUDY POPULATION.

The target group was the community, and local leaders.

3.4 Sample size

The study involved 120 participants sampled from all the villages in Nakasongola sub county.

3.5 Sampling techniques.

In this study, probability-sampling method using simple random sampling was used. The

households of the study were picked randomly by researchers. Since the area is sparsely

populated, the researchers agreed to interview the households one by one, consecutively.

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3.6 Data collection techniques.

Primary data was collected using questionnaire and checklist.

Secondary data was collected using documentary source [Records].

3.7 Data processing and analysis.

Data was processed and analyzed manually by the researchers with the help of calculators and

computers. Data was tabulated and the final findings were presented in figures and tables drawn

from Microsoft excel sheet.

3.8 Ethical consideration.

Permission was sought from the site supervisor D r . N a k k u as well as the local leaders and it

was granted. The communi ty v i s i t s were done in company o f some of the VHT

members . Consent was obtained from the respondents prior to interviews. Any information

obtained was handled with high degree of confidentiality; as there was no mentioning of people’s

names but using their signatures on the data collection tools for those who could write. For

illiterate correspondents, a thumb print was used.

3.9 Quality assurance.

The researchers themselves collected their data.

3.10. The activities carried out at the site:

A] Home/community based work.

The communities of concern were the earlier mentioned villages to which Nakasongola health

centre IV renders most of its services. At least 30 homes were visited from each village. The

objectives of these visits were to;

Find out common types of food eaten, food security and hygiene,

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Find out the health problems of the community.

Find out the essential needs of the homes in the community.

o TheLC1, Health management teams and community mobilizers of all the

mentioned villages were visited and assessment carried out pertaining health

problems, environmental and individual sanitation, common diseases and their

causes plus food security.

These leaders would also describe to us their various roles in the health sector as well as the roles

of the other members of their health management teams.

B] FACILITY BASED ACTIVITIES {FBA}

These included all the activities we used to do at the facility, Nakasongola health centre

IV in the different departments. The objectives were;

1. To do a diet history at the antenatal clinic and young child clinic to see what food is eaten and

assess whether the diet provides the macro and micro nutrients.

2. To conduct anthropometric measurements and report on the nutritional status of children

and mothers.

3. To provide nutrition education to parents/guardians of children and to pregnant

women.

4. To participate in the measurement of hemoglobin in the laboratory and to interpret the

results.

The Facility based activities were:

Immunization and child growth monitoring.

Voluntary counseling and testing [VCT].

Laboratory work bleeding patients and carrying out tests to measure their

hemoglobin levels.

Pharmacy work; packing and prescribing drugs.

Participation in consultation.

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Treatment; administering intravenous fluids/drugs, fixing cannulars and drips.

Nutrition and psycho-social support activities.

Tutorials, SDL and writing weekly reports.

C] ACTIVITIES IN THE PHARMACY.

The pharmacy has a store and a dispensary. In the store drugs are kept on shelves and the heavy

ones are placed on the pallets so that they do not come in contact with the floor. The movement of

the drugs in the store is trucked by the use of stock cards. On the stock cards they indicate

quantity received from the supplier, quantity out of the store to the dispensary and stock

remaining in the store. It also helps them to truck the drugs that are about to expire.

In the dispensary, drugs are kept on the shelves. They have a range of drugs including antibiotics

Mixtures [Antibiotics, cough expectorants, anti malarials, antifungal, Injectable and i.v fluids

and Creams). At the dispensary, prescriptions are received, interpreted and dispensed. Patients

are explained to on how to take the drugs and if there is a potential risk of interaction with foods

they are advised according. After dispensing the drugs, they are recorded. The records are manual

and the work is tedious.

D] TUTORIALS

These were always 3-hour sessions held on Mondays and Thursdays. On Mondays we would

formulate learning issues from the problem and brainstorm on them and finally derive learning

objectives to be resolved on Thursday. These tutorials were always conducted by the weekly

chairpersons with their scribes.

E] IMMUNIZATION

Immunization and child growth monitoring plus Prevention of mother to child transmission

(PMTCT) services at Nakasongola Health Centre IV. We found out that most commonly given

vaccines are;

BCG.

Polio vaccine,

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Measles vaccine

Vitamin A complement

The turns up for the mothers are fair and these mothers are always given a session of health

education talk before starting immunization every time they come.

As part of the PMTCT services, health talks are given to mothers and all the HIV/AIDs victims

every time they gather for nutrition and psycho- social support.

The facility also offers free condoms to its clients.

G] REPORT WRITING

These were meant to be summarized descriptions of weekly activities, challenges and findings,

which we submitted in to the tutor every Friday with the log books. In accordance with the

time table we had to write one page report on ;

1. A problem statement and research objectives.

2. Research study to solve problem (given as problem 66) using research methods.

H] LOGBOOK

We used to fill in our daily log of activities from Monday to Friday and give a page summary of

all the weekly activities and objectives. The books were then handed in on Friday evenings

together with the weekly reports to the site tutor for assessment.

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CHAPTER FOUR.4.0 RESULTS.

This study was carried out in Buluuli and Kalubanga villages of Nakasongola Town Council, in Nakasongola district. A total of 120 respondents were drawn from the two villages.4.1. Socio - Demography Table 4.1: Summary of Socio – Demographic Data.

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CHARACTERISTICS Frequencies Percentage

Age of respondentsBelow 5 years 0 0.0Between 6 - 18 years 0 0.0Above 18 years 120 100.0

Sex of respondentMale 23 19.0Female 97 81.0

Head of house holdMother 69 57.1Father 51 42.9Child headed 0 0.0

Type of familyNuclear family 80 66.7Extended family 40 33.3Others 0 0.0

Number of people the family

Less than 5 54 45.2Between 6 - 18 49 40.5

23 19.0Age ranges in the house hold

Below 5 109 90.5Below 6 - 18 246 204.8

Above 18 223 185.7Occupation of head of family

Civil servant 14 11.9Business personnel 17 14.3Peasant 83 69.0Others 6 4.8

Religion of the familyAnglican 57 47.6Catholic 26 21.4Moslem 17 14.3Others 20 16.7

Fig 4.1: Demography of study sample.

Fig 4.1 Shows that 18.9% of household members were under 5 years of age, 42.6% were between

ages 6 to 18, and 38.7% were above 18 years old.

Fig 4.2: Occupation of household heads

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Fig 4.2: shows that 11.9% of household heads were civil servants, 14.3% were business personnel,

while 69.0% were peasants.

4.2. Nutritional status

Table 4.2: Food security and nutrition

status

FOOD SECURITY AND

NUTRITION

Source of food

Own garden 74 61.9

Bought from markets 46 38.1

Shops 0 0.0

Commonly eaten foods

Matooke 46 38.1

Root tubers 97 81.0

Maize and its products 69 57.1

Animal products 37 31.0

Others 0 0.0

Number of meals taken per

day

One 9 7.1

Two 31 26.2

Three 77 64.3

More than three

61.9% of households sampled obtained food from the garden, while 38.1% bought food from the market.

The most commonly eaten food is Root Tubers (81.0%), followed by Maize and its products at 57.1%.

38.1% of the households consumed matooke while 31% could afford animal products.

15

Most households have 3 meals per day (64.3%), while 26.2% and 7.1% of households have two and one

meal per day respectively.

Fig4.3: Commonly consumed foods.

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4.3. Sanitation and Hygiene.

Table 4.3: Sanitation and Hygiene Status.

 Frequency

 Percentag

e

17 Water source

Borehole 49 40.5

Tap 60 50.0

Well 6 4.8

Spring 0 0.0

Others 6 4.8

18

Distance of water source

from home

Less than 1 km 80 66.7

1 - 2 Km 26 21.4

Above 2Km 14 11.9

19 Safe drinking water

A. Who take safe drinking

water 77 64.3

B. Who don’t take safe

drinking water 43 35.7

If A,

 Boiled 66 54.8

 Filtered 0 0.0

 Treated with chemicals 11 9.5

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50.0% of the sampled households use tap water for home consumption. 40.5% use water

from a borehole, while 4.8% of households use other sources of water like rain water storage.

66.7% of the sampled households draw water from less than a kilometer in terms of distance.

21.4% have a water source with a kilometer or two, while 11.9% have to trek more than 2

kilometers to access a water source.

64.3 % of the households reported consumption of safe drinking water. Boiling was the major

way of water purification (54.8% of those who drunk safe water). The other way was use of

chemicals, like water guard (9.5%). Filtration, as a method of water purification was not used

among the households sampled.

35.7% of households didn’t consume safe water, that is, they either didn’t boil it or add water

purification chemicals before use.

Fig 4.4: Common water sources.

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Fig 4.5: Distance of water source from home.

19

4.4. Health seeking behavior

Fig 4.6: Facilities accessed when sick

Health Unit Traditional healers

Herbs Church0

20

40

60

80

100

120

Fig 6: Health seeking behaviour

Fig 6: Health seeking behav-iour

No.

of r

espo

nden

ts

Fig 4.7: Facilities accessed for health care.

Health Unit Traditional healers

Herbs Church0

20

40

60

80

100

120

No.

of r

espo

nden

ts

20

85.7 % of the households sampled receive health care from health units.

Significant to note is that 11.9% of the households reported use of herbs to treat illness, while 2.4% seek

remedy from church.

Only 19.0% of the sampled households go for regular medical checkup from health units.

Of the 19%, 62.6% go for medical checkup every six months, 12.6 % go for the checkups between six

months and 1 year, 12.6% take 1 to 2 years to go for medical checkup, while as the other 12.6% spend

over 2 years before going for checkup.

The remaining 81.0 % do not go for medical checkups.

4.5. DISEASE BURDEN

Table 4.4: Common diseases and their frequencies

DISEASE BURDEN

Common diseases

Malaria 83 69.0

RTIs 86 71.4

Diarrheal diseases 11 9.5

Others 6 4.8

Frequency of diseases

Every month 69 57.1

Between 2 and 6 months 34 28.6

Over 6 months to a Year 9 7.1

Over 1 year 9 7.1

Chronic diseases

Present 49 40.5

Absent 71 59.5

If Present, Example

Was treatment given?

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Fig4.8: Common diseases affecting household members.

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Fig 4.9: Disease occurrences.

As indicated in the above figures (Fig 8 and Fig 9), Respiratory Tract Infections and Malaria are the most

common diseases affecting the households sampled, with 71.4 % and 69.0% respectively. Diarrheal

diseases affect only 9.5% of households.

The frequencies of illnesses, occurring in the households reported for; every month, between 2-6 months,

over 6 months to 1 year, and over 1 year were 57.1%, 28.6%, 7.1% and 7.1% respectively.

However, 40.5 % of the households reported cases of chronic illness such as Asthma, Hypertension, and

Sickle cell disease.

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4.6. IMMUNIZATION COVERAGE

Fig 4.10: Immunization status

70%

30%

immunisation status

Fully immunised Partially immunised not immunised

All households sampled considered immunization of relevance to their health.

However, only about 70% of the households had all their members fully immunized, with 30%

having partially immunized members.

40% of the household respondents complained of poor customer care as a challenge faced during

the immunization process.

26.7% complained about limited stock of vaccines at the immunization centres.

13.3% had long distance as their main challenge during the immunization process.

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Fig 4.11: Challenges faced during immunization.

10

5

10

15

20

25

30

35

40

45

50

Long distancePoor customer careLimited stock of vaccinesPoor communicationOthers

No. of respondents

25

4.7. CHECKLIST

Fig4.12: Graph of Check List

Latrine Rubbish pit Kitchen Aerated house

Clean compound

Utensil rack

Food store Animal house

0

5

10

15

20

25

30

35

40

Graph for check list

presentAbsent

Frequency

26

CHAPTER FIVE

5.0 DISCUSSION

The study involved 120 households and we managed to capture all our forecasted sample size.

5.1 Socio-demographic characteristics.

Most of the respondents were females, accounting for 81% of the total respondents, the rest being

male(19%).This is because the men in the study areas were out for work at the times of

questionnaire distribution.

The age distribution of all the respondents was above 18years as shown in the data above. This

confirms the validity of the information we got as all these were considered reliable adults.

Majority of the households sampled were headed by mothers (57.1%),others by fathers(42.9%0

and none by children. This implies that the women in our study area are heavy laden, affecting

their general health as depicted by their great turn ups at the health centre.

Within the sampled households, most of the family members were below 5 years of age

years(45.2%), a significant number of them lying between the ages of 6 and 18 years(40.5%).

This accounts for the high morbidity rate in children recorded at the health centre.

The study also cut across the different religious beliefs, and the majority of the residents were

found to be Anglicans (47.6%), the rest falling in other dominations; Catholics, Muslims,

traditionalists. This also affected their health seeking behaviors as the traditionalists sought for

help from the spirits, the Pentecostals from church and the rest from the health centre (majority).

With regards to occupation, majority of the respondents were peasants (69%), others were

business personnel (14.3%) and civil servants (11.9%). This shows that most people are low

income earners and this affects the quality of their health as regards their nutrition and the places

they go to for treatment. This in turn explains the poor child and maternal health as recorded at

the health facility

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5.2 NUTRITION

The study results show that most of the households sampled obtained food from their own

gardens (61.9%) while only 38.1% bought it from the market.

64.3% of the households could afford to have 3 meals a day, 26.2% had two a day and 7.1% had

only one meal a day.

Most of the meals were served with root tubers (81%), others were served maize and its products

(57.1%), matooke (38.1%) and animal products (31%).

These results depict that most of the families do not have a balanced diet in their nutrition. Their

meals are majorly deficient in proteins as shown by the few animal products consumed. They are

also generally deficient in vitamins indicated by the absence of vegetables in their meals.

They however has a strong food security as most of them grow their own food and even have

food stores for it. The people in Nakasongola preserve cassava and sweet potatoes by drying it in

preparation for the dry season, when they serve them as “kasedde”.

5.3 SANITATION AND HYGIENE.

Majority of the sampled households use tap water at home (about 50%), others obtain it form the

boreholes (40.5%) and wells 4.8%) especially when there is shortage at the taps. This is a good

indicator of their water safety. They are however affected by the distances to these water sources

as majority walk a distance of at least a kilometer to obtain it (66.7%), 21.4% of them walk a

distance between 1 and 2 km, while 11.9% have to foot more than 2km. This water is mainly

boiled for consumption (54.8%) while 9.5% use chemicals like water guard. The rest do not treat

it at all, with the belief that it is already treated from the sources pumping it to the taps.

The water safety accounts for the very low prevalence of water borne diseases like bilharzias and

typhoid as recorded at the health facility.

From the checklist graph above, about majority of the household disposed off their rubbish safely

in rubbish pits and in their gardens for manure, accounting for the high percentage of clean

compounds recorded. Human wastes were also observed to be disposed off in pit latrines,

accounting for the low prevalence of diseases like cholera and ebola which would be spread by

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poor waste disposal.

4 HEALTH SEEKINGBEHAVIOUR

From figure 6, majority of the people in the study area seek for health attention from the health

facility. A significant number, however seek for it from traditionalists while a few seek for health

attention from the spiritual healers and churches. Almost none of the respondents were found to ever

go for routine medical checkups. Actually, majority of them were ignorant about them. This good

health seeking behavior is attributed to short distance of most of the respondents’ homes from the

facility, to the facility staff and VHT’s effort to publicize the services available for example

immunization, safe circumcision, weekly health education programs, cancer screening and the effort

to attend to them fully when they come to the facility.

The facility plays a big role in prevention and control of HIV/AIDS; free condoms are provided every

single day and there are free counseling sessions on Tuesdays. Testing for HIV/AIDS is done free of

charge at the facility.

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CHAPTER SIX

6.0 CONCLUSION AND RECOMMENDATIONS.

6.1 CONCLUSION

The study has revealed that the health and health status of people of Nakasongola sub county is

still below the expected level. The major factors that contribute to the health and health status

include;

1. Low levels of income

2. Lack of mosquito nets and thick bushes around homes.

3. Poor housing facilities as most houses were found to be crowded.

4. Long distances from reliable water sources.

5. Ignorance about some essential factors like water treatment and importance of routine

medical checkups.

6. Poor nutrition as it was observed that most of their meals are protein and vitamin deficient.

6.2 RECOMMENDATIONS

On the basis of the findings of the study, the following recommendations are proposed:

1. Carryout Health Promotion and preventive activities like community health education on: use of mosquito nets to prevent malaria and attending antenatal clinics to promote maternal and child health.

2. The number of outreaches should also be increased to create more awareness on the

importance of clearing bushes from homes and give out mosquito nets to people who

cannot afford.

3. The overcrowding in the houses was caused by too many children within the same household.

We therefore recommend that the health stake holders educate people about family planning

and child spacing and their advantages, and encourage people to carry them out.

4. Local leaders should ensure proper house construction to promote proper sanitation.

5. Health stakeholders should encourage members to go for routine medical checkups by telling

them the advantages of the act.

6. More people should be trained to join the VHTs and these should be given allowance as an

encouragement to be part of the awareness teams.

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REFERENCES.

1. WHO; World health report 2002, 2004

1. Olsen SJ, MacKinon LC, Goulding JS, Bean NH ,Slutsker L.Surveillance for

foodborne

2. disease outbreaks–United States, 1993-1997.In: Surveillance Summaries, March 27,

2000.

3. MMWR 2000; 49(No.SS-1):1–59

4. McGinnis, JMFoege; actual cases of death in the United States Journal of the American

Medical ASSOCIATION,270;2207-2217,1993

31

ANNEX

Annex1. Questionnaire.

QUESTIONNAIRE FOR COMMUNITY DIAGNOSIS OF NAKASONGOLA SUB-COUNTY,

NAKASONGOLA DISTRICT.

Consent form: We are medical students from Makerere University College of Health sciences carrying

out community diagnosis in Nakasongola Sub County. This is to achieve a comprehensive report on

health status and factors affecting health in Nakasongola Sub County. We would like you to participate

in this research and we promise that the information obtained will not be linked to you directly and we

shall ensure strict confidentiality. You are free to withdraw at anytime during the course of the

interview.

Signature…………………………………………

1. Age of the respondent

A. Below 5 years

B. Between 6-17 years

C. Above 18 years

2. Sex of the respondent

A. Male

B. female

3. Who is the head of this household?

A. mother

B. father

C. child headed

4. What is the type of family?

A. nuclear family

B. extended

C. others

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5. How many people stay within this household?

A. less than 5

B. between 6-10

C. more than 10

6. How many people in this household lie within the age ranges of?

A. below 5

B. between 6-18

C. above 18

7. What is the occupation of the head of the household?

A. civil servant

B. business personnel

C. peasant

D. others

8. What is the religion of the family?

A. protestant

B. roman catholic

C. moslem

D. others

IMMUNISATION COVERAGE

9. Do you think immunization of children is important?

A. yes

B. no

C. have no idea

10. What is the immunization status of the youngest member of the household?

A. fully immunized

B. partially immunized

C. not immunized

i. If answer is A or B, why?

11. What challenges do you find with immunization generally?

A. long distance

B. poor customer care

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C. limited stock of vaccines

D. poor communication

E. others

DISEASE BURDEN

12. Which disease(s) commonly affects members of the household?

A. malaria/fever

B. RTIs(cough)

C. Diarrheal diseases

D. Others(identify)

13. How often does sickness occur in this household?

A. Every month

B. Between 2 to 6 months

C. Over 6 months to 1 year

D. Over one year

14. Does anyone in the household have a chronic disease?

A. Yes

B. No

ii. If yes which one………………………………………………..

iii. Did they get treatment for this disease

HEALTH SEEKING BEHAVIOUR

15. Where do you seek health attention?

A. From the health unit

B. From traditional healers

C. Use herbs from home

D. From church

E. Others

16. Do you go for regular medical check up

A. Yes

B. No

i. If yes ,how often

A. Within 6 months

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B. Between 6 months and 1 year

C. Between 1 and 2 years

D. Over 2 years

HYGIENE AND SANITATION

17. What is the source of water for household use?

A. Borehole

B. tap water

C. well

D. spring

E. others

18. How far is the water source?

A. less than 1 km

B. between 1-2km

C. above 2km

19. Do you treat your water?

A. yes

B. no

If yes, how do you treat the water?

A. boiling

B. filtering

C. use water guard or other chemicals

D. others

FOOD SECURITY AND NUTRITION STATUS

20. What is the source of food for this household?

A. own gardens

B. buy from markets and shops

C. others

21. What are the commonly eaten foods in this household?

A. matooke

B. root tubers

C. maize and its products

D. animal products

E. others

22. How many meals are prepared in this household per day?

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A. one meal

B. two meals

C. three meals

D. more than three meals

CHECK LIST

ITEM PRESENT ABSENT

Latrine

Rubbish pit

Kitchen

Aerated house

Clean compound

Utensil rack

Food store

Animal house

KEY INFORMAT GUIDE

1. What work do u do in this community

2. What are the health services available to the people?

3. What is the participation like in the health programs?

4. what are the issues affecting health in the community

5. What do the people do about these issues?

6. What in your opinion needs to be done about these issues?

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