Hygiene, health education and collaborative health practices in Nepal.

PIP: Health education in Nepal, according to the Long Term Health Plan (1975- 1990) emphasizes an integrated, intersectorial approach, committed to providing minimum health care to the maximum number of people. Nepal has about 16 million people, 90% of them rural, growing at over 2.7% yearly, with a rising growth rate, a 12.2% infant mortality rate, a 50% child mortality rate, and life expectancies of 46 for men and 42.5 for women. 2 health projects based on community volunteers are described: the urban Bhaktapur Development Project and the rural Jumla Project. The Bhaktapur Project employs Community Health Leaders, Village Health Workers, and Panchayat Based Health Workers to provide basic health care and health education, emphasizing prevention. These workers visit households daily, and teach sanitation, latrine construction, water supply development, first aid, detect deficiency diseases, and refer people to clinics. The Jumla Project supplies a densely populated but inaccessible mountainous region where food supplies have to be airlifted, the per capita income averages $140, firewood must be brought from may kilometers away, and local streams are used for drinking water, livestock, bathing and latrines. In the 1st 2 years of the project, 11 pit latrines and 2 gravity fed water systems were constructed. Now latrines are being built all over the region with materials supplied by the International Human Assistance Programme.^ieng

Decreased malaria morbidity in the Tharu people compared to sympatric populations in Nepal.

The Terai region of Nepal has been known to be heavily malarious since remote times, and it has, therefore, been regarded as uninhabitable by most Nepalese people. The Tharu people, who have been living in the Terai for centuries, were reputed to have an innate resistance to malaria. Following successful control of malaria by the Nepal Malaria Eradication Organization (NMEO), a large and heterogeneous non-Tharu population now inhabits the Terai along with Tharus. By analysing NMEO records, we have found that the prevalence of cases of residual malaria is nearly seven times lower among Tharus compared to sympatric non-Tharus. This difference applies to Plasmodium vivax, which is now much more common, and to Plasmodium falciparum. We suggest that the basis for resistance to malaria in the Tharu people is a genetic factor yet to be identified.

Patient education in Nepal.

The authors, using the definition of health education as a deliberately, planned, structured learning opportunity about health that occurs in a setting at a given point in time involving an interaction between an educator and learner, recommend patient education in hospitals. The authors make a strong recommendation for the health education department within the Ministry of Health in Nepal to develop patient educational programs collaboratively with the nursing division. Such programs in the authors' opinion would limit the spread of infections, decrease diseases, and allow for maximum use of equipment and facilities unfamiliar to most Nepalese. Patient education would also promote adequate utilization of existing manpower.