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
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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
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
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.
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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
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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.
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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
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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
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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