ADB_book_18 April.qxp - Himalayan Document Centre - icimod

The indicators for some common diseases arecomputed in terms of outpatient department (OPD)visits by region (Table 2.17). There are nine commonwaterborne and air (smoke) borne diseases.Compared with the national average, the relativeincidence of skin disease among hospital outpatientsis higher in the Terai, and that of intestinal worms,acute respiratory infection (ARI), gastritis, chronicbronchitis, and typhoid are lower than the nationalaverage. These diseases are most likely to occur as aresult of poor quality drinking water and lack ofnearby health facilities.Table 2.18 lists the top ten diseases identified bythe Department of Health Services of Nepal andTable 2.19 the incidence of diarrhea and ARI inchildren. Diarrhea among children below 5 years ofage is more prevalent in the Mountains and the Teraithan the national average (177 per 1,000). Diarrhea isrelated to the consumption of poor quality water. ARIis more prevalent in the Terai. In rural Nepal, ARI isrelated to the lack of outlets for smoke from solidbiofuels due to poor ventilation. About 95% of ruralhouseholds use solid fuel, including wood, cowdung, leaves, and straw, for cooking and heating(Table 2.20). The studies of Nepal Health ResearchCouncil (2003) and the Intermediate TechnologyDevelopment Group (2004) show that ventilation isvery poor in rural households and smoke from theuse of solid fuel remains indoors for long periods,which could be increasing respiratory problems.According to the Department of Health Servicesannual report 2003, based on the data recorded inthe health services, the percentage of malnourishedchildren below age 3 measured in terms of underweightis higher in the Mountain and Terai regionsthan the country average (Table 2.21).Table 2.17: Common Diseases by RegionDiseasesNational(N=8,642,852)Annual Incidence of Specific Disease ( of OPD Visits) aMountain(N=807,663)Hill(N=4,091,291)Terai(N=3,743,898)Skin disease 175.3 116.7 136.6 229.5Diarrheal disease 101.4 112.1 105.0 95.2Intestinal w orms 92.6 113.9 100.0 80.0Acute respiratory i nfection 87.2 104.5 97.5 72.4Gastritis 58.2 63.9 63.4 51.3Chronic bronchitis 30.4 31.0 32.9 27.5Anemia 28.1 22.5 26.2 31.3Typhoid 28.0 32.5 27.2 27.9Jaundice and infectious hepatitis 3.5 2.7 3.0 4.1N = number, OPD = outpatient departmentNote: Figures in parentheses for each ec ological region are OPD visits.a Annual incidence of specific disease —number of specific cases in a specific year x 1,000 per total number of OPD visits in the same year.Source: DOHS (2003)Table 2.18: Ten Leading Diseases, 2001DiseaseNational(N= 8,642,852)Mountain(N= 807,663)Percent of Total OPD Visits by RegionHill(N= 4,091,291)Terai(N= 3,743,898)Skin disease 5.76 5.38 5.18 6.35Diarrheal disease 3.44 5.00 3.94 2.73Acute respiratory infection 3.38 4.69 3.69 2.90Intestinal worms 2.76 4.44 2.99 2.28Pyrex 2.30 2.58 2.16 2.37Gastritis 2.20 3.14 2.56 1.71Ear infection 1.56 1.89 1.45 1.61Chronic bronchitis 1.20 1.41 1.36 1.02Abdominal pain 1.05 1.40 1.13 0.93Sore eye complaints 1.02 1.89 1.22 0.71Note: Figures in parentheses indicat e total OPD visitsSource: DOHS (2003)Chapter 2: Rural Environment, Poverty, and Livelihood17