HEALTH HAZARDS IN NEPAL
Background: Health in Nepal
Three of the major areas of development in Nepal focus on population, water
resource management, and health. The health of a nation is generally determined by a
number of indicators reflecting the major health concerns of its individuals. These major
indicators are life expectancy, infant mortality, maternal mortality, and the under 5
mortality. Once these statistics have been compiled and analyzed, questions can be asked
concerning the causes of these numbers and solutions offered based on governmental
services and primary health care offered to the citizens of Nepal. Three main factors that
impact state of health in Nepal are its high rate of poverty, illiteracy, and its physical
geography.
The life expectancy rate for Nepal is low, estimated to be about 55 years. This
number has increased by 13.5 years in the twenty years between 1976 and 1996, but
remains the lowest in Southern Asia. Nepal is one of three countries in the world where
the life expectancy for women is lower than for men, which is an indication that health
care for men has a higher priority than for women. (1) The highest risk group for poor
health are children under five (particularly girls) and females of reproductive age. The
mortality rate for young females is significantly higher than for males (by 24%).
According to a 1996 Nepal Living Standard Survey, only 41% of households have access
to a health facility within walking distance of 30 minutes or less. (2)
Nepal is one of the least developed countries in the world. It is estimated that 60%
of its 23 million people live below poverty level. The per capita income is around
$200.00 per year. Along with this is a traditionally high level of illiteracy. There is a
strong correlation between literacy and the health of a population. (4) Preventative health
care measures, control of communicable diseases, and nutritional programs are heavily
dependant on the education levels of a populace. Control of disease is also dependant on
the availability of safe drinking water and proper sanitation procedures and facilities.
Many of the diseases in Nepal are infectious and can be prevented by the development of
service water, sewage systems, and safe drinking water which would create a more
hygienic environment. Only about 37% of the population (34% of rural and 66% of
urban) has access to safe drinking water and only 6% have access to proper sanitation
facilities. (3)
The overall pattern of morbidity in Nepal is dominated by reproductive issues
(both maternal and perinatal), infectious disease, and nutritional disorders. These are
responsible for approximately 68% of the disease burden. Degenerative and non-
communicable diseases account for 23% of the burden, with accidents and injuries
comprising the remaining 9%. (1)
Maternal and Child Morbidity
The maternal morbidity rate is linked to services provided for in prenatal, delivery
and post-natal care. In 2000, the morbidity rate was 539 per 100,000 live births. (4) This
number is especially high when compared to countries of similar socioeconomic status.
The number of births attended by a health care provider is a low 10.8% in 2001. Early
marriage and childbirth also contribute to maternal mortality along with weak
infrastructure and health services. Nutritional deficiencies also exist with an estimated
75% of all mothers suffering from anemia caused by iron deficiency. (5) Culturally, it hasbeen a tradition for women to have their babies at home without any health care officials
attending the birth. This cultural tradition will have to be overcome before women are
comfortable seeking health care at delivery, whether in a health care facility or attended
by a trained health care professional.
The child mortality rate has decreased significantly in the past 30 years but
remains at a high level of 91 per 200,000 live births. (4) Gains have been attributed to
control of malaria, eradication of small pox and a reduction in cholera due to education.
Child malnutrition still exists at alarmingly high levels. The large number of people
below the poverty line, lack of nutritional education, inadequate health services, lack of
clean drinking water and proper sanitation all contribute to the child mortality rate.
Infectious Diseases
Some of the most common diseases of concern in Nepal are malaria, kala-azar,
Japanese encephalitis, tuberculosis, dysentery, Hepatitis A and HIV/AIDS. Estimates
from the World Health Organization predict that conditions will not improve over the
next 8 years. (2)
According to public health officials in Pokhara, an urban area 60 miles west of
Kathmandu, the main health problems are dysentery, parasites, and other water borne
diseases. In the villages outside of Pokhara, major problems are skin disease, which
results from lack of proper hygiene and sanitation, acute respiratory infection, and lung
disease that results from indoor cook fires, and malnutrition. Some people know how to
boil and filter their water for drinking, but cannot afford to or do not have the resources to
do so.
People have been taught to treat water borne diseases with jeevan gel, used
specifically for the dehydration that is caused by diarrhea. Jeevan gel is a solution of
sugar and salt that is distributed by health care officials, or can be bought in stores.
Previously, it was common to withhold water from patients with diarrhea. There is also a
marked lack of nutritional education among the population. Officials stated that while
some people may be getting enough to eat, their diet is not nutritionally balanced.
Health Care Issues Directly Linked to Water Quality
Cholera is a severe infectious disease caused by the bacterium Vibrio cholerae.
The symptoms of cholera are diarrhea and the loss of water and salts in the stool. In
severe cholera, the patient develops violent diarrhea with vomiting, thirst, muscle cramps,
and sometimes circulatory collapse. The mortality rate is more than 50 percent in
untreated cases, but falls to less than 1 percent with proper treatment. The means by
which a person can be infected is from food or water contaminated by bacteria from the
stools of cholera patients. Prevention of the disease is a matter of sanitation and proper
hygiene practices.
Typhoid Fever is an acute infectious disease caused by the typhoid bacillus
Salmonella typhi. The bacillus is transmitted by milk, water, or solid food contaminated
by feces of typhoid victims or of carriers, that is, healthy people who harbor typhoid
bacilli without presenting symptoms. Prevention of the disease is, again a matter ofsanitation and proper hygiene practices.
Hepatitis A is an acute viral infection that causes inflammation of the liver.
Symptoms begin with fever, usually followed by extreme weakness, loss of appetite,
nausea, vomiting, and muscle pains. The upper abdomen may be painful and tender. The
virus will usually run its course in about two weeks. Hepatitis A is caused mainly by poor
sanitation and lack of hygiene. It is transmitted by food or water contaminated by excreta;
by other objects taken into the mouth; from person to person. Outbreaks often occur in
refugee camps and in institutions where small children are crowded together.
Dysentery is a severe inflammation of the intestine characterized by passage of
loose feces, severe abdominal pain and cramps, diarrhea, and mucus or blood in the stool.
The two most common causes of dysentery are infection with a bacillus of the Shigella
group, and infestation by an amoeba, Entamoeba histolytica. Both bacillary and amoebic
dysentery are passed from one person to another and spread by fecal contamination of
food and water. They are most common where sanitation is poor.
Health Issues Directly Linked to the Use of Human Waste in Agriculture
Use of human waste as an agricultural fertilizer has been in practice since ancient
times. Human excreta is a rich source of nitrogen and other nutrients required for plant
growth, it encourages the formation of humus, improves soil structure making it easier to
cultivate, and contains trace elements which naturally control plant parasites and disease.
There are health risks associated with this practice, so in many countries chemical or
other organic fertilizers have replaced the use of human excreta. In Nepal, many farmers
have no other alternative; they have a choice of using human waste as fertilizer or
nothing, and therefore, a reduced food output.
Health risks are associated with use of human waste as fertilizer; pathogens can
remain viable for extended periods of time on the crops and in the soil. The dangers exist
for people who work with the fertilizer, the soil, or with unwashed crops. Parasitic eggs
and cysts may exist in the soil, the water, or on plants for many months, creating ongoing
hazards. Burning eyes, burning lungs, skin rashes and other symptoms of illness have
been found in rural farmers and residents who use human waste as fertilizer. Some of the
same diseases found in unsanitary water can be spread through untreated human waste;
polio, typhoid fever, amoeba, giardia, hook worm, pin worm, round worm, tape worm,
and trichina worm.
The excreta can be treated in various ways to eliminate disease-causing
pathogens. Composting is an option as is the use of a double-pit latrine. Composting
encourages biological decomposition of solid organic matter and produces a humus
substance which can then be used as fertilizer. The process can be aerobic or anaerobic.
If oxygen is present, bacteria will consume the organic matter, carbon dioxide is
produced, and energy is released in the form of heat. The temperature of a compost can
reach temperatures of over 70°C. At this temperature there is rapid decomposition of
protozoa, worm eggs, and pathogenic bacteria. All fecal microorganisms, including high temp.
Geographic and Economic Challenges
A major problem with treatment of health issues is the geography and lack of
infrastructure in Nepal. With 80% of the people living in agricultural areas, there is a lack
of distribution not only of medicine and medical supplies, but of food itself. In many
rural areas, people eat only potatoes supplemented with small amounts of green
vegetables. Many infants are breast fed for up to two years with no food supplements.
This results in malnutrition for babies. The widespread poverty in Nepal prevents the
country from large-scale expenditures on public sewer systems.
Nepal is a country of hills, mountains, and low-lying regions. Infrastructure is
weak, with very few roads. The roads that do exist are in poor condition. This prevents
the effective allocation of medical staff and medicine throughout the country.
National Health Policy (1991)
A National Health Policy (NHP) was developed in 1991 to address the health of
the nation. It addresses delivery of health care services as well as information and
administrative issues. Its prime objective is to approach health care at the district level
and below. The policy emphasizes community involvement, encourages participation of
the private sector, and national and international NGO’s. The 8th Health Plan (1992-
1997), the 9th Health Plan (1997-2002), and the Long Term Health Plan (2002-2017)
have since been developed, all in keeping with the objectives of the National Health Plan.
All plans focus on implementation and development at the community level, using
district health systems as a means of health care delivery.
The people of Nepal realize that improvement in health care for its citizens is
closely tied to reducing poverty, improving literacy, reducing the rate of population
growth, successful management of its water and natural resources, and an improved
infrastructure for delivery of services. In planning for the development of Nepal, officials
and citizens will work together in all of these areas. The fundamental relationship among
these factors will influence the future of improved health care in Nepal.
Obstacles to Success of a National Health Policy
• A lack of funds to service and maintain health cares facilities.
• Shortages of medicines and instrumentation along with the uneven distribution of
medicines and facilities.
• A mitigating circumstance that must be considered is the culture and religious
traditions of the Hindu people that believe human excreta should be kept away
from the house. This would prevent the use of an enclosed bathroom in the home.
Also they do not believe that human excreta should be kept in one place, which
would preclude the use of a bathroom inside and the use of a public latrine in a
village setting.
• The physical geography of Nepal and lack of good roads prevent the availability
of accessible services, especially for those living in villages in the mountains, and
hill regions.
• High level of illiteracy among the population.
• A lack of decision-making and implementation by the government with regard to
training skilled health care workers.
Solutions to problems with health care in Nepal are closely linked to education,
poverty, a governmental commitment to improved services, the Hindu religion and its
culture, and the infrastructure to support change. Water resources management and solid
waste management are two of the most critical issues that must be dealt with as Nepal
plans to develop its vision of a society where all of its citizens have access to proper
health care and education.
Works Cited
1. Karki, Yagui, “Status Review: Health, Population and Drinking Water &
Sanitation Sectors”, National Strategies for Sustainable Development, 15
November 2003. http://www.nssd.net/country/nepal/nep05.htm
2. Wagner, Klaus and Aung, Lin, “Country Health Profile: Nepal”, Deputy Regional
Director: World Health Organization. 11 November 2003.
http://w3.whosea.org/drd/hlth_sit_nepal.htm
3. An Introduction to Health in Nepal: NepalNet an electronic networking for
sustainable development in Nepal
http://www.panasia.org.sg/nepalnet.health/medicine/health.htm
4. Ligal, Rithivi Raj, Vice Chairman, National Planning Commission, “Millennium
Development Goals: The United Nations System in Nepal” United Nations. 11
November 2003. http://www.un.org.np/
5. Savada, Andrea, “Nepal: Country Studies”, Library of Congress, Federal
Research Division. 5 November 2003, http://lcweb2.loc.gov
photo by youthkiawaaz.com
