1. 1
MAKERERE UNIVERSITY
COLLEGE OF HEALTHSCIENCES
COMMUNITY DIAGNOSIS REPORTFOR 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.

2. i
DECLARATION
Weherebydeclarethe originality and authenticity of this report. Theviews expressed hereinare
mostly ours though other people’s works have been cited and referenced.

3. ii
ACKNOWLEDGEMENT
We are thankful to the Almightyfor 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 cannotgowithoutthankingDr.DhabangiAggrey, the course coordinator, fortheformal and
informal skills, and knowledgeweacquired fromhimbeforewewentto the community. We are very
grateful.

4. iii
LIST OFABBREVIATIONS.
AIDS : Acquired Immunodeficiency Syndrome.
HIV : Human immunevirus.
MMR : Maternal Mortality Rate.
TFR : Total Fertility Rate.
UDHS : Uganda Demographic and Health Survey.
WHO : World Health Organization.

5. iv
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

6. v
3.10. The activities carried out at the site:..........................................................................................9
CHAPTERFOUR. ............................................................................................................................13
4.0 RESULTS...................................................................................................................................13
4.3. Sanitation and Hygiene..............................................................................................................17
4.4. Healthseeking 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

7. vi
ABSTRACT.
Communitydiagnosis isthe comprehensive assessment of the health state of an entire community in
relation to its social, physical and biological environment. It involves identificationand
quantification ofhealth problems in a Communityaswhole.We study the morbidity,mortalityratesand
identify their causes for the purpose of identification of those at risk.
Thestudywas carried out in Nakasongola Subcounty, Nakasongola District.
During this community diagnosis,weused questionnaires and checklist to obtain information on
the socio-demographic factors, Nutrition, Hygiene, Health seekingbehavior,andmaternal and
Child Health.The collected data was then analyzed to comeupwith this report.
Thestudywas Non-intervention descriptive cross-section surveyresearch.It involved the
communityand thelocal 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.

8. 1
CHAPTER ONE
1.0 INTRODUCTION
Community diagnosis is aprocess by which the health management committeemembersand
healthstaffbegintolearnaboutthecommunity healthproblems,needsandconcernsas well as the
determinants of these problems. Everyindividual needs a family and every family needs a
community toclingto.Healthprofessionalsserveso astosatisfy their
needs.Thegreatestresourceavailableforthisisthecommunity whichis considered tobethefoundation
of the health system.
Prevention has to bedonebythe people themselves with the help of health workerswho havethe
knowledgeaboutpreventivemeasures.Thepresenceofahealthunitnearbydoesnotitself reduce the
amountof preventable illnessuntilthe people have a positive attitude towards their own health
bothin their homes and the surroundingenvironment.
Ourgoal in the communitywas to build ourcapacityandassess local concerns that determine the
healthstatusoflocalresidents,establishprioritiesofimproving theirhealth,usethedatafor
publichealthprogramplanning andpolicy making,developeffectiveinterventionsandevaluate the
impactofpublichealth programs andpolicies.
1.1 BACKGROUND
Community diagnosisinvolvescomprehensiveassessmentofsocial,physical,cultural, economic,
psychological, environmental and biological status of community in order to
identifyproblemsregardinghealth and set priorities forprogramdevelopment.
This report has the community diagnosis of Nakasongola Sub County. NakasongolaSub
CountyisfoundinNakasongola 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.

9. 2
Despitethegovernmentandministryofhealth’sinitiativeprogramtoincreasetheutilization of
healthservices,thereisstillhighprevalence of diseaseslikeMalaria,diarrheaandnew HIV infections
emerging.
Most people arepeasantswith low-incomeand low standards ofliving.
Community diagnosishasacquiredthreelevels;Descriptive,analyticalandhealthy action programs. It
is usually a slow and gradual process based on information continuously
collectedintheclinicalsituation,supplementedfrom timetotimeby surveysperformedoutside
thissituation.Forsmallpopulations,itmay benecessary tocumulateseveralyears`experience
beforesatisfactory data can be got.Thisshouldbedonetogetherwiththeinhabitantsofthecommunityto
evaluateanyvariations.
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:
Distancefromhealth unit:Longdistance fromthehealth unitmight affect theturn up.
Cultural beliefs: Dueto the cultural beliefs, people maynot seekpreventive and
curativehealth services.

10. 3
Level ofeducation:Theliterates will easilyperceive the importance of health services provided
than the illiterates.
Attitudeof health workers:Theconduct of health workers whiledeliveringthe
Servicesmayencourageordiscouragethe clients’turn up.
Inadequatehealth education:Peoplemaynot bewellversed with someof the provided
health services.
Economic status:Income ofthemayinfluencethetypeof health facilityhe/she will use.
Poorhousing facilities.
1.3 Broadobjective.
Theaimof thestudyis to carryoutcommunitydiagnosisof Nakasongola Sub
County.
1.4 Specific objectives.
Thestudywasguided bythe followingobjectives:
To determine thedemographic characteristics of the communityof Nakasongola.
To assess the nutritional statusand hygieneof thecommunity.
To assess the common diseasesand health seeking behavior.
To assess the health service delivery system in this community
1.5 Scopeofthestudy.
Thestudy wascarriedoutin Nakasongola sub county, Nakasongola county, Nakasongola district.
The researchers covered 3 villages in the subcounty; Kalubanga,Matuugo and buruuli villages. It
focusedoncommunitydiagnosis.

11. 4
CHAPTER TWO
2.0 LITERATURE REVIEW
This chapter contains theliteratureon the definition of health, health statusofpeople
ofNakasongola district, and determinants of their health.
2.1 Defininghealth
AccordingtotheConstitutionoftheWorldHealthOrganization1948,healthisdefinedas a
stateofcompletephysical,mental,emotional,intellectual,environmental,spiritualhealth,and social
well-beingand notmerelythe absenceof diseaseor infirmity.
(WHO,2004).
2.2 Health status ofthepeople of
Nakasongola district.
The health status of the people of Nakasongola districtas 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 TotalFertilityRate (TFR) of6.7birth/womanand a contraceptiveprevalencerate of
24% both contribute significantlyto theincreasein 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 estimatedat 25%in2006significantly
contributesto overall maternalmortality rate (MMR)
Malaria,respiratory tractinfections especially pneumonia, skin diseases, diarrheal
diseases, physical trauma/accidents,intestinal worms, STIs, AIDS, and maternal
complications remain theleadingcauses ofmorbidityandmortality. 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

12. 5
2.5%, intestinal worms 2.2%, STIs contributing 2.1%,maternal complications 1.6% the
rest of the percentage being contributed by AIDS.
Non-CommunicableDiseases(NCDs) are anemerging problem dueto multiple factors
such as adoption ofunhealthylifestyles, metabolicside effects resultingfrom
lifelongantiretroviral (ARV) treatment.
Neglected Tropical Diseases (NTDs), includingthose targetedforeradication, are
Stilloccurringin Uganda.Gender inequalities includingsexual andgender-based violence
remain amajorhindranceto improvement of health outcomes (UBOS, 2007).
Seventyfivepercent of thediseaseburden in Ugandahowever is still preventable through
health promotion and diseaseprevention
As recoded from DMO’s office.
2.3 Determinants of health
Determinantisdefinedasany factor, whetherevent, characteristic, orotherdefinableentity that
bringsabout changein ahealthconditionorother definedcharacteristic. These are thecauses
andotherfactorsthatinfluencetheoccurrenceofdiseaseandotherhealth-relatedevents.(Olsen et al
2000)
Many factorscombinetogethertoaffectthehealthofindividualsandcommunities.Whether
peoplearehealthy or not,isdeterminedby theircircumstancesandenvironment.Toalarge
extent,factorssuchaswhere we live,thestateofourenvironment,genetics,ourincome and
educationlevel,andourrelationshipswithfriendsandfamily allhaveconsiderableimpactson health.
AccordingtoWHO,the determinants of health include;
Incomeandsocialstatus-
Higherincomeandsocialstatusare linkedtobetterhealth.Thegreater thegapbetweenthe
richestandpoorest people, the greaterthe differencesinhealth.
Employmentandworkingconditions–
Peopleinemploymentare generally healthier,particularlythose who have more control over their

13. 6
working conditions. A direct relationship exists between
povertyandprevalenceofdiseasessuchasmalaria,malnutritionand diarrhea asthey aremore prevalent
among the poor than the rich households (UBOS2007)
Physicalenvironment–
Safewaterandcleanair,healthy workplaces,safehouses,communities
androadsallcontributetogoodhealth. Peoplewholiveinenvironmentswithpollution,high
ratesofjoblessness,inadequateaccesstohealthy andaffordablefood,fewopportunitiesfor physical
activity, or that are targeted by corporations pushing unhealthy products such as
alcohol,cigarettesandfastfood, tend toexperience adversehealthoutcomes.
Culture-
Customs, traditions and thebeliefs of the family and community allaffecthealth. The
culturalandsocio-economic contextwithinwhichwomeninUganda live hasinherent limiting
factorsthathaveabearingontheirhealth.Theruralwomenhavebeenmost disadvantagedasthesocio-
culturalenvironmentisstilltighteningitsprohibitionsonnutrition and otherhealth-seeking behavior
(FPAU1998). .
Behavioral factors-
How andwhatpeople eat,their levelof alcoholconsumption,their
engagementinphysicalactivity,ortheirpropensityforviolenceareallaffected by the
environmentaroundthem. The combination of environmentaland behavioral factorscontributes
toanincreasednumberofpeoplegettingsickandinjuredwhothenrequiremedicalservices(MC Ginn
1993)
Foodsafety;
Unsafefoodcausesmany acuteandlife-long diseases,ranging fromdiarrheal
diseasestovariousformsofcancer.WHO estimatesthatfoodborneandwaterbornediarrheal
diseasestakentogether killabout2.2millionpeople annually, 1.9millionof them
children.Foodbornediseases and threats to food safety constitute a growing public health problem
andWHO'smissionistoassistMemberStatestostrengthentheirprogrammesfor improvingthe safetyof

14. 7
food allthe wayfromproduction to final consumption.
Watersupply,sanitationandhygiene.
Around1.1billionpeoplegloballydonothaveaccesstoimprovedwatersupplysourceswhereas2.4billion
peopledonothaveaccesstoany typeof improvedsanitationfacility.About2millionpeopledieeveryyear
due todiarrheal diseases; mostofthem arechildrenlessthan5yearsofage.Themostaffectedare
thepopulationsin developingcountries,living inextremeconditionsofpoverty,normallyperi-
urbandwellersor rural inhabitants. (WHO, 2004).
Education–loweducationlevels arelinked with poor health, morestressandlowerself- confidence
.Education hasprofound health effects.Moreeducation makesan individual more awareof
healthyand unhealthychoicesand makesiteasierto makehealthychoices
Other determinants of health as outlined by WHO are; Transport, Food and Agriculture, Housing,
Waste, Energy, Industrial, Urbanization. Water, Radiation, Nutrition and health. Genetics-
inheritanceplaysapartindetermining lifespan andthelikelihoodof developing
certainillnesses.Personal behavior andcoping skills–balanceddiet,keeping
active,smoking,drinking,andhowwe dealwithlife’sstressesandchallengesallaffect health services-
accessanduseofservicesthatpreventandtreat disease influenceshealth.Gender: Menand women
sufferfromdifferent types of diseases at different ages(WHO 2002)

15. 8
CHAPTER THREE
3.0 METHODOLOGY.
3.1 STUDY AREA.
Thestudywas 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.
Mostofthe occupantsgo for lowincomegenerating activities like peasant farming whereby they
rear cattle and grow food especially root tubers, and selling food items in their localmarket
places. The commonhealth problems encountered in the areainclude; malaria, HIV/AIDS,
diarrheal diseases, upper respiratorytract infections. The RTIs are also prevalent among the
drunkards found in buruuli village.
3.2 STUDY DESIGN.
Thestudywas a Non-intervention descriptive cross-section survey research.Itinvolved the
communityand theirlocal leaders in Nakasongola sub county.
3.3 STUDY POPULATION.
Thetargetgroupwas thecommunity, and local leaders.
3.4 Sample size
Thestudyinvolved 120 participants sampled from allthe villages in Nakasongola sub county.
3.5Sampling techniques.
Inthis study, probability-samplingmethodusing simplerandomsampling was used. Thehouseholds
ofthestudywerepicked randomlyby researchers.Since theareaissparsely populated, the
researchersagreedtointerviewthe households one by one, consecutively.

16. 9
3.6Data collection techniques.
Primarydata was collected usingquestionnaire andchecklist.
Secondarydatawascollected usingdocumentarysource [Records].
3.7Data processing andanalysis.
Datawasprocessedandanalyzedmanuallyby theresearcherswiththehelpofcalculatorsand computers.
Data wastabulatedandthefinalfindings were presentedinfiguresandtables drawn from Microsoft
excel sheet.
3.8 Ethical consideration.
Permissionwas sought fromthesitesupervisor Dr. Nakku as well as the localleadersandit
wasgranted. The community visits were done in company of some of the VHT
members. Consentwasobtainedfromtherespondentspriorto interviews. Any information obtained
was handled with high degreeof confidentiality; asthere was nomentioningof people’s names but
usingtheirsignatures on thedata collection tools forthose who could write. For illiterate
correspondents, a thumb print was used.
3.9 Quality assurance.
The researchers themselves collected theirdata.
3.10. The activitiescarried out at thesite:
A] Home/community based work.
The communitiesofconcernwere the earliermentionedvillagestowhich Nakasongola health
centreIV rendersmostofits services. At least 30 homes werevisited from each village.
Theobjectives of thesevisits wereto;
Find out common types of food eaten, food securityand hygiene,

17. 10
Find outthe health problems of the community.
Find out theessential needs of thehomes in the community.
o TheLC1, Healthmanagement teamsand communitymobilizers of
allthementioned villages werevisited and assessmentcarried out
pertaininghealth problems, environmental and individual sanitation,
commondiseases andtheircausesplus food security.
Theseleaderswouldalso describeto us their various roles in thehealth sector aswellasthe roles ofthe
othermembers oftheir healthmanagement teams.
B] FACILITY BASED ACTIVITIES {FBA}
These included allthe activities weused to do at thefacility, Nakasongola health centre
IV in thedifferent 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.
Voluntarycounselingand testing [VCT].
Laboratory work bleeding patients and carrying out tests to measure their
hemoglobin levels.
Pharmacywork;packing and prescribingdrugs.
Participation inconsultation.

18. 11
Treatment;administering intravenous fluids/drugs,fixingcannularsand drips.
Nutritionand psycho-social support activities.
Tutorials, SDL andwritingweeklyreports.
C] ACTIVITIES IN THE PHARMACY.
Thepharmacyhasa store anda dispensary.In thestoredrugsarekeptonshelvesandtheheavy
onesareplacedonthepalletssothattheydonotcomeincontactwiththe floor. The movement
ofthedrugsinthestoreistrucked bytheuseofstockcards.Onthe stockcards they indicate quantity
receivedfromthesupplier,quantity outofthestoretothedispensary andstock remainingin the store.It
also helps themto truckthedrugs that are about toexpire.
Inthedispensary,drugsarekeptonthe shelves. They havearangeofdrugsincluding antibiotics
Mixtures [Antibiotics,cough expectorants, antimalarials, antifungal,Injectableandi.vfluids
andCreams). Atthe dispensary, prescriptions are received, interpreted
anddispensed.Patientsareexplainedtoonhowtotakethedrugsandifthereisapotentialriskofinteractionw
ithfoods theyareadvisedaccording.Afterdispensingthedrugs, theyare recorded. The
recordsaremanual and theworkis tedious.
D] TUTORIALS
These werealways3-hoursessionsheldonMondaysandThursdays. OnMondayswe would
formulatelearningissuesfromtheproblemandbrainstormonthemandfinallyderive learning
objectivestoberesolvedon Thursday. These tutorialswerealwaysconductedby
theweeklychairpersons with their scribes.
E] IMMUNIZATION
Immunizationandchildgrowth monitoringplusPreventionofmothertochildtransmission (PMTCT)
servicesatNakasongola Health Centre IV.We foundout thatmost commonlygivenvaccines are;
BCG.
Polio vaccine,

19. 12
Measles vaccine
Vitamin Acomplement
The turns up for the mothers are fairandthesemothersarealwaysgiven a session of health
educationtalkbeforestartingimmunization everytime theycome.
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 offersfreecondomstoitsclients.
G] REPORT WRITING
Thesewere meant to besummarized descriptions of weeklyactivities, challenges and findings,
which wesubmitted in to thetutor every Fridaywith thelogbooks.In accordancewith thetime
tablewehad to write onepage reporton ;
1. A problem statement and research objectives.
2. Research study to solve problem (given as problem 66) using research methods.
H] LOGBOOK
Weusedto fill in ourdailylogof activities from MondaytoFridayandgiveapagesummaryof allthe
weeklyactivities and objectives. The books were then handed in onFridayevenings together with
the weeklyreports to the site tutor for assessment.

20. 13
CHAPTERFOUR.
4.0 RESULTS.
Thisstudywas carried out in Buluuli and Kalubanga villages of Nakasongola Town Council, in
Nakasongola district. A total of 120 respondents weredrawnfrom the two villages.
4.1. Socio - Demography
Table 4.1: Summary of Socio – Demographic Data.
CHARACTERISTICS Frequencies Percentage
Age of respondents
Below 5 years 0 0.0
Between 6 - 18 years 0 0.0
Above 18 years 120 100.0
Sex of respondent
Male 23 19.0
Female 97 81.0
Head of house hold
Mother 69 57.1
Father 51 42.9
Child headed 0 0.0
Type of family
Nuclear family 80 66.7
Extended family 40 33.3
Others 0 0.0
Number of people the
family
Less than 5 54 45.2
Between 6 - 18 49 40.5
23 19.0
Age ranges in the house
hold
Below 5 109 90.5
Below 6 - 18 246 204.8
Above 18 223 185.7
Occupation of head of
family
Civil servant 14 11.9
Business personnel 17 14.3
Peasant 83 69.0
Others 6 4.8
Religion of the family
Anglican 57 47.6
Catholic 26 21.4
Moslem 17 14.3
Others 20 16.7

21. 14
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

22. 15
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%.

23. 16
38.1% of the households consumed matooke while 31% could afford animal products.
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.

24. 17
4.3. Sanitation and Hygiene.
Table 4.3: Sanitation and Hygiene Status.
Frequency Percentage
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
50.0%of thesampled households usetap water for homeconsumption. 40.5%use water from a

25. 18
borehole, while4.8% of households use other sources of water like rain water storage.
66.7%of thesampled 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.

26. 19
Fig 4.5: Distance of water source from home.

27. 20
4.4. Healthseeking behavior
Fig 4.6:Facilitiesaccessedwhensick
Fig 4.7: Facilities accessed for health care.
0
20
40
60
80
100
120
Health Unit Herbs Church
No.ofrespondents
Fig 6: Health seeking behaviour
Fig 6: Health seeking…
0
20
40
60
80
100
120
Health Unit Traditional
healers
Herbs Church
No.ofrespondents

28. 21
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?

29. 22
Fig4.8: Common diseases affecting household members.

30. 23
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
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.
70%
30%
0%
immunisation status
Fully immunised Partially immunised not immunised

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Fig 4.11: Challenges faced during immunization.
0
5
10
15
20
25
30
35
40
45
50
1
No. of respondents
Long distance
Poor customer care
Limited stock of vaccines
Poor communication
Others

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4.7. CHECKLIST
Fig4.12: Graph of Check List
0
5
10
15
20
25
30
35
40
Latrine Rubbish
pit
Kitchen Aerated
house
Clean
compound
Utensil
rack
Food store Animal
house
Frequency
Graph for check list
present
Absent

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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

36. 29
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.

37. 30
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.

38. 31
REFERENCES.
1. WHO;Worldhealth report 2002,2004
1. Olsen SJ,MacKinonLC,Goulding JS, Bean NH,SlutskerL.Surveillancefor foodborne
2. diseaseoutbreaks–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 UnitedStates Journal of theAmerican
Medical ASSOCIATION,270;2207-2217,1993

39. 32
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

40. 33
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

41. 34
B. poor customer care
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

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A. Within 6 months
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

43. 36
22. How many meals are prepared in this household per day?
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?