UNITED REPUBLIC OF TANZANIA
MINIS TRY OF HEALTH
AND SOCIAL WELFARE
ILEMBULA SCHOOL OF NURSING AND MIDWIFERY
COMMUNITY HEALTH NURSING FIELD WORK REPORT IGIMA GROUP
SUPERVISED BY:-
L. MGALILWA
TABLE OF CONTENTS page
Ø
TITLE……………………………………………………………………………………………………………1
Ø INTRODUCTION…………………………………………………………………………………………..3
Ø ACKNOWLEDGEMENT…………………………………………………………………………………3
Ø DEFINITION OF TERMS………………………………………………………………………………...4
Ø ABREVIATIONS………………………………………………………………………………………………5
Ø BROAD
AND SPECIFIC OBJECTIVES…………………………………………………………………6
Ø FOUR
WEEKLY PLAN………………………………………………………………………………….......7
Ø BACK
GROUND INFORMATION OF THE VILLAGE…………………………………………….8
Ø GEOGRAPHICAL
FEATURES OF THE VILLAGE………………………………………………8-10
Ø DEMOGRAFIC
INFORMATION OF THE VILLAGE………………………………………….9-11
Ø ADMINISTRATIVE
SET UP OF THE VILLAGE (ORGANOGRAM)………………………….12
Ø HEALTH
SERVICE ASSESSMENT AND USES…………………………………………………..13-19
Ø SCHOOL
HEALTH SURVEY……………………………………………………………………………....20
Ø HOME
VISITING …………………………………………………………………………………………21-22
Ø GENERAL
SOCIAL AND ECONOMICAL SITUATION OF THE VILLAGE……………..23-26
Ø ENVIRONMENTAL
SITUATION…………………………………………………………………..…….27
Ø ACTION
PLAN…………………………………………………………………………………………………..28
Ø EVALUATION
OF THE VILLAGE…………………………………………………………………………..29-30
INTRODUCTION
Community health nursing field work is a part
of community is the part of health nursing subject that every nurse student has
to undertake before completion of studies. Igima group started community health
nursing field work on 11st JAN. 2014 and ended on 08th FEB .2014.
The group consisted 5 nurse students, names are determined bellow:-
·
HANTISH MHUGO
·
IMAKULATHA MWAKALAGO
·
LUCIA
MUSHI
·
GRACE
RICHARD and
·
MICHAEL
REGNALD MNG’ONG’O
AKNOWLEDGEMENT
First of all we would like to thank our
SAVIOUR for allowing us to be the among of students nurses of Ilembula school
of nursing and midwifery, then for guiding us in this community field to be
successful, because we know this is the
golden chance for us.
Secondly thanks is direct to those Igima
villagers for their collaboration that have been shown us during community
practice period.
However it will not be fair if we won’t thank the Ministry Of Health And Social
Welfare for its planning of this program of community practice. Also
we thank the administration of Igima dispensary for giving us cooperation on
giving us important information concerning community health.
Furthermore many gratitude to coordinators
from Ilembula school of nursing and midwifery especially sir ALTO SANGA,
MICHAEL HINJU for facilitation of community health nursing course
theoretically.
DEFINITION
1.
COMMUNITY:-
is the group of people or families who may or may not share the same culture,
activities, interest, religious and some of the features but in the same level will interact each other.
2.
HEALTH:-
is the state of complete mental, physical as well as social well being and not
merely in the absences of any disease.
3.
COMMUNITY
HEALTH NURSING:- Is the field of nursing in which the family and the
community are patient.
4.
CRUDE
BIRTH RATE:- Is total number of children born per year in a particular
area.
5.
CRUDE
DEATH RATE:- is the total number of
death of people per year in a particular area.
6.
FAMILY
PLANING:- is the decision of individual or couple to decide when to have
children, how many children to have and their intervals.
7.
IMMUNIZATION:-
Is the process of introducing antigen in the body so as to increase specific
antibody for the aim of preventing a certain disease.
8.
INFANT
MORTALITY RATE:- Is the total number of death of infants who are under one
year times the factor over live birth in a
given population
9.
UNDER
FIVE MORTALITY RATE:- is the total number of children die under five years
in a particular area.
ABREVIATION
·
CBR:- crude birth rate
·
CDR:- crude death rate
·
U5MR:- under 5 mortality rate
·
BCG:- Baccilus Callmete Guerin
·
COC:- combined oral contraceptive
·
POP:- progesterone only pill
·
PCV:-
pneumococcal conjugate vaccines
·
RCH:- reproductive child health
·
OPD:- outpatient department
·
DTC:- diarrhoea treatment corner
·
IUCD:-intra uterine cervical device
·
PMTCT:-prevention of mother to child
transmission
·
TT:- tetanus toxoid vaccine
·
DPTHiBHeB:- diphtheria pertuisis,tetanus,
hemophilias influenza B, hepatitis B
BROAD AND SPECIFIC OBJECTIVES
BROAD OBJECTIVE
Utilize community health profile to come up with
community diagnosis.
SPECIFIC OBJECTIVE
Identify needs and problems of the community.
Implement health activities at igima community
village
Evaluate the intervened health activities
carried out during community health nursing field work.
Report various issues pertaining to field work
to the community village leaders,
dispensary management, community village health committee , igima primary
school administration and Ilembula school of nursing.
FOUR WEEKLY PLAN
WEEK BEGINNING
|
OBJECTIVES
|
INTERVATION
|
EVALUATION
|
12TH
JAN.2014(1st week)
|
Assess the health of community of Igima village
|
Perform
situational analysis to the community.
.
|
-the community of Igima village assessed.
|
19TH
JAN.2014(2nd week)
|
Plan activities to be carried out during community
health nursing field work.
|
-prioritize the identified needs and problem of the
community.
|
-Activities to be carried out during community health nursing
field work were planned accordingly.
|
26th
JAN.2014(3rd week)
|
Implement the planned community health nursing activities at igima village
|
-Intervene the identified community health
nursing needs and problems.
-Encourage community to solve their community health
problems
|
The planned community health activities were
implemented accordingly.
|
02NDFEB.
2014(4th week)
|
Evaluate the activities carried during the
community health nursing field work
|
-make Follow up on implementation of the agreed
planned activities
-compile field work report
-write field work report
-disseminate the community field report to the
village leader, school administration and dispensary
|
Activities carried during the community health
nursing field work evaluated accordingly.
|
HISTORICAL BACK
GROUND OF IGIMA VILLAGE
IGIMA
community village was established in 1971 under the leadership of MATHIAS LWESA
MLIGO. The origin of the name IGIMA was from the small hill called KIGIMA near by the Igima primary
school. There was an activities of digging land for building their houses. As time goes on this name of KIGIMA changed
and been pronounced that ‘IGIMA’.
Igima has only four hamlets namely:-Itomboloro,
Mlimani, Igima kati and Ukamba
GEOGRAPHICAL FEATURES
Igima village is found at Igima ward, Mdandu
division, Wanging’ombe district in Njombe region in Tanzania. This village is located
7km from main road of MAKAMBAKO to RUVUMA.
Northern
part bounded by Mhaji village, In East
bounded by tea company, in western part bounded by Mlevela and Ulowa river, In
southern part Igima village is bounded by TANWAT company, in north-east bounded by Ibumila village, in
north-west bounded by Mdandu village.
SKETCH MAP SHOW IGIMA VILLAGE
PHYSICAL FEATURE
CLIMATIC
CONDITION
The village
has three seasons which are:- winter, summer and spring seasons. Winter season started
on May up to July, summer season started on August up to September and spring
season started on December up to April.
IMPORTANT
LAND MARKS
Dispensary direction
water tank of igima village
primary School direction
DEMOGRAFIC INFORMATION
Igima has a
total population 3676. Of the total population 1679(46%) were males and 1997(54%)
were females. Males who were able to work were 270(16%) while males who were
not able 1409(84%). females who were
able to work were 362(18%) while females who were not able to work were 1635(82%).
(2012 Data, obtained from the village leaders)
Who are able to work
|
Who are not able to work
|
Total population
|
|
MEN
|
270
|
1409
|
1679
|
WOMEN
|
362
|
1635
|
1997
|
Comment:-
From the
table above shows that work force is less than non work force.
Data
concerning with children under one and five years including CBR, CDR, IMR, U5MR
and MMR are not recorded as village leaders has no tendency of recording and
keeping them. Also there is no exactly information about immigration and
emigration of the people.
ACTION TAKEN
Advice were given to igima village leaders on importance of recording and storing important
information pertaining to health such as CBR, CDR, U5MR, MMR, IMR and others.
Village chair person
|
Financial and economic committee
|
Social welfare and health committee
|
Security committee
|
Village executive officer
|
ELECTION OF
LEADERS
ELECTION OF
LEADERS
The election
is done after each five years by vote.
CRITERIA FOR CONTESTANT AND VOTERS
- Must be a permanent villager
- Must have 18 years and above
-Must
have not any criminal history
-Must
be mentally and physically fit
-Must
be able to read and write
COMMITTEES
AND RESPONSIBILITIES
At Igima village there were three committees
and each committee has got its responsibilities as shown below;
FINANCIAL
AND PLANNING COMMITTEE; To plan the source of income and how to use the
available resources.
SOCIAL
WELFARE AND HEARTH COMMITTEE; To make follow up of the health and environment
of an individual during home visiting.
SECURITY
COMMITTEE; To ensure the security of the village and its properties together
with its boundaries of Igima village.
HEALTH SERVICES
ASSESSMENT AND USE
NUMBER OF
HEALTH FACILITIES AVAILABLE
During community health nursing field work it was reported that Igima village had one dispensary which contains ten rooms. Each
room had special health use such as a room
for outpatient department (OPD), reproductive child health (RCH),diarrhoea
treatment corner(DTC), store for medicine, labour room, post natal room, room
for men, injection /dressing room and sterilization room. The dispensary had three
houses for staffs. Further more Igima village had three private medical stores.
HEALTH
RESOURCE DATA
At
Igima dispensary there are five health workers:-two enrolled nurse, two medical
attendant nurses and one clinical officer.
ORGANOGRAM OF
IGIMA DISPENSARY
CLINICAL OFFICER
|
NURSE IN CHARGE
|
ENROLLED NURSE
|
TWO MEDICAL ATTENDANT NURSES
|
AVAILABILITY OF MATERIALS /EQUIPMENTS
Material
available are not enough compared to the number of the patient attend per day. About 35 patients attend to Igima dispensary
per day. Igima dispensary gain support from the district council but no any
financial support from any NGO’s or private organizations.
A dispensary
had placenta pit and dumping hall which is not conducive.
Placenta
pit
dumping hall
About the
major key partners at Igima dispensary there is one TBA who send information of
those with pregnancy and measures their weight but no any traditional healer or
VHW.
challenges
-Nurses are
prone to infection due to insufficient latrines to their houses.
-No security
around the dispensary and nurses’ houses that leads to difficult in provision
of health services during the night.
-The
community are prone to infection related to poor damping hall and placenta pit
at dispensary
OUT REACH SERVICES
There was
one outreach services provided at Mlevela village. About five clients attend
and receive services per out reach. This because most of clients come and get
services at Igima dispensary.
During
outreach services nurses use motorcycle for the transportation to Mlevela
village
Challenges
during outreach
Ø
No financial support which nurses get per
outreach hence sometimes they use their money for transportation
Ø
Few number of clients attend
At Igima
dispensary, there is no management of
children by using IMCI chart. Due to this situation most of children receive
first aid. When the condition still abnormally referral is done.
RCH SERVICES PROVIDED
The RCH
services provided were immunization, family planning, PMCTC, weighing, outreach
services and nutrition.
IMMUNIZATION
·
MEASLES
The number of children received measles
vaccines from 2008 to 2012
Comment
On 2010 there were high number of children
vaccinated compared to other years, this may be due to the increase of child birth and
awareness of the community villager on
importance of immunization.
·
POLIO VACCINES
The number of children received polio
vaccines in 2008,2009,2010,2011 and 2012
YEAR
|
POLIO 0
|
POLIO 1
|
POLIO 2
|
POLIO 3
|
TOTAL
|
2008
|
142
|
171
|
185
|
166
|
664
|
2009
|
157
|
150
|
150
|
151
|
608
|
2010
|
160
|
221
|
215
|
247
|
843
|
2011
|
120
|
174
|
187
|
212
|
693
|
2012
|
158
|
160
|
173
|
197
|
688
|
Comment
On 2010 there were high number of children
vaccinated compared to other years, this due to the increase of child birth and
immigration.
·
BCG VACCINE
Pie chart shows the number of children
received BCG vaccines from 2008 to 2012
Comment
On 2012 high
number of children vaccinated. This related to the presence of health education
given to the parents.
·
DTPHbHIB(pentavalent) VACCINES
Grouped Bar graph shows the number of children
received pentavalent vaccines from 2008 up to 2012
Comment
On 2010 there were high number of children
vaccinated compared to other years, this due to the increase of child birth and
immigration.
TETENUS TOXIOID VACCINE
·
Grouped Bar
graph bellow shows the number of people received TT vaccine from 2010 up to
2012
Comment
The graph above show that pregnancy were
attended frequently to receive TT compared to other group of like victim and
non pregnant, this because number of pregnancy mother attended per each year
was very high compared to victims and non pregnant . also it is the principle
of government to the pregnancy woman to receive TT when visit at clinic.
VITAMIN “A”
·
Post natal
and children received vitamin “A” from 2010 up to 2012
Year
|
Post
natal
|
Children
under 9 month
|
Children
under 15month
|
Children
under 21 month
|
TOTAL
|
2010
|
163
|
206
|
303
|
320
|
992
|
2011
|
162
|
185
|
427
|
425
|
1199
|
2012
|
162
|
203
|
371
|
463
|
1199
|
Comment
On 2011 and
2012 there were high number of people received vitamin “A”. This may be related
to the high number of children in the community village and knowledge.
FAMILY PLANNING
The method of family planning applied at
Igima dispensary; C.O.C and P.O.P, Depo
provera ,IUCD, Norplant, Condom , Female sterilization and vasectomy.
TABLE BELOW SHOWS TOTAL NUMBER OF PEOPLE
USED METHOD OF FAMILY PLANNING FROM 2010 UP TO 2012
YEARS
|
C.O.C and
P.O.P
|
Depo provera
|
IUCD
|
condom
|
norplant
|
Vasectomy and
female sterilization
|
TOTAL
|
2010
|
37
|
139
|
21
|
83
|
43
|
18
|
341
|
2011
|
150
|
119
|
101
|
03
|
141
|
55
|
569
|
2012
|
188
|
299
|
61
|
37
|
47
|
00
|
632
|
Comment
From the table above shows that the number off people
received family planning method was increasing every year. This may be dueto
knowledge given to a community.
STRENGTH
OF RCH SERVICES AT IGIMA DISPENSARY
·
All RCH service
are provided at a right time.
·
There is
availability of cold chain equipment for keeping vaccine e.g refrigerator,
vaccine carrier
WEAKNESS OF RCH SERVICE AT IGIMA DISPENSARY
·
There is
inadequate of room for the provision of services such as ANC
Weighing immunization.
EPIDEMIOLOGICAL
DATA [TOP TEN DISEASES]
TABLE BELOW SHOWING THE COMMON
DISEASE FOR THREE YEARS [2010-2012] AT IGIMA DISPENSARY.
DISEASES
|
2010
|
2011
|
2012
|
TOTAL
|
ARI
|
1277
|
1538
|
1042
|
3857
|
PNEUMONIA
|
1364
|
1356
|
1004
|
3724
|
MALARIA
|
537
|
468
|
590
|
1595
|
MINOR SURGICAL
|
334
|
400
|
328
|
1072
|
FUNGAL INFENCTION
|
160
|
188
|
112
|
460
|
INTESTINAL WORM
|
153
|
185
|
218
|
556
|
GASTRO ENTERITIS
|
183
|
211
|
155
|
549
|
EYE INFECTION
|
96
|
144
|
127
|
367
|
SKIN INFECTION
|
106
|
127
|
317
|
550
|
NEUROSIS
|
156
|
123
|
145
|
424
|
Comment:-
From the table above it shows that ARI in Igima was
high probably was due to poor ventilation and change in climatic weather conditions.(Data obtained from MTUHA book)
SCHOOL
HEALTH SURVEY
Igima primary school had 506
total number of pupils. Of the total number of pupils 50 (10%) pupils were
randomly selected for physical examination. Of the total number of pupils
examined 12 (24%) were found to have health problems and 38(76%) of pupils were
free from health problems.
On examination were skin infection, excessive wax from the ear and ARI.
Other problem identify during
school health survey were congestion of pupils.
Generally environmental sanitation was
not conducive especially in latrines. Pupils were prone to diarrhoea diseases
as the school has few latrines which shows 1:36.
.
HOME VISITING
During
home visiting 25 homes were visited. Of the total homes visited 09(36%)had poor
ventilation and poor latrines.
ACTION
TAKEN
Advice
was given to the community on building houses with large enough windows and
doors so as to allow good enough ventilation.
Igima villagers participate in various
activities such as agriculture and employment. In agriculture the villagers keep
live stock such as cows, goats, pig and hens. Crops cultivation for food grown
were maize and irish potatoes.
Cash
crops grown were avocado peas and irish potatoes. In employment some of
villagers employed in tea company, schools, health services.
during
home visiting we found that the main crops grown at igima village are maize and
irish potatoes. And other crops are fruits i.e. avocado and peas.
Ø
The livestock kept at igima village are cattle,
poultry, pig and guinea pig .The average per each house are six(6)
Ø
The livestock that kept at igima village most
are used for economic status and some for nutritional status.
Ø
During home visiting some of houses have poor sanitation and ventilation
TABLE SHOW THE AVERAGE OF
LIVE STOCK KEPT AT IGIMA VILLAGE
HAMLET
|
CATTLE
|
GOATS
|
SHEEPS
|
HENS
|
ITOMBOLORO
|
93
|
44
|
04
|
674
|
MLIMANI
|
26
|
05
|
00
|
306
|
IGIMA
KATI
|
95
|
45
|
33
|
949
|
UKAMBA
|
31
|
37
|
00
|
620
|
TOTAL
|
245
|
131
|
37
|
2549
|
Data of 2013
from village chair person
Comment:-
From the
table above shows that most of villagers were keeping hens, may be this project
was very easy to care compared to other livestock.
Availability of water and its treatment
Igima
villagers depend tap water which generated and owned by TOVE- MTWANGO project.
This project supply water in sixteen village including igima village.
Treatment of water
Most of
villagers belief that water from TOVE-MTWANGO
project is clean and safe for drinking and other uses. This because they have
been educated from the owner of that project that before reach to the community
the water is being treated from the source.
The owner of that project have a tendency of
treating and testing water every after three months. Also they clean the source
of water every after being polluted.
GENERAL SOCIAL AND ECONOMIC SITUATION
ECONOMICAL
SITUATION
The economic situation of igima village is
good because most of people they depend on agriculture and some of them they
engaging with fishing activities. Others they are employed in different sector
like education, tea company healthy sector .The livestock kept at the village
are cattle, pig and guinea pig. The main crops grown are maize, Irish potatoes.
Cattles
poultry
Fishing
pig
Also most of
males of igima engage in work of transferring people from other place through
motorcycles
Motorcycle
At igima
village there is a special group trained to obtain small factories for making
soap, painting colour in the kanga (female clothes), etc
Before
process
after process
SOCIAL
SITUATION
Social s ituation
of igima village is good because most of them they cooperate in ceremony and
other Social issues, communication
through drums, notice board and telephones.
Notice
board
After being
from the working areas some of the villagers like to be recreated through
playing foot ball, singing at a church, others make baskets.
Others like to drink local bamboo juice
(ulanzi) which does not prepared in a good environment hence they are prone to
get infection caused by drinking contaminated fluids.
ENVIROMENTAL SANITATION
- most of
houses we visited about 259(40%) have
weak walls and poor floors and about 388(60%) of them have strong walls and
good floors.
-The
community depends on two types of light resources which are natural and
artificial light. The natural light is the sun and the artificial light are
like electricity, kerosine lamp, solar power, candle and torch.
Low
quality house
ACTION PLAN
IDENTIFIED
NEEDS AND PROBLEM OF THE COMMUNITY
|
INTERVATION
|
RESPONSIBLE
PERSON
|
INDICATORS
|
EVALUATION
|
Low quality of health services rendered to the
community
|
Hire needed health workers
|
DMO
|
Shortage of staffs
|
It is on Strategic plan
|
Health workers are risk to infection
|
-Construct latrine for staff.
-Purchase material and equipment especially
protective gears .
|
DMO and community village health committee
|
Clients/patient shares latrine with staff.
-Inadquate of personal protective equipments
-
|
It is on the
strategic plan
|
Community are
risk to get injury and infection
|
Sensitize the community on construction of latrines
of good quality.
|
House holder
|
Poor latrines
|
Handled to village leaders
|
Community were risk to acquire ARI
|
-Stress the community to construct houses with
large windows.
-Provide health education about
-personal hygiene -increase the size of the windows
-good environmental sanitation
|
Community
|
-Inadequate of personal hygiene
-small size of the window
-poor environmental sanitation
|
Handled to village leaders
|
High prevalence of skin infection
|
-Advice the parents to sent their pupils for
treatment.
-Provide health education about personal hygiene
|
Parents/teachers
|
-Swimming in
polluted water found at lihogosa dam
-poor personal hygiene
|
Parents understood and took an action
|
EVALUATION OF IGIMA
VILLAGE
STRONG
POINTS
·
The villagers were kindness
·
The community of igima were cooperative
·
They helped us to get information
·
Igima village had enough water supply
WEAK POINTS
There were no cooperation between village
leaders and health workers
Women participated more in village activities
rather than men
Village leaders didn’t have enough document
concerning their village
The community are risk to get infection related
to poor wastes disposal
EVALUATION OF IGIMA
DISPENSARY
STRONG
POINTS
·
Health workers were cooperative and shown us
hospitality
·
Health services provided on time
·
Most of the health services were available
WEAK POINTS
Dispensary didn’t have enough health workers,
about six health workers required.
Dispensary didn’t have enough health facilities
and materials for the provision of health services.
There were in adequate staffs houses.
Dispensary didn’t have enough document
concerning health progress.
Health workers were prone to infection related
to sharing latrines with patients/clients.
Dispensary had placenta and rubbish pits which
were not conducive.
EVALUATION OF IGIMA
PRIMARY SCHOOL
STRONG
POINTS
·
The school teachers were kindness and
cooperative.
·
The school environment was clean and so
attractive.
·
School had quality and good toilets which
contained two rooms for special pupils with deformities.
·
All pupils got lunch at school every day except
on Wednesday, Saturday and Sunday.
·
Pupils
respected their teachers and other.
·
The school had enough classrooms
WEAK POINTS
The school hadn’t enough males teachers
Parents didn’t show cooperation with school
administration.
The school had small sizes of the classrooms
compared to number of pupils in the class.
school latrines was not enough to fulfill the
needs of the pupils.
Hakuna maoni:
Chapisha Maoni