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ThesisItem Open Access CASE CONTROL STUDY ON RISK FACTORS ASSOCIATED WITH LOW BIRTH WEIGHT IN NEPAL(Department of Public Health Faculty of Health Science Shalom Institute of Health and Allied Sciences Sam Higginbuttom University of Agriculture, Technology And Sciences, Prayagraj – 211007, 2019) YADAV, DILIP KUMAR; Shukla, Prof. (Dr.) G. S.Introduction: Birth weight is defined as the first weight of the foetus or newborn obtained after birth, the measurement being taken preferably within the first hour of life, before significant postnatal weight loss has occurred (Butler and Behrman, 2007). Low birth weight, which is defined as birth weight <2.5 kg regardless of gestational age, is thus result of either prematurity or retarded intrauterine growth or a combination of both (Adam, 2016; Wardlaw, 2004). Low birth weight is one of the major public health problems worldwide; in developed countries, about one half of all LBW infants are preterm (<37 wk gestation) while in developing countries, most of LBW infants are born at term and are affected by intrauterine growth restriction that may begin early in pregnancy (Villar and Belizán, 1982b; World Health Organization, 2005). Globally about 20 million newborn babies were born with low birth weight and the prevalence of low birth weight was 15% in 2014 (Achadi et al., 2016). Globally every year, 2.6 million babies die before reaching one month old among them one million (an estimated 7,000 newborn babies every day) die on the first day they born (UNICEF, 2018). Epidemiological observations found that infants weighing less than 2,500 g are approximately 20 times more likely to die than heavier infants (Wardlaw, 2004). Low birth weight is highly correlated with perinatal, neonatal and post-neonatal morbidity and mortality (McIntire et al., 1999) and is associated with development of chronic diseases in adulthood (Barker, 1995; Barker et al., 1993). The objective of the study was to find out the risk factors associated with low birth weight and pattern of morbidity and mortality among normal birth weight and low birth weight neonates. Methods: This was a hospital based case control study conducted in two tertiary level hospital of Nepal (Koshi Zonal Hospital, Biratnagar from state 1 and Narayani Regional Hospital, Birgunj from state 2). 368 mothers with term single live low birth weight babies were nested as case and 736 mothers with term single live normal birth weight babies were nested as control for case control XVI studies. Cases were selected sequentially till the required number of cases completed. Mothers not willing to participate in the study, having preterm birth and having multiple births were excluded from the study. For one case two controls were selected. While selecting control, sex of the babies and place of delivery were matched. Babies with low birth weight of case group and babies with normal birth weight of control group were followed up after 28 days to find out the pattern of morbidity and mortality among LBW and NBW neonates. Result: After adjustment for potential confounders, socio-demographic factors which influenced the delivery of low birth weight were husband with no formal education [AOR 2.66, 95% CI: (1.65- 4.26), p<0.001], husband with primary education [AOR 2.17, 95% CI: (1.40-3.37), p<0.001], husband with secondary education [AOR 1.52, 95% CI: (1.06-2.18), p=0.021] and women with monthly household income less than NRs 10000 [AOR 3.64, (95% CI: 1.65-8.00)]. After adjustment for potential confounders, maternal and obstetric factors which influenced the delivery of low birth weight were maternal height less than 146 cm [AOR 5.60, (95% CI: 1.90- 16.52), (p=0.002)], maternal weight 50 kg or below [AOR 2.26, (95% CI: 1.21-4.21), (p=0.010)], primi parity [AOR 10.09, (95% CI: 3.13-32.48), (p<0.001)], multi parity [AOR 6.54, (95% CI: 2.00-21.35), (p=0.002)], rest in day time ≤2 hours [AOR 3.73, (95% CI: 1.84-7.56), (p<0.001)], rest in night time for < 8 hours [AOR 8.17, (95% CI: 3.06-21.78), (p<0.001)], IFA consumption for 60 days or less than 60 days [AOR 2.49, (95% CI: 1.12-5.48), (p=0.024), IFA consumption for 61-120 days [AOR 2.48, (95% CI: 1.47-4.19), (p<0.001)], no calcium consumption [AOR 3.26, (95% CI: 1.80-5.91), (p<0.001)], consuming less amount of food [AOR 6.88, (95% CI: 1.93-24.55) (p=0.003)], consuming same amount of food [AOR 3.16, (95% CI: 1.86-5.36), (p<0.001)], consuming food for 2 times [AOR 13.88, (95% CI: 3.44- 55.97), (p <0.001)], consuming green leafy vegetable for 1-3 days in a week [AOR 2.12, (95% CI: 1.18-3.79), (p=0.011)], and not consuming egg [AOR 4.94, (95% CI: 1.48-16.42), (p=0.009)]. After adjustment for potential confounders, socio-cultural and environmental factors which influenced the delivery of low birth weight were no husband’s cooperation [AOR 1.56, (95% CI: 1.08-2.24), (p=0.015)], restricted to eat some food [AOR 2.43, (95% CI: 1.10-5.35), (p=0.027)], XVII using highly polluting fuel [AOR 2.24, (95% CI: 1.39-3.61), (p=0.001)], cooking together had 47% less chance [AOR 0.53, (95% CI: 0.36-0.79), p=0.002], practicing open defecation [AOR 2.43, [95% CI: (1.31-4.50), p=0.005] and practicing non-sanitary latrine [AOR 1.94, 95% CI: (1.25-3.03), p=0.003]. After adjustment for potential confounders, birth outcome associated with low birth weight were women who delivered on 37 weeks, head circumference <35 cm [AOR 7.88, (95% CI: 3.87- 16.05), (p<0.001)], APGAR score at 1 minute of birth [AOR 2.29, (95% CI: 1.61-3.26), (p<0.001), and APGAR score at 5 minute of birth [AOR 8.33, (95% CI: 3.38-20.52) , (p<0.001)]. Neonatal mortality rate among normal birth weight babies was 4/1000 live birth and among low birth weight babies was 22/1000 live birth whereas Neonatal morbidity rate among normal birth weight babies was 77/1000 neonates and among low birth weight babies was 252/1000 neonates. Bivariate conditional logistic regression analysis found that neonatal mortality was about five times higher [AOR 5.06, (95% CI: 1.08-29.12), p=0.040] among low birth weight babies compared to normal birth weight babies whereas neonatal morbidity was about four times higher [AOR 4.04, (95% CI: 2.59-6.30), p<0.001] among low birth weight babies compared to normal birth weight babies. Conclusion and recommendation: Determinants responsible for the low birth weight babies were husband education, monthly household income less than 10000, maternal height less than 146 cm, maternal weight 50 kg or below, parity, rest in day time ≤2 hours, rest in night time for < 8 hours, IFA consumption for ≤60 days, IFA consumption for 61-120 days, no calcium consumption, consuming less amount of food, consuming same amount of food, consuming food for 2 times, consuming green leafy vegetable for 1-3 days in a week, not consuming egg, lack of husband’s cooperation, restricted to eat some food, using highly polluting fuel, cooking alone, practicing open defecation, practicing non-sanitary latrine, gestational age of babies, head circumference <35 cm and APGAR score <7 whereas low birth weight babies had higher neonatal morbidity and mortality. XVIII Finding of the present study emphases the need for improving the financial condition, maternal health, utilization of ante natal care, nutritional education and fuel used to cooking whereas low birth weight babies need special care to reduce the neonatal morbidity and mortality.ThesisItem Open Access “STUDY ON NUTRITIONAL STATUS OF CHILDREN UNDER 5 YEARS IN PALPA DISTRICT, NEPAL: SPECIAL REFERENCE TO BAAL VITA”(SHALOM INSTITUTE OF HEALTH AND ALLIED SCIENCES SAM HIGGINBOTTOM UNIVERSITY OF AGRICULTURE, TECHNOLOGY AND SCIENCES ALLAHABAD-211007, UP, INDIA) KARKI, DEELIP KUMAR; Bose, Dr. Dipak KumarMalnutrition has been defined as “a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients”. Malnutrition is a silent killer, under-reported, under-addressed public health problem. It does not only directly affect the children by reducing their physical and mental performance but also makes the situation worse by making the children susceptible to infection, recovery is slower and mortality is higher. It is one of the foremost underlying cause of the child morbidity and mortality. As per the findings of Nepal Demographic and Health Survey (NDHS, 2016) stunting is 36 per cent, while underweight and wasting, 27 per cent and 10 per cent respectively. The main objective of study is to assess the nutritional status of children under 5 years in Palpa district, Nepal: special reference to Baal vita. Palpa district was selected for the present study. Cross sectional community based study was conducted where multistage sampling was adopted. A total of 390 respondents, the mother of the children between the age group 6 months to 5 years, were randomly selected. Nutritional status was measured by weight in kilogram, with the help of weighing machine, height of the child was measured with the help of measuring tape and mid upper arm circumference (MUAC) of left hand was measured by using measuring tape (Shakir tape), also assessed through weight for age (underweight) and height for age (stunting) and weight for height (wasting) standards. Similarly, 24 hours dietary recall method was adopted to find the dietary intake of children. Majority of respondents were from 20-29 years of age group most of them were Hindu. It was observed that one fifth (20.51%) children were mild malnourished 17 followed by 5.13 per cent were moderate malnourished on the basis of weight for age. On the basis of height for age, around one quarter (22.31%) were mildly impaired, followed by 3.84 per cent were moderately and 1.03 per cent severely impaired. On the basis of weight for height mild impaired children were 4.62 per cent, moderate impaired 1.79 per cent and severe impaired were 0.51 per cent. The association between maternal education and nutritional status of children (weight for age) is significant. More than three quarter (78.71%) respondents had received four ANC visit according to schedule. Majority of respondents (80.76%) had taken full course of iron tablet during pregnancy and after delivery of the 42 days, the child of respondent who had not taken full course of iron tablet is more likely to be malnourished (OR=5.40, p<0.005). More than three quarter (76.15%) respondents had introduced breastfeeding within 1 hour and 91.79 per cent had introduced exclusive breastfeed up to 6 months. There is significant association between nutritional status of children and colostrums feeding. The respondents who were not feed colostrums, children are more likely to be malnourished (OR=9.06, p<0.005). More than two third (67.45%) children had taken normal amount of calorie as recommended level. Multivariate analysis found that association between nutritional status (weight for age) of children and education of mother, family types, immunization status, Sex of children, colostrum feeding, exclusive breastfeeding, history of illness of child, receiving of iron all are found significant. Present study found that majority of the respondents (71.03%) were fully aware about Baal vita and there is association between education of mother and information about Baal vita. Likewise, 39.23 per cent respondents were fully aware about the advantages of Baal vita (micronutrient powder). Majority of the children (52.56%) had taken the Baal vita. There is no difference between consumption of 18 Baal vita and improvement in weight and height. Majority of respondents (61.95%) suggested about regular supply and 50.73 per cent suggested needed of awareness program to increase in coverage of Baal vita. Nutritional status is satisfactory in comparison to national level but the coverage of Baal vita is low. Social mobilization, dissemination of health education, advertisement in mass media and conduct awareness program regarding Baal vita are the keys of success of the program.ThesisItem Open Access Impact of Janani Surkasha Yojana(JSY) on beneficiaries in Allahabad District (U.P)(Shalom Institute of Health & Allied Sciences, FHS Sam Higginbottom University of Agriculture, Technology & Sciences Allahabad – 211007, India) SINH, AKANKSHA; Bose, Dr. Dipak KumarJanani Suraksha Yojana (JSY) is a safe motherhood intervention under National Health Mission. This ambitious scheme was launched on 12th April 2005, to intend & encourage institutional delivery and provides access care during pregnancy in the postpartum period thereby reduces maternal and infant mortality. Janani Suraksha Yojana (JSY) is a 100% centrally sponsored scheme and it integrates cash assistance with delivery and postdelivery care. The success of the scheme would be determined by the increase in institutional delivery among the poor families (Ministry of Health and Family Welfare, 2006). In Hindi language, Janani means mother, Suraksha means protection and Yojana means scheme. Evaluations of the JSY indicate that it has succeeded in increasing the use of antenatal care services and institutional deliveries, and reducing perinatal and neonatal deaths (Lim et al., 2010; UNFPA, 2009).This scheme came into existence as each year over 500,000 women around the world die due to complications related to pregnancy and child birth and around ten million children under the age of five die-two million in first day and another two million in the remainder of the first month of life. Effective, affordable and practical intervention to improve maternal, neonatal and child health (MNCH) exist, and have markedly reduced mortality where implemented on a large scale. Research indicates that low-income countries could substantially reduce the number of maternal and child deaths by implementing a limited number of cost effective interventions at specific points in time. The objective of the study was to describe the modus oprendi of JSY program for analyzing its strength and weakness. To ascertain & compare the level of knowledge about services rendered by the scheme and the practices followed by the respondents. To find out the factors influencing the health practices among the respondents. To find out suitable strategies to overcome the problems. The Research Methodology opted for this research was Qualitative & quantitative descriptive study with multistage sampling was done. In each block approximately 130 institutional deliveries take place every month. Therefore; 130×6= 780 and thus 780×4=3120.Thus 10 % of the total population i.e.312 beneficiaries were selected and with the help of snow ball technique 312 non-beneficiaries were selected from the same block. Therefore total respondents were 624 including both beneficiaries and non-beneficiaries. Present study focuses on the knowledge, attitude & practices of the beneficiaries & non-beneficiaries and many different results were revealed. Though there were all facilities available at their doorstep; still there was lack in practices. It was due to lack of family support, socio-economic status & other issues which was indirectly increasing the IMR & MMR. Overall, institutional deliveries increased by (42.6%) after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. In this study it was founded that (38.46%) of the beneficiaries and (54.48%) of nonbeneficiaries both belonged to age group between 25-29 whereas it was observed that late pregnancies were less. (47.43%) of the beneficiaries and (49.67%) of the non-beneficiaries were educated up to primary school they were able to read and write whereas it was observed that (3.86%) beneficiaries and (5.15%) non-beneficiaries were educated up to intermediate. Maximum (57.69%) of the beneficiaries & (32.69%) of non-beneficiaries were involved in agriculture. Maximum (83.33%) of the beneficiaries and (95.19%) of the non-beneficiaries belonged to Nuclear families whereas it was observed that (13.33%) belonged to joint families. It was also observed during the study that (36.22%) of the beneficiaries had more than 5 family members and (40.72%) of the non-beneficiaries had 4 family members in their families whereas it was observed that (7.37%) beneficiaries and (1.92%) non-beneficiaries had 3 members in their families. Majority (64.42%) of the beneficiaries annual income was up to 50,000 as they belonged to labour class where their income was on daily wages and (42.62%) non-beneficiaries were earning above 1,00,000 whereas it was observed that (10.89%) beneficiaries were earning above 1,00,000 and (22.45%) non-beneficiaries were earning up to 50,000 who preferred private institutes and other health institutions for delivery as they are financially stable whom we have referred as non-beneficiaries in our research. Maximum (92.62%) of the beneficiaries and (95.19%) non-beneficiaries belonged to Hindu religion. Maximum (62.17%) of the beneficiaries was SC and maximum (69.87%) non-beneficiaries belonged to SC. Majority (72.11%) of the beneficiaries & (88.34%) had low standard of living whereas it was observed that (4.17%) beneficiaries & (8.66%) belonged to high class. Present study impact on Janani Suraksha Yojana on in its beneficiaries in Allahabad District of Uttar Pradesh concluded that there were certain strength and weakness which were found during the research work. Strength; Increased institutional deliveries, active Participation of ASHAs, regular 3 ANC, full immunization, improved maternal & child health & proper hygiene. Weakness: ASHAs motivated but still registration was not done according to their expectations, facilities were poor & some were financially stable so they preferred private institutes, during complication patient were referred to nearby district hospital. Which was time consuming & risky for the patient. Their knowledge was good as according to the expectation but as they were not prompt in availing facilities provided by the scheme. Many of the beneficiaries were not aware that the scheme provides food during the stay in the health center & they even avoided postnatal checkup as they felt it was not going to benefit them.ThesisItem Open Access KNOWLEDGE, ATTITUDE ON HIV-AIDS AND PRACTICE OF SEXUAL BEHAVIOR AMONG HIGH RISK BEHAVIOR GROUP IN SAPTARI AND JHAPA, NEPAL(Department of Public Health Shalom Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture, Technology & Sciences, Allahabad – 211007, (U.P.) India, 2017) SINGH, BIRENDRA KUMAR; Bose, Dipak KumarAcquired Immune Deficiency Syndrome (AIDS) remains a public health problem of major significance in most parts of the world. The first HIV infection was detected in 1988 in Nepal. Since then HIV and AIDS epidemic has evolved from low to concentrated among “High risk groups” i.e. Injecting Drug Users (IDUs), Female Sex Workers (FSWs), Men having Sex with Men (MSM) and Seasonal labor Migrants. The objective of this study was to find out socio-demographic characteristics, knowledge, attitude on HIV-AIDS among the respondents and assess the types of behavior that places them at risk of contracting HIV-AIDS in Saptari and Jhapa district of Nepal. This was the cross sectional descriptive study carried out among 457 high risk behavior groups (FSWs, MSMs, IDUs and clients of FSWs) who come for treatment at VCT centre of both district. Multi stage sampling was adopted and data were collected using a pre-tested interview schedule. The study reported that (65.21 %) of respondents were comes under urban settlement and (61.49 %) were in 20-30 year age group. The majority of the respondents (70.24 %) were drinking alcohol, (51.20 %) having addiction, (31.29 %) having intoxicating, only (22.98 %) respondents injecting drug without doctor’s prescription and (52.95 %) had RTI problems. The overall level of knowledge regarding HIVAIDS was (42.89 %) medium level, followed by (34.35 %) high level and (22.76 %) low level. Majority of respondents (67.61 %) were partially aware about major mode of transmission. The overall level of attitude towards HIV-AIDS was (45.08 %) medium level, followed by (41.79 %) high level and (13.13 %) low level. Respondents had positive attitude towards seeking of treatment, if get infected HIV-AIDS. Respondents had ii negative attitude towards disclosure of HIV-AIDS, if get infected. High probability of contracting HIV-AIDS were reported among the respondents, who had having intoxicating drugs (82.52%) and who had using alcohol during sexual activity (75.00 %). Practice of addiction, injecting drugs without doctor’s prescription, use of alcohol during sexual activity, negligence to use condom, high frequency of sex with partner per day, early age at first sex, and use of intoxicating drugs were found the major types of behavior that places the respondents at risk of contracting HIV-AIDS. Majority of respondents had encountered the problems of negative response and attitude of family, teacher & society, difficulty in associating with family, stigmatized for being members of a socially marginalized group, depression/committing suicide, discrimination in daily lives, insult/humiliation, hopelessness and RTI/STIs. Majority of the respondents suggested increasing access and utilization of STI services in the upcoming days, providing education and promoting safer sexual practices, empowerment on rights to live a life free from any kind of violence and sexual exploitation. Based on the results of the study and experiences, it seems to conduct different activities as increase the awareness of HIV-AIDS to make high risk behavior groups aware from the comprehensive knowledge of transmission of HIV-AIDS, awareness program to promote safer sexual practices, Prevention programs for consistent use of condom, Free condom distribution programs through NGOs/ health workers/ volunteers to cover the target population etc. A module on HIV-AIDS and high risk sexual behavior to be developed by the Government in consultation with concerned NGOs & INGOs and implements that module through them to enhance knowledge and practices of high risk behavior groups.ThesisItem Open Access A Study on Knowledge and Practice of ASHA under NHM Programme of Allahabad District(SHALOM INSTITUTE OF HEALTH AND ALLIED SCIENCES SAM HIGGINBOTTOM UNIVERSITY OF AGRICULTURE, TECHNOLOGY & SCIENCES (FORMERLY ALLAHABAD AGRICULTURAL INSTITUTE) NAINI, ALLAHABAD-211007, 2017) GUPTA, AMRITA; Gupta, NeenaASHA program has created a groundswell for NRHM and the focus of NRHM was to develop strategies and implement activities with an aim to achieve Millennium Development Goals (MDGs). For example, in relation to maternal and child healthcare, the aim is to identify pregnant women at early stages of pregnancy and refer to nearest public health facility and follow-up through complete episode of delivery and immunization of newborn, infant and children. A strategy was developed to have community engagement activities through CHWs in the form of Accredited Social Health Activist (ASHA) and they are visible and audible presence among community which is leading more and more people amongst the community to seek health care. The ASHA as a volunteer is selected through a local community to take health services to the door step of the community. ASHA receives an incentive based on the activities she undertakes. The present study has been planned for ascertaining how efficient the ASHA is to play their defined roles effectively with the objectives. Objective: To find out knowledge of ASHA assisting all programme under NRHM and to determine the practices of ASHA in the community. Material and Methods: It was a cross - sectional study conducted during Oct 2013 to Feb 2015. The random sampling technique was adopted to select the district and block. The data was collected using interview schedule. All the ASHA of study villages (405) were selected as sample size. Results: Almost all the ASHAs are resident of local community. In general, selection of ASHAs appeared to be fair. As a majority of them belong to the 5 younger age group, and enthusiastic. All the ASHAs have been given seven days induction training followed by four - four days periodic induction training for about a year. In general ASHAs are not satisfied and happy with the training. Their perception about their job responsibilities appeared to be incomplete and improper. Majority of them were not aware about their role in changing the behavior about infant feeding, family planning, routine immunization, hand washing and sanitation. They were also not very much aware about their role in birth registration. Most important motivational factor for the ASHAs is the financial gain and hope of being absorbed in government job. However in some areas ASHAs were not functioning properly. VHSC has not been established in many villages. All the ASHAs have been accepted very well in the community and are acting as a link between community and health providers. Most of the ASHAs preferred helping in delivery and immunization. These activities are also associated with financial incentives. Conclusion: The success of the ASHA programme is highly dependent on the individual ASHAs who are chosen to advocate for and provide knowledge about the importance of healthy practices and for that ASHAs are envisioned as change agents at the forefront of efforts to reduce maternal, neonatal and child mortality in India. It is evident that ASHAs lack the essential knowledge to perform their jobs to the best of their ability. Non-availability of proper transport facility mainly for pregnant mothers along with irregular supply and replenishment of medicinal kits were major problems faced by the ASHAs. Improvements in training, supervision and support for ASHAs are needed in order to maximize on the potential they represent.ThesisItem Open Access Impact of Community Based Integrated Management of Childhood Illness in ‘Urawn’ Ethnic Community of Nepal with Special Reference to Acute Respiratory Infection(Sam Higginbottom Institute of Agriculture, Technology & Sciences (SHIATS), 2016) Koirala, Arun Kumar; Bose, Dipak KumarAfter recognition of Acute Respiratory Infection (ARI) as a major public health problem by Ministry of Health Nepal (MoH), an integrated approach to manage childhood illness at the community level, Community Based Integrated Management of (CB-IMCI) program was implemented and several studies have been conducted in various areas. Unfortunately, study of the said program on ethnic community has not been conducted. Therefore, researcher in this study had tried to explore the Impact of CB-IMCI on ARI among the children under 5 years in Urawn community and its associating factors. Five VDCs from each district (Morang and Sunsari districts) were selected purposively for sample by probability proportion to size using Microsoft Office Excel. A cross sectional study design was adopted and significance levels were observed with 95% confidence level (p≤0.05 for significant) with the sample size 401 of women having children less than 5 years from Urawn ethnic Communities. Data was analyzed through the Statistical Package for Social Sciences (SPSS) version 16. The respondents were with the mean SD age was 28.90 4.46 years. Among total respondents, about 82.80% were Illiterate. About 4/5th of the respondents worship Nature. Most of the households had multiple income sources viz. 77.81% daily wages, 63.34% labor work, 49.88% agriculture and so on (multiple answers). But 2/5th (40.6%) of family members had sufficient family income for their survival throughout year. Most of all (98.50%) households had general stove made by clay and they use biomass (firewood and cow dung) for cooking purpose. About 1/4th (24.4%) of total households had stagnation of smoke in the kitchen where 38.5% mothers take their children beside them during cooking time. About half of the family members lived with smokers. This showed that the children and women are always at risk of getting ARI in Urawn communities. General education in school and socio-economic status of respondents did not show any significance difference with knowledge on CBIMCI program and getting pneumonia respectively (p>0.05). After implementation of CBIMCI, maximum number of mothers (95%) found capable to identify the major signs pneumonia (Kukukhla in their Kuduk tongue) which was highly significant difference (P<0.001) and without delay almost all were seeking help from multiple sources. Seeking help from FCHV and health Institution during severe ARI was increase from 1 per cent to 38.1 per cent and 10.2 per cent to 69.3 per cent respectively, which were highly significant change seen (P<0.001) after implementation of CBIMCI. The percentage of mothers in giving plenty of breast milk and seeking help from FCHV/ HW for preventive activities, increased from 60.1% to 87.3% and 3.5% to 51.9% respectively which was highly significant changes after implementation of CBIMCI (p<0.001). Almost all mothers (99.8%) had heard about EBF and 91.8% had right knowledge on duration of EBF. Among the total respondents who had right knowledge of EBF, 98.4% of them got knowledge after the implementation of CBIMCI, which was significant change (p<0.01) and among the mothers who had knowledge of EBF in relation to prevention of pneumonia, 99.3% of them had received that knowledge which was also found highly significant change after the implementation of CBIMCI (p<0.001). In this study it was found that almost all mothers (99%) got knowledge on immunization which was highly significant changes after implementation of the program (p<0.001), but only three forth of them had knowledge on reason to immunize their children, which was significant change after the implementation of CBIMCI (p<0.001). Though one forth had no knowledge of reasons to immunize children, all mothers (100%) had felt the need to give vaccines and they immunized their children. Likewise all mothers had fed Vitamin ‘A’ to their children and almost all (99.75%) had received knowledge on the importance of vitamin A to their children after implementation of CBIMCI which was highly significant change (p<0.001). In in-depth interview FCHV were found aware on activities under the CBIMCI program but three fifth of them only could explain about all diseases that are focused by the program. All had knowledge about the ARI service, but only four fifth of them had knowledge of other services that must be provided through this program. Though all FCHVs had knowledge of all signs and symptoms most of them were not able to differentiate pneumonia and severe pneumonia as per WHO protocol. Therefore, except advice for home treatment for cough and cold (mild ARI) cases, they did not like to take risk if found additional other signs along with cough and cold, and referred to the Health Institution with drug (co-trimaxazole). Community people along with VDC secretary and FCHVs had experiences of decreasing trend of ARI and its mortality in their village after implementation of CBIMCI program and all were found satisfied with the services provided by FCHVs. In community, though awareness and practices among mothers and service facilitators were increased, there were still lacking on some knowledge and practices among both mothers and FCHVs in reference to ARI. . Therefore, time to time refreshers training to FCHVs and awareness activities to mothers through different Medias should be implemented by the Government. Monitoring and supervision at field level from concern authorities seems equally important to enhance knowledge level of FCHVs and their skills in reference to ARI. Orientation to mothers during mothers’ meeting by FCHVs, training for traditional Healers on ARI, activities for smokeless stove installation, income generation activities by concern agencies can improve health condition of the children further in relation to ARI.