Grade 10 || Adolescence, Sexual and Reproductive Health Education || Notes

PART 1: SEXUALLY TRANSMITTED DISEASES (STDs)

🔵 Definition of Sexually Transmitted Diseases

Sexually Transmitted Diseases (STDs) are infections that spread from one person to another through sexual contact.

Definition: STDs are diseases transmitted through unprotected sexual intercourse, multiple sexual partners, unnatural sexual practices, and lack of proper sexual health education.

Unsafe Sexual Practices Include:

• Sexual contact without marriage
• Multiple sexual partners
• Sexual contact using drugs/alcohol
• Unnatural sexual activities
• Sexual contact at an early age

PART 2: HIV/AIDS

🔵 Definition

HIV - Human Immunodeficiency Virus
AIDS - Acquired Immune Deficiency Syndrome

Definition: AIDS is a condition where the body's immune system becomes weakened due to HIV infection, making the person susceptible to various opportunistic infections.

First Discovery:

First AIDS patients identified in USA in 1981

In Nepal, first 4 AIDS patients identified in 1988 (2045 BS)

🟢 Causes of HIV/AIDS Spread in Nepal

1. Unemployment and Foreign Employment

• Economic hardship forces youth to go abroad for work
• Long separation from family leads to unsafe sexual practices
• Workers return infected and spread to partners

2. Human Trafficking

• Nepali girls/women trafficked to India and other countries
• Forced into sex work
• Become infected and spread disease upon return/deportation

3. Sexual Activities in Border and Urban Areas

• Lack of legal recognition for sex work
• Unchecked sexual activities in border areas
• Hidden prostitution in urban areas

4. Lack of Sexual Education/Awareness

• Sex education still considered taboo
• No open discussion between parents and children
• Lack of knowledge about HIV/AIDS transmission and prevention

5. Social Hesitation in Open Discussion

• Social stigma about discussing sexual matters
• People hesitate to visit health centers for STD treatment
• Fear of social discrimination

🟢 Modes of HIV Transmission

• Unprotected sexual contact with infected person
• Blood transfusion from infected person
• Sharing contaminated needles/syringes/razors without sterilization
• Mother to child transmission during pregnancy, childbirth, or breastfeeding
• Using contaminated equipment for tattooing/piercing

🟢 Symptoms of HIV/AIDS

Initial Stage (Window Period)

• After HIV enters body, some may experience flu-like symptoms
• Symptoms may disappear within few days
• Person can still transmit HIV during this period
• Blood tests may not detect HIV for up to 2 months (Window Period)

HIV Positive Stage

• After window period, blood tests show HIV positive
• HIV gradually weakens immune system
• Various opportunistic infections appear

AIDS Symptoms

• Weight loss more than 10% of body weight
• Diarrhea for more than one month
• Fever for more than one month
• Night sweats
• Cough for more than one month
• Skin itching/rashes
• Sores/ulcers on body
• Mouth and throat infections
• Slow healing of wounds
• Final stage - mental illness, TB, cancer, pneumonia leading to death

🟢 Prevention and Control of HIV/AIDS

• Avoid multiple sexual partners; use condoms
• Provide employment opportunities to prevent trafficking
• Strict legal action against human trafficking
• Sexual education and awareness programs
• Use only tested blood for transfusion
• Use only sterilized needles/syringes
• HIV+ women should avoid pregnancy; if pregnant, deliver under medical supervision
• Mass media campaigns about AIDS effects and prevention
• Discourage drug abuse and sharing needles
• No discrimination against HIV+ people; provide social support
• Prevent women trafficking through employment and income generation
• Avoid all sexual activities at early age (under 25 years)

PART 3: SYPHILIS

🔵 Definition

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum.

Definition: Syphilis is a chronic bacterial infection that spreads through sexual contact and can cause serious health problems if left untreated.

Characteristics:

• One of the oldest known STDs
• More common in young adults with multiple partners
• Can be cured if treated early
• If untreated, affects brain, liver, heart and can cause death

🟢 Mode of Transmission

• Unprotected sexual contact
• Infected mother to child during pregnancy
• Blood transfusion from infected person

🟢 Stages and Symptoms

Primary Stage

• Painless sores/ulcers on genitals, mouth, lips, tongue, skin
• Appears 1-5 weeks after infection
• Heals spontaneously without treatment

Secondary Stage

• Enlarged lymph nodes (painless)
• Skin rashes on palms and soles (non-itchy)
• Patient may not notice symptoms

Tertiary Stage

• If untreated, bacteria spread through blood to heart, brain, bones, muscles
• Symptoms: heart disease, paralysis, mental disorders, blindness

🟢 Prevention and Control

• Avoid unsafe sexual contact; use condoms
• Control social problems like prostitution
• Immediate health checkup if symptoms appear
• Use only tested blood
• Health education and awareness programs

PART 4: GONORRHOEA

🔵 Definition

Gonorrhoea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae (Gonococcus).

Definition: Gonorrhoea is a bacterial infection that affects the mucous membranes of the reproductive tract, mouth, throat, eyes, and rectum.

Characteristics:

• Also called "Clap"
• Affects both men and women
• Increases risk of HIV infection
• Can cause infertility if untreated

🟢 Mode of Transmission

• Sexual contact with infected person
• Contact with infected genital secretions
• Using contaminated clothes/towels of infected person

🟢 Symptoms

In Men:

• Frequent, painful urination
• Burning sensation during urination
• Yellowish-green discharge from penis
• Swollen/reddened urethral opening
• Small sores around genitals

In Women:

• Lower abdominal pain
• Swollen fallopian tubes leading to infertility
• Vaginal discharge
• Bleeding between periods

In Infants:

• Eye infections
• Swelling of eyelids
• Discharge from eyes
• Can cause blindness

🟢 Prevention and Control

• Avoid unsafe sex; use condoms
• Do not use clothes/towels used by infected person
• Use only tested blood
• Immediate medical treatment if symptoms appear
• Health education and awareness

PART 5: CHANCROID

🔵 Definition

Chancroid is a sexually transmitted disease caused by the bacterium Haemophilus ducreyi.

Definition: Chancroid is a bacterial infection characterized by painful sores on the genitals and swollen lymph nodes in the groin.

Characteristics:

• Less common than HIV, Syphilis, Gonorrhoea
• Initial symptoms similar to Syphilis (often confused)
• Causes painful ulcers and swollen lymph nodes

🟢 Mode of Transmission

• Unprotected sexual contact
• Using contaminated clothes/towels of infected person

🟢 Symptoms

• Painful sores around genitals
• Swollen lymph nodes in groin area
• Difficulty in walking
• Pus discharge from sores

🟢 Prevention and Control

• Practice safe sex
• Maintain genital hygiene
• Have sexual contact only with regular partner
• Sexual education and awareness programs

PART 6: SAFE MOTHERHOOD

🔵 Definition of Safe Motherhood

Safe Motherhood refers to ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth.

Definition: Safe motherhood includes proper care during pregnancy, safe delivery, and postnatal care for both mother and newborn. It aims to reduce maternal and infant mortality and morbidity.

Components of Safe Motherhood:

• Pregnancy at appropriate age
• Antenatal care and checkups
• Nutrition, hygiene, family support, exercise, rest
• Preparedness for emergencies during pregnancy
• Safe delivery by trained birth attendant
• Newborn care and protection from cold
• Postnatal care for mother and baby

PART 7: SAFE MOTHERHOOD EDUCATION AND HEALTH SERVICES

🟢 Key Aspects of Safe Motherhood

1. Appropriate Age for Pregnancy

• Early marriage still prevalent in Nepal
• Physical maturity occurs after 20 years
• Pregnancy before 20 years causes health risks
• Both men and women should understand this

2. Family Planning

• Limit number of children
• Space children 3-4 years apart
• No gender discrimination
• Proper planning ensures better care

🟢 Pregnant Women and Awareness

Antenatal Care Visits (Minimum 4 Visits)

First Visit: As soon as pregnancy is confirmed

Second Visit: 5-6 months of pregnancy

Third Visit: 8 months of pregnancy

Fourth Visit: Last month or before delivery

Additional Visits: If complications arise or as advised

During Antenatal Visits:

• TT vaccine (2 doses) - First at first visit, Second within 1-6 months
• Extra nutritious food - green vegetables, fruits, milk, meat, eggs
• Avoid heavy work, lifting, carrying
• Personal hygiene maintenance
• No tobacco, alcohol, drugs; avoid soil/chemicals
• Avoid overeating and excessive rest
• Family support and care

🟢 High-Risk Pregnancy Conditions

Pregnancy should be avoided in following conditions:

Mother's age below 20 years or above 35 years

• Ideal reproductive age: 20-35 years
• Below 20: physical immaturity
• Above 35: declining physical capacity

Low weight/short stature mother

• Weight below 45 kg, height below 5 feet
• Small uterus and vagina
• Difficulty in safe delivery

Mother with HIV/AIDS or chronic diseases

• HIV, other STDs
• Cancer, heart disease
• Risk of transmission to child

Multiple pregnancies (more than 4 children)

• Weakens mother's health
• High-risk for complications

Mother taking harmful medications

• Some medicines affect fetus development
• Can cause birth defects

🟢 Common Problems During Pregnancy

Minor Problems:

• Nausea and vomiting
• Chest and abdominal pain
• Backache
• Fatigue
• Loss of appetite
• Swelling of feet
• Varicose veins and redness
• Vaginal discharge and itching
• Difficulty in eating, sitting, sleeping as pregnancy advances

Major Problems (Emergency Signs):

• Swelling of feet, hands, face
• Repeated vomiting
• Severe lower abdominal pain
• Bleeding from vagina
• Severe headache
• Excessive fever
• Fits/convulsions
• High blood pressure
• No fetal movement

Note: If any major symptoms appear, immediate medical attention is required.

🟢 Abortion

Definition: Abortion is the expulsion of the fetus from the womb before 22 weeks of pregnancy.

Types of Abortion:

a) Spontaneous Abortion (Miscarriage)

• Natural loss of pregnancy before 22 weeks
• Due to mother's health, genetic factors
• Causes: uterine abnormalities, infections, poor nutrition, stress, genetic defects

b) Induced Abortion (Medical Abortion)

• Intentional termination of pregnancy
• Reasons: unwanted pregnancy, gender preference, unsafe sex, health risks, fetal abnormalities
• Legal in Nepal up to 12 weeks with woman's consent
• Beyond 12 weeks only in special circumstances

Unsafe Abortion:

• Using untrained providers
• Taking unapproved medicines
• Going to quacks
• Using traditional methods

Risks of Unsafe Abortion:

• Infection
• Excessive bleeding
• Uterine perforation
• Infertility
• Death

Safe Abortion Services in Nepal:

• Government approved health institutions
• Family planning associations
• District hospitals
• Safe abortion kits available

PART 8: MATERNAL AND CHILD HEALTH CARE

🔵 Definition of Maternal and Child Health Care

Maternal and Child Health Care refers to health services provided to pregnant women, lactating mothers, and children under five years.

Definition: MCH care encompasses all health services from pregnancy through childbirth and up to five years of age, ensuring the health and wellbeing of both mother and child.

Importance of MCH Care:

• Protects pregnant women's health
• Ensures safe delivery through trained health workers
• Vaccination and nutrition during pregnancy
• Reduces maternal and infant mortality
• Protects reproductive rights

Pregnancy Period: From conception to 280 days (40 weeks) - a critical period requiring special care and family support.

🟢 Maternal and Child Health Care Measures

1. Care of Pregnant Woman

a) Personal Hygiene

• More vaginal discharge during pregnancy
• Maintain cleanliness
• Regular bathing
• Create healthy environment

b) Nutritious Food

• Increased nutritional requirement
• Eat for two (mother and fetus)
• Protein-rich foods: pulses, soybeans, meat, fish, eggs, milk
• Fresh fruits and vegetables
• Iron, calcium, vitamins
• Malnourished mothers give birth to low-weight, unhealthy babies

c) Light Exercise and Rest

• Regular light exercise beneficial
• Morning walks in fresh air
• Avoid heavy work, lifting, carrying
• Long standing causes fatigue
• Avoid stress
• Adequate rest

d) Health Checkup

• Regular health checkups
• Monitor fetal development
• Early detection of complications
• Timely treatment
• Final month checkup essential

e) Use of Medicine

• Avoid self-medication
• Take only prescribed medicines
• Some medicines harm fetus

f) Vaccination

• TT vaccine (Tetanus Toxoid)
• First dose at 7 months pregnancy
• Second dose one month after first
• Protects mother and newborn from tetanus

2. Safe Delivery and Natal Care

• Never leave delivering woman alone
• Hospital delivery safest
• If home delivery, inform trained health worker/ traditional birth attendant
• Prepare delivery kit in advance
• Signs of labor → take to health center or inform attendant

Home Delivery Preparation:

• Give light liquid diet
• Separate toilet arrangement
• Provide encouragement and security
• Clean, warm delivery room
• Attendant should have clean hands, short nails, sterilized equipment

Home Delivery Kit Contents:

• Clean cloth
• Thread for cord tying
• Clean scissors/blade
• Sterile gauze
• Clean soap and water

3. Care for Postnatal Mother (First 2 months after delivery)

• Extra nutritious food (milk, meat, eggs, fruits, vegetables, ghee)
• Special attention to genital hygiene
• Breastfeed baby immediately
• Encourage walking for blood circulation
• Clean genitals with warm water after urination
• Exclusive breastfeeding
• No heavy work, lifting, carrying (risk of uterine prolapse)
• Information about family planning

4. Infant and Child Health Care

Newborn weight: About 3 kg
Newborn height: About 50 cm
First year weight: Triple of birth weight
First year height: Increase by 50%

Importance of First 1000 Days: From conception to 2 years - critical for child development

Newborn Care:

1. Clean mouth and nose for breathing
2. Wrap in clean cloth, keep head slightly lower
3. Clean body with soft cloth
4. Keep baby below mother's chest until cord falls (prevents infection)
5. Cut cord 2 cm from navel with sterilized instrument
6. Put baby to breast immediately
7. Immediate health check if: no crying, bluish color, difficulty breathing, no sucking
8. Regular health checkups

🟢 Breastfeeding and Nutrition

Importance of Breastfeeding:

1. Mother's milk is best and cheapest food
2. Contains all nutrients and disease-fighting antibodies
3. Initiate within 2-3 hours of birth
4. Colostrum (first milk) provides immunity
5. Continue even if milk seems less
6. Feed every 2-3 hours interval

Exclusive Breastfeeding: Only mother's milk for first 6 months

Duration: Continue breastfeeding up to 2 years

Benefits:

• Provides complete nutrition up to 6 months
• Protects from infections
• Emotional bonding
• Natural family planning up to 6 months

🟢 Supplementary Food

Need for Supplementary Food:

After 5-6 months, breast milk alone insufficient

Introduce supplementary foods from 5-6 months

In Nepal, "Rice feeding ceremony" (Pasni) at 5-6 months scientifically appropriate

Supplementary Foods:

Khichdi (rice-lentil porridge)

Mashed potatoes

Mashed vegetables

Fruit pulp

Egg yolk

Gradually increase quantity with age

🟢 Immunization Schedule

🔴 SUMMARY POINTS

1. STDs - diseases transmitted through sexual contact
2. HIV/AIDS - caused by HIV virus; no cure but preventable; transmission through blood, sex, mother to child, contaminated needles
3. Syphilis - caused by Treponema pallidum; 3 stages; curable if treated early
4. Gonorrhoea - caused by Neisseria gonorrhoeae; affects reproductive tract
5. Chancroid - caused by Haemophilus ducreyi; painful genital sores
6. Safe Motherhood - care during pregnancy, delivery, and postnatal period
7. Antenatal Care - minimum 4 visits during pregnancy
8. High-risk Pregnancy - age below 20/above 35, low weight, diseases, multiple pregnancies
9. Abortion - spontaneous or induced; legal up to 12 weeks in Nepal
10. MCH Care - care for mother and child up to 5 years
11. Breastfeeding - exclusive for 6 months; continue up to 2 years
12. Immunization - protects children from 6 killer diseases

🔑 KEY DEFINITIONS

🎯 LEARNING OBJECTIVES

After studying this chapter, students will be able to:

• Define STDs and identify their types
• Explain HIV/AIDS transmission, symptoms, and prevention
• Describe Syphilis, Gonorrhoea, and Chancroid
• Understand safe motherhood concepts
• Identify high-risk pregnancy conditions
• Explain abortion types and legal aspects
• Describe MCH care measures
• Understand breastfeeding importance
• Know immunization schedule
• Apply preventive measures in daily life

💡 EXAM TIPS

For definitions: Memorize key terms exactly as given

For HIV/AIDS: Remember discovery (1981 USA, 1988 Nepal), transmission (5 modes), symptoms (10 points), prevention (12 points)

For Syphilis: Remember 3 stages with symptoms

For Gonorrhoea: Differentiate symptoms in men/women/infants

For Safe Motherhood: Remember 4 antenatal visits, high-risk conditions, minor/major problems

For Abortion: Know 12 weeks legal limit, types, risks

For MCH Care: Remember care for pregnancy, delivery, postnatal, newborn

For Breastfeeding: Exclusive 6 months, continue 2 years, benefits

For Immunization: Remember vaccine names, doses, schedule, diseases prevented

For numbers:

• HIV first discovery: 1981
• Nepal first cases: 1988
• Antenatal visits: 4
• Abortion limit: 12 weeks
• Exclusive breastfeeding: 6 months
• Continue breastfeeding: 2 years
• BCG dose: 1
• DPT doses: 3
• Polio doses: 3
• Measles dose: 1
• TT doses: 5 (2 during pregnancy)

📊 IMPORTANT DATA

First AIDS cases in world: 1981 (USA)

First AIDS cases in Nepal: 1988 (4 persons)

Ideal reproductive age: 20-35 years

Legal abortion limit: 12 weeks

Pregnancy duration: 280 days (40 weeks)

Exclusive breastfeeding: 6 months

Breastfeeding duration: 2 years

Newborn weight: ~3 kg

Newborn height: ~50 cm

Antenatal visits: Minimum 4

🧠 MEMORY TRICKS

1. 4 Major STDs: "HSGC" - HIV, Syphilis, Gonorrhoea, Chancroid
2. 5 HIV Transmission Modes: "BBSMC" - Blood, Birth, Sex, Mother to child, Contaminated needles
3. 12 HIV Prevention Points: "ACES-SUPPORT" - Avoid multiple partners, Condoms, Employment, Sex education, Sterilized needles, Universal precautions, Public awareness, Partner notification, ORT, Rest, Testing, Treatment
4. 3 Stages of Syphilis: "PST" - Primary, Secondary, Tertiary
5. 4 Antenatal Visits: "F5-8-L" - First (confirmation), 5-6 months, 8 months, Last month
6. 6 High-Risk Pregnancy: "AALMPD" - Age (<20/>35), Abnormal weight, Ailments, Lots of children, Medicine, Physical condition
7. 6 Minor Pregnancy Problems: "NVBFAS" - Nausea, Vomiting, Backache, Fatigue, Appetite loss, Swelling
8. 8 Major Pregnancy Problems: "SSVBFHSF" - Swelling, Severe vomiting, Vaginal bleeding, Bad headache, Fits, High BP, Severe abdominal pain, Fetal movement absent
9. 4 Newborn Care Points: "CCCC" - Clean, Cord cut, Colostrum, Checkup
10. 6 Vaccines: "BDPPMT" - BCG, DPT, Polio, Pneumonia, Measles, Tetanus