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tEÅ & m,f v u© P mawG e J Y t
oufqHk;EdkifwJh a&m*gawG jzpf
vmwwf y gw,f / 'D h t wG u f
(Emergency Management of
Obstetric Care = EmOC) qdkwJh
ta&;ay:pDrHukorI (om;zGm;)
oifwef;awGudk usef;rma&;Xm
ewdkif; (r,fawmfaq;cef;tyg
t0if) rSm oifMum;ay;aeMuyg
w,f/
uav;arG;NyD;awmhvnf;
em&D0uftwGif; arG;uif;pu
av;udk EdkYcsdKwkdufa&;eJY quf
vufjyKpkapmihfa&Smufa&;vkyf
ief;rsm; aemufxyfvkyfaqmif
Muygw,f/
uav;rS tarEdkYudk pdkYvdkuf
jcif;[m rD;zGm;NyD; aoG;oGefwm
udk tawmftwef umuG,fay;
ygw,f/ bmjzpfvdkYvJqdkawmh
om;tdrfudk jrefjrefusHKUapjcif;
aMumifh (om;tdrfrS) aoG;,dkpD;
jcif;avsmhyg;apvdkY jzpfygw,f/
udk,fawGUt& wifjy&r,f
qdk&if ...
vGecf w
hJ hJ (10)ESpaf usmcf efu
jzpfygw,f/ usaemfhtrsdK;orD;
[m uav;arG;NyD; EdkYrxGuf
ao;wJ h t wG u f (uav;uk d )
csufjcif;EdkYrwdkufEdkif/ 1-2 em&D
ausmfausmfavmufMumvmwJt h awGyg0ifNyD; ]arG;uif;puav;
csdefrSm rD;zGm;NyD; aoG;oGefrIa0'
emudk cHpm;&ygw,f/ aoG;aygif
csdefus? jzLzwfjzLa&mfjzpfNyD;
owdvpfovdk jzpfomG ;ygw,f/
aoG;vefYoGm;jcif;jzpfygw,f/
ta&;ay:aq;0g;ukoay;Edkif
vdkYom touf&Sif&jcif;jzpfyg
w,f/ arG;vrf;aMumif; aoG;,dk
pD;&wm[m om;tdrfjyefrusHKU
(Uterine atomy) jzpfjcif;aMumifh
jzpfygw,f/ EdkYxGufNyD; uav;
om EdkYpdkYvdkufygu om;tdrfjref
jrefusHKUNyD; 'DtEÅ&m,feJY BuHKcsif
rS BuHKygvdrfhr,f/
usaemfah rG;vlemawGrmS vnf;
uav;awG EdkYaumif;aumif;pdkY
NyDqdk&if (usaemf) t&rf;aysmf/
rdcifEdkYeJY uav;udk aus;Zl;wif
&ygw,f/ rdcifaoqHk;wJht
aMumif;&if;awGrSm rD;zGm;NyD;
aoG;oGejf cif;[m tjzpfrsm;qH;k /
(rSwfcsuf = rD;zGm;NyD; aoG;
oGefjcif;&JU taMumif;trsdK;rsdK;
&Sdygw,f/ arG;zGm;pOf arG;vrf;
aMumif; pkwfNyJ'Pf&m&jcif; t
ygt0if tjcm;taMumif;rsm;)
rdcifEt Ykd aMumif; waphwapmif;
uav;arG;NyD;wJh rdcifawG
rSm y½dkvufwifeJY atmufqDwdk
pif qdkwJh cspfjcif;arwÅm a[mf
rkef;awGaMumif; EdkY&nf*vif;
(&ifom;)rsm;rS EdYk &nfawG xGuf
vmygw,f/
yxrqH;k xGuv f m wJEh Ykd &nf
awGukd EdYk O;D &nfvYkd ac:ygw,f/
EdkYOD;a&rSm uav;udk,fcHtm;
aumif;apwJh "mwfawG? 0rf;
aysmhaysmhoGm;apwJh "mwfawG?
tom;0gwmudk wm;qD;EdkifwJh
"mwfawGyg ygw,f/
tarwdkif; uav;arG;NyD; EdkY
&nf csufcsif;xGufavhr&Sd/ t
aMumif ; trsd K ;rsd K ;aMumif h y g/
Oyrm- uav;udk EdkYrwdkuf
wwfwm? (a&m*g&Sv d Ykd ) aq;0g;
awG aomufae&wm? tar em
zsm;rusef;jzpfaewmeJY t&nf
"mwfcrf;ajcmufwmawG .. us
aemfwdkY wdkif;jynfrSmawmh tm
[m&csdKUwJh taMumif;&if;cHu
ydkrsm;r,f/
tarawGrSm EdkY&nfxGuf&Sd
wJh yrmP tenf;trsm;vnf;
uGmjcm;Muygw,f/ tcsed Zf ,m;
xm;NyD; EdYkwu dk w f mxuf uav;
qmwdik ;f EdYk wu dk af y;ygu EdYk &nf
xGuf&SdrI ydkrsm;vmapw,f/
Ed&Yk nfxJrmS bmawGygovJ
ynm&SifawG pl;prf;avhvm
aewm tawmfMumNyD/ 'gay
r,fh (EdkY&nfxJrSm) yg0ifwJh t
&mawGudk tao;pdwfrodMu
ao;/
EdkYOD;&nfrSm y½dkwdef;eJY u
av;ud, k cf t
H m; jr§iahf pwJh "mwf
awG & J U } tpmajcvk y f i ef ; ud k
aumif;rGefapw,f/ t0ga&mif
t&nfusJusJ EdkYOD;&nfudk t&t
rd wkdufcdkif;wm[m uav;awG
&JUudk,fcHtm;udk jr§ihfwifay;Edkif
vdYk jzpfygw,f/ 'grS ul;pufa&m
*g (Oyrm - tqkwfa&mif? erdk;
eD;,m;?0rf;avQma&m*g ponf)
rsm;udk umuG,fEdkifyghr,f/ t
csdKUrdcifawGrSm (EdkYOD;&nf) [m
uav;rarG ; cif u wnf ; u
xGuf&Sdvmwwfygw,f/
3-4 &ufMumvmwJt h cg EdYk
OD;&nf usJusJawG[m t&nf
rsm;vmNyD; csdKarT;vmygw,f/
&eHY[m uav;udk qGJaqmifyg
w,f/ aemufyikd ;f EdYk&nf[m jypf
vmNyD; uav;a&qmwmawG
&,f? qmavmifrGwfodyfrIawG
&,fudk ajzazsmufay;ygw,f/
rdcifEdkYrSm uav;twGuf tm
[m&aygif;pHk yg0ifw,f/ t
oifhazmfpyfxm;NyD;om;/ wul;
wu xkwfydk;xm;p&mrvdk/ a&
cJaowÅmxJvnf; odrf;qnf;
xm;p&mrvd k / a&"mwf a yg
pmrsufESm (6) odkY ```
6 NIGHTINGALE
``` pmrsufESm (5) rStquf
<u,fNyD; y½dkwdef;? tqD? um
bGe[ f u kd 'f ½dw
k ?f oH"mwftygt
0if owÅK"mwffrsm;? ADwmrif
oufapmifh"mwfrsm;? tpmajc
tifZdkif;awGeJY uav;BuD;xGm;
zGHUNzdK;apwJh a[mfrkef;"mwfawG
rsm;vSygw,f/
'gayr,fh a&m*g&SdwJh rdcif
awG? aq;aomufae&wJh tar
awGrSm a&m*gydk;awG? uav;udk
tEÅ&m,fay;EdkifwJh "mwfypönf;
rsm; EdkY&nfxJrSm ygvmNyD; (u
av;uk)d a&m*gb,awG jzpfap
Edkifygw,f/ 'gaMumifhvnf; t
&ufpGJrdcifawG? HIV ydk;a&m*g
onf rdcif? a&&Snfaq;0g;
aomufoHk;ae&wJh rdcifawG[m
orm;awmfawGeJY wdkifyif uko
rI jyK&ygr,f/ rdcifEYkd rwdu k o
f ifh
ygu uav;EdkYrIefY? EGm;EdkYawGudk
tm;ud;k &awmhrmS aygh/ okawo
ejyKcsufrsm;t& rdcifEdkYudk ,SOf
EdkifwJh? tpm;xdk;vdkY&wJh EdkY&nf
qdkwm (,cktcsdeftxd) ray:?
r&Sdao;/
tarEdkYqdkwm arwÅmaoG;
aMumifh jzpfvmwm/
uav;EdkYrIefYqdkwm pD;yGm;
a&;tawG;aMumifh jzpfvmwm
qdkawmh b,fwlyghrvJaemf/ EdkY
rxGufwJhtarawGtwGuf wD
xGifay;wm jzpfEdkifayr,fh tEÅ
&m,fruif;wJh"mwfawG ygavh
&Sdw,f/
EGm;EdkYuaum/
EGm;EdkYuawmh EGm;uav;
awGyJ pdkYoihfwmaygh/
EGm;EdkYrSm ADwmriftD; (u
av;rsm; rsdK;yGm;t*FgzGHUNzdK;rIt
wGuf vdktyfwJh"mwf)? oH"mwf
eJY toHk;0ifwJh tqD"mwf pwm
awG vHk;0ryg/ EGm;EdkYwdkufwJh
uav;awGrSm aoG;tm;enf;
a&m*gawG cHpm;&avh&Sdw,f/
'ghtjyif tpmraMuEdkifwJht&m
awG? ausmufuyfudk 0efydapwJh
ypö n f ; awG v nf ; ygao;/
aemuf uav;awGudk "mwfr
wnfhjcif;qdkif&m ,m;ema&m*g
awGvnf; jzpfapEdkifw,f/
rdcifE&Ykd nf&UJ tusKd ;aus;Zl;rsm;
uav;rsm;twG u f OD ;
acgif;rS ajczsm;txd tusdK;&Sd
apwJht&m/
- OD;aESmufzGHUNzdK;rI rSefuef
NyD; OmPfaumif;wJh uav;awG
jzpfapw,f/
- rsufpt d jriftm½Hk aumif;
apw,f/
- em;a&m*gawG umuG,f
ay;ygw,f/
- rsufEmS <uufom; oefrm
apw,f/
- tmoD;a&mifjcif;udk um
uG,fay;w,f/
- tay:ydkif; touf½SL
use;f rma&;*sme,f
vrf;aMumif;awG? yef;em&if
usyfeJY tqkwfa&miferdk;eD;,m;?
wkyfauG;a&m*gawG tjzpfenf;
apw,f/
- ESvHk;udk yHkrSef tvkyfvkyf
apw,f/
- 0rf;ysuf^0rf;avQmjcif;eJY
tlvrf;aMumif; ydk;0ifjcif;awG
udk tjzpfenf;apw,f/ tpm
"mwfrwnfhrIeJY tlrBuD;a&m*g
awGvnf; avQmhcsEdkifw,f/
- tltwufa&mifwm um
uG,fay;w,f/
- (EdkY&nfrSm qm;"mwf? y½dk
wde;f "mwf odyrf rsm;wJt h wGu)f
ausmufuyfawG 0efrydbJ yHkrSef
tvkyfvkyfapw,f/
- qD;vrf;aMumif; ydk;0if
a&m*gjzpfyGm;rI enf;apw,f/
- qD;csdKa&m*g (uav;b
0rS pwifjzpfwJh trsdK;tpm;)
tEÅ&m,f uif;a0;apEdkifw,f/
- ESif;cl? ,m;em tjzpf
enf;apw,f/
- uav;b0 tqpftjrpf
a&mif&rf;rIudk avsmhapw,f/
- uav;udk yHkrSefBuD;xGm;
apNyD;? t0vGejf cif;a&m*grS um
uG,fay;ygw,f/
- 0rf;csKyfjcif; avsmhenf;
apNyD; rpifteHY qdk;½Gm;jcif;rS
uif;a0;apygw,f/
rdcifawGtwGuv f nf; rdcif
EdkYwkdufjcif;[m tusdK;rsm;vSyg
w,f/
- om;tdrfudk jyefusHKUapNyD;
(uav;arG;NyD;) aoG;oGejf cif;udk
enf;apygw,f/
- obm0w&m;t& om;
qufjcm;apygw,f/
- OtdrfeJY &ifom;uifqm
jzpfyGm;EIef;udk avsmhenf;apyg
w,f/
uav;EdkYwkdufjcif;[m tm
[m&ay;wJhvkyfief;tjyif rdcif
eJY uav;cspfjcif;arwÅmudk cdkif
NrJapygw,f/ uav;awG&JU
oufawmiho f ufom&Srd ?I pdwcf s
&rI&JU t&if;tjrpfwckjzpfyg
w,f/ aEG;axG;El;nHhrIudk u
av;rS xdawGUcHpm;&ygw,f/ (
EdkYAl;awGeJYuGmy)/ rdcif&ifcGif
wGi;f rSm vHNk cHKpdwcf sab;uif;wJh
cH p m;rI u d k &ygw,f / Child
Portection (uav;oli,fum
uG,af &;qdw k m rdcifEYkdpwduk pf Of
uwnf;u pwifwmyg/)
rdcifwdkif; od&Sdxm;oifhwJh
tcsufrsm;rSm
- EdkYwdkufjcif;[m qlnH*sD
usaewJh uav;udk Nidrfouf
at;csrf;apygw,f/
- pdk;&drf ylyefpdwfrsm;aewJh
uav;udk pdwfat;csrf;om,m
apw,f/
- aeraumif;? xdckduf'Pf
&m&? aMumufvefYaewJhuav;
udk ESpfodrfhrIay;ygw,f/
- uav;[m tEÅ & m,f
uif;NyD; tcspfcHae&ygw,f/
- aumif;pGm tdyfaysmfap
w,f/ (EdkY&nfrSm uav;udk
tdyfaysmfapwJh a[mfrkef;awG yg
wJhtwGuf)
rdcifEYkd wdu k af uR;enf;ESifh rl0g'
rsKd ;qufymG ;use;f rma&;Xme
awGrSm oifay;avh&Sdw,f/ u
av;EdkYwkduf&mwGif uav;a&m?
taryg oufawmifhoufom&Sd
r,fhtaetxm;? uav;rS (t
arh) EdkYoD;acgif;udk rudkufrd
atmif uav;yg;pyfrS EdkYtHkudk
tjynfht0iHkrdatmif pwJhenf;
awGudk AGD'D,dk? qvdkuf½Id;? ½kyfyHk
um;csyfawGeJY vufawGUoifjy
ay;Muygw,f/
uav;EdkYwkdufenf; rrSefyg
u EdYk &nftxGuef nf;jcif;? EdYk tkH
cJjcif;? EdYko;D acgif; a&mif&rf;^uGJ
'Pf&m&jcif;eJY EdkYjynfwnfem
pwmawG jzpfwwfygw,f/
aq;½H?k aq;cef;rsm;rSm EdYk csdK
wdkufauR;a&;rl0g'qdkwmawG
&Sdygw,f/ atmifjrifaom rdcif
EdkYwdkufauR;a&;rl0g' tqifh
(10)qifhqdkwm xif&Sm; toHk;
rsm;vSygw,f/
- usef;rma&;0efxrf;rsm;
tvG,w f ul yHrk eS q
f ufo, G o
f d
&SdEdkifwJh csrSwfxm;NyD; ay:vpD
rl0g' &Sd&r,f/
- usef;rma&;0efxrf;tm;
vHk;rS 'Drl0g'udk taumift
xnfazmfEdkifzdkY vdktyfwJh uRrf;
usif r I a wG u d k avh u sih f a y;&
r,f/
- udk,f0efaqmiftrsdK;o
rD;wdkif;udk EdkYwkdufjyKpkjcif;eJY? EdkY
wkdufjcif;&JU tusdK;aus;Zl;awG
&Sif;jyNyD; od&Sdap&r,f/
- uav;ud k b,f v d k E d k Y
wdkufr,f? tu,fvdkY uav;eJY
tar cGJae&ygu EdkYwkdufzdkY t
jcm;enf;vrf;rsm;udk oifjyay;
&r,f/
- (aq;0g;nTefMum;csuf
rsm;rSty) arG;uif;puav;
rsm;udk rdcifEdkY&nfrSty tjcm;
t&nf? tpmawG rauR;&ef/
(Exclusive Breast Feeding)
- w&uf (24)em&DvHk; t
areJYuav; twlw&l adS ezdYk pDpOf
ay;&r,f/
- uav;EdYkqmwdik ;f EdYkwu dk f
zdkY tm;ay;wdkufwGef;&r,f/
- csdKvdrf? EdkYoD;acgif;twk
awGudk uav;rsm;udk (vHk;0) r
ay;&ef/
- EdkYwdkuftaxmuftul
ay;tkyfpkrsm;eJY qufoG,fay;
NyD; (aq;½Hkqif;rdcifrsm;udk) vTJ
ajymif;ay;yg/
(wenf; - rdcifrS aemuf
qufvufEdkYwdkufEdkif&ef tm;
ay;yg/ 4 v (0g) 6 vtxd
EdkYwrsdK;wnf;? 6 vrS (2)ESpft [m&&SdwJh tpmpm;? t&nfrsm;
trSw-f 23? Mo*kwv
f ? 2010-ckEpS f
wdkif;EdkifiHwck&JU ta&;BuD;qHk;
xd tarEdkYqufwkdufNyD; jznfh rsm;aomufay;&r,f/ EdkY&nft usef;rma&;vkyfief;wckjzpfwJh
pGuftpmrsm; auR;arG;wwfap xGurf sm;wJah q;awG&adS yr,fh , twGuf usef;rma&;0efxrf;
&ef aq;½Hkqif;rdcifrsm;tm; y cktcsdefxd w&m;0ifoHk;cGifhr&Sd rsm;omru jynfolvlxkrS yl;
nmay;oifjy&rnf/) rl0g'awG ao;/ aygif;yg0ifvmrI ]rsm;jym;vmrS
uawmh aumif;rSaumif;/ us ar;cGef; (4)/ / uav;udk om} vkyfief;BuD;atmifjrifvm
aemfwdkY &mEIef;jynfh vkyfaqmif rdcifEYkd csufcsif;wdu k v f Ykd r&ao; rSm/ ,ckaqmif;yg;wGif ]rdcifEdkY
Edik Nf yDvm;qdw
k mpOf;pm;Mu&r,f/ bl;qdk&if bmqufvkyf&rSmvJ/ wku d af uR;a&;}udo k m aZmif;ay;
uav;udk EdkYAl;wdkuf csdKvdrfay; azmfjyxm;w,f/ tjcm;aom rd
pdkY&if tarEdkYrpdkYwwfawmhbl; cif? uav;apmifha&SmufrIvkyf
uav;tarawG ar;avh&SdwJh qdkwm [kwfygovm;/ ief;rsm;pGm &Sdao;aMumif;/ Oy
ar;cGe;f rsm; tajz (4)/ / tarEdkYcsuf rm- umuG,af q;xd;k ESjH cif;vkyf
ArmjynfrSm q&m0efqdkwm csif;rxGuf&if pdwfcs&wJh (t ief;rsm;/
pD r H t k y f c sKyf a &;vnf ; vk y f &
jcm;tarawGqDrS) EdkYudk wdkuf rdcifEYkdwudk af uR;jcif;uawmh
w,f/ txl;ukawGrSty wdkuf vdkY&ygw,f/ 'grSr[kwf pdwf aiGukefoufom? uav;ao
e,f? NrdKUe,fq&m0efawG[m csab;uif;wJhEdkYrIefYudk a½G;cs,f EIef;avsmhcsay;wJhtjyif um
aq;ukoa&; (aq;ynm? cGJ azsmfwdkufaygh/ uav;ausmuf uG,af q;awGuv kd nf; pGr;f tm;
pdwf? uav;? om;zGm;^rD;,yf uyfysufapwJh r,fvrif;awmh ydkrdkaumif;rGefapw,fvdkY ynm
bmom&yf? txl;jyKbmom&yf owdxm;yg/ EdYk A;l ? csdKvdro f ;kH wJh &SifawGu qdkxm;av&JU/
Oyrm-em;? ESmacgif;? vnf uav;awG tarEd k Y r pd k Y w wf urÇ m csD v k y f i ef ; jzpf w J h t
acsmif;bmompHk) tjyif rdcif? awmhb;l qdw k m vH;k 0r[kw/f u wGuf usef;rma&;0efxrf;aygif;
u av;use;f rma&;apmihaf &Smuf av;qdkwm oifp&mrvdkbJ t pHk vIyf&Sm;EdkifrS rdcifuav;?
rI oifwef;ay;&wmawG? vkyf arEdkYudk pdkYwwfygw,f/ tar usef ; rma&;vk y f i ef ; BuD ; awG
ief;awG aqmif½Guf&wmawG uom EdkYxGufvmwJhtcsdefrSm atmifjrifvmrSmyg/ ] [dkvlryg
tjcm;vkyfief;awGeJYvnf; tm; BudK;pm;wdkufay;r,fqdk&if t vJjzpfwmyJ} qdkwJhtawG;xuf
avhr&SdMu/ arEdkYudk jyefpdkYygvdrfhr,f/ ygvm&ifydkaumif;vmrvm;?
rdcif? uav; apmihfa&Smuf aq;0g;aomufoHk;rIrsm;eJY bmtBuHOmPfawG? ulnDrIawG
rIvkyfief;awGvkyfawmh? om; EdkYwkdufjcif;tusdK;oufa&mufrI &rvm;qdw k myJ usaemfawG;csif
zGm;vkyfief;awGvkyfawmh u rsm;udkvnf; EdkYwdkufrdcifawG ygw,f/
av;tar? rdcifawGeJY tNrJxd ar;avh&Sdygw,f/ aq;0g;rsm; usaemfMum;zl;cJhwJh uav;
awGU qufqH&ygw,f/ tJ'DrSm taMumif;udkvnf; tusOf;½Hk; tarwa,muftaMumif; ajym
tar? rdcifawGrS EdkYwdkufauR; azmfjyyghr,f/ jy&if; aqmif;yg;udk tqH;k owf
jcif;eJY ywfoufwJh ar;cGef;awG EdYkwu kd rf cd ifawGrmS tEÅ&m,f yg&ap/
tar;cH&ygw,f/ ar;avh&SdwJh r&Sd aomufoHk;EdkifwJh aq;rsm; waeYrmS q&m0efwa,muf
ar;cGef;tcsdKUeJY tajzrsm;udk rSm - tufpfy&if? yg&mpDwarm qDudk uav;tarwa,muf
azmfjyyghr,f/ yifeDqDvif? uzvdkpydkvifESifh a&mufvmNyD; ...
ar;cGef;(1)/ / arG;uif;p bmrDwGefuJhodkY t,m;aysmuf ] q&m ... usruav;u
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trSw-f 23? Mo*kwv
ar;ckdifa&m*g[m BudKwif
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(ausm½kd;ab;&Sd<uufom;rsm;
jyif;xefpGmusHKUjcif;aMumifh)
tjcm;aemufqufwGJqdk;usdK;rsm;
- a&"mwfqkH;½SHL;jcif;
- aoG ; oMum;"mwf avQmh
enf;jcif;
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ul;pufjcif;
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ponfwkdYjzpfEkdifygw,f/
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wdwfqdwfrJarSmifaom t
cef;wGif; aocsmpGmjyKpkyg/ (t
aMumqGJ wufjcif;ukd ykdrsm;ap
EkdifwJh qlnHjcif;ESifh tvif;
a&mifukd a&Smif&Sm;yg/ taMum
wufjcif;rsm;ygu toufao
apEkdifygw,f)
Ringer taMumaq;ay;yg/
(rS e f u ef a om a&"mwf t m;
xdef;odrf;Ekdif&efjzpfygw,f/)
tpmauR;&ef ESmacgif; t
pmtdrfykdufukd okH;yg/
taMumqGw J ufjcif;rsm; &yf
wefYap&ef aq;0g;rsm;okH;yg/
(Anticonvulsive Drugs)
- Diazepam 0.3mg/kg stat
(Max: 3mg/kg/day) ay;yg/
- Phenobarbital 3-5 mg/kg/
day
pmrsufESm (9) odkY ```
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aMumifh vlaygif; 25oef;ausmf
aoqHk;cJh&NyD; jzpfygw,f/
NyD;cJwh EhJ pS f rwfvu rufqD
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awGudk a&m*gjzpfyGm;apwJh Adkif;
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wkyaf uG;a&m*gawGuawmh ydNk yD;
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tyifawGeJY wd&dpämefawG ayguf
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pdwfaysmuf ysufpD;rIawGeJY t
ajymif;tvJawG[m vlYordkif;
umvwavQmufrmS vlom;awG
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w,f/
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u a*[aA'uxdu a';Apfrm
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ckESpfuwnf;u a&m*gtopf
300 ausmf azmfxkwfowfrSwf
EdkifcJhygw,f/ 60%u vlawG
u wd&dpämefawGudk ul;pufcJh
wmjzpfNyD; 70% uawmh awm
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qHvm&mu jzpfay:vmwmyg/
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xdawGUqufqrH u I ae a&m*gt
opfawG ay:vmvdrfhOD;r,fvdkY
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vkdY ajymygw,f/
t"dutcsufwckuawmh
vlawGukd t&ifu raezl;wJhae
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bl;/ tckawmh tJ'Da&m*gawG
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pdkufysdK;a&;tzGJUu *sif qvif;
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]wd&dpämefarG;jrLa&;rSm&SdwJh t
ajymif;tvJawG[m vlom;awG
udk ul;pufjzpfyGm;apEdkifwJh wkyf
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bufw;D &D;,m;awG&UJ aygufymG ;
aexkid rf I b0puf0ikd ;f udk ajymif;
vJoGm;apEdkifygw,f/ Oyrm
tm;jzifh w½kwfjynfvdk wdkif;
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vdt k m; ydNk yD; jrifrh m;vmrIu tdrf
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awmifyikd ;f w½kwjf ynfwckwnf;
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&Sdygw,f/
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use;f rma&;*sme,f
``` pmrsufESm (8) rStquf
NIGHTINGALE 9
jzpfyGm;aeaom a&m*gykd;ukd [efYwm;Ekdif&efESifh a&m*gykd; ul;
pufaeaom 'Pf&mukd uko&ef y#dZD0aq;rsm;ukday;yg/
- Benzyl penicillin IV 50mg/kg stat (xdkYaemuf Pen V udk waeY
4 BudrfEIef;jzifh wywf qufay;yg/)
tqdyfajzaq; (Tetanus Antitoxin)
ta&jym;atmufaq;xkd;jcif; (SC)
arG;uif;puav;rsm; - 1500 units
uav;rsm; - 2500-5000 units
vlBuD; - 5000-10,000 units
umuG,faq;xdk;jcif;
uav;i,frsm;ukd DPT xkd;aq; (4) ywfjcm;pD 3 Budrf xkd;yg/
(6ywf? 10ywf? 14ywf)
TT (Tetanus Toxoid) xkd;aq; - txl;ojzifh touf 15
ESpfuae 45ESpftMum; trsdK;orD;rsm;twGuf 5 Budrfxdk;yg/
(T1-T5)
T1 (yxrtMudrf) xkd;jyD; 1 v apmifhyg/
T2 ('kwd,tMudrf) xkd;NyD; 6 v apmifhyg/
T3 (wwd,tMudrf) xkd;NyD; 1 ESpf apmifhyg/
T4 (pwkw¬tMudrf) xkd;NyD; 1 ESpf apmifhyg/
(5) Budrfwdwdxkd;xm;wJh trsdK;orD;rSm ar;ckdifa&m*g umuG,f
EkdifpGrf;tm; tESpf (30) &SdoGm;r,f/ olYtouf (60) txd ar;ckdif
a&m*gaMumifh raoEkid af wmhb;l / olwifruygbl;? olYrmS 'DumuG,f
pGr;f &Sad e&if oluarG;wJah rG;uif;puav;wkid ;f rSmvnf; 'Da&m*gukd
umuG,fEkdifpGrf; &SdoGm;rSmyg/
arG;uif;puav; ar;ckid af &m*g (Neonatal Tetanus) udk b,fvkd um
uG,fvJ/
- uk, d 0f efaqmiftrsdK;orD;rsm;tm; ar;ckid u f muG,af q;ukd (1)
vjcm;pDjcm;NyD; ESpfMudrftjynfht0xkd;ay;jcif;/
- ykd;owfxm;aom ud&d,mrsm;okH;NyD; rD;zGm;ay;jcif;ESifh
csufBudK; jzwfjcif;/
- uav;csuBf udK;w0du k f *Gr;f udak &aEG;qGwNf yD; oefY&iS ;f a&; vkyf
ay;yg/ (wywfausmcf efYMumvQif csurf S 'Pf&m ajcmufvmNyD;
temaz; uGmusoGm;ygvdrfhrnf/)
- ynmay;jcif;
Ä ukd,f0efaqmiftrsdK;orD;rsm;ukd umuG,faq;xkd;&ef
pnf;½kH;yg/
Ä ½k;d &mvufonfrsm;ukd umuG,af q;xk;d jcif; jyKvkycf idk ;f yg/
Ä rD;zGm;&mwGifjyKpkaomtcg a&usufat;tokH;jyKjcif;
0g;jcrf;jym;jzifh csufMudK;jzwfjcif;ukd a&Smif&Sm;jcif;
ponfwkdYukd ynmay;yg/
taxGaxG umuG,fjcif;
- 'Pf&mrsm;tm; oefY&Sif;jcif;? ykd;owfjcif;/
- rnfonfch pJG w d u
f o
k rIurdk qkd yk;d owfxm;aom ud&, d mrsm;ukd
tokH;jyKyg/
- ar;ckdifumuG,faq;ukd tMudrftjynfht0xkd;xm;yg/
rif;ol&ed f
&dpämefawGuwqifh arG;jrLa&; jzwfNyD; vlom;awGqu D kd a&muf
vkyfief;eJY tdrfarG;a&MuufawG vmEdkifajc&Sdw,fqdkwmudk rod
qDudk ul;ajymif;vmNyD; vlawG Muygbl;/ olwdkYawG&JU vSnfh
eJY xdawGUrIyNkd yD; eD;uyfvmMuyg ywfrrI sm;jym;vmwmeJYtrQ a&m
w,f/ tvm;wlyJ 0ufawGrSm *gopfjzpfyGm;rIvnf; ydkNyD; t
jzpfyGm;wJh wkyfauG;[mvnf; vm;tvm&Sdvmygw,f/ wkyf
NyD;cJhwJh q,fpkESpftwGif;u auG;Adkif;&yfpfawG[m vlawGt
us,fjyefYyGm;rsm;vmwm awGU& pm;tpmawGeJY ydkNyD;eD;uyfaewJh
ygw,f/ ] 1990 ckESpfwkef;u twG u f vl o m;awG t wG u f
0ufwkyfauG; qifhyGm;rsdK;wck a&m*gb,tEÅ & m,f a wG [ m
wnfyJ &SdcJhygao;w,f/ tck vnf; ydkvdkYrsm;jym;aew,fqdk
awmh rsdK;pHkjzpfEdkifwJh qifhyGm;rsdK; wmudk usaemfwdkYowdjyK&yg
oHk;rsdK;awmif &SdvmygNyD} vdkY vdrfhr,f/
a'gufwm qvif;*sif;bwfu usef;rma&;? ynma&; tm;
ajymygw,f/ enf;csdKUwJhaeMuwJh usaemfwdkY
tJ'v D kd topfaygufymG ;vm jrefrmEdkifiHom; arG;jrLpdkufysdK;
wJh Adkif;&yfpfawG&JU p½dkufobm a&;orm;awGtaeeJY wd&dpämef
0[m BudKwifajymvdkY r&ovdk awGudk xdawGUudkifwG,f&mrSm
odyÜHynm&SifawGtaeeJYvnf; txl;owd&SdMuzdkY vdktyfwJht
olwdkYawG[m b,fvdkrsdK; rsdK; aMumif; today;wifjyvdkufyg
pdwft&Htwm;awGudk ausmf w,f/ pdk;aevif;
10 NIGHTINGALE use;f rma&;*sme,f odyÜHynm&SifawG[m (rsdK;½dk;ADZ)
&JU vQdKU0SufcsufawGudk waeYw
jcm; ydkrdkod&Sdvmaeygw,f/ *sD
EHI;rf (Genome) qdkwJh (rsdK;½dk;ADZ
ajryHk) (Human Genetic Map)
udk wdk;wufacwfrDwJh uGefjyL
wmodyÜHtultnDeJY cktcgrSm
a'guw
f moD[armif a&;qGJazmfxkwfEdkifcJhygNyD/
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ud, k t
trSw-f 23? Mo*kwv
f wGi;f rSm omrefrsuaf pheYJ
f ? 2010-ckEpS f
rjrif&wJh uifqmqJvf b0u
ae wjznf;jznf; wcsdKUvnf;
jref j ref q ef q ef B uD ; xG m ;NyD ;
aemufq;kH rSm jrifomxifom t
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b0udk a&mufygw,f/ 'Dae&m
rSm Mum;jzwf&Sif;jyvkdwmu
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umuG , f a q; qd k w mus

uifqma&m*gukx;kH opf
vmyfpnf;twGi;f udk euf½idI ;f pGm
xdk;azguf0ifa&mufNyD; rsdK;½dk;ADZ
tajccHudk vdkufvH&SmazGMuo
awG[m uifqmr[kwfbJ om awmh 3 v? 6 v? wESpf? w
refqJvfawG yGm;rsm;BuD;xGm;½Hk oufwmvHk; pojzifh a&m*gudk
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uifqmumuG,af q;
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om&SdcJhygw,f/
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awmh enf;enf;oufqdk;&SnfrSm
ayghav/
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oufom&ifoufom/ rouf
om&if toufygygNyD; tacgif;
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awmhwmygyJ/
'gaMumifh wcsdKUu xyf
jznfhMuw,f/ Cut And Wait
(jzwfawmuf? vSD;z,fypfNyD;&if
(apmifMh unf)h qkw d m&JU aemufrmS
(Pray For God) (bk&m;rSm ouf
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r[kwf? roufomvdkY a&m*gydk
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uifqma&m*gukxHk;/ 'Daemuf
aq;odyÜHynm&yfawG wdk;wuf
vmawmh wqif h w uf v myg
w,f/
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udkabmh (Cobalt)? &ufx&D,rf
pwJh "mwfa&mifjcnftrsdK;rsdK;wdYk
eJY ukowJh ("mwfa&mifjcnfuk
xHk; (Radiotherapy)? jyif;xef
wJhaomufaq;? xdk;aq;awGeJY
(Chemotherapy) aemufqufwJG
wGJzufukoenf;awG ay:vm
jyefwm? ck rsufarSmufumv?
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qdwfudk wleJYxkowfovdk yGm;
csiw f ikd ;f yGm;aeavh&wdS hJ uifqm
qJvu f vyfpnf;awGukd awGUjrif
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Budwf (Tumour) udk cGJpdwfuk y
nm (Surgery) eJY cGpJ w d ?f vS;D jzwf?
z,fxkwfNyD;wJhaemuf "mwf
a&mifjcnfeYJ xyfNyD;awmh owf/
"mwfa&mifjcnfeJYowfw,fqdk
wm rsufapheJY rjrif&? rjrifEdkif
wJh uifqmqJvfuvyfpnf;
awGudk jyif;xefwJh a&mifjcnfeJY
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rSm t&yfpum;eJY ]"mwf uif
w,f} vdkY vlodrsm;? ac:a0:
avh&SdMuygw,f/ 'Dawmh uif
qmqJvfywf0ef;usifrSm&SdwJh
aumif;wJh qJvw f csdKUyg xdcu kd f
aoaMuysuf p D ; uk e f y gw,f /
aemufqHk;ay: "mwfa&mifjcnf
pufawGqdk&if vdktyfwJhae&m
uGuw f jd zpfatmif uifqmae&m
udkom csdefNyD; a&mifjcnfay;vdkY
&atmif BudK;pm;wDxGifNyD; uGef
jyLwmeJY wGufcsuf? csdefq? uk
oMuayr,fh "mwfa&mifjcnf
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qHauom wEG,fvHk; qHk;NyD;
r,fov D &Si?f q&mav;rsm;*dP k ;f
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armif? OD;yÍÆif;? udk&ifvlxGuf
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ygw,f/
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(Tamoxifen)/ ruf o d k x &uf
qdwf (Methotrexate) qdw k hJ uif
qmaq;awGuvnf; jyif;o
vm;vdkY rar;eJY/ qHyifuRwfap
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cHwGif;ysuf? aq;rl;eJY (tdk) pHkvdkY
ygyJ/ 'gaMumifh vuf&Sduifqm
ukx;kH [m qdck o hJ vdk yk½u G qf w d f
udk ]wl}eJY xkowfovdkyg/
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(rSwyg;) tjcm;r&SdrdkY 'DaeYxd
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ckcsdefeJY ra0;awmhwJh tem*wf
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awmhr,f/ ckawmif uifqma&m
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xGufvmaeygNyD/
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uifqma&m*gukx;kH opfuawmh
vdk wbufrSmvnf; aq;odyÜH BudwfrsdK;udk aq;odyÜHynmrSm
ok a woeorm;awG [ m vl a&wd k t zk t Bud w f (Benign abmobm0awG rwlnDMuyg
om;rsdK;EG,af wGrmS a&m wd&pämef Tumour) vdkYac:ygw,f/ Oyrm bl;/ xda&mufrIvnf; uGmjcm;
avmurSmyg 'ku©ay;vsuf&SdwJh trsdK;orD; &ifom;wcsdKUrSm jzpf uGJjym;ygw,f/
t&ifu enf;awGeJY wrluGJjym; (uifqm)a&m*gqd;k BuD;udk wGe;f wwf w J h zd k i f b ½d k t J ' D E d k ; rm; umuG,faq;xdk;jcif; (,
jcm;em;ygw,f/ vSefwkdufzsuf umuG,fzdkYt (Fibroadenoma) ac: tBudwf cifutac: Vaccination? ,ck
uifqma&m*gumuG,af q;? wGuf uifqma&m*g b,fvdk rsdK;yg/ tac: Immunization) rSm cE¨m
(Cancer Vaccine) jzpfygw,f/ jzpfay:vmw,f? bmaMumifjh zpf uif q mtzk t Bud w f u d k udk,f ckcHpGrf;tm;pepf (Body
xyfNyD;ajym&&if ausmufa&m*g ay:w,f? b,fvdkysHUyGm;w,f? r,fvpf*eifhusL;rm; (Maligna- Immune System) qd k w mud k
(Small pox) umuG , f a q; b,fvdkumuG,fESdrfESif;EdkifrvJ nt Tumour) ac:ygw,f/ ydkrdk tajccHygw,f/
(Vaccine)? ydkvD,dk taMumao qdkwmawGudk tywfwukwf pnf;ysuf0g;ysuf? txdef;t t&ifuawmh cE¨mud, k &f UJ ck
a&m*g umuG,faq; (Polio rjywf tm;xkwfBudK;yrf;cJhMuyg uGyfrJh BuD;yGm;? yGm;rsm;aewJh cHpGrf;tm;pepf (Body Immune
vaccine) wdkYvdk umuG,faq; w,f/ qJvfuvmyfpnf;qdk;awGyg/ Mechanism) qdkwmudk vlwdkif;
(Vaccine) jzpfw,fqdkwmygyJ/ 'gjzifh&if (uifqma&m*g) tkyfpkvdkufBuD;xGm;NyD; &rf;um; rMum;zl;? rod&SdcJhayr,fh ckcsdef
'Dawmh uifqm (Cancer) qdk qdkwm b,fvdkjzpfvmovJ/ qd;k oGr;f um qJvaf umif;awGukd cgrSm a&yef;pm;NyD; vlaygif;
wm bmvJ / umuG , f a q; zsufqD;wwfygw,f/ rsm;pGm&JU toufZD0defudk acRae
(Vaccine) qdkwm bmvJ/ odzdkY uif q mtp qJ v f i ,f u wcg bDEdkif;usL;rm;wcsdKU wJh a&m*gqdk;BuD; HIV/AIDS
vdkygw,f/ cE¨mudk,fxJrSm&SdwJh rsm; vnf; tcGifhomtajctaeay;? aMumifh? cE¨mudk,f ckcHpGrf;tm;
ajrmifqef;jym;wJh qJvfuvmyf ajymif;vJciG &hf cJ&h if (uifqmjzpf usqif;jcif;qdw k mudk Mum;zl;ol
uifqm (Cancer) pnf;trsdK;rsdK;[m yHkrSeft&qdk vmzdkY tajctaezefwD;cGifh&cJh rsm;vmygNyD/
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Like Structures) ]uif q m} avmufuo kd m wd;k yGm;? BuD;xGm; 'Dtcg umpDEdk;rm; (Carcinoma) aoG;xJrmS aoG;jzLO (WBC-
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9/ ydefoGm;w,faemf/ trsKd;orD; 82% [m rk wwfw,f/} BBC
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rdef;uav;udkukoay;&wJh &Sif;jyygw,f/ rdef;uav; em; ygw,f/ BBC
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x&ef e D q m;rpf t uf q pf ,mOfarSmufrI? aoewfypfrI? aq;udk EdkifiHtm;vHk;u xdcdkuf
``` (a&SUzHk;) ta&jym;a&m*grS ... av;yJaygh/ Mumvm&if olYudk oefY&Sif;atmif rvkyfEdkifbl;/ olYudk [m aoG;cJrIudk tm;ay;wJht "m;xdk;rIeJY ajrjr§Kyfrdkif;aygufuGJ 'Pf&mvlem ukq&m0eftm;vH;k
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ygw,f/ aomufrI? rdom;pkrsKd;½dk;? 0NzdK;rI qufajymygw,f/ BBC atmifjrif&if 'g[m usef;rm tm;upm;vkyfwmxuf tdrft avsmhenf;oGm;ayr,fh aoG;r
awmfvSefa&;yJvkyfwm? b,fu ykdufqH&rSmvJ/ AZG awGyJ ulnD a&;e,fy,frmS {&mr atmifjrif vkyfvkyfwmu ydkNyD; &ifom; qHk;ao;wJh trsKd;orD;awGrSm
``` (a&SUzHk;) ucsifa'o HIV rS
aeEkdif&ifawmh odyfaumif;rSmaygh/ olwdkY tultnDuvnf; rvHkavmufbl;/ ravmufwJhtjyif rIBuD;wck jzpfoGm;ygvdrfhr,f/ uifqmudk umuG,f&ma&muf awmh xl;jcm;rI r&Sdygbl;/
NGO awGukd 0ifzkdY tpkd;&u ydwfxm;wmav? aemufNyD; rl;,pfaq;0g;awG &yfoGm;wmvnf; r&Sdbl;} 'gayr,fh vlawGtm;vH;k oH;k Edik f w,fvdkYqdkygw,f/ vIyf&Sm;rI 3 rsKd;xJrSm tdrf
[k tjcm;aom autkdiftdk t&m&SdwOD;u ajymonf/ wJh tqifha&mufzdkY ESpfwcsKdU Oa&myEdik if H 9 Edik if uH trsK;d wGif;tvkyf[m aoG;qHk;NyD;eJY
2008 ckESpfu HIV wkdufzsufEkdif&ef e,fomveftajcpdkuf AZG tzGJYukd KIO \ xdef;csKyfonhf MumEdkifygao;w,f/ orD; 2 odef;ausmfudk 6 ESpfcGJ aoG;rqHk;ao;wJh trsKd;orD; 2
vkdifZmNrdKUokdY 0ifcGihfjyK&ef ajrmufykdif;wkdif; ppfXmecsKyfokdY awmif;qkdcJhaomfvnf; xkdpOfu wkdif;rSL; vufwmAsLrif tifwD*sif MumavhvmwJt h cg tdrw f iG ;f rSm rsKd ; pvH k ; rS m &if o m;uif q m
AkdvfcsKyftkef;jrihfu ]vHk;0} cGifhrjyKaMumif; wHkYjyefcJhonf/ ,ckwdkifvnf; AZG tzGJYudk ucsiftxl; Lactalbumin antigen eJY azmfpyf wHjrufpnf;vSn;f ? zkeo f wk ?f t tEÅ & m,f u sqif ; oG m ;apwm
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tckvkyfaewmawmif 'Da&m*gwkdufzsufzdkY trsm;BuD; vkdao;w,f/ ynmay;rIu tcsdeftrsm;BuD; y½dkwif;wrsKd;ukd ypfrSwfxm; ydkxda&mufw,fvdkY qdkygw,f/ usqif;NyD; aoG;qHk;NyD; trsKd;
ay;&tkH;r,f} a'owGif; NGO tzGJYwckrS 0efxrf;wOD;u ajymonf/ wdkufzsufwmjzpfNyD; umuG,f 'DtrsKd;orD;awG[m wywfudk orD;awGrmS awmh 20% usqif;
uG,fvGefol KIO tzGJY\ OuúX r&efb&efqkdif;u ucsifvlxktwGif; HIV/AIDS ukd 0g;rsdKoGm;rSm aq;xdk;cH&wJh <uufawGrSm w ysrf;rQ 16-17 em&Davmuf apygw,f/ BBC
pkd;&drfonhftwGuf ppftpkd;&ESihf typf&yfpJcJh&ef taMumif;t&if;wcktaejzihf yg0ifcJhonf[k 0g&ihf qufoG,frIawG rzGHYNzdK;ao;o
ucsift&m&SdwOD;u jyefajymonf/ vdk om;tdrw f iG ;f taetxm;u
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Ekdifao;bl;ayghaemf}[k olu rZdÑrukd ajymonf/ vdYk okawoDawGu qdyk gw,f/
2008 ckESpfwGif jrefrmwEdkifiHvHk;wGif HIV ESifh touf&Sif aexdkifol 242000 &SdNyD; vlOD;a& 'gaMumifh 24 ywftwGif;
tcsKd;tpm;ESifh Edkif;,SOfvQif yQrf;rQ 0.67 &mcdkifEIef;jzpfonf/ rZÑdr? Mo*kwf (3) &uf udk,f0efzsufcs&if oaE¨om;rSm
``` (a&SUzHk;) xm;0,fc½dkif rS ...auG;zsm;emrI tenf;i,f&adS yr,fh tckavmavmq,frmS use;f rma&; bma0'emrS cHpm;&rSmr[kww f hJ
0efxrf;awGu uGif;qif;NyD; aq;jzef;ay;aew,fvdkY aq;½Hk0efxrf;wOD;u ajymygw,f/ twGuf 24 ywfrwdkifcif udk,f
ppfudkif;wdkif; uav;NrdKUrSmvnf; uav;awG aoG;vGefwkyfauG;jzpfyGm;aeNyD; uav;0NrdKUe,fu 0ef z suf c scG i f h O ya'ud k quf
vmwJh uav;vlemwOD; tckv (28) &ufaeYu qH;k yg;oGm;w,fvYkd vlemrdom;pkwOD;uajymygw,f/ vufxm;&SdzdkY NAdwdoQq&m0ef
]uav;0u &Jpcef;uaevmNyD; aq;ukocHwJh uav;i,fwa,muf NyD;cJhwJh Ak'¨[l;aeYu awGu axmufcHvdkufygw,f/
qHk;yg;oGm;&Smw,fAs/ tJ'Dvdkawmh Mum;w,f/ uav;0NrdKUrSmvnf; aq;½Hkawmh&Sdw,f/ 'gayr,fh oaE¨om;avmif; touf0ifcsdef pdwfykdif;eJY udk,fum,ydkif; rlr
c½dkifNrdKUBuD; jzpfwJh uav;NrdKUudkyJ vrf;nTefvdkufawmhwmayghAsm/ rEkdifreif;jzpfwJh oabmav;awG rdcif0rf;xJu oaE¨om; om;zGm;-rD;,yfyg&*lrsm;&JU jyef rS e f r I a wG a Mumif h arG ; zG m ;NyD ;
jzpfawmhav/ vlemtaetxm;uawmh uav;awGtwGufqdk&if usyfusyfwnf;wnf; >ywfodyf avmif;awG[m 24 ywfrjynfhrD vnfo;kH oyfcsuf tpD&ifcpH mrSm b0wavQmufvHk; qdk;qdk;0g;
aeatmif &Sdaew,fcifAs/ wckrSmawmif 2 a,muf 3 a,muf tJovdkawGawmif xm;&wmrsKd;awG rSm emusifrIa0'em cHpm;&wJh azmfjyvdkufygw,f/ udk,f0ef 6 0g; vlpOfrrSDjzpfEdkif&ifawmh 24
vnf;&Sdw,f/ tjyifaq;cef;awGvnf; tjynfhyJ/ taxmuf t xm; r&S d b l ; vd k Y v odYk r[kwf 24 ywf a&mufwhJ ywfaemufydkif;rSm ukd,f0efzsuf
uav;aq;½Hku wm0efus q&mrwOD;uawmh ]uav;yJjzpfjzpf? vlBuD;yJjzpfjzpf tukefvHk;u NAdwdefq&m0efawGu awmf0if txd oaE¨om;rSm OD;aESmuf cscGifh ay;ygw,f/ BBC
awmh vlemawmh &Sw d myJ tpfr/ aoqH;k EIe;f awGawmh bmawGawmh r&Sb d ;l / rMum;rdb;l } vdYk qdyk gw,f/
``` pmrsufESm (13) rS NyD;awmh ckeu ajymcJhovdk vdift*Fgu tifrwefEke,fw,fav/
tcsKdUuawmh usef;rma&;eJY ywfoufvm&if 0efxrf;awGtaeeJY yGiyhf iG v hf if;vif; vlxu k t
kd oday;wm?
'gaMumifh uRrf;usifwJh usef;rma&;0efxrf;awGeJYyJ cGJpdwfoifhygw,f/ cGJpdwfNyD;wJhtcgrSmvnf;
ynmay;wm? uGif;qif; ppfaq;wmawGvkyfzdkYvkdw,fvdkY ajymqdkaeygw,f/ 'DAGDbD? Zlvdkif (30) &uf
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