ud;D yd <ud fi!

LH m¾fhaIK tallh
m%cd ffjoH fomd¾;fïka;=j, ffjoH yd iudka;r úoHd mSGh
Y%S ,xld rcrg úYaj úoHd,h
 oi uil isyskhg
“wïudjrekag fifkyiska”

ud;D yd <ud fi!LH m¾fhaIK tallh

m%cd ffjoH fomd¾;fïka;=j, ffjoH yd iudka;r úoHd mSGh
Y%S ,xld rcrg úYaj úoHd,h

—oehla iok uõjreka rlskakg˜

© Maternal and Child Health Research Unit (MCHRU), Department of Community
Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka

First edition 2019 July
Second edition 2019 December

Authors: Sudanthi Anuraduddhika Sooriyahetti, Thilini Chanchala Agampodi

Contributers
Gayani Amarasinghe
Imasha Jayasinghe
Ayesh Hettiarachchi
Janith Warnasekara
Dulani Somasiri
Thejani Gunathilaka
Chamara Sampath Paththinige

Editors: Suneth Agampodi, Nuwan Wickramasinghe

Drawings: Rushani Perera

Graphics: Dasun Sandeepa, Vishmitha Sandeepa

Layout editing: Suneth Agampodi, Rushani Perera

Type Setting: W.I. Madhushani

ISBN 978-955-0189-17-5

This book was originally developed as a supporting material for the

GEEPMD research project, supported by the Accelerating Higher
Education Expansion and Development (AHEAD) Operation of the
Ministry of Higher Education, Sri Lanka funded by the World Bank.
MCHRU
 msÿu
ish reysfrka ksul<
f,dj w.kdu jia;=j
oi uila l=i ord
oEjila w; ord
cSú; ld,hla is; ord isák
iqjyila wïudjrekagæ

wïuf.a ku:
 fmdf;a l;dj

Y%S ,xld rcrg úYajúoHd,fha ffjoHmSGfha m%cd ffjoH fomd¾;fïka;=j

úiska m<uq jrg 2019 j¾Ifha wrUd oefha uõjreka fjkqfjka uy;a jQ fifkyiska
ksujk o fi!LH mKsúv tl;=jls fï' fujeks uy`.= ld¾hhla ksujQfha wkqrdOmqr
osia;%slalfha .¾NkS uõjreka i|yd osh;a l, oejeka; fi!LH m%j¾Ok jHdmD;shla
Wfoid tkï f;dard.;a udi ;=kla we;=<; wkqrdOmqr osia;%slalfha ,shd mosxÑ jk
uõjreka 3000la w;r fkdñ<fha fnod yeßugh'

b;d ir, niska ,shd" lú" Ñ;% we;=<;a fldg úÑ;% iajrEmfhka ksujd we;s
fuu fmd;a msxp rg mqrd uõjrekaf.a fukau lafIa;%fha úoaj;=kaf.a;a m%idohg;a
w.h lsÍug;a ,laùug .; jQfha b;d iq`M ld,hls' fuu fmd;a msxp jevigyk
i|yd f;dard.;a uõjrekag muKla iSud fkdù iqjyila Y%S ,dxflah uõjreka w;g
m;aúh hq;= nj fndfyda fokdf.a u;h úh' tkhska fuh rgmqrd fmd;a wf,ú ie,a
fj;g fnodyeÍu fjkqfjkau kej; j;djla uqøKh lrk ,oS"

fï fmd;a msxp ilid we;af;a ujlf.a .¾NKS iuh f.fjk wdldrhg

.e,fmk whqßka tkï udi kjh mqrdjg ujlg we;sjk .eg`M " ujf.a ye.`Sï iy
ujl úiska oek.;hq;= oE wdoS fndfyda foa ms<sfj,ska ilia fldgh'

hï whqrlska Tn w;g m;ajk fï fmd;amsxp Tng;a Tnf.a ore meáhdg;a

fi!LHu;a fygoskla WodloSug bjy,a jkq we;ehs wm b; is;ska m%d¾:kd lruq'
;jo W;a;Í;r uõ moúh oeÍug lem ù isák oefha iqjyila wïudjrekaf.a .eìKs
iuh mßmQ¾K lrkqjia Tfí foda;g ;s<sK lrk fuu fmd;a msxp Tn b;d i;=áka
mßyKh lrkq we;ehs wms wfmalaId lruq'
 fm, .eiau

1. wïfï oeka nndg udihhs 1

2. wïu;a la,sksla hk fyd`o wïfulao@ 2
3. .¾NKS iufha wdorKSh lemlsÍï 3
4. oeka nndg udi 02 6
5. tlu u,g fm;s y;rla 7
6. wïu;a ,iaikhs - ys;;a ,iaikhs 9
7. fu;a is;e;s ujla 11
8. wïfula fjkak .dkg bkak 12
9. oeka nndg udi 03 13
10. msßmqka orefjla ;kkakg 14
11. fodhs fodhs fodhs fodhsh nnd 17
12. uf.a mq;dg lsß .`.=,hs 19
13. mqf;a''''''''' 20
14. lsßleáhg n;a ljkak - foaÿkafka mdg .kak 21
15. oeka nndg udi 04 22
16. ynqx lghs n;a folghs - n;a ljkak yrs f,aishs 23
17. fï nnd n;alk ;ek 24
18. oeka nndg udi 05 25
19. fodhs fodhs fodhs fodhsh nnd 26
20. oeka nndg udi 06 27
21. mqf;a''''''''' 28
22. wïud fyd`o l,amkdfjka bkafka 29
23. oeka nndg udi 07 30
24. pQá meáhd fyd`Èkao@ 31
25. oeka nndg udi 8 32
26. yÈiaishlg uu iQodkï o@ 33
27. oeka nndg udi 9 35
28. br y`o ujqka lsr u; uq`M f,djla wef; 36
29. meáhd tkakhs hkafka 37
 W;a;Í;r uõ moúh

wdorKSh wïfï"

wïud flfkla lshkafk rgg oehg iïm;la oeka b;ska mqxÑ ldf, b|ka fl,sljg
iskdfjka .; lrmq ksoyia cSú;h w`M;a u.lg fhduq flfrk " w`M;a u.lg fhduq
flfrk" w`M;a n,dfmdfrd;a;= msreKq" w`M;a j.lSï mejfrk iqkaor ld,hla njg
m;afjkakhs hkafk'

fï mqÑ ,iaik rfÜ zz wïud ZZ lshk flkdg ;sfhkafk f,dl= ;ekla wms
wfma wuu,dj fndfydau wdorfhka" f.!rjfhka j.lSfuka n,d.kak ne|S isákjd'

rejka je,s .en isôk rka jka i`o lsrK kqUghs

;sid jeõ osh mqrd iqmsfmk fld`o mshqï kqUghs
,o`M fndam;a isU wefok uqÿ mjka r< kqUghs
f,dfõ iqkaor" mskanru foA mqf;a kqU kughs

l=fia ,sh,k w¨;a f,a je,a r;a;rka kqTghs

,fha mQosk kejqï lsß je,a ÿfõ kqf´ uqjghs
yfoa o`M,k fifka wmuK uf.a mK álghs
f,dfõ b;sfrk fid`ÿre ri ;eka ish,a,u kqUghs
 wïfï nndg oeka udihhs '
uu mq x Ñ .ïñßia weghla ;rï'
uu wïuf.a .¾NdI ì;a ; s h g iú fjñka
bka f ka '
ux f.dvla mq x Ñ ;uhs ' ta ; a uu ±ka ojis k a
oji w¨;a ffi, yodf.k f,dl= fjkjd'
b;= r e udi wg mq r djg uu wïuf.a <`.s k a u
bka k jd'
udi wg ú;rla o @ kE wïfï" uq ¨ cS ú ; ldf,
mq r djguæ

1
 01
iqj mKsúv

wïu;a la,sksla hk zzfyd`oZZ wïfulao @

wfma rfÜ wïu,d yß fyd`ohs' ;uka .ek ys;kjg;a jvd ta f.d,af,d

ys;kafka" ta ;ukaf. l=fia bkak wysxil ore meáhd .ek' wkak ta ksid odyla
jev ;sín;a fldfydu yß la,sksla hkjd'

la,sksla .shdu wïu,df. iSks n,kjd" fm%Y¾ n,kjd" Wi nr ukskjd" uQ;%d

mÍlaId lrkjd' t;fldg .¾NKS ld,fha yg.kak mq¨jka oshjeähdj" .eí j,smamqj
jeks frda. ;;a;aj l,a;shd y`ÿkd .kak mq¨jka fjkjd' tfyu y`ÿkd .;a;u tajdg
blaukg m%;sldr lr,d wïug .¾NKs ld,h ;=, kSfrda.Sj cSj;a fjkak mq¨jka
fjkjd jf.au wïuf.a frda.S ;;ajh ksid wysxil ore meáhg fjkak mq¨jka w;=re
wdka;rd rdYshla j,lajd .kak mq`Mjka'

ta jf.au idhkfhaoS l=fia m%udKh ^nqêkfha Wi& uekSu" wïuf. nr jeäùu"

ialEka mßlaIK hkdosfhka l=fia bkak ore meáhf.a j¾Okh ;lafiare lrkak
mq¨jka' tfyu lr,d n,,d j¾Okfha .eg¨ ;sfhk wjia:d j, ta i`oyd blaukska
l%shd;aul fjkak mq`Mjka'

b;ska lsis÷ wvqmdvqjla ke;s ksfrda.S ore meáfhla fï f,daflg odhdo lrk
tfla j.lSu wïud ;ksju ord.kak ´fka kE' fkdjeroSu" yß ojig la,sksla
.sys,a,d ta j.lSu ffjoHjrfhla tlal fnod.kak'

wïud yeuodu la,sksla hkafka nndg f.dvla wdof¾ yskaod'''''

2
ys;g oefkk foa ,shuqo@ '''''''''''''''' 01

wo uu la,sksla .sh m<uq oji

m<uqjeks la,sksla oji lshkafka wïud flfklag wu;l fkdjk
w;aoelSula' ta ojfia wïud f.dvla i;=gq ysf;k w;aoelSï j,g jf.au iuyrúg
ÿl ysf;k w;aoelSï" wmyiq;dj,g;a uqyqK fokak we;s' b;ska wïug tod ys;=Kq"
oeKqkq foa ,sh,d n,uq'

uf.a m<uq la,sksla oji Wodfjkfldg nkaähg i;s ''''''''''''

uu Wfokau la,sksla hkak ,Eia;s jqkd ''''''''
uf.a ys;g oekqfKa ''''''''''''''''
 02
iqj mKsúv

.¾NKS iufha wdorKSh lemlsßï

wïud flfklaf.a wdorKSh ord.ekSï" lemlsÍï jpk j,g f.akak yß
wudrehs' ta;a ta lemlsÍï myiq lrkak" Woõ lrkak wmg mq¨jka'

01' Tlafldu;a yrs Tlaldrhhs'''''''''' jukhhs ''''''''''

meáhd l=ig wdj uq,au udi lsysmfha wfma wdorKSh wïu,dg Tlaldr.;sh"
jukh tkak mq¨jka' tal iajdNdúlhs' Wfoag wef`oka ke.sákak l,ska l%Sï l%el¾
ìialÜ tlla yß" lr lrmq mdka fm;a;la yrs lkak' fyñka ief¾ ke.sákak' ;eô,s
jf.a Èhr j¾. jeämqr .kak' mq¨jka yeu fj,djlu tl mdr f.dvla ke;=j ál
ál fndkak' mq¨jka yeu úgu ys; fjk;lg fhduq lrk jevl kshef,kak' ta
.eku l,amkd lf<d;a Tlaldr .;sh jeä fjkjd' myiq ieye,a¨ weÿï w`Èkak' ;o
n`omá jf.a we`ÿï me<ÿï Ndú;d lrkak tmd' bÕ=re wvx.= wdydr j,skq;a jukh"
Tlaldr .;sh wju lr.kak mq¨jka' m%Odk wdydr fõ,a .kakd úg;a tljr úYd,
m%udKhla fkdf.k l=vd wdydr m%udK" jeä fõ,a .Kkla f,i lEug .kak'
kj;skafku ke;=j widudkH úoshg jukh hkjd kï" ffjoHjrfhla uqK.efyk
tl ;ud jvd fyd| æ æ

02' fldkafo wudrejg;a lrkak fohla æ

meáhf.a nr jeä fjkak fjkak wïug fldkafoa fõokdjla we;s fjk tl
idudkHhs' ta ;;a;ajh wju lr .kak yels iEu úgu fldkao fl,ska ;shdf.k
jdäfjkak" weúÈkak' wêl nr tiùfuka je<l=fKd;a ;uhs fyd|æ ìu ;sfhk
fohla weys`Èk úg fyda nrla Wiq,k úg fldkafoka kefukafka ke;sj oKysfika
kefukak n,kak' tÈfkod jev lghq;= lrk ,shk fïi" t<j¨ lmk fïi
;ukaf.a Wig .e,fmk wdldrhlg ilia lr.kak;a mq,qjka' me;,s wä iys;
mdjyka Ndú;d lsrSu;a" ksod.ekSug ;o fuÜghla Ndú;d lsrSu;a fldkaog iqjhls'
fldkafoa fõokdj wêl jk úg uo WKqiqï c,h frÈ lvlg f.k fldkao fyd`Èka
iïNdykh l< yelshs'
u, noaOh ksid;a fldkafoa fõokdj tkak mq,qjka' ta yskaod fyd|g j;=r fndk tl"
m<;=re lk tl wïug f.dvdla Wojq fjhs'

3
03' uQ;%d oeú,a,la" uQ;%d msgfjk jdr .Kk jeäùula" uQ;%d tlal f,a
msgùula jf.a fohla Wfkd;a@
fï ´kEu frda. ,laIKhla uQ;%d wdidOkhla ksid fjkak mq¨jka' uQ;%d
iuÕ f,a msgùu úfYaIfhka wjOdkhg ,laúh hq;= lreKla' fldfydu jqK;a
fyd`og j;=r î,d blaukska ffjoHjrfhla yuqjg hk tl wïug jf.au wïudf.a
mqxÑ meáhf.a wdrlaIdjg;a yßu jeo.;a'

04' ll=,a fol;a bosñ,d''''''''''

wïudf.a j<¨lr" mdo bÈfukjdkï" jeä fõ,djla ysgf.k isàfuka
je<lSu ;uhs fyd|' myiq mdjyka m<Èkak' ksod.kak úg" úfõl .kak úg mdo
Wl=f,a uÜgug jvd Wäka ;nd.ekSfuka bosuqu wvq lr.kak mq,qjka'

05' .¾NKS ld,fhaoS kyr .eg .eyqfkd;a@

ll=,aj, kyr .eg .eyqfKd;a talg wdOdrl fïia m<|skak mq,qjka' ta
jf.au f.dvdla fj,d ysgf.k bkak tl wvq lf,d;a" ksod.ksoaos ll=,a álla Wia
uÜgulska ;shdf.k ksod.;af;d;a fï kyr .eg .efyk .;sh wvq lr.kak" tal
wïug Woõ fõú' .¾NKS ld,fhaoS iuyr wïu,dg fhdaks ud¾.h wjg;a" kyr .eg
.efikak mq,qjka' t;fldg fmdä fj,djlg ksod.ksoaoS wïud Wl=, álla Wia
uÜgul ;sh,d ksod.kak mq,qjka kï" .eg .eiqkq kyr wjg whsia ;shkak mq,qjka
kï" wïudg myiqjla oefkaú' fï frda. ,laIK tkak tkaku jeäfjkjd kï
ffjoHjrfhla uqK.efykak hk tl yrsu jeo.;a'

06' flKavd fmrf,k fj,djg''''''''''

flKavd fmrf,oaoS" flKavj, yrs ll=,aj, yrs udxY fmaYsj, ;shqKq
fõokdjla oefkkjd' fïl jeäfhkau fjkafka ?g' tfyu fjk fj,djg" ll=f,a
weÕs,s Wvq w;g" j<,qlr foig ;oska weof.k b|Sfuka iy ta udxY fmaYS ;oska
ñrslSfuka fï fõokdj wvq lr.kak mq,qjka' .¾NKS ld,fhaoS fï úosyg flKavd
fmrf,k tl wvq lr.kak wïug mq,qjka mdoj," j<,qlr ls%hdldrs;ajhg
jeo.;ajk l%uj;a uDÿ jHdhdu lrkak'

4
07' uykais nj
.¾NKS fj,d uq,a udij, iuyr4 wïu,dg fjfyila oefkkak mq,qjka'
fïlg ;sfhk tlu W;a;rh ;uhs" mq,qjka ;rï úfõl .kak W;aiy lrk tl'
oj,a ld,hg ll=,a fol Wäka ;shdf.k bkak W;aiy lrkak' tosfkod jev lghq;=
lr.kak f.or Woúhf.ka mq,qjka fj,djg Woõ .kak' uykaish lshkafka .¾NKS
ld,fhaoS idudkH ;;a;ajhla jqkdg" tal fjk fjk frda.j, ,laIKhla fjkak;a
mq,qjka' ta ksid wefÕa f,a uos .;sh ^kSrla;sh& iy yDo frda. ms<sn|j úfYaIfhka
ie,ls,su;a úh hq;=uhs'

08' la,dka;h
.¾NKS ld,fha iuyr wïu,dg la,dka; .;shla ks;ru ;sfhkak mq,qjka'
mqgqjl fyda wef|a ydkaisù isg" b;d blaukg ke.sáoaoS ;uhs jeämqru la,dka; .;sh
tkafka' b;ska" b|f.k bo,d yrs" ydkaisfj,d bo,d yrs ke.sáoaoS fyñysg ke.sákak'
ysgf.k boaoS la,dka; .;shla oefkkjd kï" blaukska jdäfj,d la,dka; .;sh
wvqfjklka bkak' Wvqw;g ydkaisfj,d boaos la,dka; .;sh we;s fjkjd kï" jï
we,hg yerS ydkais fjkak' fldfydu jqk;a wêreêr mSvkh" .eí j,smamqj" reêrfha
iSks uÜgfï isÿjk fjkialï" yDo frda. hk wjodkï wjia:dj,;a la,dka;h
we;sfjkak mq,qjka' tu ksid .¾NKS iuh mqrdjgu ffjoH /ljrKh ,nd.ekSu
f.dvdla jeo.;a'

5
 oeka nndg udi 02
wïfï fï n,ka k ' uu ±ka cEï f.ähla
;rï'
ug ±ka pQ á pQ á we`.s , s yefoka k wrka '
fï n,ka k wïfï ug ±ka Wvq f;d,la
yefokjd'
pQ á kyhla yefokjd' weys ms h yefokjd'
uu ,ia i k nfnla fjhs fka o wïfï@

6
 03
iqj mKsúv

tlu u,g fm;s y;rla

ljqo b;ska fï u,@
wïudf.a l=fia ojiska oji msfmk mqxÑ frdai u,'''' ta u,g ,iaikg iqj|g
msfmkak ´k fjkjd'''''''''' fm;s 4 la'

f*da,sla weisâ fm;a; - iqÿ mdg pQá fm;a;

pQá meáhd l=ig tkak udi 3 lg l,ska bo,d f*da,sla weisâ fm;a; fndkak
mgka .;a;kï ;uhs fyd`o' ta lshkafka orefjla n,dfmdfrd;a;=fjk újdyl
hqj,la kï fï .ek úfYaI wjOdkhla fhduq lrkak ´k' ta fm;a; .¾NKS ld,h
mqrdjgu iy nnd yïnjqkdhska miafi;a udi 6la hk;=re fkdjrojd fndkak u;l
;shd.kak ´k' wïug .kak neß jqKdkï wo b`oka yß fndkak mgka .kak mq¨jka'

t;fldg wehs fï fm;a; ta u,g jeo.;a@

pQá meáhdf.a iakdhQ moaO;sh fyd|g j¾Okh fj,d" kSfrda.S orefjla ìys
lrkak wïudg mq`Mjka fjkafka fï fm;a; yßhg .;af;d;a ;ud'

hlv fm;a; - ÿUqre mdg fm;a;

pQá meáhd l=ig weú;a udi ;=klg miafia" ta lshkafka i;s 12 la f.jqKu
hlv fm;a; fndkak mgka .kak ´k' Th ldf,ag fnfy;a wmamsrshhs ;ud talg
?g lEu ld,d hlv fm;a; fndkak' wmamsrsh .;sh wvq fjkak ìialÜ tlla lkak
mq`Mjka' hlv fm;a; fndkak lsÜgqj yß" î,d meh 2 la we;=,;a yrs f;a" fldams
fndk tl kï fyd| mqreoaola fkfï' t;fldg we`.g hlv Wrd.kak tl wvq
fjkjd' ta jf.au fï hlv fm;a; fndoaos" tal;a tlalu úgñka iS fm;a;;a u;l
we;=j fndkak' yenehs ta tlalu le,aishï fm;a; fndk tlkï kqjKg yqre kE'

wehs fï fm;a; u,g ´kE@

pQá meáhdg f,a uÈ fjkak ;sfhk wjodku jf.au" meáhdf.a wïug f,a
uÈ fjkak ;sfhk wjodku;a fï fm;af;ka wju lr.kak mq`Mjka' t;fldg nndg
ksfrda.Sj wïudf.a l=i we;=f<a jefvkak mq`Mjka' ta ú;rla fkfï hlv fm;s ìõju
meáhd bmfooaos wvq nr orefjla fjk tl wju lr.kak;a" .¾NKS ld,fha wïug
je,f|k frda. wdidok wju lr.kak;a wïug mq,qjka'

7
 04
iqj mKsúv
t;fldg kSrla;sh ^wef.a f,a uÈùu& ksid hlv fm;s fol
ne.ska fndk wïu,d fldhs fj,djg o fï fm;s fol
fndkak ´k@ yßu f,aishs" tlla Wfoag wksl ?g" fm;s folu tljr ìõfjd;a Wrd
.ekSu wvq fjk ksihs" ffjoH jre tfyu ks¾foaY lrkafka'

úgñka iS fm;a; - iqÿ $ ly fm;a;

fï fm;a; fndkafka wïud hlv fm;a; fndoaÈuhs' taflka wïud fndk
hlv fm;a; we`.g Wrd .kak Woõ fjkjd' yßhg f.dgqfld< j,g foys weUq,a
álla odkfldg jf.a'

le,aishï fm;a; - iqÿ f,dl= fm;a;

fï fm;a; fndkak mgka .kafk;a meáhd l=ig weú;a udi 3 ka" ta lshkafka
i;s 12 ka' yenehs ta fm;a; kï hlv fm;a; tlal î,d yßhkafka kE' hlv fm;a;
? fndkjd kï le,aishï fm;a; Wfoag fndkak' Wfoaghs" ?ghs folgu hlv fm;s
fndkjd kï le,aishï fm;a; oj,ag fndkak'

fï fm;a; jákafka wehs wfma mqxÑ u,g@

ore meáhdf.a wiaÓ" o;a iúu;a fjkak le,aishï Wjukd fjkjd' ta jf.au
.¾NKS ld,fha§ jeäfjk le,aishï wjYH;djh ksid wïudf.a o;a iy wia:s
Èrdhdu" ysifla ye,Su" w;mh fjõ,Su" ysrsjeàu" uiamsvq fmr,Su" msg.eiau" ore
meáhdf.a j¾Okh nd,ùu;a fï fm;a; yßhg ìõfjd;a wju lr.kak mq`Mjka'
;o ysre t<shg u,la ue,fjkak;a mq¨jka uf.au fï fm;sál ;o ysre t<sh jefgk
;ekl ;enqfjd;a .=K úkdY fjkjd' úfYaIfhka hlv fm;a; wms odkafka ysre
t<sh fkdjÈk ÿUqre mdg fnda;,hl'

kshñ; fõ,djg fm;s .kakjd jf.au fm;s wdrlaId lr ;nd .ekSu;a yßu jeo.;a'
tfykï u;lhsfka"
tlu u,g - fm;s y;rhs'

wïuf.a pQá meáhd fjkqfjka f*da,sla weisâ fm;a;" hlv fm;a; tlal úgñka iS fm;a;" le,aishï
fm;a; wïud fkdjrojdu fndkjd fkao@

8
 wïu;a ,iaikhs - ys;;a ,iaikhs

orefjla l=fia orka bkak wïud flfkla fldhs;rï kï ,iaiko@

bÈßhg fkrd wdmq l=i" msreKq ,eu" mska mdg jqK lïuq,aæ .¾NKS ujla
lshkafka fidndoyfï wmQreu ks¾udKhla' b;ska Th ldf,g fmdâv we;akï
;s.eiafik" l,n, fjk ixfõ§ fjk ys; fmdâvla ikaiqka lr.kak" ,iaik
lr.kak mq¨jka kï mqxÑ meáhd f.dvla kSfrda.Sj fï f,dalfha t<sh olS'

b;ska fï ys; ikaiqka lr.kak tlg ;uhs wms i;su;a nj jeãu lshkafka'
fïl fï uyd ixlS¾K jevla fkfï'

fï i;su;a nj jeãu lshkafka lrk lshk foa" olsk foa" .ek isysfhka
wjfndaOfhka bkak tl' tal wïug ;=ka úÈhlg lrkak mq¨jka'

m<fjks úÈh tÈfkod jev ál l,amkdfjka lrk tl' WodyrKhla úÈhg

meáhd f,dl= fjkak f,dl= fjkak wïug kefukak lrkak wudre fjkjd'
t;fldg frÈ ál je,g odk tl mjd uyd uykais jevlaæ frÈ ál je,g od,d —
yfmdhs uykaishsæ˜ ys;kjdg jvd" uu .jqu w;g .;a;d' j;=r ál ñßl=jd" oeka
,iaikg je,g oeïud' tfyu ys; ys; frÈ ál jkkak mq¨jkaa kï" t;fldg
Ndjkd lrkak fjkuu fõ,djla hkafka kE' tÈfkod jev ál lroaÈu Ndjkdj
fj,d' wïuu n,kakflda t;fldg fldhs;rï wd;au ;Dma;shla ,efnkjdo lsh,d'

fofjks úÈh ;uhs fïl Ndjkdjla úÈhg Wfoa wjosjk fudfydf;a iy rd;%S
kskaog fmr mqreÿ mqyqKq lsÍu' tal;a yßu myiqhs' wïug lrkak ;shkafka
fufyuhs¦ uq,skau myiq brshõjlska ydkaisfj,d ll=,aj, weÕs,sj, boka ysiflia
olajd wïuf.a weÕ osf.a l%ufhka isysfhka n,df.k hkak' ta lshkafka'''''''''' weÕg
oefkk myi" ;oùï" pQá meáhd oÕ,k yeá" wms yqiau .ksoaoS Wria l+vqj by< my<
hk yeá ys;ska n,ñka fom;=f,a b|ka ysia uqÿk olajd l,amkdj f.kshkak' ;j
úoshla ;uhs'''''''''' myiq bßhõjlska jdä fj,d yß" ydkais fj,d yß" wïud yqiau
.kak tl .ek l,amkdfjka bkak tl' ta lshkafka yqiau we;=<g .kak úg - yqiau
we;=<g .kakd nj;a" yqiau t<shg odk úg - yqiau t<shg odk nj;a is;kak'

9
 t;fldg fudllao ;=kafjks úÈh' talg lshkafka i;su;a p,k lsh,d' wïug
mq¨jka ñâjhs*a ñia lshdfok úoshg .¾NKS iufha jHdhdu ál fyd| isysfhka
lrkak'
• ll=f,a we`.s,s kud kej; È. wßkak
• m;=,a Wvg Tijd my;g oukak
• oKsia my,g ;o lrkak' nqre,a lrkak'
• je,ñg fmfoi my<g ;o lrkak' nqre,a lrkak'
• Wrysia my<g ;o lrkak' nqre,a lrkak'
• ysi my<g ;o lrkak' nqre,a lrkak'
• uqyqfKa fmaYs ;o fjk f,iska uqyqk yl=,d .kak' nqre,a lrkak'

t;fldg uq¨ we`.u ieye,a¨fjk yeá wïug oefkaú'

Ndjkd lrkak fjku fj,djla ´ks kE' fyd| isysfhka fros ál jkk tl;a Ndjkdj;a'

10
 05
iqj mKsúv

fu;a is;e;s ujla

ffu;%Sh lshkafka ;udg;a wka whg;a hym;la fõjdæ hs m%d¾:kd lrk tl'

wïud okakjdo@ ffu;%sh lshkafka T!IOhla' ;du ffjoH úoHdfjkaj;a fidhdf.k

ke;s ;rï iqjlsÍfï n,hla ;sfhk fndfydau ják T!IOhla'

b;ska kqÿre ojil f,dafla ;sfhk W;a;Í;ru moúh ,nkak iQodkï fjk wïfula"
mrsmQ¾K fjkak kï fo;fka lsß msfrkakd jf.a yojf;a ffu;%Sh msfrkak ´fka'

wd.u fudlla Wk;a" cd;sh fudlla Wk;a yeuodu Wfoa wjos jqkdu iy ;o kskaog
fmr ;ukaf.a l=ig w; ;shka fufyu lshkak'

W;a;Í;r uõ moúh ,eîug isák uu"

wdrlaId fjïjdæ
i;=gq is;a we;af;la fjïjdæ
kSfrda.S fjïjdæ
iqjm;a fjïjdæ

ud fukau udf.aa l=ifha jefvk orejd o"

wdrlaId fj;ajdæ
i;=gq is;a we;af;la fj;ajdæ
kSfrda.S fj;ajdæ
iqjm;a fj;ajdæ

wïud flfkla mrsmQ¾K fjkak kï" fo;fka lsrs msfrkakd jf.a yojf;a ffu;%Sh msfrkak ´k'

11
 06
iqj mKsúv

wïfula fjkak - .dkg bkak

ialkaO foay o¾Ylh ^BMI& lshkafka fudloao okakjo ? wïuf.a wef`.a

nrhs" Wihs mdúÉÑ lr,d wms yod .kak ñkqula' b;ska kSfrda.S ldka;djlf.a Th
w.h .¾NKS fjkak l,ska ;sfhkak Tfka 18'5-23 w;r w.hl' b;ska tfyu ;shk
wïfula kï ojig m%Odk wdydr fõ,a 03la .kak ´fk' ta fõ,a 03 g kshñ;
m%udKfhka OdkH" w, j¾." i;aj wdydr" m<d j¾." t<j`M" m,;=re" lsß wdydr
tl;= lr.kak ´k' .¾NKs iufha wïug ´k fmdaIKh jeä ksid fï wdydr fõ,a
.ek jeä wjodkhla olajkak Tk' ta m%Odk fõ,a ;=kg wu;rj ;j wu;r fõ,a
folla tl;= lr.kak;a wïug mq`Mjka' fjkod lkjg jvd fmd,algq ye`os nd.hl
m%udKhlska" fnod.kak n;a jeä lrk tl m%udKj;a' fjkod lkjg jvd t<j`M"
m<d" OdkH;a" álla jeäfhka lkjkï ;ud fyd`o'

kuq;a BMI 18'5 g jvd wvq ta lsõfj .¾NKs fjkfldg ;rula flÜgq
wïfula kï" ffjoH jrfhla uqK .eys,d Wmfoia .kak tl jeo.;a' t;fldg
ffjoHjrhdg mq`Mjka wïuf.a wdydr rgdfõ wvqmdvqjla ;sfhkjkï tal y`ÿkd
.kak' f,dl= f,dl= foaj,a lrkak Wjukd kE' tosfkod fõ,g n;a" u[af[dlald"
b`os wdmam jf.a msá ;shk wdydr álla jeämqr tl;= lr.kak' fjkog jvd fõ,la
folla jeämqr lkak' lEu ms,sfh, lroaos f;,a fïi ye`os 1-2 tl;= lrkak' ud`M"
lrj," ì;a;r" îc j¾." t<j`M" m<d jf.a taj;a jeämqr wdydr fõ,g tl;= lrkak'
.eìKs uõjrekag w;HjYH fmdAIl fndfydauhla wvx.= ;%SfmdaI fkdñf,au ud;D
idhk j,ska wïu,dg ,nd.kak mq`Mjka'

ta jf.au ;rula ;rndre wïud flfkla kï" ta lshkafka BMI w.h 24'9 g
jvd jeä kï" msá ;sfhk lEu ^n;a" mdka" w," n;," fldia" fo,a&" iSks" f;,a ;sfhk
lEu wvqfjka wrf.k" OdkH j¾." m<;=re yd m<d j¾. jeämqr .kakjd kï ;uhs
wïughs orejghs fokakgu fyd|' uia ud¿ .;a;g lula kE' yenehs f;,a" fmd,a
lsrs wvqfjka æ

fï jf.a wïuf. wdydr rgdfõ hï hï fjkialï isÿlr,d wïuf. ialkaO

foay o¾Ylh fyd`o w.hlg f.akak mq`Mjka'

12
ys;g oefkk foa ,shuqo@ '''''''''''''''' 02

myq.sh udi ;=k''''''''

m<uq udi ;=k wjidk fõf.khs hkafka' cSúf;ag f,dl= fjkila' nfnla ,efnkak
bkakjd lsh,d oek.;a;u uf.a is;g oekqfka'''''''''
01' myq.sh udi ;=k mqrdjg uf.a ys;g i;=gla oekqfka''''''''''

02' ug ÿl ys;sÉp fj,dj,a fkd;snqKdu fkfjhs' ta lsõfõ''''''''''

 wïudf.a n;a ms`.dk'''''''
;=ka udfi f.ú,d wïug lkak mq,qjka jqkdu wms w,q;a jevla lruq'

wïug f,vla ÿlla ke;=j blaukska wïuf. pQá meáhg fyd|ska jefvkak;a wïud
lk n;a msÕdk yrsu jeo.;aa' lEu lkak n;a ál fnod.;a;g miafia msÕdk osyd
n,df.k tal Ñ;%hg k.kak wïug mq,qjkao@ myiqlï ;sfhkj kï cdhdrEmhla
wrf.k miafi wekao;a lula kE'
tl ojil Wfoa" oj,a" rd;%S lEu fõ, we;a;gu fldfyduo lsh,d we|,d ne,qqfjd;a
wïuf. lEu msÕdk oekg jvd .=Kodhl lr.kak lrkak ´fk fudkjo lsh,
yÿk.kak wïudgu mq,qjka fõú ' fyd|ska u;l ;shd.kak wïud w|skak ´k
wïuf. idudkH ojil we;a;u lEu fõ,'
my; WodyrKho n,kak'
WodyrKh
wdydr fõf,a PdhdrEmh uu w`Èk rEmh

uf.a idudkH WoEik wdydrh

Tng Tfí WoEik wdydr fõ,la we`o kï lrkak mq¨jkao@
Èkh (-
uf.a idudkH Èjd wdydrh
Tng Tfí Èjd wdydr fõ,la we`o kï lrkak mq¨jkao@
Èkh (-

uf.a idudkH rd;%S wdydrh

Tng Tfí rd;%S wdydr fõ,la we`o kï lrkak mq¨jkao@
Èkh (-

wïu fï n;a msÕdk mjq,a i!LH fiajd ks<OdßKshg ^ñâ jhs*a fkdakdg& yrs"
ffjoHjrhdg yrs fmkakqfjd;a ta wh lsh, fohs fldfyduo l==fia bkaak
orejdg yrshk úêhg ;j;a fyd|g n;a msÕdk fjkia lr.kafk lsh,¡
 oeka nndg udi 03
wïfï uu ±ka foys f.ähla ;rï
f,dl= nfnla'
uf.a we`. we;=f, f.dvla tajd ±ka yeÈ,
;shkafka wïfï' uu yß <máhs' wïud lk
fndk lEu cd;s" fnfy;a cd;s wrka ;uhs
uu yefokafka' wïug f.dvla wdi ysf;k
fohla lshkako@ wïfï" nndf.a yoj; oeka
.efykjd' wïudf.a yoj; .efykjd jf.a
fo.=Khla fõf.ka'''''' wïug i;=gqhs fkao@

13
 07
iqj mKsúv

msßmqka orefjla ;kkakg'''''

mqxÑ orefjla lshkafka yeu .eyeKq flfkl=f.au ySkhla' mqxÑ ldf,a

uq,skau fndkslaflla w;g .;a; ojfia b`o,d wms iQodkï fjkafka wïud flfkla
fjkak' orejd l=ig tkak;a l,ska b`o,du f*da,sla weisâ fm;s fndkafka" orejd
l=ig wd od b`okau .=K lEu cd;s lkafka" mqxÑ firmamq folla odka yß mßiaiug
weúÈkafka" la,sksla hkafka" hlv fm;s - úgñka fm;s fndkafka fï yeufoau
lrkafka lsisu ÿlla lrorhla ke;sj kSfrda.S orefjla fï f,daflg wrf.k tkak'

fï jf.au wïud wdihs fkao ;ukaf.a orejd ljodyß bf.kSug ,eos orefjla
fjkjd olskak" ,iaikg isxÿ lshk" kgk" Ñ;% w`Èk" yeufoau mq¨jka ljqre;a
wdof¾ lrk" yefudaf.au ys; Èkd.;a; orefjla fjkjd n,kak' ;ukaf.a ore
meáhd ljoyß fï rfÜ fyd| ;ekl bkakjd n,kak@

wkak talg lrkak ´k foa ;uhs uu fï lshd fokak hkafka'

fïlg lrkak ´fka orejdf.a uq,a <udúh ixj¾Okh lrk tl' wefyoaÈ
álla ixlS¾K jqKdg lrkak ;sfhkafka yßu ir< fohla'

orefjla uq,skau fï f,daflg toa§ thdf.a fudf<a ffi, ì,shk .dKla

;sfhkjd' iakdhq ;ks ;ksj ;uhs ;sfhkafka' tajd tlska tl iïnkaO fj,d
;shkafka fndfydu wvqfjka' b;ska ta iakdhq tlska tl iïnkaO lr.kak pQá
meáhg ;kshu nE' thdg talg Wojq lrkak ´fka thdf.a wïud" wmamÉÑ iy mjqf,a
Woúhhs'

fïl nnd wïudf.a l=ig wdj ojfia b`o,du mgka .kak ´fka fohla' l=ig
w; ;sh,d nndg l;d lrk tl" nnd l=fia boaÈ isxÿ lshk tl" msß;a lshk tl"
hd{d lrk tl fï fiaru whs;s fjkafka nndf.a uq,a <udúh ixj¾Okhg ;ud'

nnd bmÿkhska miafia thd f.dvla mqxÑ ldf,u thdg jgmsgdj

y`ÿkajdfokak mgka .kak' nndg jegfykafka kE jf.a fmkqkg ta yeufohlau

14
nndg jegfykjd' ^WodyrKhla úÈhg —fï mqf;a u,laæ˜ lsh,d wïud nndg
fmkajoa§ nndf.a fudf,a iakdhq —u,˜ w`ÿk.kak wjYH iïnkaO;d yod .kakjd'
tfyu lsh,d wdfh wdfhu nndg u, fmkajoa§ ta iïnkaO;d iaÓr fjkjd' Bg
miafia wïug mq¨jka ál ál lreKq tl;= lrkak' —fï mqf;a r;=mdg u,la˜" —fï
mqf;a r;=mdg frdai u,la˜" —fï mqf;a iuk<fhla uf,a jy,d˜ wïudf.a láka
lshfjk yeu jpkhla u wïudf.a wysxil oremeáhdg fldaáhla jákjd' ta yeu
jpkhlskau thd,df.a wkd.;h ;SrKh fjkjd'

15
 08
iqj mKsúv
yenehs tl fohlaæææ

orejd mqxÑ ldf,a wïud thdg y`ÿka

15 jd kqÿka lsisu fohla thd .dj f,dl=
fjoaÈ b;=re fjkafka kE' wïud isxÿ lshd fkdÿkafkd;a wkd.;fha fyd`o
.dhlfhla fjkak ysgmq orefjla wmsg wysñ fjhs' wïud Ñ;%% w`Èkak lshd
kqÿkafkd;a olaI Ñ;% Ys,amsfhla wmsg wysñ fjhs' wïud .Kka lrkak lshd
kqÿkafkd;a .Ks;h yeuodu thdg johla fjhs' mqxÑ ldf,u jeäysáhkag i<lkak"
wd.u oyu woyk" .y fld< i;d isõmdjg wdof¾ lrkak" bjikak" fnod
yod.kak" ms<sfj,g bkak thdg mqreÿ lf<d;a rEmh jf.au ukqiailñkq;a f.dvdla
fmdfydi;a r;a;rka orefjla fï f,daflg fokak wïudg ksielfhkau mq¨jka
fjhs'

b;ska fufyu w¨;a foa y`ÿkajd §u mia wdldrhlska isoaO fjkak ´fka'

weia folg u,la y`ÿkajd fooaÈ

kdihg u,a iqj`o y`ÿkajd fokak mq,qjka'
lka folg ó ueiaidf.a y`v y`ÿkajd fokak ´fka'
mqxÑ we`.s,s j,g u,a fm;af;a isks÷ nj y`ÿkaj,d fokak ´fka'
mqxÑ osjg ri y÷kajd fokak ´k' yenehs b;ska wu;r wdydr .kak mgka
.;a;hska miafia'

t;fldg ;uhs yeu w;skau iúu;a iakdhq iïnkaO;d orejdf.a fudf,a we;=f,a
yefokafka'

wïudf.a láka lshefjk iEu jpkhlau wïudf.a wysxil ore meáhdg fldaáhla jákjd'

16
 fodhs fodhs fodhs fodhsh nnd

ore ke<ú,s lú lshkafka" ;ukaf.a ore meáhd .ek ;sfhk wiSñ; wdorh
ksid wïud flfkaf.a uqúka ksrdhdifhka .ehqKq lú' ta lúj, ;kqj ks¾udKh
fj,d ;shkafka pQá meáhdg f.dvla myiqfjka kskao hk úÈhg' b;ska ta lú fol
;=kla fufyu igyka lrkafka wïug ljoyß meáhdj ksÈlrjkak ú;rlau
fkfõ" meáhd l=i we;=f<a b`Èoa§;a wïug mq¨jka úÈyg lshkak' wïud okakjo thd
fï fiaru we;=,g fj,d wyka bkak j.@

fodhs fodhs fodhs fodhsh nnd Tkak nfnda we;skakshd

nhs nhs nhs nhsh nnd
w;g fjr¨ weys`o f.fka
bKg m,d fk,d f.fka
nrgu or lvdf.fka
ths wïud ú.ilsfka
uf.a mq;d yß ymkd
ojil fld<Ug hkjd
mKï ;syla Wmhkjd
bka mKula ug fokjd
uqks isßmd isôñkafka
iufkd< .sß fmfoiskafka
u`o iq<.hs fï tkafka
uf.a mq;d ksÈhkafka
.,a wrfò isákakshd
.,ska .,g mkskakshd
nnqg nfha ÿjkakshd
mqf;a kqfò f,dl= wïud
wf;a j<,a,la ±ïud
kef;a w.h tys ksïud
kdvd fodhshka wïud
nqoaOx irKhs mq;dg
Oïux irKhs mq;dg
ix>x irKhs mq;dg
fï;=ka irKhs mq;dg

17
 wdorKsh wïud flfkla fjkak fmr iQodku w;HdjYHhs' .¾NKS
ldf,a ;uka .ek n,d .kakjd jf.au nnd wdjg miafia wïuf.a
w;skau bgq flfrk jeo.;a foaj,a lsysmhla .ek l,skau ys;,d n,,d
yßhg ±kf.k bkak tl f.dvdla jákjd'

b;ska ta .ek ys;,d ;uhs fï mqxÑ fmdf;a B<`. msgq lSmh

,shefjkafka' wfma mqxÑ meáhg lsß fmdjkafka" wfma lsß leáhdj
f,dl= meáfhla lrkak lEu ál ljd.kafka fldfyduo@ wms ±kauu
fï .ek fydh,d n,uqo@

18
 09
iqj mKsúv

uf.a mq;dg lsß .`.=,hs

udi kjhla mqrdjgu l=i we;=f,a ;shdk yß mßiaiug /lf.k fï

f,daflg wrka tk mqxÑ oremeáhg wïug ´fka f,dfla ;shk fyd`ou foa fokak'
u,a mSia fros j,ska isks`ÿjg uymq .jqï fmdä wkao,d " jQ,a f;dmams fïia od,d"
fldÜg ;=k y;rlska jg lr,d" isks`ÿ we;sß,a,l ksoslrk ore meáhg wïud
flfklag fokak mq`Mjka jákdu odhdoh fudloao okakjo?
uõlsß
oremeáhd fï f,daflg Wmkaod" m<uqfjks meh Nd.h we;=<;oSu mgka wrka udi
06la mqrdjgu uõlsß ú;rlau oremeáhdg fok tl ;uhs fyd|' orefjl=g ta udi
06 la mqrdjg fnfy;la fya;la fokak jqfkd;a ñil j;=r fmdolaj;a wms ore
meáhdg fmdjkafka kE' uq,a udi 06 mqrdjgu orefjl=g wjYH ish¨u fmdaIl wjYH
ixhq;sfhka " wjYH m%udK j,ska orejdf.a wdydr cS¾K moaO;shg iqÿiq wdldrhg
ilia fj,d ;shk tlu wdydrh ;uhs uõlsß'

ta jf.au'''''''''' wïud okakjo uõlsß §fuka Tfí lsßleáhdg w;ajk jdis ksula kE'
uõlsß §u u.ska orejdg l=vd ld,fha we;sjk weÿu" mdpkh" Yajik frda.
fndfydauhla j<lajd .kak mq¨jka' ta jf.au" orejd fndfyda nqoaêu;a fjkjd'
wïuf.a orejd jeäysáfhla Wkdu ;rndre mqoa.,fhla ùu" wêreêr mSvkh"
Èhjeähdj jeks frda.j,g f.dÿre ùu wju fjkjd' ta fiaru;a tlal wïuf.hs"
mqxÑ meáhf.hs wdorKSh ne|Su ;j ;j;a Yla;su;a fjkjd' nnd wïudg f.dvdla
,x fjkjd'
b;ska oj,ag jf.au u;l we;=j ?g;a nnd
b,a,k ´ku fj,djl uõlsß fokak wfma wdorKSh
wïu,d iQodkï nj wms okakjd' wkak tfyuhs
wdorfhka oremeáhj lsßleáfhla lrkafka'
udi 06 f.jqkg miafi wïug mq¨jkafk
ujqlsß fok .uka fjk;a wdydr fyñka ief¾" wms
wdorfhka yod.;a;= lsßleáhg y`ÿkaj,d fokaak'

19
 mqf;a'''''

W;=rk fifka f,a je,a oyil .djd

uq;= leg mdg lsß ì`ÿ fo;kg wdjd
mq;=f.a ,má f;d,a fm;s tlsfrka kdjd
u;= nqÿ fjkd ,sh uqÿ yi/,a mEjd

Wr Wr cSúf;a fndk r;a;rka mqf;a

fmr fmr uq¨ f,hu kqUgu fmdjñ isf;a
jr jr b,a¨jg wïug lula kef;a
br y`o ujqka lsr u; uq`M f,djla wef;a

;ukaf.a oremeáhdg wïud flfklag fokak mq,qjka jákdu odhdoh ;uhs uõlsrs æ

20
 10
iqj mKsúv

lsßleáhg n;a ljkak - foaÿkafkka mdg .kak

udi 06 msreKhska miafia blaukska" blaukg f,dl=fjk meáhg uõlsß

ú;rla kï oS,d uos' uõlsß tlalu ynqx ljkak;a ´fkuhs' t;fldg meáhf.a
j¾Okhg wjYH fmdaIKh jf.au" thdg i;=áka o`.,,d bkak jqjukd Yla;sh;a
,efnkjd'

wms pQáhdf.a nKaähg j;=r jf.a lEu odkafka kE'''' fnßfjkak Wh,
.d.;a;= yekafoka fíÍ jefgkake;s ;rï >klï lEu j,ska mgka.;af;d;a ;ud
pQá meáhd fyd`og ymkak mqreÿfjkafka' ykq Yla;su;aa fjkafk' wïug ojiska oji
tlska tl w¨;a lEu j¾. tl;= lrkak mq,qjka'

uq,skau len,s rys; n;a fyda OdkH j¾.hlska meáhg lEu y`ÿkajd fokak
mq¨jka' udi 08 mekakyu kï" álla f,dl= len,s ymkak mq¨jka pKaäfhla ;uhs
bkafka'
t;fldg udi 9 fjoaos fyd`og weia lrlj,d n;a ms`.dk osyd
n,kak meáhg mq¨jka' wkak ta ksid foaÿkafka mdgg lEu tl
ms<sfh, lrkak mq`Mjkakï meáhd yßu wdidfjka lEu lhs'
WodyrKhla úosyg ;eô,s mdáka lerÜ len,s lsysmhla"
ly mdáka mßmamq álla" fld< mdáka m<d fudkjd yß
ms`.dkg oeïuu n,kafld lEu ms`.dfka ,iaik'

wjqreoao msreKyu neßhehs wïuhs wmamÉÑhs

lk n;a ms.dfkkau meáhg fokak'

fnrs fjkak Wh, .d .;a;= yekafoka fírS jefgkake;s ;rula Wl= lEu j,ska
mgka .;af;d;a ;ud pQá meáhdg we;s fjkak fmdaIKh ,efnkafka'

21
 oeka nndg udi 04
wïfï" uu fodvï f.ähla ;rï
f,dl= fj,d'
fï n,ka k wïfï ug ±ka ,ia i k
pQ á weia folla ;s f hkjd' t<s f h f,da f la
yßu ,ia i khs o wïfï@ wïug mq ¨ jka o
ug wefyka k is x ÿ ls h ka k ' nndg ±ka
wefykjd' ;d;a ; g ls h ka k nndg l;d
lrka k ls h ,d' ug wdihs ;d;a ; df.a
lgy`v wyka k '

22
 1211
iqj mKsúv

ynqx lghs n;a folghs n;a ljkak yß f,aishs

zzpqá meáhg n;a ljk tlkï hqoaOhlaZZ

zzn;a ljd.kak tl yßu wudrehs wfkaZZ
zzwfma nnd n;a lkafku kE wfkaZZ

nndg lEu ljk tl .ek weyqjyu wïu,df.ka wykak ,efnk ms<s;=re

lsysmhla ;uhs Th' wehs we;a;g tfyu fjkafka nnd ys;kafka n;a ljk tl
wïuf.a rdcldrshla lsh,d' t;fldg n;a lk tl thdf.a jevla lsh,d thdg
ta;a;=.kajkafka fldfyduo? uq,skau nndf.a nv.skak wïud w`ÿr.kak ´k'
orefjlaf.a nv.skak wïfulag jvd oefkk flfkla fï f,dafla fjk bkakjo?
tl tl nnd,df.a nv.sks ix{d tl tl úosyhs' iuyr nnd,d w`vkjd" iuyre
álla lror lrkjd" oÕ lrkjd" nv.sks wjdu lK lyk" w;a lfÜ odk" uQK
lik nnd,;a bkak mq`Mjka' b;ska ;ukaf.a nndg wfõKsl nv.sks ix{dj w`ÿr
.kak tl ;ud wïuf.a ymkalu'

B,`.g fudlo lrkafka@ nndf. nv.skak w`ÿr.;a; .ukau wïud talg

blaukg l%shd;aul fjkjd lsh,d nndg fmakak ´fka' fudk jefâ lr lr Wkak;a
wxl tl nndg lEu tl iQodkï lrk tl fjkak ´fka' —bkak mqf;a uu blaukg
.syska lEu tl yoka tkakï˜ lsh,d lshkfldg nnd wïuj úYajdi lrkak mgka
.kakjd' —ug nv.sks Wk .uka wïud lEu f.k;a fokjd'˜ lsh,d nnd f;areï
.kakjd' wkak ta úYajdfia yßu jeo.;a nndg n;a ljkak'

udi 6 msfrkfldg nndg lEu lkak ;ekla ,Eia;s lr.kak ´fka' —uf.a
mq;d lEu lkafka fu;k b|kafka''''''''''˜ ljkak mgka .kafka tfyu lshdf.k'
nndg ljkafka fyd`o wjOdkfhka' wdofrka l;d lrñka" Wkkaÿ lrjñka'
àù n,n, orejdg ljkak nEfka' orejdg fok wjOdkh u; ;uhs wïuf.hs
orejf.hs ine|shdj f.dv kef.kafka' tfyu yefok lsßleáh rgla jáhs'

wïug lSlre meáfhla yod.kak ´k kï" nndg n;a ljoaos fyd| wjodkfhka"
wdorfhka thdgu lemfj,d n;a ljkak ´k'

23
 fï nnd n;a lk ;ek

nndj tl ;ekl jdä lrjf.k lEu ljkak mqreÿ lrkak' tfyu lSj
.uka wïu,dg ysf;kafk
—wks;a wh kï lshhs' lr,u tmehs n,kak˜
kuq;a uq, b`o,u tl ;ekl ;shka lEu ljkak mqreÿ lr.;af;d;a n;a ljk
tl zzhqoaOhlaZZ fjkafka kE'
nndg n;a ljkak f.or tl ;ekla fjka lrkak mq,qjka kï f.dvla
fyd|hs' t;k fmdä fïihla mqgqjla ;sh,d" tfyu ke;a;ka ,iaik meÿrla t<,d
Wk;a mq¨jka' ta f;dard .kak ;ek fudlla jqk;a nndf.a wjodkh f.dvla tfy
fufy hk" WodyrKhla úosyg ks;ru jdyk tyd fuyd hk mdrlg uqyqK,d f;dard
.kak tmd' fudlo lk fj,dfõ nndf.a wjOdkh ;sfhkak ´fka lEug'

yenehs ;ks mdg ì;a;shla osyd n,df.k n;a lkak nndg lïue<s ysf;hsfka'
ta ksid lEu cd;s j, ,iaik mdg mdg rEm álla nnd lEu lk ;ek ì;a;sfha
w,jkak mq¨jka kï" nnd n;a lk .uka f.dvla foaj,a bf.k .kSú' yenehs nndg
ljk .uka àù n,k tl kï fyd|u ke;s fohla'

wïug lrorhla fkdù nKaä msfrkak n;a lk" fyd`o nfnla yod.kak
jefâ b;ska ;sfhkafk wïuf.a wf;au ;udæ fudlo nndg ljk tl Ndjkdjla
jf.a yskaod wjOdkfhka lrkak ´k'

wïud okakjdo@

pQáldf,a b`o,u lEu ljkak l,ska w;afidao,d msyso,d bkaojuqq' lEu ld,d
bjr fjÉp .uka nndg;a fmakak ldmq ;ek msßisÿ lruq' t;fldg biairyg yß
f,aishs'

nndg n;a ljkak f.or tl ;ekla fjka lrkak'

24
 oeka nndg udi 05
f,dl= wUhla ;rï wïfï nnd ±ka '
ug ±ka tfyg fufyg hka k ;a mq ¨ jka ' ux
o`. jeähs o wïfï@ wïug ßfokjdo@ wïud
oeka yß ,ia i khs ' wïud ug ,ia i k .jq u la
uy,d fokjd fka o @
wïfï ug yß md¨hs ' ug wefyka k is x ÿ
ls h ka k ' uf.;a tla l l;d lrka k ' fudlo
wïudf.a lgyv ug wefykjd'

25
 uf.a mq;=g'''''''''' uf.a ¥g'''''''''
uqks isßmd isU i`o Èh foda;la f.k kdjd
msi tk u`o k< wkak ÿfõ iqÿ i`o ydjd
uf.a mq;= uqj w. j<dl=,l i| /ia .djd
cSjh jQ j. iq<`. weú;a ryila lSjd

reÿre rl=iq le< fyg ojil rka lsre< ord

wú f.k wdjo /csKla fjhs kqU Èh; mqrd
uf.a mq;= f;o .=K ta /csKg foñ fifkfy fmrd
oel Èheù .sh fndkak ÿfõ cSú;h Wrd

,enqKo ch ne;sS ,iaik yqr;,a .;s we;a;S

ch ieureï ke;sS pqÜglaj;a lror ke;a;S
uf.a mq;= ueo .;s wïuf.a f,dafla wreue;a;S
is;a ,d ,she,qks fodhshka uf.a iqÿ u,a fm;a;S

fï mq;= ÈKq rg
ks;s oï Èkq rg
fï ìu isU isU
mq;= ksÈhk i|

wïud okakjo thd lú fiaru we;=,g fj,d wyka bkak j.

26
 oeka nndg udi 06
wïfï uu oeka cïfnda , hla jf.a '
fï n,ka k wïfï nndg ±ka ,ia i k
pQ á uQ K la ;s f hkjd''''' weys n eñ
;s f hkjd''''' fldKa f v ;s f hkjd' uu
wïud jf.a o" wma m ÉÑ jf.a o wïfï'
uu ljq r e jf.a Wk;a ug wïud
f.dvla wdofrhs fka o @

27
 mqf;a '''''''''

ujd iõisß úuka me,lg

jeäh foõ ksos Wl=,f;a
ojd iyila ;ejq,a kqUf.ka
lsß iqj`o úh cSúf;a
fydjd kqT <h .efí ir;ei
ksù hhs osú ux fmf;a
fodjd osúhu ;nñ f;d, u;
b,a,mka rka leá mqf;a '''

isyska iajrfhka ;nk blshl

iquqÿ fofldmq,a fmdmshkd
jyka lr.kq fudlg t;fldg
ujqka lsß ,eu llshkd
,jka ;Kmq~q jfÜ oejfÜ
oyla lsß je,a ,sh,kd
kqjka hq. mshjdk rkal`o
isyskfhkafoda yskefykd'''

f;df,a bysfrk ìxÿ lsßosh

ßfokq fkd;nd msi,ñ
fodf,a isys,i if`oa WKqiqu
kef;a fkdlshd i,ió
mef,a ueo rka hyka ;kjd
uf.a mK ál i;mñ
uf,a jeähu isks`ÿ yßfhka
ueõj fom;=, ism.ó'''

28
ys;g oefkk foa ,shuqo@ '''''''''''''''' 04

myq.sh udi ;=k''''''''

01' myq.sh udi ;=k mqrdjg uf.a ys;g i;=gla oekqfka''''''''''

02' ug ÿl ys;sÉp fj,dj,a fkd;snqKdu fkfjhs' ta lsõfõ''''''''''

 13
wïud fyd`o l,amkdfjka bkafka' iqj mKsúv

udi kjhla mqrdjg ;ukag;a jvd ;ukaf.a ore meáhd .ek ys; ys; wfma
wdorKSh wïu,g álla l,amkdfjka bkak ´fk wjia:d lsysmhla .ek ;uhs fï
lshkak hkafka' nh fjkak fkfuhs' nqoaêu;aj jev lrk tl ;uhs fu;kÈ
jeo.;au'

b;ska .¾NKS ld,h ;=<§ fï jf.a fohla we;s jqfkd;a oj,a ? fkdn,d blaukg
frday,lg hkak ´k'

• fhdaks ud¾.fhka reêrh jykh ùu

• fhdaks ud¾.fhka j;=r jeks Y%djhla msgjSu
• j,smamqj (FIT)
• weia fmkSfï fjkialï iu. wêl ysiroh
• wêl nfâ lelal=u $ nfâ by< m%foaYfha fõokdj ^b< weg l+vqjg háka&
• N+EK p,k ^orejd o`.,k jdr .Kk& wvq ùu
• WK

29
 oeka nndg udi 07
wïfï '''' wïfï '''' nndj
wefykjdo wïfï
''''' oeka kï uu wka k dis f.ähla ;rï'
uu ál ál my<g yefrkjd' oeka wïuf.a
;= r e,g tka k ,x fjkjfka ál ál' wïfï
ug oeka weys ms , a , ï .yka k mq ¨ jka ' wïud
ug ÿka k q pQ á u pQ á weia fol oeka mßia i ï'
nnd we`.s , a , Wrka k ;a oka k jd' ux bmÿK
.uka u l= l a l = fndka k ;uhs fï mq r eÿ
fjka f ka ' ug lys k a k mq ¨ jka " ug bla l d
jefgka k wrka wïfï'''''
uu oeka iïmQ ¾ K nfnla ' æ

30
 14
iqj mKsúv

pQá meáhd fyd`Èkao@

´l yeu wïud flfklagu oefkk ìhla''' b;ska iuyr fj,djg fï ìh

idOdrK Wkdg iuyr fõ,djg wksis ìhla' b;ska nh fjkak ´ko keoao lsh,d
o< jYfhka woyila .kak ;uhs wïu,dg .¾NKS iufha wjika Nd.h fjoa§ N%EK
p,k igyka m;la fokafka'

• yeuodu Wfoa 6 ;a 8 ;a w;r nnd o`.,k jdr .Kk" .Kka lrkak mgka
.kak'
• ta mgka .;a; fj,dj meyeÈ,sj igyka lrkak'
• pQá meáhd o`.,kjd wïug oefkoa§ tl fldgqjla ,l=Kq lrkak'
• tl wjia:djl§ meáhdf.a p,k lsysmhla oekqfKd;a ta lsysmhu tlla lsh,d
.Kka lrkak'
• meh 12 la hoa§ wvqu ;rfï nnd 10 mdrlaj;a o`.,kak ´k' 10 mdrla oe`.¨ju
wïug .Ksk tl kj;a;kak mq¨jka'
• meh 12 la hklka 10 mdrlaj;a oe`.¨fõ ke;akï yß" meh ;=kla hklka
nnd oeÕ,qfõ ke;akï yrs blaukg biamsrs;df,g hkak ´k'

31
 oeka nndg udi 08
wïfï ;j i;s y;rls k a uu
wïuf.a ;= r e,g tkjd'
oeka bia i r ;rï o`.,ka k nndg
wïuf. nKa ä h we;= f ,a bv uÈ' ta
jq K dg wïuj uu w,a , ,d n,kjd'
wïug oefkkj fka o @ ug bjis , a , la
kE uf.a wïuf.a ,ia i k uQ K ols k a k
wïfï' uu wïug f.dvdßhla
wdofrhs '

32
ys;g oefkk foa ,shuqo@ '''''''''''''''' 05

uu i;su;a nj mqreÿ l, yeá …

ys;g oefkk foa ,shuqo@ '''''''''''''''' 06
fï fmd; ''''''''
udi 5-6 la mqrdjg wïud fï fmd; f.dvdla mrsiaiñka <Õ ;shd.;a;d" lsfhjqjd'
fmdf;a ;sfhk m%Yakdj,s msfrõjd' b;ska wïug fï fmd; .ek ysf;kafka fudkjo
lsh,;a" fï fmd;g ;j tl;= Wkdkï fyd|hs ysf;k foaj,a fudkjo lsh,;a wmsg
lshkak' wms ta .ek oek.kak f.dvla leu;shs'

wmsg ,sshkak

ud;D yd <ud fi!LH m¾fhaIK tallh,

m%cd ffjoH fomd¾;fïka;=j"
ffjoH yd iudka;r úoHd mSGh,
Y%S ,xld rcrg úYaj úoHd,h,
id,shmqr.

wïud fï iqÿ mdg msgq j, ,shmq foaj,a wksla wïu,dg;a m%fhdackj;a fjkak mq¿jka¡
wïud ,shmq fï foaj,a wfma iólaIK j,g ,nd.k rfÜ wksla wïu,dg;a jevla
lrkjdg leu;s kï fï iqÿ msgq ál lv, wmsg tjkak¡
 15
iqj mKsúv

yÈiaishlg uu iQodkïo@

wfma wdorKSh wïu,d meáhd bmfok tl .ek ie,iqï lrkafka orejd

l=ig tkak;a l,ska b`o,duhs' ÿfjla o mqf;la o oek.kak;a l,ska b`o,u mqxÑ mqxÑ
.jqï fmdä" fldÜg Wr uy,d" isks`ÿ we`o we;sß,s iQodkï lrf.k u`. n,dk bkafka
;ukaf.a wdorKSh wuq;a;j ms<s.kak' b;ska ta ;rï fmr iQodkula ;sfhk wïud
l,a ;shd iQodkï lr.kak ´k" ;SrKh lr.kak ´k foaj,a lsysmhla ;sfhkjd' ta
;SrK .kak l,ska .fï ñâ jhs*a fkdakd tlal yrs" wïuf.a fodia;r uy;a;hd
tlal yrs álla l;d lr,d n,kak'

wïud l,a;shd .kak ´k ;SrK fudkjo@

Ø nnd yïnfjkak yß" yÈis fj,djl§ yß hkafka fudk biamsrs;df,go@
Ø /hlos jqk;a ta biamsrs;df,g wïud hkafka fldfyduo@ ta lshkafka
;%Sù,rhla tfyu fydhd .kak yeá@
Ø ta hkfldg ld;a tlalo hkafka@
Ø yÈis fõ,djl l;d lrkak" mKsúvhla fokak ´k whf.a ÿrl:k wxl' ta
lsõfõ ifydaorfhla" wi,ajdisfhla" ;%Sfrdao r: ysñfhla" ñâ jhs*a fkdakd
jf.a'

fïjd fld<hl ,sh,d fyd`Èka fmak ;ekl w,jk tl f.dvla jákjd'

Ø ta jf.au" fï jev ál lr.kak wïug úhou fldÉprla hhso@ ta úhoï
fydhd .kafka fldfyduo@

wïud biamsrs;df,g wrka hkak ´k fudkjo@

Ø wïud <`. ;sfhk .¾NKS igyka m;'
Ø ñâ jhs*a fkdakdf.ka b,a,.;a; ,ehsia;=fõ ;sfhk nnd yïnfjoaos jqjukd
fjk nvqndysrdosh'
Ø wïudf.a we`ÿï" me<`ÿï" ye`ÿkqïm; iy uqo,a miqïìh'
Ø wïughs wïud tlalka hk flkdghs jqjukd lEu îu fudkd yrs'

33
wïud biamsrs;df,g hkak ´k ljoao@
Ø biamsrs;df,a <Õ kï bkafka" nnd yïfnk ,laIK wdjyu'
Ø biamsrs;df,g f.dvla ÿr kï bkafka" nnd yïnfjkak ;sfhk ojig i;s
02 l 03 lg l,ska biamsrs;df,g <Õmd; ;ekl" f.or lÜáh tlal yrs"
w÷rk flfkla tlal yrs" kej;=fkd;a ;uhs fyd|'

uf.a Wm;a iy yosis wjia:d ie,eiau'

yosiaishloS biamsrs;df,g hk úosh wïud l,ska ie,iqï lr,d ,sh,d ;enqfjd;a tal
ys;kafkj;a ke;s l,n, fj,djg wïug Woõjla fõú' tfykï wms wïuf.a yosis
wjia:d ie,iqï my;ska igyka lruqo@

yosiaishloS hk frday, :
frday,g we;s ÿr :
frday,g hdug .;jk ld,h :
m%jdyk l%uh :
;%Sfrdao r:hla kï ÿrl;k wxlh
ta i|yd uqo,a fjkalr we;ao hk j. :
wïud tlal hkafka ljqo@ :
wïud .shdu f.or wks;a <uhs we;akï n,d.kafka ljqo@

ksjfia isg frday,g hdug fndfyda fj,d .;fõ kï$ m%jdyk myiqlï ke;skï"
udi kuh msfrkfldg wïug kj;skak mq,qjka <Õ ;ekla ;sfhkjo@

34
 oeka nndg udi 09
wïfï" fï ;uhs wka;su udfia''''
wïug bjiSula keoao udj olsklka''@ uu oeka
fyd`og yeÿKq nfnla' wïud ux o`.,k jdr
.Kk wr ldâ tfla ,l=Kq lrkjd fkao@ ta .ek
l,amkdfjka bkakjd fkao@ wïud nhfjkak tmd'
uu blaukg t<shg tkaïflda wïuf.a ;=re,g''''
t;l,a uf.a wïud f.dvdla mßiaiug
bkafkdafka'''

35
 W;=rk fifka f,a je,a oyil .djd
uq;= leg mdg lsß ì`ÿ fo;kg wdjd
mq;=f.a ,má f;d,a fm;s tlsfrka kdjd
u;= nqÿ fjkd ,sh uqÿ yi/,a mEjd

Wr Wr cSúf;a fndk r;a;rka mqf;a

fmr fmr uq¨ f,hu kqUgu fmdjñ isf;a
jr jr b,a¨jg wïug lula kef;a
br y`o ujqka lsr u; uq`M f,djla wef;a

;ukaf.a oremeáhdg wïud flfklag fokak mq,qjka jákdu odhdoh ;uhs uõlsrsæ

36
ys;g oefkk foa ,shuqo@ '''''''''''''''' 07
myq.sh udi ;=k''''''''

myq.sh udi ;=k wïug meáhf.a nr fyd|gu oefkkak we;s' iuyrúg oekakï
t<shg wdjkï fyd|hs lsh,;a ysf;kak we;s' fldfyduyrs meáhj n,d.;a;fka
lsh,d i;=gl=;a we;s' b;ska wïug fï .¾NKS iufha wjika udi ;=k is;g oekqfka
fldfyduo lsh,d ,shuqo@ i;=g jf.au ys;g fmdä fmdä ÿla iy.; wjia:d wdmq
fj,dj,a .ek;a ,shkak'
 16
iqj mKsúv

meáhd tkakhs hkafka

wïudf.a l=ig fj,d udi kjhla mqrdjg .=,s fj,d ysáh mqxÑ meáhd
wïudf.a ;=re,g tk oji" wïudf.ka m<fjks lsß W.=r fndk oji" wïudf.a
we`.s,af,ka w,a, .kak oji" wïudf.a uQK Èyd n,,d yskdfjk oji tkak tkaku
,x fjkjd' b;ska meáhd t<shg tkakhs hkafka lsh,d wïud fldfyduo oek
.kafka@
meáhd tkak hoa§ wïudf.a fhdaks ud¾.fhka reêrh uqiqjqkq Y%djhla .,dk
tkjd' ta jf.au wïug <Õ <Õu nfâ lelal=u tkjd' ta tk fõokdj;a tkak
tkaku jeä fjkjd'

t;fldg wkak tal iqN wdrxÑhla æ mqxÑ meáhd tkakhs hkafka' b;ska wïud
mq,qjka blaukg biamsrs;df,g hkak ´k'

37
 miqjok
W;a;Í;r ud;D;ajh cd;sfha mokuhs' ud;D yd <ud fi!LH m%j¾Okh w;ska
oshqKqfjñka mj;sk wks;a rgj,g idfmalaIj Y%S ,xldj bosßfhkau /oS isáhs' ud;D
fi!LH úldYkfhys ( Obstetric Transition) isõ jk wjêh olajd wNsudkj;a f,i
.uka lr we;s wmg" ;jÿrg;a ud;D fi!LHh kxjd,Sug kï ujlf.a ldhsl fukau
udkisl fi!LHhgo ixfõoS jQ .=Kd;au Ndjfhka mßmQ¾K fiajdjla ,ndoSu b;du
jeo.;ah'

ksoyia wOHdmkh;a" ia;%S-mqreI idudkd;au;djh;a iq/lSu fya;=fjka

wfkl=;a oshqKq fjñka mj;sk rgj,g idfmalaIj wfma wïudjrekag lshùfï iy
,sùfï yelshdj fkduoj ;s<sK ù ;sfnkjd' th m%fhdackhg .ksñka ujlf.a
.¾NKS iuh iqjm;a lsÍu Wfoid Y%S ,xldfõ ud;D yd <ud fi!LH ixrlaIK
m%;sm;a;shkg wkql+,jhs fuu fmd;a msxp ks¾udKh jkafka' .¾NkS iuh f.fjk
wdldrhg fm<.iajd we;s fï fmd;a msxfpys wvx.= Wmfoia fyd|ska lshjd n,d is;a
ordf.k" ta wkqj lghq;= lsÍfuka wfma wïudjrekag uõ moúh iqrlaIs; lr.ekSug
rel=,la ,efnkq we;ehs wms wfmalaId lrkafkuq'

fuu fmd;a msxp ks¾udkh lsÍu i|yd ixl,amuh jYfhkao" ksjeros

f;dr;=re fm<.ekaùfukao " jd.a l,d fl!Y,Hfhkao oyosh uykaisfhkao" uqøK
odhl;ajfhkao Woõ ÿka ish`M fokdg" rcrg ffjoH mSGfhaa ud;D yd <ud fi!LH
m¾fhaIK tallh fjkqfjka wmf.a ldreKsl ia;+;sh msßkuuq'

zzoehla iok uõjreka rlskakgZZ fuu fmd;a msxp odhl jkq we;ehs wms
úYajdi lrkafkuq'

ffjoH ;s<sKs w.ïfmdä MBBS, MSc, MPH, PhD

ud;D yd <ud fi!LH m¾fhaIK tallh
m%cd ffjoH fomd¾;fïka;=j"
ffjoH yd iudka;r úoHd mSGh
Y%S ,xld rcrg úYaj úoHd,h

MCHRU