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A Report on Community Diagnosis and Mobilization Conducted Between 22 nd

September and 6 th October 2019 at Mogotio Sub-County in BARINGO County,
Kenya

Article · July 2022

DOI: 10.9790/1959-1104011121

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IOSR Journal of Nursing and Health Science (IOSR-JNHS)
e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 11, Issue 4 Ser. I (Jul. – Aug. 2022), PP 11-21
www.iosrjournals.org

A Report on Community Diagnosis and Mobilization

Conducted Between 22nd September and 6th October 2019
at Mogotio Sub-County in BARINGO County, Kenya
BRIDGET NDUTA MWANIKI
Kenya Medical Training College Faculty of Public Health
Nutrition & Dietetics Department Kabarnet Campus

Abstract
Introduction: The Community Diagnosis and Mobilization exercise was conducted between 22 nd September and
6th October 2019 in Mogotio Sub-County, Baringo County, Kenya by the September 2018 Nutrition and
Dietetics certificate students from Kenya Medical Training College, Kabarnet Campus. Its main intention was
imparting skills and knowledge on community mobilization and diagnosis, where the community gets to
understand its health and nutrition issues, and address them using the available resources.
Methodology: the activity was undertaken in three phases; pre-field, actual field work activities and post- field
activities. The cross-sectional design was employed, with a total sample of 132 households. children aged 0- 59
months old and pregnant or lactating women aged 15-49 years in these households were targeted. A structured
questionnaire was used for data collection in Kisanana ward (Molo Sirwe and Mukurin), Mogotio ward
(Ngubereti and Sirwa) and Emining ward (Emining and Maji moto),while the tools and instruments were pre-
tested in Kipsogon community unit. Analysis was done using SPSS Statistical software version 22. Logistical
and ethical considerations were also made during the CDX.
Results:Majority of the people in Mogotio sub-county were married, and 57.35% of the respondents had
primary level education. 94.7 % of the residents were Christians and 53.66% were farmers. A majority of the
water sources in this sub-county were surface water and borehole.Boiling was majorly used for water treatment
in most community units since it was cheap and safe.57.35% of the respondents burnt their waste. 98.7%
children under five years in Mogotio Sub County had received OPV1 in 2019 while 96% had received OPV3.
72% of the pregnant and lactating women were at risk of being malnourished, while 46% were
malnourished.96.6% of the children aged 6- 11 months in Mogotio Sub County had received vitamin A
supplements at least once. Children 12-59 monthsthat had been dewormed were 72.9%.
Conclusion:Health education and awareness was commendable amongst residents of Mogotio Sub-County.
Moreover, there was good immunization coverage.The households reported reduced attendance of Child
Welfare Clinic after 11 months. There was need to improve the levels of de-worming within Mogotio sub-county.
There was also an urgent need to achieve 100 percent toilet coverage within Mogotio sub-county.
Recommendations: based on the findings of the CDX, recommendations made include increased routine mass
screening in areas with low health nutrition and sanitation indicators and upscaling health and nutrition
outreaches. Moreover, the CHEWs and CHVs should be trained in details for positive impacts in the community.
There was also an identified need to conduct health education and implement WASH. Support training of
mother-to-mother support groups, inter-sectoral collaboration and partnership, women groups and CBOs on
IGAsand post-harvest handling of food were identified as crucial improvement areas.
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Date of Submission: 24-06-2022 Date of Acceptance: 06-07-2022
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I. Introduction
1.1 Background Information
According to W.H.O., community diagnosis (CDX) refers to a qualitative and quantitative description
of health and factors that influence the health in a certain community. It is basically the foundation for
improving and promoting the health of the community members. It identifies the problems that the community
faces and using available resources, suggests ways in which to address these factors and respond to community
needs. This is based on the fact that CDX involves assessment, and is evidence-based and comprehensive in its
approach to primary health care. Therefore, CDX is very crucial in strengthening the linkages between
healthcare teams and communities for better healthcare.
Mogotio Sub-County is in Baringo County. It has three wards; Mogotio ward covering 287.53 KM 2,
Emining ward covering 529.21 KM2 and Kisanana ward covering 487. 13 KM2. The sub-county has 5 divisions,
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23 locations, 50 sub-locations and 216 villages. The major source of livelihood is farming and pastoralism. This
sub-county has a total male population of 41,271 and female 41,463. It has one new Sub-County Referral
Hospital referred to as Mogotio Sub-County Referral Hospital.
Malnutrition is a complex phenomenon that manifests as either over- or under- nutrition. While the
rates of overweight and obesity have been on a steady rise, wasting, underweight and stunting are still prevalent
in Mogotio Sub-county, Baringo County. The main economic activity in Mogotio is agriculture where majority
of the residents, especially in the rural areas grow perennial crops for subsistence, and sisal as the permanent
crop for commercial purposes. The county experiences inadequate rainfall, leading to water shortage and
ineffective farming. Although the IMAM operations were scaled up in January 2015, < 60% of the
malnourished children < 5 years were enrolled due to low program awareness and household/ caregiver
workload. The sub-county is vulnerable to disease outbreaks and drought.
Long distance to health facilities and one-off mass screening remain key challenges to locals.
Alcoholism, migration, SFP stock-out, short child space intervals, ignorance of caregivers, and stigma of
malnourished children are key contributors to malnutrition in the sub-county. There is low OTP program
coverage in areas > 5 Kilometres from IMAM service delivery point due to low awareness. As such, the
prevalence of malnutrition in the sub-county remains high. According to SQUEAC report 2015, there were a
significant number of malnutrition cases admitted with Mid Upper Arm Circumference ranging from 115mm to
124mm who were admitted to Supplementary Food Program (SFP) and Outpatient Therapeutic Program (OTP)
as mitigation strategies.

1.2 Objectives
1.2.1 Main Objective
Determine the nutrition status and health of children aged 0- 59 months and pregnant or lactating women aged
15-49 years.
1.2.2 Specific Objectives
1. Estimate the present acute malnutrition prevalence in children 0 – 59 months old
2. Determine morbidity rates among household members over a three month recall period.
3. Estimate Measles, Oral polio vaccines (OPV1-3), and BCGimmunization coverage
4. Determine de-worming, Zinc supplementation for diarrhea, Vitamin A supplementation, and
MNP’ssupplementation coverage among children 0-59 months.
5. Estimate the nutritional status of pregnant or lactating women aged 15- 49 years
6. Establish the status of household food security, sanitation, water, and hygiene practices
7. To determine the health care service delivery to the target group
8. To estimate time taken before acquiring service delivery
1.2.3 Process Objectives
1. Conduct a community entry
2. Conduct data collection and analysis
3. Evaluate the sub-county’s healthcare system and partnerships
4. Disseminate feedback to the key stakeholders.

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 A Report on Community Diagnosis and Mobilization Conducted Between 22nd September ..

Figure 1:Mogotio Sub-County Map

II. Methodology And Organization

2.1 Organization of the CDX
The CDX started with engagement of the stakeholders so as to create rapport, and brief them about the
objectives, methods, and purpose for the community diagnosis. The lead in this was the Baringo County Health
Office, who also officially trickled the information down, up to the communities to be involved. Second, there
was the actual field work activities, that started with introductory training so as to familiarize the students with
the module’s content, which took two days. Pretesting the data collection instruments and the actual data
collection were also done in this stage. Third, the post-field activities entailed of data cleaning and entry,
analysis, writing the report, and feedback dissemination.
During the dissemination, barazas were organized by the sub-county community strategist, where all
relevant stakeholders participated. There was representation of SCHMT, CHC, CHEWs, CHVs, Chiefs and Sub-
Chiefs from all the wards.All the health indicators captured in the data collecting tools were discussed in-depth,
as a basis of making the needed changes. Consequently, a clinical outreach (medical camp) was conducted by
the students under supervision of their lecturers and in partnership with Mogotio sub-county Hospital. This was
done in a slum in Mogotio town referred to as Kokoto. This slum is overpopulated, with many under-five
children, lactating and pregnant women living in abject poverty. Activities of the outreach included
anthropometric screening, documentation, deworming, Vitamin A supplementation and referrals. All severely
and moderately malnourished childrenwere referred for IMAM services in the nearest hospitals. This also
applied to the pregnant and lactating women on basis of MUAC.
The nutrition and dietetics students from KMTC, Kabarnet Campus were involved in the CDX as a
crucial component for the fulfilment of their course. They resided in the community for effective teaching and
learning, and to enable them examine and participate in addressing health problems by proposing effective
interventions. Moreover, this enabled them to better visualize the communities’ health care difficulties. The
communities were unfamiliar to the students, marginalized, and reaching households was a challenge. Through
this exercise, the students also learnt varying communication skills, dissemination skills, data analysis, and its
collection.

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 A Report on Community Diagnosis and Mobilization Conducted Between 22nd September ..

2.2 Study Design

The CDXused the cross-sectional descriptive design, which permitted an overview of the community at a point
in time.
2.3 Study Area
The community setting of choice was Mogotio Sub-County, Baringo County, where the students were involved
with the community between 22nd September and 6th October 2019. This area was selected based on the high
malnutrition levels, healthcare challenges, and semi-arid nature. Therefore, it would offer a rich learning
experience to the students. Two community units in every ward were visited as follows;
a) Kisanana ward-Molo Sirwe and Mukurin
b) Mogotio ward- Ngubereti and Sirwa
c) Emining ward- Eminingand Maji moto
2.4 Study Population
The population of interest for this diagnosis was children between 0 to 59 months, and pregnant or lactating
women of age 15-49 years.
2.5 Sampling Procedure
132 households took part in the CDX at Baringo County, Mogotio Sub-County, which was selected purposively
based on the health indicators. The diagnosis also applied a two-stage cluster sampling. probability proportional
to population size was used for selecting the clusters, after which simple random sampling was used in selecting
the households that responded to the questionnaire.
2.6 Data Collection Instruments and Tools
Various techniques and methods were used in conducting the CDX. Moreover, different actors were involved.
The data collection methods used varied, and encompassed of observation, structured questionnaires, and key
informants. The CDX examined varying primary health care domains, including community’s history, vital
community institutions, communication means, power structure, leadership, and culture, as indicted by Sousa et
al. (2017).
2.7 Pretesting of Instruments and Calibration of Tools
The data collection questionnaires were pretested in clusters that were not part of the larger diagnosis, for
accuracy and reliabilityof all tools and instruments. The pretest was done in Kipsogon community unit. The
pretesting involved practicing knowledge acquired on how to take anthropometric measurements,
questionnaires’ completeness and sampling methodology.
2.8 Data Collection Procedure
A structured questionnaire aided in data collection. Data that was collected on anthropometry, vaccination
information, morbidity rate within the previous three months, food security, water hygiene and sanitation. Data
collection tools that the nutrition survey guidelines recommends were adopted in the CDX, with minor
modifications so as to meet the intended objectives. A market survey was done on Friday 25th September, 2019
in Mogotio market to determine the affordability, accessibility and availability of foods in this sub-county,
which would be a reflection of the food security status in the Sub-County.
2.9 Data Management and Analysis
The data cleaning, entry and analysis was done using SPSS version 22.
2.10 Logistical and Ethical Considerations
The local authorities received adequate information regarding the CDX. Verbal consent was obtained prior to
data collection. The decision of caregiver to participate or withdrawal was respected. Participation was also
voluntary. Confidentiality was maintained for all the data. Moreover, the findings of the CDX were shared with
the key stakeholders, which enabled the students to practice use of adult learning skillsand effective
communication skills.

III. Findings
3.1 Demographic indicators
The total population of males and females in Mogotio Sub County was 41271 and 41463 respectively. A
household in Mogotio Sub-County had an average of 5 persons. The children aged between 6-59 months
screened were 252.
3.3.1 Marital status
Majority of the people in this subcounty were married; 118 women married followed by 18 single women.
Table 3.1: The Respondents’ Marital Status
community unit
Molo Sirwe Ngubererti Emmining Sirwa Mukurin Maji Moto
Count Count Count Count Count Count
Married 18 20 20 21 21 18
Marital Status
Single 3 2 3 3 1 6

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 A Report on Community Diagnosis and Mobilization Conducted Between 22nd September ..

Divorced 0 0 0 0 0 0
Widowed 0 0 0 0 0 0

3.3.2 Education level

57.35% of the respondents had primary level education, 30.15% secondary-level, 11.03% college-level while
0.74 % attended the adult education level.
Table 3.2: The Respondents’ Education Level

3.3.3 Religion
94.7 % residents were Christians, 3.03% Muslims and 1.52% did not have any religion.
Table 3.3: The Respondents’ Religion

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3.3.4 Occupation
53.66% were farmers, 22.06% self-employed,5.86 % had formal employment, and 2.94 % were still students.
Most respondents were female, which indicatedthat a few have formal employment and majority do farming for
a living.
Table 3.4: The Respondents’ Occupation

3.2 Environmental indicators

Based on the international human rights, water access and sanitationare basic human rights. Therefore,
all people should be able to access essential safe drinking water amounts, as well as basic sanitation facilities.
Moreover, the water ought to be affordable, acceptable, safe, physically accessible and sufficient for both
domestic and personal use. There is a very close relationship between sanitation and water. Many human rights
can realized efficiently if the right to sanitation and water are achieved. High stunting levels and under-nutrition
are some of the outcomes of poor WASH indicators, which also leads to diarrhoea, a major killer among
children (Pruss-Ustun et al, 2014). In turn, a child’s immunity is compromised, leading to a vicious circle.
About 25% of stunting is linked to five and above diarrhea episodes before 24 months (Checkley et al, 2008).

3.2.1 Main sources of water

Improved water sources, if accessible, helps in reducing the faecal risk, in addition to associated
diseases’ frequency. It isalso connectedto socioeconomic characteristics, such as education and income.
Drinking water coverage consider the use of both unimproved drinking water sources and improved drinking
water sources (piped water). A majority of the water sources in this sub-county were surface water and borehole.
Unprotectedsurface water was highly used in Maji Moto, Sirwa and Molo Sirwe. Therefore, there was a high
risk of waterborne diseases.

Table 3.5: Water Sources in the Sub-County

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3.2.1.1 Distance to the Water Source and Queuing Time

Based on the minimum standards for WASH- SPHERE handbook, 500 meters is the maximum distance that any
household should walk to reach the closest water point. Moreover, queuing for the water should not take over 15
minutes, while filling a 20-litre container should use less than three minutes. However, these parameters were
yet to be achieved in Mogotio Sub-County.

Table 3.6: Distance to Water Source

3.2.1.2 Methods of drinking water treatment

Water treatment is important to prevent waterborne disease. Households only treated drinking water. However,
water used in food preparation was not treated. Boiling was the method majorly used in most community units
since itwas cheap and safe.

Table 3.7: Methods of Water Treatment

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3.2.2 Sanitation
Table 3.8: Household Waste Disposal

3.2.2.1 Waste disposal

Waste disposal is very crucial in health care since improper waste disposed ultimately contribute to various
ailments.57.35% of the respondents burnt their waste,25.74% had dug a pit, while 13.97% disposed waste
anyhow.
3.2.2.2 Toilet coverage
Basic sanitation services entails of having excreta transported through sewers for treatment off-site. With poor
excreta management, different diseases can be transmitted, leading to malnutrition. Every year, insufficient
sanitation contributes to 280,000 diarrheal deaths. With proper sanitation facilities, which can either be
improved or unimproved, health is promoted.

Table 3.2: Types of Toilet

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The findings established that the traditional pit latrines, which is an unimproved sanitation facility, was the
commonly used in the sub-county.

3.3 Anthropometric Indicators

For acute malnutrition prevalence using W-H z-score and MUAC, GAM (Global Acute Malnutrition)
defines a z-score that is below -2 W-H or a MUAC less than 12.5 cm, with/without edema. GAM is further
broken down into SAM (Severe Acute Malnutrition) when the z-score is below -3 W-H or a MUAC less than
11.5 cm, with/ without edema, and MAM (Moderate Acute Malnutrition) when the z-score is < -2 and >-3 W-H
(WHO, 2006) or a MUACof ≥11.5 cm – <12.5 cm. Based on the findings of the CDX, 12% and 22% of the
children had SAM and MAM respectively, on the basis of MUAC.

3.4 Immunization Coverage

Kenya had the goal of achieving 90% by the close of the 2 nd medium term plan (2013- 2017), under
one immunization coverage. Based on the Kenyan guidelines, a child is considered to be fully immunized if they
have received all prescribed antigens, and one dose of Vitamin A at least once prior to the first birthday,
following the national immunization schedule. Research indicates that immunization goes along way in
protecting children and the larger community from critical diseases, considering that spread is also minimized.
Since vaccines trigger the immune system, vaccinated people’s immune systems respond more effectively, and
diseases are less severe. Many diseases are currently rare as a result of the high immunization rates.
This CDX assessed the coverage of three vaccines; BCG, OPV1, OPV3at nine and eighteen months.
The BCG vaccine is known to be successful in minimizing the chances and severity of both military TB and TB
meningitis, particulalry in infants and young children. This is more so in Kenya where there is a high prevalence
of TB, and the chances of infant or young children’ exposure to an infectious case are high. From the CDX
results, 95.2% of the children had been immunized. Moreover, children under five years who had received
OPV1 were 98.7% in Mogotio Sub County in 2019 while for 96% had received OPV3. This indicates a high
immunization coverage in the sub-county, which is highly recommendable for disease prevention. However, the
Sub-county ought to target for 100% immunization coverage.

3.5 Maternal Nutrition

During pregnancy, optimal maternal nutrition, is one of the key strategies for promoting child survival
during the initial 1000 days. Through it, child mortality among those less than five years can be minimized upto
15%, if implemented on a 90% coverage (Bhutta etal., 2013). During pregnancy and lactation, there is high
nutrient needs, whose absence leads to exhaustion of the reserves, and consequently malnutrition. Gestational
malnutrition is often associated with low birth weights, and poor growth and development. Therefore,
malnutrition in pregnant and lactating women should be treated as an emergency. Household food insecurity is
linked to poor maternal nutrition, and consequently, fetus growth retardation, low birth weight and malnutrition
among children under five years. WHO recommends daily intake of 60mg elemental iron and 0.4mg folic acid
throughout the pregnancy to prevent anemia.These recommendations have since been adopted by Kenya
government in its 2013 policy guidelines on supplementation of iron folic acid supplementation (IFAS) during
pregnancy.
During the CDX, assessment of maternal nutrition was through MUACmeasurements of all pregnant
and lactating women (15 to 49 years) in all sampled households. The maternal malnutrition was defined as
MUAC measurements < 21.0cm while risk of malnutrition was defined as MUAC measurements between 21.0-
<23.0cm. The findings established that 72% of the pregnant and lactating women were at risk of being
malnourished, while 46% were malnourished. This indicates the need of upscaling targeted interventions, which
will help eliminate malnutrition in the vulnerable groups. Moreover, the need for folic acid and iron
supplementation should not be ignored.

3.6 Vitamin A Supplementation

More than 140 million children face the risks of blindness, hearing loss, illness and death if no
immediate action is taken to offer them the vitamin A supplements. Annually, two doses are recommended to
save children’s lives. Globally, vitamin A supplementation coverage has been dropping for the previous six
years, thereby exposing over a third of the children to the detrimental vitamin A deficiency’s effects. This
indicates the need for more sustainable, cost-effective, safe, and evidence-based programs so as to end
preventable deaths among children.
In its national nutrition action plan (2012- 2017), third priority objective, Kenya aims at minimizing
micro-nutrient deficiencies, prevalence through supplementations, fortification, and awareness. Vitamin A is
among the key micronutrients of concern. Vitamin A supplementation on a large scale can greatly help in
reducing preventable child deaths annually (Jones et al, 2003). Moreover, it can enhance disease resistance and

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 A Report on Community Diagnosis and Mobilization Conducted Between 22nd September ..

minimize mortality from all causes by about 23% (UNICEF, 2007). According to WHO (2018), if children aged
6- 59 months are supplemented with two high-dose Vitamin A supplements annually, spaced 4-6 months apart,
then their immune systems would be strengthened immensely, and there would be higher survival chances.
Supplementations also protects against common infections, thereby reducing mortality and improving survival
chances.
According to the diagnosis, 96.6% of the children aged 6- 11 months in MogotioSub County had
received vitamin A supplements at least once, and 29.4% of children aged 12 to 59 months in the Sub County
had been supplemented at least once. The reduction in % shows children are not taken to CWC after finishing
the 9-month immunization hence there is hardly vitamin Asupplementation above 9 months.

3.7 De-Worming
De-worming is a crucial intervention for the control of parasites, in addition to preventing anemia
(Jones,Steketee&Black, 2003). According to WHO, children from the developing countries ought to be de-
wormed once in every six months, based on exposure to poor sanitation and inaccessibility to clean safe water.In
the CDX, 72.9% of the children aged 12-59 monthsin Mogotio Sub County were dewormed. In particular school
going children were dewormed, however, no documentation showed that; the caregiver only recalled from the
report given by the children. Children above three years were hardly dewormed since the caregiver ceased to
take the child to CWC as required up to five years.

IV. Conclusions And Recommendations

4.1 Conclusion
Health education and awareness was commendable amongst residents of Mogotio Sub-County.This
was evident in the level of education where 98 percent of the population had attained basic primary
education.Thereis a strong relationship between nutrition health outcomes and level of education.
There was good immunization coverage within Mogotio Sub-County. 98.7% of the children under five
years in 2019 had received OPV1. while for OPV3, therewere 96%. This positive statistic ensures a health
future for children within the subcounty.The households reported reduced attendance of Child Welfare Clinic
after 11 months.96.6% of the children aged 6- 11 months in MogotioSub County had received vitamin A
supplements at least once, and 29.4% of children between 12 to 59 months had been at least supplemented once.
The reduction in % shows children are not taken to CWC after finishing the 9-month immunization hence there
is hardly vitamin A supplementation above 9 months.
There was need to improve the levels of de-worming within Mogotio sub-county. The children 12-59
months dewormed was 72.9% in Mogotio Sub County. In particular, school going children were
dewormed.However, no documentation showed that as the caregiver only recalled from the report children gave.
Children less than 3 years were hardly dewormed since the caregiver ceased to take the child to CWC as
required up to 5 years.
There was an urgent need to achieve 100 percent toilet coverage within Mogotio sub-county, based on
the fact that poor excreta management linked to disease transmission and malnutrition. Inadequate sanitation
also leads to deaths annually due to diarrhoea. Therefore, the need for proper sanitation facilities cannot be
ignored, for better health.

4.2 Recommendations
1. Increased routine mass screening in hot spot areas where health nutrition and sanitation indicators are
still low
2. Upscale health and nutrition outreaches, including activities related to pregnancy and lactation,
supplementation with Vitamin A, and deworming in outreach sites, as well as ECDE.
3. Train CHEWs and CHVscomprehensively on nutrition and primary health care
4. Support training of mother-to-mother support groups on MIYCN and BFCI.
5. Conduct health education, in addition to implementing WASH in the community, in addition to schools
6. Support partnership and inter-sectoral collaborations on health and nutrition
7. Support Community Based Organizations (CBOs) and women groups on IGAs for resilience
8. Support post-harvest food handling in schools and households.
9. Enhance food security by using irrigation schemes and kitchen gardening in Mogotio Sub- County.

ACKNOWLEDGEMENT
We acknowledge the support of the following;
1. Principal at KMTC Kabarnet Campus, James Kosgei, for his immense logistical and financial support
during the entire activity.

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 A Report on Community Diagnosis and Mobilization Conducted Between 22nd September ..

2. Sincere gratitude to the County Nutritionist, Madam Ann Kimwa, for her support in having the CDX
exercise approved by the Health Coordinator of Baringo County, and overseeing its success at the grassroot
level.
3. Special thanks to officers from the Health Management Team, Mogotio Sub-County, led by Madam
Brigid, the Sub-County Nutrition Coordinator, and Linda, fordifferent implementations, participating actively
and supervisory roles played during this period.
4. Superior gratitude is extended to Mogotio Catholic Church for their care and provision of the nutrition
students with accommodation during the CDX period.
5. Special regards to all the CHEWs and CHVs who participated in the exercise, aiding in community
mobilization as well as entry.
6. We highly appreciate the households thatresponded to our questionnaire.
7. We acknowledged the local administratorsfor mobilizing the community and guiding the students
during the entire exercise.
8. The lecturers are thanked for their tireless efforts in the various capacities, including our dear driver
Silas Semo (RIP).
9. Lastly, the September 2018 certificate students in Nutrition & Dietetics arehighly acknowledged and
thanked for relentlessly collecting quality data and cooperating throughout.

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BRIDGET NDUTA MWANIKI. “A Report on Community Diagnosis and Mobilization

Conducted Between 22nd September and 6th October 2019 at Mogotio Sub-County in
BARINGO County, Kenya.” IOSR Journal of Nursing and Health Science (IOSR-JNHS), 11(4),
2022, pp. 11-21.

DOI: 10.9790/1959- 1104011121 www.iosrjournals.org 21 | Page

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