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Preface

This is the 5th time we are going to publish the HEALTH BULLETIN of Nilphamari District and it is my pleasure that I have the opportunity to take part in publishing this bulletin for consecutive third time. In comprison of the first one this bulletin is more informative . We have lot of limitations in defferent side in spite of that we have lot of acheivement . We should let all the people know about this wonderful acheivements and this Bulletin will play vital role in it . It will help us to know about the gaps in our performance and also to compare our status regarding health service and acheivments with other districts. It will also help the policy makers to take dicission in giving inputs to upgrade of this district . With this Health Bulletin we can prove that we are in the right track in acheiving the goal of MDG 4 , MDG 5 and SDG in spite of our limitation in different sectors. Dr.Md.Abdur Rashid Civil Surgeon Nilphamari

Dr.Md.Abdur Rashid
Civil Surgeon
Nilphamari Civil Surgeon Office
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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EDITORIAL BOARD

Chief Editor

Dr.Md Abdur Rashid, Civil Surgeon


Special Acknowledgement

1. Professor Dr. Abul Kalam Azad, ADG (Admin)

Editors

1. Dr.Md.Moniruzzaman, MOCS

2. Md.Mahbubu Rabbani, Statistical Assistant

3. Md.Abdul kader, SHEO

Contributors

1. Md.Nur Alam Siddiqe, D.EPI Superintentdant

2. Sree Gones Chandra Roy, DSI


Certificate of Authentication

We, the above members of the Editorial Board, hereby certify that we collectively examined the content and data used in this LHB 2016 and to the best of our knowledge they represent the true picture of the local situation.

Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Basic Information
Name of District Nilphamari
Organization Code 10001463
Name of Civil SurgeonDr.Md.Abdur Rashid
Land Phone No. 1 55161302
Land Phone No. 2 N/A
FAX No. 55161218
Mobile No. 01712092795
Email nilphamari@cs.dghs.gov.bd
GPS location of CS Office Lati: 25.5546 And Long: 88.5052
No. of Upazila in the District6
No. of Households in the District 382891
Population in the District 1953504
Area of District in sq km 1643.40
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Existing Health Facilities
Facility Type Total No.of Faciliti(es) No. of Beds
Medical College Hospital 0 0
District Hospital 1 100
General Hospital 1 100
Upazila Health Complexes 4 200
Union Sub Centers 21
Union Health & Family Welfare Centers (under DGHS) 0 0
Union Health & Family Welfare Centers (under DGFP) 56 0
Rural Dispensaries 0 0
Community Clinics 174 0
Trauma Centers 0 0
MCWCs (belong to DGFP) 2 20
Chest Disease (TB) Clinics/Hospitals 1 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Existing Health Facilities
Facility Type Total No.of Faciliti(es) No. of Beds
Private Clinics/Facilities 21 250
NGO Clinics/Facilities 3 100
10 Bed Hospitals 0 0
20 Bed Hospitals 1 20
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of Live Births & Child Deaths in the District (Jan-Dec, 2015)
Total No. of live births: 45,147



Neonatal Mortality Rate: 22.9 (Per 1,000 live births)
Total No. of Children Treated under IMCI Program : 96,135
Fully Vaccinated Children (<= 12 months): 97 %
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of Maternal Health Services Provided in the District (Jan-Dec, 2015)
R.P.W. (No.) : Reg. Pregnent Women; 1st ANC (No.) : At least 1 ANC; 4th ANC (No.) : ANCs (4+); N.deli(No.) : Normal Delivery; C.deli(No.) : Cesarean Section; O.deli(No.) : Other Assisted Delivery; PNC(No.) : PNC Within 2 days;

Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of Maternal Health Services Provided in the District (Jan-Dec, 2015)

Indicator DH's Total UHC Total Govt. Facilities NGO Facilities Private Facilities MCWCs (belongs to DGFP) Not in Facilities (Home, Camps, etc. by govt. & other providers) Total
Reg. Pregnent Women 3042 4586 17466 10652 2447 934 11277 50404
At least 1 ANC 3042 4586 17466 10652 2447 934 11277 50404
ANCs (4+) 191 3140 7928 9566 2275 731 5566 29397
Normal Delivery 2191 3178 7181 6849 1078 1492 14202 36171
Cesarean Section 156 65 2333 1340 6427 55 0 10376
Other Assisted Delivery 0 0 0 0 0 0 0 0
PNC Within 2 days 2347 3748 9888 4371 5105 743 12817 39019
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of Maternal Health Services Provided in the District (Jan-Dec, 2015)

Indicator DH's Total UHC Total Govt. Facilities NGO Facilities Private Facilities MCWCs (belongs to DGFP) Not in Facilities (Home, Camps, etc. by govt. & other providers) Total
Maternal Death 3 3 16 0 3 0 29 54
Total Deliveries 2347 3243 9514 8189 7505 1547 14202 46547
Valid TT5 Coverage (%) 32.
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of OPD & Emergency visits, Admissions & Deaths
Health Facility OPD visits (Year 2023)
Male
(Age
<= 5)		 Female
(Age
<= 5)		 Total Male
(Age
> 5)		 Female
(Age
> 5)		 Total Grand-Total
Male Female Both
District Hospital 23539 27540 51,079 46299 61871 108,170 69838 89411 159249
Upazila Health Complex 18173 20491 38,664 33779 38914 72,693 51952 59405 111357
Union Sub-Centers 19200 23447 42,647 339660 43625 383,285 358860 67072 425932
Union Health & Family Welfare Centers (under DGHS) 0 0 0 0 0 0 0 0 0
Union Health & Family Welfare Centers (belong to DGFP) 1748 2248 3,996 3235 11519 14,754 4983 13767 18750
Rural/Urban/Thana Health Centers 0 0 0 0 0 0 0 0 0
Community Clinics 181580 238858 420,438 408156 702086 1,110,242 589736 940944 1530680
Trauma Centers 0 0 0 0 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of OPD & Emergency visits, Admissions & Deaths
Health Facility OPD visits (Year 2023)
Male
(Age
<= 5)		 Female
(Age
<= 5)		 Total Male
(Age
> 5)		 Female
(Age
> 5)		 Total Grand-Total
Male Female Both
MCWCs (belong to DGFP) 1540 1668 3,208 466 4606 5,072 2006 6274 8280
Chest Disease (TB) Clinics/Hospitals 0 0 0 2733 6496 9,229 2733 6496 9229
Private Clinics/Facilities 2530 3164 5,694 6450 19647 26,097 8980 22811 31791
NGO Clinics/Facilities 14204 28357 42,561 38027 77771 115,798 52231 106128 158359
10 Bed Hospitals 0 0 0 0 0 0 0 0 0
20 Bed Hospitals 0 0 0 0 0 0 0 0 0
Medical College Hospital 0 0 0 0 0 0 0 0 0
Any other health facility 1345 1543 2,888 3421 4322 7,743 4766 5865 10631
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of OPD & Emergency visits, Admissions & Deaths
Health Facility Emergency visits (Year 2023)
Male
(Age
<= 5)		 Female
(Age
<= 5)		 Total Male
(Age
> 5)		 Female
(Age
> 5)		 Total Grand-Total
Male Female Both
District Hospital 2823 2824 5,647 188970 18900 207,870 191793 21724 213517
Upazila Health Complex 779 9820 10,599 16505 20115 36,620 17284 29935 47219
Trauma Centers 0 0 0 0 0 0 0 0 0
Chest Disease (TB) Clinics/Hospitals 0 0 0 0 0 0 0 0 0
10 Bed Hospitals 0 0 0 0 0 0 0 0 0
20 Bed Hospitals 0 0 0 0 0 0 0 0 0
Medical College Hospital 0 0 0 0 0 0 0 0 0
Any other health facility 0 0 0 0 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of OPD & Emergency visits, Admissions & Deaths
Health Facility Admissions (Year 2023)
Male
(Age
<= 5)		 Female
(Age
<= 5)		 Total Male
(Age
> 5)		 Female
(Age
> 5)		 Total Grand-Total
Male Female Both
District Hospital 4312 4411 8,723 28254 28856 57,110 32566 33267 65833
Upazila Health Complex 8583 10137 18,720 17639 24978 42,617 26222 35115 61337
Trauma Centers 0 0 0 0 0 0 0 0 0
Chest Disease (TB) Clinics/Hospitals 0 0 0 83 0 83 83 0 83
10 Bed Hospitals 0 0 0 0 0 0 0 0 0
20 Bed Hospitals 0 0 0 0 0 0 0 0 0
Medical College Hospital 0 0 0 0 0 0 0 0 0
Any other health facility 0 0 0 0 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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No. of OPD & Emergency visits, Admissions & Deaths
Health Facility In Patient deaths (Year 2023)
Male
(Age
<= 5)		 Female
(Age
<= 5)		 Total Male
(Age
> 5)		 Female
(Age
> 5)		 Total Grand-Total
Male Female Both
District Hospital 30 40 70 54 66 120 84 106 190
Upazila Health Complex 21 19 40 86 71 157 107 90 197
Trauma Centers 0 0 0 0 0 0 0 0 0
Chest Disease Clinics (TB Clinics) 0 0 0 0 0 0 0 0 0
10 Bed Hospitals 0 0 0 0 0 0 0 0 0
20 Bed Hospitals 0 0 0 0 0 0 0 0 0
Medical College Hospital 0 0 0 0 0 0 0 0 0
Any other health facility 0 0 0 0 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Morbidity Profile

Top (5) causes of child morbidity (age <= 5 years)

Total No. of admitted patients reviewed for under five morbidity profile 27443
No. ICD-10 Code Disease name No. of Cases %
1 A09 A09 Diarrhoea and gastroenteritis of presumed infectious origin 5027 18.3
2 J189 J189 Pneumonia, unspecified 4121 15.0
3 A01 A01 Typhoid and paratyphoid fevers 4029 14.7
4 Y09 Y09 Assault by unspecified means 2921 10.6
5 T29 T29 Burns and corrosions of multiple body regions 1951 7.1

Top (5) 30+ population disease profile

Total No. of cases reviewed for 30+ population disease profile 76302
No. ICD-10 Code Disease name No. of Cases %
1 A09 A09 Diarrhoea and gastroenteritis of presumed infectious origin 11029 14.5
2 Y09 Y09 Assault by unspecified means 10005 13.1
3 J45 J45 Asthma 7044 9.2
4 K29 K29 Gastritis and duodenitis 5987 7.8
5 A010 A010 Typhoid fever 5152 6.8
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Mortality Profile

Top (5) causes of death for age <= 5 years

Total No. of cases reviewed for age <= 5 years 110
No. ICD-10 Code Disease name No. of Cases %
1 P21 P21 Birth asphyxia 49 44.5
2 J189 J189 Pneumonia, unspecified 22 20.0
3 P229 P229 Respiratory distress of newborn, unspecified 12 10.9
4 G009 G009 Bacterial meningitis, unspecified 10 9.1
5 G049 G049 Encephalitis, myelitis and encephalomyelitis, unspecified 8 7.3

Top (5) Maternal causes of death

Total No. of cases reviewed for maternal deaths 07
No. ICD-10 Code Disease name No. of Cases %
1 O72 O72 Postpartum haemorrhage 2 28.6
2 O64 O64 Obstructed labour due to malposition and malpresentation of fetus 2 28.6
3 O141 O141 Severe pre-eclampsia 1 14.3
4 O15 O15 Eclampsia 1 14.3
5 O469 O469 Antepartum haemorrhage, unspecified 1 14.3
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Mortality Profile

Top (5) causes of death between ages 30 & 70 years

Total No. of cases reviewed for causes of death (30 to 70 years) 270
No. ICD-10 Code Disease name No. of Cases %
1 I11 I11 Hypertensive heart disease 89 33.0
2 J449 J449 Chronic obstructive pulmonary disease, unspecified 62 23.0
3 R560 R560 Febrile convulsions 41 15.2
4 I21 I21 Acute myocardial infarction 38 14.1
5 G969 G969 Disorder of central nervous system, unspecified 32 11.9
Water & sanitation
Indicators District %
Coverage of households having access to safe drinking water (%) 100.0
Coverage of households having access to sanitary latrines (%) 91.0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Surgeries done under the CS Office
Type No.
Major Surgeries 240
Minor Surgeries 4096
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - designation grade wise)
Grade Sanctioned Filled-up Vacant Vacancy %
Male Female Total (M+F)
District Total
Grade 1 0 0 0 0 0 0.0
Grade 2 0 0 0 0 0 0.0
Grade 3 0 0 0 0 0 0.0
Grade 4 4 1 0 1 3 75.0
Grade 5 18 6 3 9 9 50.0
Grade 6 22 11 1 12 10 45.5
Grade 7 19 13 3 16 3 15.8
Grade 8 125 49 28 77 48 38.4
Grade 9 16 12 4 16 0 0.0
Grade 10 144 99 4 103 41 28.5
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - designation grade wise)
Grade Sanctioned Filled-up Vacant Vacancy %
Male Female Total (M+F)
District Total
Grade 11 150 98 39 137 13 8.7
Grade 12 21 12 7 19 2 9.5
Grade 13 65 41 17 58 7 10.8
Grade 14 4 2 1 3 1 25.0
Grade 15 24 16 8 24 0 0.0
Grade 16 252 127 56 183 69 27.4
Grade 17 2 1 1 2 0 0.0
Grade 18 0 0 0 0 0 0.0
Grade 19 5 5 0 5 0 0.0
Grade 20 186 129 31 160 26 14.0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - designation grade wise)
Grade Sanctioned Filled-up Vacant Vacancy %
Male Female Total (M+F)
Civil Surgeon Office
Grade 1 0 0 0 0 0 0.0
Grade 2 0 0 0 0 0 0.0
Grade 3 0 0 0 0 0 0.0
Grade 4 1 1 0 1 0 0.0
Grade 5 0 0 0 0 0 0.0
Grade 6 0 0 0 0 0 0.0
Grade 7 2 2 0 2 0 0.0
Grade 8 1 1 0 1 0 0.0
Grade 9 0 0 0 0 0 0.0
Grade 10 2 1 1 2 0 0.0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - designation grade wise)
Grade Sanctioned Filled-up Vacant Vacancy %
Male Female Total (M+F)
Civil Surgeon Office
Grade 11 5 5 0 5 0 0.0
Grade 12 1 1 0 1 0 0.0
Grade 13 3 3 0 3 0 0.0
Grade 14 0 0 0 0 0 0.0
Grade 15 1 1 0 1 0 0.0
Grade 16 1 1 0 1 0 0.0
Grade 17 5 4 1 5 0 0.0
Grade 18 0 0 0 0 0 0.0
Grade 19 1 1 0 1 0 0.0
Grade 20 2 1 1 2 0 0.0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - personal grade wise)
Grade Filled-up
Male Female Total (M+F)
District Total
Grade 1 0 0 0
Grade 2 0 0 0
Grade 3 0 0 0
Grade 4 1 0 1
Grade 5 8 3 11
Grade 6 12 1 13
Grade 7 10 3 13
Grade 8 12 35 47
Grade 9 19 9 28
Grade 10 5 22 27
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - personal grade wise)
Grade Filled-up
Male Female Total (M+F)
District Total
Grade 11 0 0 0
Grade 12 0 0 0
Grade 13 0 0 0
Grade 14 0 0 0
Grade 15 0 0 0
Grade 16 0 0 0
Grade 17 0 0 0
Grade 18 0 0 0
Grade 19 0 0 0
Grade 20 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - personal grade wise)
Grade Filled-up
Male Female Total (M+F)
Civil Surgeon Office
Grade 1 0 0 0
Grade 2 0 0 0
Grade 3 0 0 0
Grade 4 1 0 1
Grade 5 0 0 0
Grade 6 0 0 0
Grade 7 3 0 3
Grade 8 0 0 0
Grade 9 1 0 1
Grade 10 1 1 2
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources (Pay scale - personal grade wise)
Grade Filled-up
Male Female Total (M+F)
Civil Surgeon Office
Grade 11 5 0 5
Grade 12 1 0 1
Grade 13 3 0 3
Grade 14 0 0 0
Grade 15 0 1 1
Grade 16 1 0 1
Grade 17 4 1 5
Grade 18 0 0 0
Grade 19 1 0 1
Grade 20 1 1 2
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Status of Human Resources under DGHS updated during this report preparation
Man
power		 Commu-
nity
Clinic		 USC/
UHFWC/
RD		 UHC DH/GH Others IM-
CI
Trai-
ned		 Basic
EOC
Trai-
ned		 CS-
BA
Tr-
-ai-
ned
San-
cti-
on-
ed		 Fill-
ed-
up		 San-
cti-
on-
ed		 Fill-
ed-
up		 San-
cti-
on-
ed		 Fill-
ed-
up		 San-
cti-
on-
ed		 Fill-
ed-
up		 San-
cti-
on-
ed		 Fill-
ed-
up
Physician 0 0 62 44 76 46 34 19 10 3 0 0 0
Nurse 0 0 0 0 101 64 40 28 37 32 13 9 0
Medical Assistant 0 0 46 29 10 9 0 0 0 0 17 0 0
Medical Technologist 0 0 0 0 0 0 6 4 8 4 0 0 0
CHCP 189 178 0 0 0 0 0 0 0 0 54 0 0
HI 0 0 0 0 17 16 0 0 0 0 0 0 0
AHI 0 0 0 0 51 51 0 0 0 0 0 0 0
HA 0 0 0 0 253 161 0 0 0 0 0 0 0
Total 189 178 108 73 508 347 80 51 55 39 84 9 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Equipment report is up-to-date
Equipment   Not installed (No.) Total (No.)
Functional (No.) Non-functional
Repairable (No.) Non-Repairable (No.)
Vehicles
Ambulance 0 0 0 0 0
Bus 0 0 0 0 0
Jeep 1 0 0 0 1
Microbus 0 0 0 0 0
Pickup 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Equipment report is up-to-date
Equipment   Not installed (No.) Total (No.)
Functional (No.) Non-functional
Repairable (No.) Non-Repairable (No.)
Air conditioner
Air conditioner (split type) 3 0 0 0 3
Air conditioner (window) 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Equipment report is up-to-date
Equipment   Not installed (No.) Total (No.)
Functional (No.) Non-functional
Repairable (No.) Non-Repairable (No.)
Generator
Generator (diesel/petrol) 0 0 0 0 0
Generator (Gas) 0 0 0 0 0
Solar panel 0 0 0 0 0
IPS 1 0 0 0 1
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Equipment report is up-to-date
Equipment   Not installed (No.) Total (No.)
Functional (No.) Non-functional
Repairable (No.) Non-Repairable (No.)
ICT equipment
Computer (desktop) 0 0 0 0 0
Laptop 2 0 3 0 5
Printer (dot matrix) 0 0 0 0 0
Printer (inkjet) 0 0 0 0 0
Printer (laser) 5 2 0 0 7
Scanner 1 0 0 0 1
UPS 4 0 0 0 4
Fax 0 0 0 0 0
Intercom 0 0 0 0 0
Internet fixed line 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Equipment report is up-to-date
Equipment   Not installed (No.) Total (No.)
Functional (No.) Non-functional
Repairable (No.) Non-Repairable (No.)
ICT equipment
Internet wireless line (Modem) 0 0 0 0 0
Multimedia 2 0 0 0 2
OHP 0 0 0 0 0
PA system 0 0 0 0 0
Land phone 2 0 0 0 2
Mobile phone 0 0 0 0 0
Photocopier machine 0 0 0 0 0
Digital camera 0 0 0 0 0
Video camera 0 0 0 0 0
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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Important information and necessary issues you want to raise
Nilphamari District Hospital : We want to give service to the people of Nilphamari specialy the poo and ultra poor. But due to shortage of manpower in all level.We unable to provide the desire of general people. It was a 50 bed setup hospital in the year 2002 upgreaded to 100 bed hospital in the year 2003 with manpower of 50 bed setup. At present the number of doctors are only 10 , though it is 22 in 50 bed setup. But the hospital is overloaded. Now the bed occupancy rate 200%. As there is no restriction of visitors in the hospital. So it is not possible to maintain the cleanliness of thr hospital properly . Shortage of Sr.&Jr. consultant,Medical officers , nurses. paramedics ,other class 3 & 5 employer is another are major giving proper service to the patients. Urgently Need : Human Resources ( Doctors ,Nurses ,paramedics , & other) . Improvement of cleanliness through proper drainage system. Regular disposal of waste by Municipality. Visitors control.Long term Need : Establlisment of 250 Beded Hospital from 100 bed Adminitrative Approval of 250 Beds Hospital and apointment of Human Resources . Increased Budgery Allocatin from 25000 tk. per to at least 50.000/- Per Bed . Separate MSR Budgetary Allocation for out Dr.Md.Abdur Rashid. Civil Surgeon, Nilphamari.
Local Health Bulletin 2016 for Nilphamari Civil Surgeon Office, Nilphamari Sadar, Nilphamari

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