“ I congratulate you for your bold and strenuous effort in bringing out the Textbook of Preventive and Social Medicine for medical students in India. This book would definitely become popular very soon in India.”
— Dr M Sudarshan, Professor and Head, Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore
“This book is very informative and well written and can be used as reference by community health personnel engaged in health care delivery.”
— Dr Deoki Nandan, Professor, Department of Social and Preventive Medicine, SN Medical College, Agra
“I congratulate you for writing a good Textbook of Preventive and Social Medicine.”
— Dr VN Mishra, Professor and Head, Department of Social and Preventive Medicine, LLRM Medical College, Meerut
“It was a pleasure to go through this book. The contents have been brought out at the desired standard.”
— SD Gaur, Professor and Head, Department of Preventive and Social Medicine, BHU, Varanasi
“The Textbook of Preventive and Social Medicine by Dr Mahajan and Dr Gupta is a very good attempt.”
— Dr Abdul Rauf, Professor and Head, Department of Social and Preventive Medicine, Government Medical College, Srinagar
(THIRD EDITION)
MC Gupta MBBS, MD (Medicine), MPH, LLB
Ex-Dean and Professor National Institute of Health and Family Welfare, New Delhi
Formerly Additional Professor All India Institute of Medical Sciences, New Delhi
Formerly Associate Professor Department of Preventive and Social Medicine Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha
BK Mahajan (Late) MBBS, DPH, FCCP, FIAPSM
Deputy Director, Health Services, Bombay State (1958-60)
Formerly Professor of Preventive and Social Medicine at Medical College, Jamnagar (1960-73)
Mahatma Gandhi Institute of Medical Sciences, Sevagram (1973-82)
Senior Consultant, ICDS Central Technical Cell, AIIMS (1982-87)
Jitendar P Vij
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Textbook of Preventive and Social Medicine
© 2003, MC Gupta, BK Mahajan (Late)
All rights reserved. No part of this publication and CD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher.
First Edition: 1991
Second Edition: 1995
Third Edition: 2003
Revised Reprint: 2005
9788180610707
Typeset at JPBMP typesetting unit
Printed at Replika Press Pvt Ltd., 310 EPIP, HSIDC, Kundli, Sonepat (Haryana)
Dedicated to
My dear wife
Dr Manju Gupta (27-1-1948—13-6-1996) without whose inspiration and sacrifice this book would not have been possible
7Foreword to the First Edition
I deem it my proud privilege to write the Foreword to the Textbook of Preventive and Social Medicine by Dr BK Mahajan and Dr MC Gupta. I know Dr Mahajan for the last 20 years and have gone through his earlier book Preventive and Social Medicine in India, published in 1972. Like me, many teachers have been pressing for subsequent updated editions of that book which has not been available since 1974. Perhaps Dr Mahajan was not able to bring out subsequent editions because of his preoccupation with his Methods in Biostatistics, whose popularity is indicated by the fact that it is running in its fifth edition. Dr MC Gupta, whom I know for more than a decade, has held senior faculty positions at prestigious institutions like the AIIMS, MGIMS and NIHFW, and has extensive and varied experience in various aspects of community medicine. He has done a remarkable job as a coauthor in the present book. I have gone through the entire manuscript at various stages of preparation and have been making suggestions about the current trends in discipline, which have been well taken by the authors. I am sure that the teachers and the taught, as well as the public health administrators, will find this new book very useful. I am sure, it will be widely read and put into practice for various public health and epidemiological studies.
Dr G Anjaneyulu
Professor and Head,
Department of Preventive and Social Medicine,
Osmania Medical College,
Hyderabad
President, Indian Public Health Association,
9Preface to the Third Edition
It has been our constant endeavour to provide the latest and the most up-to-date information to students and health professionals as relevant to their needs in view of the changes that take place continually in the public health scenario. Though the third edition has been prepared after thorough revision of the previous edition and much new matter has been included, feedback from professors of Preventive and Social Medicine in various medical colleges suggested the need for inclusion of certain new topics or for more detailed treatment of others.
In order to fulfill this perceived need, the following topics have been written up in detail and are included herewith, to be distributed as an addendum to the third edition:
- Epidemiological study design
- Biomedical Waste Management
- Anthrax and bio-terrorism
- Nosocomial infections
- Oral diseases
- Disaster management.
Needless to say, the above will be duly incorporated in the next edition.
The chapter on epidemiological study design has been kindly written by Dr Suresh Kumar Rathi, Asst. Prof of Epidemiology, Department of Community Medicine, CU Shah Medical College, Surendra Nagar, Gujarat. The remaining chapters have been written by me with invaluable inputs from my son, Dr Namit Gupta, junior resident in AIIMS. To both of them, I am extremely grateful.
I am also grateful to the students and faculty members who suggested the inclusion of the above topics based upon their felt needs. Last, but not the least, it is the good fortune of both the readers and the authors that this book has dynamic and resourceful publishers who are ever-willing to respond to the needs of their clients and are prepared to shoulder the extra burden of bringing out a comprehensive addendum.
It is hoped that this effort will be useful in its purpose. Readers may kindly feel free to communicate any suggestions to me at the e-mail ID given below. All communications would be gratefully acknowledged and promptly responded to.
MC Gupta
10Preface to the First Edition
Preventive and social medicine is one of the most important subjects in the curriculum of a medical student. Unlike other subjects, preventive and social medicine, community medicine and community health are the concern not only of those specialising in these fields but of all others in the medical profession, including those engaged in active clinical care as well as the health administrators. As a matter of fact, the subject is of serious concern to all interested in human health and welfare, whether in the medical profession or not. The present book is patterned on the earlier book Preventive and Social Medicine in India by Prof BK Mahajan, published in 1972. However, the marked developments in the subject during the last 20 years have necessitated extensive changes and additions. Hence, this volume is presented as a new book in its first edition. The entire approach is epidemiological and the subject matter is presented in a linked and continuous manner. The language and style are simple, and attractive with emphasis on practical aspects which may be of utility not only to PHC medical officers and health administrators but even to general practitioners.
The whole book is divided into four parts. The first part deals with the general aspects of preventive and social medicine and its scope. The second part, comprising two-third of the book, is built around the epidemiological triad. The third part deals with demography, vital statistics and biostatistics. The fourth part is devoted to health care of different groups, and includes detailed discussion of primary health care, health policy and the relation between health and development. The above division is objective and purposeful. It makes the reader familiar with the essential course content of community medicine, inculcates in him the epidemiological approach to health and disease, and prepares him to practise family medicine as a family physician. A chapter on general practice has been added for this purpose.
Though the book is primarily written for the undergraduate students, it would be of use to the postgraduate students as well. The number of references has been kept to a minimum. Only those references have been included which substantiate a controversial or less widely-known point, or which relate to recent work or review.
Interrelation between health and development, health manpower planning, communicable disease epidemiology in natural disasters, mental health program and the program for control of acute respiratory infections have been discussed in detail. The national ICDS program has been given adequate coverage. Care has been taken to include practical aspects in relation to diagnosis and management of leprosy, which may have to be tackled by many PHC medical officers and general physicians. Special attention has been paid to the chapters on social environment, host factors and health, non-communicable diseases, food and nutrition, demography and vital statistics, health policy, planning management and administration, primary health care, health education, information and communication, maternity and child health, school health, geriatrics, mental health and health service through general practitioners so as to present the concerned topic in a most up-to-date and easily comprehensible manner.
Some sections, such as those relating to water supply and disposal of wastes, could have been reduced further by omitting certain details; the latter have been retained in view of the requirement of public health administrators. The existing curricula of various universities, as also the suggestions from eminent professors, have been given due consideration while preparing this book. We shall feel amply rewarded if this book is found useful for students, teachers, public health administrators and PHC medical officers.11
We are grateful to a large number of colleagues in different parts of India who spared their valuable time and effort to go through the manuscript, offered constructive suggestions and incorporated appropriate changes wherever necessary. These include Prof YL Vasudeva and Prof Sunder Lal (Rohtak), Prof RD Bansal and Prof SC Chawla (LHMC, Delhi), Prof OP Aggarwal (UCMS Delhi), Prof G Anjaneyulu (Hyderabad), Dr GS Meena (MAMC, Delhi), Prof IC Verma, Dr Bir Singh and Dr Ravi Gupta (AIIMS, Delhi), Dr GVS Murthy and Dr K Madhavani (Wardha), Dr LN Balaji (UNICEF) and Prof KK Wadhera (CMC, Ludhiana). Prof Bansal, Prof Anjaneyulu and Prof Wadhera, in particular, took special pains to go through the entire manuscript critically at various stages of preparation. We owe special gratitude to Prof G Anjaneyulu, for writing a foreword for the book after going through the entire manuscript.
We are thankful to the American Public Health Association, Washington, and the Institute of Health and Nutrition, Delhi, for permission to reproduce certain portions of the text from their publications. Reference to original source has been made wherever this has been done. We must thank to Jaypee Brothers Medical Publishers Pvt Ltd, who have done a marvellous job in record time, in spite of delay from our side. We must also acknowledge the contribution of our typists Shri Rameshwar Dayal and Shri Murli Manohar, whose excellent typing skills greatly reduced the drudgery associated with drafting and redrafting of a manuscript. Lastly, we must express our heart-felt thanks and indebtedness to our wives who silently, and sometimes not so silently, suffered—their husbands continuously lost in books, papers and proofs in utter disregard of their domestic responsibilities.
BK Mahajan
MC Gupta
12Acknowledgements
Several colleagues have contributed to the third edition. Dr GVS Murthy, Assistant Professor (Community Ophthalmology), AIIMS, has written the chapters on “Concepts in community medicine” and “Research methodology”. He has revised and updated the chapters on “Respiratory infections” and “Arthropod borne diseases”. He has also written the sections on Epidemiology of blindness (Chapter 20) and National blindness control program (Chapter 27). Shri BBL Sharma, Assistant Professor (Health Economics), NIHFW, has partly written the chapter on “Health Economics”. Dr SS Dipti, Senior Lecturer, Medical College, Amritsar, has greatly expanded the chapter on “Social Environment”. Dr Neeraj Sethi, Reader (MCH), NIHFW, has revised and updated the chapter on “MCH”.
Data from a large number of national and international publications have been incorporated in the book. Proper references have been given at all places and the sources have been duly acknowledged. Any lapse in doing so is purely unintentional.
Shri Namit Gupta (first author's son), studying at SMS Medical College, Jaipur, has been a source of great help during the preparation of this edition.
The authors wish to thank Shri Narender Gupta, who put the manuscript on the word processor with amazing speed and accuracy. His regularity and punctuality greatly helped in the timely completion of the task.
The authors also wish to compliment the publishers, Jaypee Brothers Medical Publishers Pvt Ltd, for bringing out this edition of the book in a highly attractive, revised format.