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Community Medicine with Recent Advances
AH Suryakantha
SECTION 1: BASIC CONCEPTS OF COMMUNITY MEDICINE
CHAPTER 1:
Introduction to Community Medicine
HYGIENE
PREVENTIVE MEDICINE
SOCIAL MEDICINE
Social Anatomy
Social Physiology
Social Pathology
Social Therapy
COMMUNITY DIAGNOSIS
Community and Hospital Medicine
CHAPTER 2:
Concept of Health
INTRODUCTION
PHYSICAL DIMENSION
MENTAL DIMENSION
SOCIAL DIMENSION
SPIRITUAL DIMENSION
EMOTIONAL DIMENSION
VOCATIONAL DIMENSION
POSITIVE HEALTH
WELL-BEING
Objective Component
Subjective Component
HUMAN DEVELOPMENT INDEX
GDP
HDI
SPECTRUM OF HEALTH
DETERMINANTS OF HEALTH
Genetic (Biological) Factors
Environmental Factors
Life Style (Way of Living)
Socioeconomic Conditions
Education
Occupation
Income
Health Services
Aging of the Population
Other Factors
INDICATORS OF HEALTH
Uses
Mortality Indicators
Morbidity Indicators
Disability Rates
Nutritional Status Indicators
Health Care Delivery Indicators
Utilization Rates
Indicators of Social and Mental Health
Socioeconomic Indicators
Health Policy Indicators
Environmental Indicators
Indicator of Quality of Life
Other Indicators
CHAPTER 3:
Concept of Disease
INTRODUCTION
THEORIES OF DISEASE CAUSATION
Old Theories
Germ Theory of Disease
Limitations of Germ Theory
EPIDEMIOLOGICAL TRIAD
Theory of Multifactorial Causation (Web of Causation)
NATURAL HISTORY OF DISEASE
Prepathogenesis Phase
Agent Factors
Host Factors
Environmental Factors
Risk Factors
Risk Groups (Susceptible Population)
Pathogenesis Phase
ICEBERG PHENOMENON OF DISEASE
CHAPTER 4:
Concept of Prevention
INTRODUCTION
PRIMARY PREVENTION
Health Promotion
Specific Protection
PRIMORDIAL PREVENTION
Population Strategy
High-risk Strategy (Individual Strategy)
SECONDARY PREVENTION
Early Diagnosis and Prompt Treatment
TERTIARY PREVENTION
Disability Limitation
Rehabilitation
SECTION 2: ENVIRONMENT AND HEALTH
CHAPTER 5:
Environment and Water
INTRODUCTION
PHYSICAL ENVIRONMENT
BIOLOGICAL ENVIRONMENT
SOCIAL ENVIRONMENT
CULTURAL ENVIRONMENT
WATER
WATER CYCLE
Merits of Ground Water
Demerits of Ground Water
WELL
Shallow Well
Deep Well (Driven Well)
Differences between Shallow Well and Deep Well
Artesian Well
Sanitary Well
Location
Construction
Protection
HEALTH HAZARDS OF WATER CONTAMINATION
Biological Hazards
Chemical Hazards
PURIFICATION OF WATER
PURIFICATION OF WATER ON LARGE SCALE
Storage
Filtration
Modified Filters
Differences between Slow Sand Filters and Rapid Sand Filters
Chlorination
Action of Chlorine
Principles of Chlorination
PURIFICATION OF WATER ON SMALL SCALE
Household Purification of Water
Physical Methods
Chemical Methods
Mechanical Methods
Demerits of Reverse Osmosis (RO) Purifiers
Ultraviolet Purifiers
Chemical Purifiers
Disinfection of Wells
Horrock's Apparatus
Procedure of Disinfection of Well
Continuous Method of Chlorination
Sanitation of the Swimming Pool
Sanitation Measures
Maintenance of Cleanliness
HARDNESS OF WATER
Definition
Causes
Types
Measurement
Grading of Hardness of Water
Advantages of Hard Water
Disadvantages of Hard Water
Removal of Hardness
CONSERVATION OF WATER RESOURCES
Protection of Water Resources
Building-up of Subsoil Water Reserves
SANITARY ANALYSIS OF WATER
Field Survey
Laboratory Examination of Water Samples
Collection of Sample of Water
Sampling Technique
LABORATORY EXAMINATION OF WATER
Physical Examination of Water
Chemical Examination of Water
Biological Examination of Water
Bacteriological Examination of Water
Fecal Streptococci
Clostridium perfringens
Plate Count (Colony Count)
Standard Tests for Members of Coliform Group
Interpretation of Results of Disinfected Water
Tests for the Presence of Fecal Streptococci and Cl. perfringens
Radiological Examination of Water
Virological Examination of Water
CHAPTER 6:
Air and Ventilation
INTRODUCTION
CHANGES IN THE AIR DUE TO HUMAN OCCUPANCY
EFFECTS OF VITIATED AIR
INDICATORS OF THERMAL COMFORT
Air Temperature
Air Temperature and Humidity
Air Temperature, Humidity and Air Movement
Effective Temperature
Corrected Effective Temperature
McArdle's Maximum Allowable Sweat RATE
Comfort Zone
AIR POLLUTION
Air Pollutants
Chemical Pollutants
Biological Pollutants
Sun Light
Temperature Inversion
Sources of Air Pollution
Hazards of Air Pollution
Immediate and Acute Effects
Delayed and Chronic Effects
Global Effects of Air Pollution
Indicators of Air Pollution
Prevention and Control of Air Pollution
Engineering Technology
Legislations Measures
General Measures
VENTILATION
Standards of Ventilation
Fresh Air Supply
Systems of Ventilation
Natural Ventilation
Artificial Ventilation (Mechanical Ventilation)
CHAPTER 7:
Noise
INTRODUCTION
Frequency
Intensity
NOISE LEVEL VALUES
INSTRUMENTS USED IN THE STUDY OF NOISE
HAZARDS OF NOISE POLLUTION
Auditory Effects
Quantifiable
Nonquantifiable
Nonauditory Effects
PREVENTION AND CONTROL OF NOISE POLLUTION
Control of Noise at Source
Increasing the Distance
Reduction of Exposure Time
Acoustic Barrier
Miscellaneous Measures
CHAPTER 8:
Light
INTRODUCTION
MEASUREMENT OF LIGHT
NATURAL LIGHTING
Measures to Improve Natural Lighting
ARTIFICIAL LIGHTING
Other Sources of Artificial Light
HEALTH HAZARDS OF LIGHTING
Biological Effects
CHAPTER 9:
Radiation
INTRODUCTION
NONIONIZING RADIATIONS
Ultraviolet Rays
Sources
High-Risk Persons
Hazards
On the Skin
On the Eyes
Prevention
Visible Light
Hazards
Infrared Rays
Hazards
Microwaves
Radiofrequency Waves
Laser Radiations
IONIZING RADIATIONS
Electromagnetic Radiations
Corpuscular Radiations (Particulate Radiations)
Radiation Units
Sources of Ionizing Radiations
Health Hazards of Ionizing Radiations
Epidemiological Points
PREVENTION AND CONTROL OF RADIATION HAZARDS
Primary Prevention
Safety of the Machine
Safety of the Worker
Safety of the Environment
Other Measures
Secondary Prevention
CHAPTER 10:
Housing
INTRODUCTION
REQUIREMENTS OF A HOUSE
HOUSING STANDARDS
HOUSING AND HEALTH
Standards of Rural Housing
INDICATORS OF HOUSING
Physical Indicators
Economic Indicators
Social Indicators
HOUSING PROBLEM
Measures to Solve the Housing Problem
CHAPTER 11:
Meteorology
INTRODUCTION
ATMOSPHERIC PRESSURE
Aneroid Barometer
Barograph
Effects on Health
Effects of Diminished Atmospheric Pressure
Effects of Increased Atmospheric Pressure
Management
AIR TEMPERATURE
Measurement
Health Hazards of Air Temperature
Effects of High Temperature
Effects of Low Temperature
HUMIDITY
Absolute Humidity
Relative Humidity
Measurement
Dry and Wet Bulb Hygrometer
Sling Psychrometer
AIR MOVEMENT
CHAPTER 12:
Disposal of Wastes
REFUSE
Health Hazards
Storage of Refuse
Collection of Refuse
METHODS OF REFUSE DISPOSAL
Dumping
Controlled Tipping (Sanitary Landfill)
Composting
Manure Pits
Burial
Incineration
RECYCLING OF REFUSE
DISPOSAL OF EXCRETA
Sanitation Barrier
Methods of Disposal of Excreta (Night Soil)
Bore Hole Latrine (Earth Pit Deep Latrine)
Dug Well or Pit Latrine
Waterseal Type of Latrines
Trap
Septic Tank Latrine
Aqua Privy (Aqua-Water; Privy-Latrine)
Chemical Closet
Sanitary Temporary Latrines for Fair, Mela, Camp, etc.
Biogas Plant
Composting
WATER CARRIAGE SYSTEM (SEWERAGE SYSTEM)
House Drainage
Water Closet
Soil Pipes
House Drain
Public Sewer
Sewer Appurtenances
DISPOSAL OF SULLAGE
Soakage Pit
DISPOSAL OF SEWAGE (SEWAGE TREATMENT)
Objectives of Sewage Treatment
Biochemical Oxygen Demand
Chemical Oxygen Demand
Suspended Solids
TREATMENT OF SEWAGE
Primary Treatment
Secondary Treatment
Biofiltration
Bioaeration
Secondary Sedimentation
Sludge Digestion
Other Methods of Sewage Disposal
Sewage Dilution
Sewage Lagoon
Sewage Farming
CHAPTER 13:
Management of Hospital Waste
INTRODUCTION
CHARACTERISTICS OF HEALTH CARE WASTE
QUANTITY OF HEALTH CARE WASTE
OBJECTIVES OF THE WASTE MANAGEMENT SYSTEM
SAFE WASTE MANAGEMENT PRACTICES HELPS
LEGISLATIVE FRAMEWORK
Categories of Waste
STRATEGIES ADOPTED FOR HOSPITAL WASTE MANAGEMENT
Waste Reduction and Management Strategy
Waste Assessment Strategy
Waste Recycling Strategy
Hospital Waste Disposal
Collection of Wastes
Source Segregation
Transportation
Storage
Treatment
AVAILABLE TREATMENT AND DISPOSALTECHNOLOGIES
Newer Technologies
EXISTING AVAILABLE TECHNOLOGIES
Incineration (Mass Burn Technology)
Double Chamber Pyrolitic Incinerator
Function
Design
Standards for Incinerators
Operating Standards
Emission Standards
Single Chamber Incinerator
Rotary Kiln Incinerator
Chemical Disinfection
Wet and Dry Thermal Treatment
Wet Thermal Treatment (Autoclaving)
Dry Thermal Treatment (Screw-feed Technology)
Deep Burial
Standards for Deep Burial
Landfilling
Worm Composting
Microwave Irradiation
Plasma Torch Technology
Pros and Cons at Plasma Torch Technology
Locations of Current Facilities of PTT
Inertization
Hydroclave
Advantages of Hydroclave
Comparison between Hydroclave, Autoclave and Microwave
DO'S AND DON'TS OF HEALTH CARE WASTE
Do's
Don'ts
Waste Sharps Management
Decontamination Procedure
Chemical Treatment
Autoclaving
Plastic Waste Management
Shredding
Plastic Shredder
SUMMARY
CHAPTER 14:
Electronic Waste Management
E-WASTE BURDEN GLOBALLY
BURDEN IN INDIA
SOURCES OF E-WASTE
Individuals and Small Businesses
Large Businesses, Institutions and Establishments
Original Equipment Manufacturers
IMPACTS/HAZARDS OF E-WASTE
Effects on Environment
Effects on Health
BASEL CONVENTION
WASTE MINIMIZATION TECHNIQUES
MANAGEMENT OF OPTIONS
E-WASTE DISPOSAL
E-waste Recycling
Steps in Recycling
Landfilling
Incineration
Reusing
CHAPTER 15:
Medical Entomology
CLASSIFICATION OF ARTHROPODS
ARTHROPOD BORNE DISEASES
Common Terms Used in Entomology
Extrinsic Incubation Period
Infective Mosquito
Infected Mosquito
Definitive Host
Intermediate Host
Infestation
Metamorphosis
PRINCIPLES OF ARTHROPOD CONTROL
Arthropods of Public Health Importance
MOSQUITOES
Morphology
Head
Thorax
Life Cycle and Life Habits
Egg Stage
Larva Stage
Pupa Stage
Adult Stage
Classification of Mosquitoes
Control of Mosquitoes
Antilarval Measures
Antiadult Measures
Personal Protection
Remote Sensing in Vector Control
Integrated Vector Control
FLIES
Housefly (Musca Domestica)
Head
Thorax
Abdomen
Life Cycle
Bionomics
Mechanism of Transmission of Diseases
External Carriage System
Internal Carriage System
Control Measures
Sandfly
Public Health Importance
Life History
Control Measures
Tsetse Fly (Glossina)
Morphology
Life History
Control Measures
Black Fly
FLEAS
Rat Fleas
Morphology
Head
Thorax
Abdomen
Life History
Breeding Places
Egg Stage
Larval Stage
Pupal Stage
Adult Stage
Modes of Transmission of Disease
Biologically
Mechanically
By Defecation
Flea Indices
Control Measures of Fleas
LICE
Morphology
Life Cycle
Egg Stage
Larva or Nymph Stage
Adult (Imago) Stage
Diseases Transmitted
Pubic Louse (Phthirus Pubis; Crab Louse)
Control Measures of Lice
BUGS
Bedbugs
Bionomics
Control Measures
Triatoma Bugs (Reduviid Bugs)
Morphology
Life Cycle
Control Measures
TICKS
Morphology
Life Cycle
Control Measures
MITES (CHIGGERS)
Trombiculid Mites (Harvest Mites)
Life Cycle
Diseases Transmitted
Control Measures
Itch Mites (Sarcoptes Scabiei: Acarus Scabiei)
Morphology
Life Cycle
Control Measures
Other Mites
Dust Mite (Dermatophagoides Pteronyssinus)
Blood Sucking Mite
CYCLOPS (WATER FLEA)
Morphology
Life Cycle
Control Measures of Cyclops
DISINSECTION
Insecticide Formulations
Solutions
Suspension
Emulsion
Dust
Granules
Disinsection Equipment
Sprayers
Duster
Disinsection Methods
Space Spraying
Residual Spraying
Area Spraying
INSECTICIDE TOXICITY
Organochlorine Compounds
Treatment
Organophosphorus Compounds and Carbamates
Treatment
Pyrethrins and Pyrethroids
SECTION 3: NUTRITION AND HEALTH
CHAPTER 16:
Nutrition and Health
INTRODUCTION
Food
Nutrient
Nutrition
Dietetics
Balanced Diet
CLASSIFICATION OF FOODS
NUTRIENTS
Macronutrients
Micronutrients
PROTEINS
Supplementary Actions of Proteins
Functions of Proteins
Daily Requirement
Mixed Vegetable Proteins (Vegetable Blends)
Evaluation (Assessment) of Proteins
Digestibility Coefficient
Biological Value
Net Protein Utilization (NPU)
Essential Amino Acid Score (Chemical Score)
Protein Efficiency Ratio
Protein Energy Ratio
FATS
Functions of EFA
Sources of Fats (Table 16.2)
Animal Sources
Vegetable Sources (Edible Oils)
Functions
Hydrogenation of Oils
Refined Oils
Daily Requirement
Applied Aspects
CARBOHYDRATES
Functions
Sources
Carbohydrate and Disease
Dietary Fiber
Functions
VITAMINS
FAT SOLUBLE VITAMINS
Vitamin A
Functions
Sources
Animal Sources (as Retinol)
Vegetable Sources (as β-carotene)
Extraocular Manifestations
Assessment of Vitamin A Deficiency
Hypervitaminoses A
Vitamin D
Functions
Sources (Table 16.6)
Deficiency
Rickets
Investigations
Daily Requirement (Table 16.7)
Hypervitaminosis D
Vitamin E (Tocopherol)
Vitamin K
WATER SOLUBLE VITAMINS
Vitamin B Complex Group
Thiamine (Vitamin B1)
Deficiency
Riboflavin (Vitamin B2)
Niacin (Nicotinic Acid) (Vitamin B4)
Pyridoxine (Vitamin B6)
Folic Acid (Pteroylglutamic Acid; Folacin) (Latin, Folia = Leaf)
Cyanocobalamin (Vitamin B12)
Vitamin C (Ascorbic Acid)
Sources
MINERALS
Calcium
Iron
Iodine
Sources
Iodine Cycle
Grading of Goiter (WHO 1994)
Fluorine
Laboratory Investigations
Fluoride Testing
Prevention and Control
OTHER TRACE ELEMENTS
Zinc
Copper
Cobalt
Chromium
Selenium
Ultratrace Minerals
Antioxidants
FOOD GROUPS
Cereals
Rice
Milling
Parboiling
Effect of Parboiling
Wheat
Maize (Corn; Bhutta)
Millets
Jowar (Sorghum; Kaffir Corn; Milo)
Ragi
Pulses (Legumes)
Vegetables
Green Leafy Vegetables (GLVs)
Other Vegetables
Roots and Tubers
Nuts and Oil Seeds
Groundnuts (Peanuts; Monkey Nuts)
Fruits
Milk and Milk Products
Milk Products
Types of Milk (Derived Milk)
Milk Standards
Egg, Meat and Fish
Egg
Fish
Meat
Fats and Oils
Sugar and Jaggery
Condiments and Spices
Miscellaneous
Coffee, Tea and Cocoa
Soft Drinks
Alcoholic Beverages
Salt
ENERGY REQUIREMENTS
BALANCED DIET
Suggested Substitution for Nonvegetarians
FOOD HYGIENE
Food Additives
Food Preservation
Objectives
Principles of Food Preservation
Methods of Food Preservation
Food Processing
Sanitation of Food Establishments (Restaurants, Eating Houses)
Conservation of Nutrients
Before Cooking
During Cooking
After Cooking
Food Fortification
Food Adulteration
Tests for Adulterants
Milk Hygiene
Pasteurization
Sterilization
Tests for pasteurization
Meat Hygiene
Inspection of Animals (Antemortem Examination)
Inspection of Meat (Postmortem Examination)
Slaughter Houses
Inspection of Fish
Tinned Meat and Fish
Food Allergy
FOOD RELATED DISEASES (PUBLIC HEALTH NUTRITION PROBLEMS)
Deficiency Diseases
Protein Energy Malnutrition
Vitamin Deficiency Diseases
Strategy
Disability Limitation
Mineral Deficiency Diseases
Twelve by Twelve Initiative
Excess of Food Consumption
Food-borne Intoxications
Lathyrism (Lathyriasis)
Epidemic Dropsy (Argemone Poisoning)
Prevention and Control Measures
Endemic Ascites
Toxic Polyphenols
Aflatoxicosis
Ergotism
Food Poisoning
Classification of Food Poisoning
Investigation of an Outbreak of Food Poisoning
Prevention and Control
Food-borne Diseases
Assessment of Nutritional Status
Direct Methods of Assessment
Thickness of Skin-fold (Tissue Anthropometry)
Indirect Method of Assessment
Assessment of Ecological Factors
DIET SURVEY
Oral Questionnaire Method
Questionnaire Method
Food Inventory or Log Book Method
Food List Method
Weighment of Raw Foods
Weighment of Cooked Foods (Recipe Method)
Analysis of the Cooked Food
Points to be noted while doing Diet Survey
INDICATORS OF MALNUTRITION
NUTRITIONAL SURVEILLANCE
NATIONAL NUTRITION POLICY
Introduction
Strategies
Direct Short-term Strategies
Indirect Long-term Strategies
Implementation
National Programs on Nutrition
ANNEXURE
SECTION 4: OCCUPATIONAL HEALTH
CHAPTER 17:
Occupational Health
INTRODUCTION
BURDEN OF OCCUPATIONAL DISEASES
Aims
Objectives
ERGONOMICS
Working (Occupational) Environment
OCCUPATIONAL HAZARDS
Physical Hazards
Chemical Hazards
Biological Hazards
Mechanical Hazards
Psychosocial Hazards
Other Hazards
PNEUMOCONIOSES
Silicosis
Importance
Pathology and Pathogenesis
Incubation Period
Clinical Features
Diagnosis
Complications
Management
Anthracosis (Coal Workers’ Pneumoconiosis)
Pathology
Pathogenesis
Asbestosis
Clinical Features
Byssinosis
Bagassosis
Farmer's Lung
Prevention of Control of Pneumoconioses
Mass Sociogenic Illness
LEAD POISONING (PLUMBISM)
Sources of Lead
Absorption, Storage and Elimination
Clinical Features of Plumbism
Inorganic Lead Poisoning
Organic Lead Poisoning
Other Epidemiological Features
Diagnosis (Table 17.5)
Management
Prevention and Control
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
Prevention of Plumbism among Children
Metal Fume Fever (Brass Founder's Ague)
OCCUPATIONAL CANCERS
Agent Factors
Environmental Factors
Influencing Factors
Features of Occupational Cancers
Prevention of Industrial Cancers
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
OCCUPATIONAL DERMATOSES
Host Factors
Prevention
Health Promotion Measures
Specific Protection
Early Diagnosis and Prompt Treatment
OCCUPATIONAL HEALTH IN AGRICULTURAL INDUSTRY
Prevention and Control of Agricultural Hazards
HAZARDS DUE TO INDUSTRIALIZATION AND URBANIZATION
Physical (Environmental) Hazards
Psychological Hazards
Social Hazards
Miscellaneous Hazards
ACCIDENTS IN INDUSTRIES
Factors—Responsible for Accidents
Causes
Human Factors
Environmental Factors
Prevention
OFFENSIVE TRADES AND OCCUPATIONS
Keeping of Animals
Slaughtering of Animals
Blood Boiling and Drying
Bone Boiling and Crushing
Gut Scraping
Fat and Tallow Melting (Soap Making)
Fellmongering
Tanning
Paper Mills
Oil Mills
Rice Mills
SICKNESS ABSENTEEISM
Extent of the Problem
Causes (Factors Influencing)
Preventive Measures (Reduction Measures)
WOMEN IN INDUSTRY
Menstruation and Dysmenorrhea
Pregnancy
Menopause
Ability of Women to Work
HEALTH STATUS OF INDUSTRY
PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS
Primary Prevention
Health Promotion of Workers
Specific Protection
Secondary Prevention
Tertiary Prevention
LEGISLATION
Indian Factories Act, 1948
Employees’ State Insurance ACT, 1948
Scope
Administration
Finance
Benefits to Employees
Sickness Benefit
Maternity Benefit
Disablement Benefit
Dependent's Benefit
Funeral Benefit
Medical Benefit
Miscellaneous Medical Benefits
Cost of Medical Benefit
Rehabilitation Benefit
Benefits to Employers
Workmen's Compensation Act, 1923
SOCIAL SECURITY
Social Insurance
Social Security for Industrial Workers
Social Security for Civil Servants
Social Security for General Public
Social Assistance
Difference between Social Insurance and Social Assistance (Table 17.8)
SECTION 5: EPIDEMIOLOGY
CHAPTER 18:
Principles and Practice of Epidemiology
EPIDEMIOLOGY
Definition
Events
Distribution
Determinants
Disease Frequency
OBJECTIVES OF EPIDEMIOLOGY
EPIDEMIOLOGICAL APPROACH
SCOPE OF EPIDEMIOLOGY
Measurements in Epidemiology
Rate
Ratio
Proportion
MEASUREMENT OF MORBIDITY
Incidence
Related Terms
Attack Rate
Secondary Attack Rate
Hospital Admission Rate
Prevalence
Differences between Incidence and Prevalence (Table 18.1)
Prevalence Rate
MEASUREMENT OF MORTALITY
Crude Death Rate
Definition
Specific Death Rate
Cause Specific Death Rate
Group Specific Death Rate
Specific Death Rate
Period Specific Death Rate
Case Fatality Rate
Proportional Mortality Rate
Survival Rate
Differences between Case Fatality Rate and Crude Death Rate (Table 18.2)
Standardized Death Rate (Adjusted Death Rate)
Direct Standardization
Indirect Standardization
EPIDEMIOLOGICAL STUDIES (METHODS)
Observational Studies
Descriptive Studies (Descriptive Epidemiology)
TIME DISTRIBUTION
Short-term Fluctuations
Common Source Repeated/Continuous Exposure Epidemic
Propagated Epidemic
Modern or Slow Epidemics
Periodic Fluctuations
Seasonal Trend
Cyclic Trend
Long-term Fluctuations (Secular Trend)
PLACE DISTRIBUTION
International Variations
National Variations
Rural-Urban Variations
Local Distribution of the Disease (in an Area)
PERSON DISTRIBUTION
Age
Sex
Marital Status
Occupation
Social Class
Behavior
Stress
Migration
Measurement of Disease
Making Comparison with Known Indices
Formulation of Etiological Hypothesis
Uses of Descriptive Epidemiology
ANALYTICAL STUDIES (ANALYTICAL EPIDEMIOLOGY)
Case-Control Study
Study-Design
Selection of Cases
Selection of Controls
Matching
Measurement of Exposure in Both the Groups
Analysis
Framework of Case-Control Study
Bias in Case—Control Study
Cohort Study
Study Design
Types of Cohort Studies
Prospective Cohort Study
Retrospective Cohort Study (Historical Cohort Study)
Combination of Retrospective and Prospective Cohort Studies
Steps in Cohort Study
Framework of Cohort Study
Advantages and Disadvantages of Cohort Studies
Differences between Case-control and Cohort Studies (Table 18.7)
EXPERIMENTAL EPIDEMIOLOGY (EXPERIMENTAL EPIDEMIOLOGICAL STUDIES)
Clinical Trial (Randomized Controlled Trial)
Drawing of Protocol
Selection of Reference Population
Randomization (Selection of Study and Control Group)
Manipulation or Intervention
Follow-up
Assessment of Outcome
Reporting
Field Trial
Community Trial
NONRANDOMIZED TRIALS
Uncontrolled Trials
Natural Experiments
Before and After Comparison Trials
ASSOCIATION AND CAUSATION
Association
Causation
Temporial Association
Strength of the Association
Specificity of the Association
Consistency of the Association
Biological Plausibility
Coherence of the Association
Spurious Association
Indirect Association
Direct (Causal) Association
One-to-one Causal Relationship
Multifactorial Causation
USES OF EPIDEMIOLOGY
CHAPTER 19:
Epidemiology of Infectious Diseases
COMMONLY USED TERMS
SURVEILLANCE
History of Surveillance
Objectives of Surveillance
Elements of a Surveillance System
Approaches to Surveillance (Data Collecting Procedures)
Analysis and Interpretation of Surveillance Data
Presentation of Surveillance Data
Improvement in the Surveillance System
Types of Surveillance
Attributes of Surveillance
Uses of Surveillance
Improvement in the Surveillance System
DYNAMICS OF DISEASE TRANSMISSION
Reservoir
Human Reservoir
Animal Reservoir
Soil Reservoir
Routes of Transmission
Direct Modes of Transmission
Indirect Modes of Transmission
Susceptible Host
INCUBATION PERIOD
Related Terms
Uses of Incubation Period (Table 19.2)
INVESTIGATION OF AN EPIDEMIC DISEASE
Importance
Objectives
Steps
PREVENTION AND CONTROL OF AN EPIDEMIC DISEASE
Elimination of Reservoir
Breaking of Channel of Transmission
Protection of Susceptibles
Immunization (Table 19.3)
IMMUNIZING AGENTS
Vaccines
Immunoglobulins
Human Normal Immunoglobulins and Human Specific Immunoglobulins
Anti-sera
Chemoprophylaxis
Adverse Events Following Immunization
IMMUNIZATION PROGRAM
Appraisal Points
COLD-CHAIN
Definition
Importance
Walk in Coolers (WIC)
Cold Box
Deep Freezer
Ice-lined Refrigerator
Refrigerator (Conventional)
Vaccine Carrier
Estimation of Requirements for Immunization
Estimation of Eligibles
Estimation of Vaccine Needs
Estimation of Requirements of Immunization Cards
Estimation of Cold Chain Requirements
Estimation of Vaccine Efficacy
SCREENING FOR DISEASE
Aim
Objective
Uses
Types of Screening
Mass Screening
High-risk Screening
Multipurpose Screening
Multiphasic Screening
Opportunistic Screening
Criteria for Screening
Disease
Screening Test
Interpretation
Exercise
Lead Time
DISINFECTION
Allied Terms
Types of Disinfection
Prophylactic Disinfection (Precurrent Disinfection)
Concurrent Disinfection (Concomitant Disinfection)
Terminal Disinfection
Classification of Disinfectants
Natural Disinfectants
Physical Disinfectants
Chemical Disinfectants
Solid Disinfectants
Liquid Disinfectants
Coaltar Disinfectants
Quaternary Ammonia Compounds
Iodine
Hydrogen Peroxide
Alcohol (Spirit)
Formalin
Gaseous Disinfectants
Standardization of Disinfectant
Miscellaneous Disinfectants
DISINFECTION PROCEDURES
High Level of Disinfection
HOSPITAL-ACQUIRED INFECTIONS (NOSOCOMIAL INFECTIONS)
Definition
Causes
Sources and Reservoirs of HAI
Mode of Transmission
Prevention and Control of Nosocomial Infections
Elimination of the Reservoirs or Sources
Breaking the Channel of Transmission
Protection of Susceptible Persons
Administrative Measures
EMPORIATRICS
Health Problems of Travelers
Problems Faced by Travelers
Health Advice to Travelers
INTERNATIONAL HEALTH REGULATIONS 2005
Evolution
Chapter I. General Provisions
Article 23: Health Measures on Arrival and Departure
Chapter III. Special Provisions for Travelers
Article 30: Travelers Under Public Health Observation
Article 31: Health Measures Relating to Entry of Travelers
Article 32: Treatment of Travelers
CHAPTER 20:
Epidemiology of Communicable Diseases
STORY OF SMALLPOX (VARIOLA MAJOR) (OBITUARY)
HUMAN MONKEYPOX
CHICKENPOX (VARICELLA; WATERPOX)
Host Factors
Pregnancy
Environmental Factors
Modes of Transmission
Pathology and Pathogenesis
Incubation Period
Clinical Features
Complications
Management
Prevention
Active Immunization
Passive Immunization
ACUTE RESPIRATORY INFECTIONS
Magnitude of the Problem
Classification
Etiological Classification
Anatomical Classification
WHO Classification
Etiology
Host Factors
Environmental Factors
Social Factors
Prevention and Control
Health Promotion
Specific Protection
Early Diagnosis and Prompt Treatment
Supportive Treatment at Primary Health Care Level
MEASLES (MORBILLI; RUBEOLA)
History
Extent of the Problem
Agent Factors
Reservoir of Infection
Host Factors
Environmental Factors
Pathogenesis
Incubation Period
Clinical Features
Complications
Respiratory Complications
Gastrointestinal Complications
Neurological Complications
Ophthalmic Complications
Management with Nursing Care
Prevention and Control
Measles Vaccine
Nature
Indication
Composition
Adverse Effects
Vaccine of Multiple Antigen (Combined Vaccine)
Passive Immunization
Other Points
Global Eradication of Measles by 2020
Progress
Requirements for Measles Eradication
Regional Measles Elimination
Next Steps
German Measles (Rubella)
History
Agent Factors
Environmental Factors
Clinical Features
Complications
Diagnosis
Congenital Rubella (Rubella Syndrome)
Prevention
MUMPS
Host Factors
Environment Factors
Clinical Features
Complications
Prevention and Control
INFLUENZA
History
Agent Factors
Morphology of the Virus
Antigenic Variations
Influenza Terminology
Human Seasonal Influenza
Avian Influenza (Bird Flu)
Pandemic Influenza
Epidemiology
Magnitude of Seasonal Influenza
Magnitude of Pandemic Influenza
Magnitude of Avian Influenza
Reservoir of Infection
Source of Infection
Communicability
Host Factors
Environmental Factors
Modes of Transmission
Clinical Presentation
Seasonal Influenza
Avian Influenza
Pandemic Influenza
Laboratory Diagnosis
Biosafety Measures
Tests
Case Definitions for Avian and Pandemic Influenza
Case Definition for Avian Influenza
Case Definition for Pandemic Influenza
Case Management
Supportive Treatment
Discharge Policy
General Precautions against Avian Flu
Immunization
Immunization against Pandemic Flu (Swine Flu)
Chemoprophylaxis
Control Measures of Avian Flu
Infection Control in Health Care Facility
Precaution Levels
Contact Precautions
Case Management during Pandemic
Nonpharmaceutical Interventions
Revised Guidelines by Ministry of Health and Family Welfare
Category-A
Category-B
Category-C
WHO Phasing of Pandemic Influenza
Preparedness and Response
Phase Descriptions
Hurdles in the Control of Influenza
DIPHTHERIA
Agent Factors
Host Factors
Environmental Factors
Modes of Transmission
Portal of Entry
Pathology and Pathogenesis
Clinical Features
Schick Test
Procedure
Interpretation
Treatment
Prevention and Control
Immunization
DPT Vaccine (Triple Antigen)
Instructions to the Parents
Community Diagnosis of Diphtheria
WHOOPING COUGH (PERTUSSIS)
Agent Factors
Reservoir
Infective Material
Period of Infectivity
Host Factors
Environmental Factors
Modes of Transmission
Incubation Period
Pathology and Pathogenesis
Clinical Features
Catarrhal Stage
Paroxysmal Stage (Spasmodic Stage)
Convalescent Stage
Complications
Management
Prevention
MENINGOCOCCAL MENINGITIS (CEREBROSPINAL FEVER OR CEREBROSPINAL MENINGITIS)
Distribution
Agent Factors
Causative Agent
Reservoir of Infection
Infective Material
Host Factors
Environmental Factors
Period of Communicability
Pathogenesis
Incubation Period
Clinical Features
Prognosis
Prevention and Control of Epidemic Meningitis
Haemophilus influenzae Meningitis
TUBERCULOSIS
Memorable Discoveries and Milestones
Tuberculosis: A Global Burden
Indian Scenario
Daily Burden in India
Points of Serious Concern
Epidemiological Indices (Measurement of TB)
Frequency of Infection
Frequency of Disease
Prevalence of Drug Resistant Cases
TB Mortality Rate
Agent Factors
Reservoir of Infection
Infective Material
Period of Infectivity
Host Factors
Incubation Period
Pathology and Pathogenesis
Clinical Features
Complications
Investigations
Sputum Examination
X-ray of the Chest
Tuberculin Test (Mantoux Test; PPD Test)
Interpretation of the Reaction
Prevention and Control
Elimination of Reservoirs
Chemotherapy
First-Line Drugs
Second-Line Drugs
Phases of Chemotherapy
Intensive Phase
Continuation Phase
Domiciliary Treatment
Treatment Regimens
Short Course Chemotherapy
Advantages of Short Course Chemotherapy (Compared to Long Course Chemotherapy)
Disadvantage
Breaking the Channel of Transmission
Protection of Susceptibles
General Measures
Specific Measures
BCG Vaccine
Nature
Indication
Diluent
Dose
Route
Schedule
Immunity
Complications
Newer Anti-TB Drugs
Review on National Tuberculosis Control Program
Revised National Tuberculosis Control Program
Strategies
Directly Observed Treatment-Short Course
Changes in Revised National Tuberculosis Control Program Policy
Points on Revised National Tuberculosis Control Program Treatment
Some Important Definitions Under Revised National Tuberculosis Control Program
Functions of Tuberculosis Unit
Screening of Contacts
TUBERCULOSIS AND HIV
Impact of HIV on TB
Impact of TB on HIV
Clinical Presentation
Management of HIV and TB
Magnitude of the Problem
Recent Advances in Multidrug Resistant TB Cases and Revised National Tuberculosis Control Program
Drug Resistance
Types
Extensively Drug Resistant TB
Importance
Magnitude of the Problem
Risk Factors (Causes)
Diagnosis
Case Finding Strategy
DOTS-Plus
Framework of DOTS-Plus
Anti-TB Drugs
Treatment of MDR-TB/XDR-TB
WHO Guidelines
Drug Dosages and Administration
Follow-up
Recording
Prevention of Spread of MDR-TB
WHO Stop TB Strategy
SEVERE ACUTE RESPIRATORY SYNDROME
Agent Factors
Reservoir
Age Incidence
Sex Incidence
Mode of Transmission
Infectious Material
Period of Infectivity
Incubation Period
Clinical Features
Prodromal Phase
Respiratory Phase
Investigations
Case Definition for Surveillance (WHO)
Treatment
Prevention and Control
Early Detection of Infection
Containment of Infection
Personnel Protective Attire
Care of the Environment
Hand Hygiene
Miscellaneous Measures
Instructions to House-hold Contacts
SARS—What We Need to Know?
TYPHOID FEVER
Milestones
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Treatment of Carriers
Instructions to Typhoid Carriers
Prevention of Carrier State
Source of Infection
Infective Material
Period of Communicability
Host Factors
Mode of Transmission
Pathology and Pathogenesis
Ileum
Spleen
Gallbladder
Incubation Period
Clinical Features
Investigations
Complications
Treatment
Prevention and Control
Elimination of Reservoir
Breaking the Channel of Transmission
Protection of Susceptibles
Cellular Extract Vaccine
ACUTE DIARRHEAL DISEASES
Magnitude of the Problem
Global
India
Causes of Diarrhea
Infectious Diarrhea
Viruses
Reservoir
Age Incidence
Sex Incidence
Environmental Factors
Predisposing Factors
Mode of Transmission
Related Terms
Secretory Diarrhea
Osmotic Diarrhea
Effects of Loss of Fluids and Electrolytes
Incubation Period
Clinical Features
Degree of Dehydration
Treatment Plan A (Prevention of Dehydration)
Best HAF is ‘Salt-Sugar Solution (SSS)’
Treatment Plan B (Correction of Some Dehydration)
Merits of ORT
Limitations of ORT
Maintenance of Hydration (i.e. by Treatment Plan A)
Treatment Plan C (Treatment of Severe Dehydration)
Dosage of IV Fluids
Prevention and Control
Elimination of Reservoirs
Restoration of Nutritional Status
Breaking the Channel of Transmission
Newer Antidiarrheal Vaccines
Rota Virus Vaccine
Rotarix
Rota Teq
ORT-Corner
CHOLERA
History
Magnitude of the Problem
Epidemiological Features
Agent Factors
Causative Agent
Serological Classification (Gardner and Venkataraman's Classification)
Period of Infectivity
Reservoir of Infection
Host Factors
Age and Sex
Environmental Factors
Season
Climate
Modes of Transmission
Predisposing Factors
Pathology and Pathogenesis
Incubation Period
Clinical Features
Laboratory Investigations
Method of Collection of Stools
Method of Collection of Water
Culture
Prevention and Control
Elimination of Reservoirs
Cases
Blocking the Channel of Transmission
Protection of Susceptibles
VIRAL HEPATITIS
Hepatitis A
Magnitude of the Problem
Agent Factors
Host Factors
Environmental Factors
Pathology and Pathogenesis
Clinical Features
Investigations
Prevention and Control
Hepatitis B
Synonyms
Magnitude of the Problem
Agent Factors
Host Factors
Modes of Transmission
Prevention and Control
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G
POLIOMYELITIS (Greek: Polio = Gray, Muellos = Marrow)
History
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Infective Materials
Period of Infectivity
Host Factors
Immunity
Environmental Factors
Risk Factors (Provocative Factors)
Modes of Transmission
Pathology and Pathogenesis
Clinical Spectrum
Polioencephalitis
Bulbar Poliomyelitis
Diagnosis
Management
Hydrotherapy (Treatment in Swimming Pool)
Prevention and Control
Immunization
Active Immunization
Merits
Demerits
Composition
Route
Schedule
Mechanism of Protection
Advantages of Oral Polio Vaccine
Associated Risk
Contraindications
Storage
Instructions to the Mother
Reasons of Vaccine Failures
Passive Immunization
Vaccine-Vial Monitor
How to read VVM?
Eradication of Poliomyelitis
Differential Diagnosis of Poliomyelitis
Transverse Myelitis
Traumatic Neuritis
Pulse Polio Immunization
DRACUNCULIASIS
Synonyms: Dracontiasis, Dracunculiasis, Guinea Worm Disease
Magnitude
Agent Factors
Agent
Life Cycle
In Man
In Cyclops
Reservoir of Infection
Host Factors
Incubation Period
Pathogenic Effects and Clinical Features
Laboratory Diagnosis
Management of a Case
Prevention and Control
National Guinea Worm Eradication Program (1983)
AMOEBIASIS
Agent Factors
Agent
Reservoir
Source of Infection
Infective Material
Period of Communicability
Age and Sex Incidence
Environmental Factors
Mode of Transmission
Pathology and Pathogenesis
Intestine
Liver
Lungs
Brain
Incubation Period
Clinical Features
Intestinal Amoebiasis
Amoebic Liver Abscess
Investigations
Examination of Stool
Examination of the Blood
Serological Tests
Liver Aspirate
Treatment
Prevention and Control
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
GIARDIASIS
Agent Factors
Agent
Trophozoite
Cyst
Life cycle
Reservoirs
Mode of Transmission
Host Factors
Incubation Period
Clinical Features
Complications
Diagnosis
Treatment
Prevention and Control
ASCARIASIS
Agent Factors
Agent
Life Cycle
Reservoir
Host Factors
Environmental Factors
Mode of Transmission
Incubation Period
Clinical Features
Laboratory Diagnosis
Direct Evidences
Indirect Evidences
Prevention and Control
ANCYLOSTOMIASIS
Distribution
Agent Factors
Agent
Life Cycle
Reservoir
Age and Sex Incidence
Occupation
Environmental Factors
Pathogenic Effects and Clinical Features
Clinical Features of Hookworm Infestation
Laboratory Diagnosis
Examination of Stool
Examination of Blood
Prevention and Control
Elimination of Reservoir
Blocking the Channel of Transmission
Protection of Susceptibles
TETANUS
History
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Occupation
Immunity
Mode of Transmission
Pathology and Pathogenesis
Incubation Period
Clinical Features
Differential Diagnosis
Treatment
Clinical Types of Tetanus
Prognosis
Prevention and Control
Health Promotion
Specific Protection
Guidelines for the Prevention of Tetanus in the Community
NEONATAL TETANUS
Extent of the Problem
Public Health Importance
Predisposing Factors
Pathology and Pathogenesis
Clinical Features
Elimination of Neonatal Tetanus
Strategies for the Elimination of NNT
MALARIA (Mala = Bad; Aria = Air)
History
Magnitude
Trend of Malaria
Agent Factors
Agent
Life History
Reservoir of infection
Host Factors
Predisposing Factors
Environmental Factors
Incubation Period
Clinical Features
Measurement of Malaria (Malariometry)
Prevalence Rates of Malaria
Incidence Rates of Malaria
Entomological Parameters (Vector Indices)
Prevention and Control
Elimination of Reservoirs
Breaking the Channel of Transmission
Personal Protection
National Antimalaria Program
LYMPHATIC FILARIASIS
History
Current Filariasis Situation
Socioeconomic Burden
Agent Factors
Reservoir of Infection
Host Factors
Social Factors
Environmental Factors
Vectors
Mode of Transmission
Pathogenesis
Clinical Features
Filaria Survey
Mass Blood Survey
Clinical Survey
Entomological Survey
Xenodiagnosis
Skin and Serological Tests
Filarial Indices
Newer Diagnostic Modalities
Control of Lymphatic Filariasis
Elimination of Reservoirs (i.e. Control of Parasites)
Breaking the Channel of Transmission
Protection of Susceptibles
Integrated Vector Control
National Filaria Control Program
PLAGUE
History
Agent Factors
Agent
Reservoir
Host Factors
Environmental Factors
Flea Indices
Modes of Transmission
Pathology and Pathogenesis
Incubation Period
Clinical Features
Bubonic Plague (Zoonotic Plague)
Septicemic Plague (Pestis Siderans)
Pneumonic Plague (Demic Plague)
Meningitis Plague
Laboratory Investigations
Prevention and Control
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
LEISHMANIASES
Visceral Leishmaniasis
Magnitude of the Problem
Agent Factors
Life Cycle
Reservoir of Infection
Host Factors
Environmental Factors
Miscellaneous Factors
Mode of Transmission
Incubation Period
Clinical Features
Prevention and Control of Kala-azar
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
ARBOVIRAL DISEASES
Classification of Arboviruses
Group A Viruses (Alpha Viruses)
Group B Viruses (Flavi-viruses)
Bunyamwera Super Group
Others
YELLOW FEVER
Distribution and Extent of the Problem
Agent Factors
Agent
Reservoir of Infection
Period of Communicability
Host Factors
Clinical Features
Investigations
Management
Prevention and Control
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
Personal Protection
Surveillance Program
International Certificate of Vaccination against Yellow Fever
Prevention of Yellow Fever in India
DENGUE FEVER
Magnitude of the Problem
Agent Factors
Pathophysiology
Clinical Features
Investigations
Management
Prevention and Control
JAPANESE ENCEPHALITIS
Agent Factors
Management
Prevention and Control
Safety Precautions
Instructions to the People
Epidemiological Points
Case Definition
CHIKUNGUNYA FEVER (EPIDEMIC POLYARTHRITIS)
Causative Agent
Reservoir
Vector
Extrinsic Incubation Period
Clinical Features
Prevention and Control
KYASANUR FOREST DISEASE
History
Agent Factors
Host Factors
Life Cycle
Incubation Period
Clinical Features
Investigations
Management
Prevention and Control
RICKETTSIAL DISEASES
EPIDEMIC TYPHUS
Prevention and Control
ENDEMIC TYPHUS
SCRUB TYPHUS
INDIAN TICK TYPHUS
ROCKY MOUNTAIN SPOTTED FEVER
RICKETTSIAL POX
TRENCH FEVER
Q-FEVER
Prevention and Control Measures
EXTENT OF THE PROBLEM
Agent Factors
Agent
Host Factors
Social Factors
Demographic Factors
International Travel
Changes in the Lifestyle
High-risk Groups
Prevention and Control
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of the Susceptibles
Other Measures
SYNDROMIC CASE MANAGEMENT OF RTIs/STIs (SYNDROMIC APPROACH)
Steps Involved in Adopting Syndromic Approach
Gathering Information for Syndromic Diagnosis of STDs
History Taking
Clinical Examination
Steps in Examining the Patient for STI Syndromes
Male Patients
Female Patients
Roles and Responsibilities of the Doctors while Caring for Patients with STI (6 Cs)
Advantages of the Syndromic Case Management
Disadvantages of the Syndromic Case Management
Managing STI using the Syndromic Approach
Seven Pre-packed STI/RTI Kits for Syndromic Management
Diagnosis and Treatment for Partners based on the First Patient
HUMAN IMMUNODEFICIENCY VIRUS (HIV)/ACQUIRED IMMUNODEFICIENCY SYNDROME
HISTORY
MAGNITUDE OF THE PROBLEM
INDIA
Agent Factors
Life Cycle of HIV
Infective Materials (Source of Infection)
High-risk Groups
Attributable Factor for HIV Transmission
Pathogenesis (Immunology) (Life Cycle)
Opportunistic Organisms
Clinical Spectrum of HIV/AIDS
Stage I: Acute Retroviral Syndrome (Seroconversion)
Stage II: Early Asymptomatic Disease (CD4 Count > 500 mm3) (Normal CD4 Count = > 600 mm3)
Stage III: Intermediate HIV Infection (CD4 Count 200-500/mm3)
Stage IV: Late Stage HIV Disease (CD4 Count 50-200 mm3)
Stage V: Advanced HIV Disease (CD4 Count < 50 mm3)
Diagnosis of HIV
Diagnosis of AIDS
Clinical Presentation of Children with AIDS
Major Signs
Minor Signs
Prevention and Control of AIDS
Elimination of Reservoirs
Caution
Goals of ART
Clinical Criteria to Start ART
Anti-retroviral Drugs
Dosage Schedule of First Line ARV Regimens
Indications for Changing Treatment
Second Line Regimen
Monitoring of ART Response
Immune Reconstitution Syndrome
Conditions Reported as IRS
Breaking the Channel of Transmission
Protection of Susceptible Persons
AIDS VACCINE
Major Challenges towards the Development of an Effective HIV/AIDS Vaccine
CLINICAL TRIAL ON AIDS VACCINE
Standard (Universal) Precautions
Disposal of Wastes (Explained under Management of Hospital Waste)
Disposal of Dead Bodies of Individuals who have Died of HIV/AIDS
Postexposure Prophylaxis
Steps of PEP
Parent to Child Transmission of HIV
Risk Factors for MTCT
Prevention of Mother to Child Transmission of HIV
Primary Prevention Strategies
Secondary Prevention Strategies
Measures of PMTCT during Breastfeeding
RABIES
Historical Perspective
Extent of the Problem
Etiology
Reservoir of Infection
Infective Material
Period of Infectivity
Susceptibility
Modes of Transmission
Route of Entry of Virus
Pathology and Pathogenesis
Incubation Period
Clinical Features
Clinical Features of Dumb Rabies (Paralytic Rabies)
Laboratory Diagnosis
Antemortem
Postmortem
Management of Hydrophobia Case
Prevention of Rabies in Man
Postexposure Prophylaxis
Principles of PEP
Wound Treatment (First Aid Treatment)
Observation of the Animal (Wherever Possible)
Antirabies Immunization
Indications for Antirabies Immunization
Situations where Antirabies Immunization is not Indicated/Required
Rabies Vaccine History
Vaccines Prepared from Animal Tissues
Vaccines Prepared from Primary Animal Cells (Modern Tissue or Cell Culture Vaccines)
Vaccines Prepared from Standardized Cell Lines (Cell Bank)
Active Immunization
Antirabies Vaccines (ARVs)
THERE IS NO SINGLE DOSE VACCINE OR A VACCINE GIVING LIFELONG IMMUNITY
Nerve Tissue Vaccines
Dosage Schedule
WHO Guidelines for Postexposure Treatment (PET)
Suckling Mouse Brain Vaccine
Duck Embryo Vaccine or Flury's Vaccine
Cell Culture Vaccines
Intramuscular Schedules
Intradermal Schedules
Failure with Cell Culture Vaccine
Passive Immunization
Advice to the Patient
Re-exposure to Rabies
Pre-exposure Immunization
Control of Rabies in Dogs
Personal Protection against Rabies
LEPROSY (In Greek, ‘Leper’ means Scaly)
History
Magnitude of the Problem
World
India
Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Race
Malnutrition
Immunity
Environmental Factors
Social Factors
Infectivity
Modes of Transmission
Pathology and Pathogenesis
Incubation Period
Classification of Leprosy (Clinical Spectrum of Leprosy)
WHO Classification
Field Workers’ Classification
Clinical Presentation
Case Evaluation
Bacteriological Examination
Lepromin Test
Applications
Clinical Spectrum (Figs 20.75 to 20.81)
Skin Lesions
Diagnosis
Diagnosis and Treatment Algorithm of Leprosy
Key Points
Investigations
Complications
Lepra Reactions
CONTROL OF LEPROSY
Medical Measures
General Measures
Early Case Detection
Chemotherapy
Definition of Terminologies (WHO) (Table 20.31)
STANDARD CHILD TREATMENT REGIMEN (10-14 YEARS)
For MB Leprosy
For PB Leprosy
Epidemiological Points
SUMMARY
Management of Leprosy Reaction
‘Candidate Vaccines’ against Leprosy
ICRC vaccine
M vaccae Vaccine
Chemoprophylaxis
Deformities in Leprosy (Flow chart 20.9)
Rehabilitation
Health Education
Key Messages
Social Measures
Managerial Aspects
Evaluation
Operational Indicators
Epidemiological Indicators
Leprosy Organizations in India
National Leprosy Eradication Program
National Leprosy Elimination Campaign
Myths and Realities of Leprosy Elimination
Leprosy Day
YAWS
Magnitude
Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Immunity
Social Factors
Environmental Factors
Modes of Transmission
Period of Communicability
Incubation Period
Clinical Features
Laboratory Investigation
Treatment
Eradication of Yaws
CHAPTER 21:
Epidemiology of Noncommunicable Diseases
NONCOMMUNICABLE DISEASES
Burden, Socioeconomic Implications, Policies and Program for Prevention and Control of Noncommunicable Diseases in India—A Report on National Summit on NCDs
National Response to Noncommunicable Diseases
FUTURE PLAN TO PREVENT AND CONTROL NONCOMMUNICABLE DISEASES
Approach
Programs
CORONARY ARTERY DISEASE ISCHEMIC HEART DISEASE
Predisposing Factors
Nonmodifiable Risk Factors
Modifiable Risk Factors
Prevention of Coronary Artery Disease
Primary Prevention
Primordial Prevention
Secondary Prevention
CONGENITAL HEART DISEASES
Acyanotic Heart Diseases (Left-to-Right Shunt)
Acyanotic Heart Diseases without a Shunt
Cyanotic Heart Diseases (Right-to-Left Shunt)
Altitude at Birth
Prematurity
Maternal Age
Sex of the Child
Prevention
RHEUMATIC HEART DISEASE
Agent Factor
Clinical Features
Major Manifestations
Minor Manifestations
Prevention of Rheumatic Fever and Rheumatic Heart Disease
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
HYPERTENSION
Classification
Magnitude
Rule of Halves
Tracking of Blood Pressure
Risk Factors
Nonmodifiable Risk Factors
Modifiable Risk Factors
Clinical Manifestations
Prevention of Hypertension
Primary Prevention (Primordial Prevention)
Secondary Prevention
Tertiary Prevention
STROKE
History
Classification
Ischemic Stroke
Hemorrhagic Stroke
Magnitude of the Problem
Epidemiology
Risk Factors
Signs and Symptoms
Diagnosis
Management
Prevention and Control
OBESITY
Body Mass Index
Limitations
Waist Circumference
Waist-hip Ratio
Risk Factors
Nonmodifiable Risk Factors
Modifiable Risk Factors
Health Hazards of Obesity
Prevention and Control
Aims
Strategies
Dietary Changes
Physical Activity
Health Education
Barrier Surgery
INTRODUCTION
Magnitude
Distribution
Risk Factors
Agent Factors
Host Factors
Environmental Factors
Pre-existing Conditions
Prevention and Control
Primary Prevention
Secondary Prevention
Tertiary Prevention
EPIDEMIOLOGY OF CANCER CERVIX
Agent Factor
Host Factors (Risk Factors)
Prevention and Control of Cancer Cervix
Primordial Prevention
Secondary Prevention
Tertiary Prevention
DIABETES MELLITUS
CLASSIFICATION OF DIABETES MELLITUS
Primary
Type 1
Type 2
Secondary
Pancreatic Pathology
Magnitude
Agent Factors
Host Factors (Risk Factors)
Age
Sex
Genetic Factors
Obesity
Pregnancy
Environmental Factors
Potential Diabetic
Latent Diabetic
INDIAN DIABETIC RISK SCORE (IRDS)(DEVELOPED BY MADRAS DIABETES RESEARCH FOUNDATION)
IDRS Analysis
Age
Waist Circumference
Physical Activity
Family History
Screening for Diabetes
Examination of Urine
Examination of Blood
Glucose Memory Test (Glycosylated Hemoglobin)
Prevention and Care
Primary Prevention/Primordial Prevention
Secondary Prevention
Tertiary Prevention
INTRODUCTION
Global Problem
India
Measurements of Accidents and Injuries
Mortality Indicators
Morbidity Indicators
Disability Rate
Types of Accidents
Agent Factors
Host Factors
Other Factors
Environmental Factors
Prevention
Safety Education
Safety Measures
Legislative Measures
INTRODUCTION
Extent of the Problem
Global
India
Causes
Refractive Error
Glaucoma
Causes in the Retina
Avoidable Blindness
Host Factors
Environmental Factors
Socioeconomic Status
Other Factors
Prevention and Control
Eye Care
Specific Ophthalmic Programs
Rehabilitation
Other Preventive Measures
Vision 2020: The Right to Sight
MOBILITY OF BLIND
Mobility with the Help of a Companion
Long Cane
Electronic Devices
Guide Dogs
Sensory Training and Mobility
Daily Living Skills
COMMUNITY OPHTHALMOLOGY
Synonyms
SECTION 6: HEALTH-RELATED DISCIPLINES
CHAPTER 22:
Maternal and Child Health Services (Preventive Obstetrics and Pediatrics)
MOTHER AND CHILD—ONE UNIT
Reasons
MCH Problems
Objectives of MCH Services
Components of MCH Services
Services to the Mothers
Services to the Children
SERVICES TO THE MOTHERS
Preconceptional Care
Antenatal Care (Care of the Mother During Pregnancy Period)
Objectives
Visits
Components of Antenatal Care
Prevention of Mother to Child Transmission of HIV (PMTCT)
Intranatal Care
Objectives
Clean and Safe Delivery
Prevention of Infections
Maternal Signals
Fetal Signals
Use of Partograph in the Management of Labor
Advantages of Domiciliary Care
Disadvantages
Advantages of Institutional Care
Disadvantages
Postnatal Care
Objectives
Promotion of Speedy Recovery Psychologically
Prevention of the Development of Postnatal Complications
To Check Adequacy of Breastfeeding
To Provide Family Welfare Services
To Provide Care of the Newborn
ESSENTIAL AND IMMEDIATE CARE OF THE NEWBORN
Objectives of the Neonatal Care
Care of the Eyes
Care of the Nose and Throat
Care of the Umbilical Cord
Care of the Rectum
Care of the Skin
Prevention of Neonatal Complications
Danger Signs of the Newborn
At-risk Newborns
LOW BIRTH WEIGHT BABY
Definition
Grading
Determinants of Birth Weight
Preterm Baby
Small for Date Baby
Synonyms
Importance
Computation of Low Birth Weight
Magnitude of the Problem
Causes
Medical Causes
Social Causes
Related Terms
Care of Low Birth Weight Babies
Normal Care at Home
Special Care at Home
Special Care in the Hospital (Intensive Neonatal Care)
Prevention of LBW Baby
KANGAROO MOTHER CARE
Components of Kangaroo Mother Care
Kangaroo Position
Kangaroo Feeding Policy
Early Discharge
Follow-up
Duration of Kangaroo Mother Care
Benefits of Kangaroo Mother Care
Parameters to be Monitored during Kangaroo Mother Care
FEEDING OF INFANT
Breastfeeding
Process
Physiology of Breastfeeding (Breastfeeding Reflexes)
Reflexes in the Baby
Reflexes in the Mother
Factors Affecting the Reflexes
Position and Technique of Feeding
Signs of Good Attachment (Fig. 22.11A)
Signs of Poor Attachment (Fig. 22.11B)
Right technique of Feeding in a Right Position of the Child is the Key to the Success of Breastfeeding
Exclusive Breastfeeding
Principles of Breastfeeding
Merits of Breastfeeding
Advantages to the Baby
Advantages of the Mother
Advantages to Both Mother and the Child
Advantages to the Family and Nation
Malpractices in Breastfeeding
Weaning
Dangers of Artificial Feeding
Demand Feeding
Technique of Feeding
Expression of Milk
Manual Expression
Mechanical Expression
Breast Problems
Common Problems
Breastfeeding under Special Conditions
Low Birth Weight Baby
New Pregnancy During Lactation
A Newborn with Cleft Lip or Palate or Both
RELACTATION
Induced Lactation
Baby Friendly Hospital Initiative
Aim
Objectives
Importance
Criteria for Recognition of the Hospital as ‘Baby Friendly’
Ten Steps
Benefits to the Hospitals
IMS-Act
The Act Prohibits
Penalty
Monitoring
Breastfeeding Promotion Network of India
Goals
GROWTH MONITORING
Important Growth Charts
The New WHO Growth Chart
New Growth Charts in India
Old Growth Charts Used in India
UNDER FIVES CLINIC
Importance
Aim
Functions
HANDICAPPED CHILDREN
Extent of the Problem
Problems of Having a Disability
Classification of Handicapped Children
Physically Handicapped Children
Mentally Handicapped Children (Mentally Retarded)
Socially Handicapped Children
Prevention of Handicap
Primary Prevention
Secondary Level of Prevention
Tertiary Level of Prevention
Child Placement Measures
JUVENILE DELINQUENCY
Causes
Prevention
CHILD GUIDANCE CLINIC
SCHOOL HEALTH SERVICES
Objectives
Components of School Health Program
Health Services
Healthful School Living (Healthful School Environment)
School Building
Healthful teaching
Mid-day Meal
Physical Education Procedures
Pupil-pupil Relation and Pupil-teacher Relation
Health Education
INDICATORS OF MCH CARE
Maternal Mortality Rate
Magnitude
Causes of Maternal Mortality
Reduction of Maternal Mortality Rate
Mortality During Infancy
Stillbirth
Formula
Causes
Perinatal Mortality Rate
Incidence
Causes of PMR
Prevention of PMR
Neonatal Mortality Rate
Formula
Causes
Prevention of Neonatal Mortality Rate
Postneonatal Mortality Rate
Formula
Causes
Infant Mortality Rate
Definition
Formula
Importance
Magnitude of the Problem
Causes of Infant Mortality
Predisposing Factors
Prevention of Infant Mortality Rate
Mortality Occurring during Childhood
One to Four Year Child Mortality Rate
Child Survival Index (Child Survival Rate)
RIGHTS OF THE CHILD
The Current Level and Goals of MCH Care
National Programs for the Welfare of Mothers and Children
Organization of MCH and FP Services
CHILD WELFARE AGENCIES
Activities
INTEGRATED MOTHER AND CHILD DEVELOPMENT SERVICES SCHEME (IMCDS SCHEME)
Aim
Objectives
Beneficiaries
Services
Nucleus
Key Person
Functions
Organization, Structure of ICDS Project
Anganwadi Worker/Teacher (AWW)
Supervisor (Mukhya Sevika)
Child Development Project Officer
Monitoring and Evaluation
Assistance
Kishori Shakti Yojana
Interventions
Administrative Set-up of ICDS (Table 22.3)
Introduction of WHO Growth Standards in ICDS
STREET CHILDREN
Government and Non-Government Responses
CHAPTER 23:
Demography
DEMOGRAPHIC CYCLE (DEMOGRAPHIC STAGES)
Stages of Demographic Cycle
SIZE OF THE POPULATION (MAGNITUDE OF THE POPULATION)
Census
Errors (Limitations) of Census
Uses of Census
POPULATION TREND IN THE WORLD
POPULATION TREND IN INDIA
COMPOSITION OF THE POPULATION
Age and Sex Composition (Population Pyramid)
Literacy Level
Dependency Ratio
Occupational Composition
Socioeconomic Status
Housing (Living Condition)
Marital Status
Religion
Languages Spoken
Life Expectancy (Expectation of Life)
Family Size
DISTRIBUTION OF THE POPULATION
Urbanization
Hazards of Urbanization
POPULATION DYNAMICS
Marriages
Marriage Rate
Fertility
MEASUREMENT OF FERTILITY (FERTILITY INDICATORS)
Crude Birth Rate
General Fertility Rate
General Marital Fertility Rate
Age Specific Fertility Rate
Age Specific Marital Fertility Rate
Total Fertility Rate
Total Marital Fertility Rate
Gross Reproduction Rate
Net Reproduction Rate
Child Woman Ratio
Pregnancy Rate
Abortion Rate
Abortion Ratio
MEASUREMENT OF MORTALITY
Death Rate
International Death Certificate
Infant Mortality Rate
Migration
POPULATION EXPLOSION (POPULATION BOMB)
Reasons for Population Explosion
Causes of High Birth Rate
Causes of Low Death Rate
Hazards of Population Explosion
POPULATION STABILIZATION
Reduction of Birth Rate
Nonbirth Control Measures
Birth Control Measures (Family Planning Methods)
CHAPTER 24:
Family Planning
NEED FOR FAMILY PLANNING
Demographic Grounds
Socioeconomic Grounds
Health Grounds
Women's Health
Fetal Health
Child Health
SCOPE OF FAMILY PLANNING SERVICES
Concept of Family Welfare
Eligible Couple
Couple Protection Rate
Target Couples
Unmet Need for Family Planning
CONTRACEPTIVE METHODS (FERTILITY REGULATING METHODS; TECHNIQUES OF BIRTH CONTROL)
Temporary (Nonterminal Methods; Spacing Methods)
Terminal (Permanent Methods; Sterilization Methods)
TEMPORARY METHODS
Barrier Methods
Physical Methods
Chemical Methods
Combined Methods
Intrauterine Devices
Types of IUDs
Mechanism of Action
Advantages
IUD Insertion
Indications for Removal of IUD
An Ideal IUD Candidate
Contraindications for IUD Insertion
Time of Insertion
Instructions Following IUD Insertion
Disadvantages (Side Effects and Complications)
Failure Rate
Restoration of Fertility after Removal
Hormonal Contraceptive Methods (Steroidal contraceptives)
Combined Oral Contraceptive Pills (COC Pills; Birth Control Pills)
Monophasic Pills
Triphasic Pills
Progestin Only Pills
Estrogen, Postcoital Pills (Emergency Oral Contraception)
High Dose Progesterone
High Dose Estrogens
Estrogen—Progesterone Combination (Yuzpe Method)
Once a Month Pill (Long Acting Pill)
Male Pill
Injectable Contraceptives
Subcutaneous Implants (Norplant Implants)
Vaginal Rings
Postconceptional Methods
Menstrual Regulation
Menstrual Induction
Induction of Abortion
Medical Abortion
Medical Abortion and the MTP-Act
Medical Termination of Pregnancy Act, 1971
Miscellaneous Methods
Abstinence
Coitus Interruptus
Fertility Awareness-based Methods
Lactational Amenorrhea Method
Nonhormonal, Long Acting Oral Pills
Birth Control Vaccines
TERMINAL METHODS
Vasectomy
Procedure
No Scalpel Vasectomy
Instructions after Surgery
Effectiveness
Merits
Demerits
Constraints
Tubectomy
Minilaparotomy (Pomeroy Technique or Interval Procedure)
Laparoscopy Procedure
Instructions after Surgery
Effectiveness
Merits
Demerits
EVALUATION OF CONTRACEPTIVE METHODS
CHAPTER 25:
Biostatistics
VARIABILITY
APPLICATIONS OF BIOSTATISTICS
Types and Sources of Data
Continuous Data
Discrete Data
Sources of Data
Experiments
Surveys
Records
Sources of Health Statistics
PRESENTATION OF STATISTICAL DATA
TABULATION
Qualitative Tables
Quantitative Tables
Cumulative Frequency Table
DIAGRAMMATIC PRESENTATION
Points to be Remembered in the Construction of a Diagram or Graph
Bar Diagrams/Charts
Histogram
Frequency Polygon
Frequency Curve
Line Diagram
Cumulative Frequency Curve or ‘Ogive’
Scatter Diagram or Dot Diagram
Pie Diagram
Pictogram
Map Diagram or Statistical Map
Spot Map (Geographic Spot Map)
Shaded Map
MEASURES OF CENTRAL TENDENCY
Mean
Median
Graphic Method for Locating the Median
Mode
MEASURES OF LOCATION—QUANTILES
MEASURES OF DISPERSION
Standard Deviation
Applications of Standard Deviation
Coefficient of Variation
PROBABILITY
Probability Distributions
Normal Distribution and Normal Curve
Binomial Distribution
Mean Features of the Binomial Distribution
Poisson Distribution
Skewed Distribution
SAMPLING
Characteristics of a Representative Sample
Census Enumeration v/s Sampling Enumeration
Sampling Designs (Sampling Methods; Sampling Techniques)
Types of Sampling Techniques
Simple Random Sampling
Systematic Sampling (Systematic Random Sampling)
Stratified Random Sampling
Multistage Sampling
Cluster Sampling
Multiphase Sampling
Nonprobability Sampling
Size of the Sample
Calculation of Sample Size for Qualitative Data
For Quantitative Data
Errors in Sampling
Sampling Errors
Nonsampling Errors
SAMPLING VARIATION
Standard Error of the Mean
Significance
NULL HYPOTHESIS (DENOTED AS H0)
TESTS OF SIGNIFICANCE
General Procedures for Testing a Hypothesis
Standard Error of the Mean (SE x)
Uses of SE
Calculation of SE of the Mean
Standard Error of the Difference between Two Means
Procedure
Standard Error of Proportion
Uses of Standard Error of Proportion
Standard Error of Difference between two Proportions
Conclusion
‘t’ Test (Student's “t” Test)
Degrees of Freedom
Chi-square Test (χ2 Test)
Applications of χ2 Test
Steps
Yate's Correction
Result
ANALYSIS OF VARIANCE
NONPARAMETRIC TESTS
Sign Test
Wilcoxon's Signed Rank Test
Mann-Whitney Test
CORRELATION AND REGRESSION CORRELATION
Interpretation of Bivariate Data
Scatter Diagram
Correlation Coefficient
Inference
REGRESSION
Regression Coefficient
Regression Equation
Nonlinear Regression
Multiple Correlation and Regression
Spearman's Rank Correlation Test
LIFE TABLE
Description
Column-1 (Age X)
Column-2 (lx)
Column-3 (qx)
Column-4 (dx)
Column-5 (Lx)
Column-6 (e0x) (Life Expectancy)
Uses of Life Table
ANNEXURE - I
Table of Unit Normal Distribution
ANNEXURE - II
Table of Random Numbers
ANNEXURE - III
Table of t Distribution
ANNEXURE - IV
Table of χ2 Distribution
ANNEXURE - V
Kendall's Table
CHAPTER 26:
Social Science
COMMUNITY
CULTURE
ACCULTURATION
FAMILY SYSTEM
FAMILY CYCLE
FAMILY TYPES
Nuclear Family (Elementary; Primary Family)
Extended Primary Family
Three Generation Family
Joint Family (Joint Extended Family)
Broken Family (Broken Home)
Problem Family
Differences between Joint Family and Nuclear Family System (Table 26.2)
FAMILY FUNCTIONS
Homely Life
Economic Security
Reproduction
Education
Socialization
Emotional Support
Social Care
Support
Bridging the Generation Gap
Job Distribution
ROLE OF FAMILY AND CULTURAL FACTORS IN HEALTH AND DISEASE
Health Perception
Housing Condition
Personal Hygiene
Child Rearing
Socialization
Personality Formation
Lifestyle
Dietary Practices
Disposal Practices
Reproductive Behavior
Care of the Sick and Injured
Stabilization of Adult Personality
SOCIAL PROCESS
Socialization
Role
Acculturation
Social Controls
Social Change
Social Stratification
Socioeconomic Status
Classification of Socioeconomic Status
Modified Method
Below Poverty Line
Health Hazards of Poverty
Social Class Difference in Health and Disease
SOCIAL FACTORS IN HEALTH AND DISEASE (SOCIAL PATHOLOGY)
Social Constraints
Poverty
Illiteracy and Ignorance
Migration
Industrialization and Urbanization
Social Evils
Smoking Tobacco and Drinking Alcohol
Caste and Casteism
Gender Bias and Gender Discrimination
Child Neglect and Child Abuse
Child Labor and Child Abandonment
Stress and Stress Behavior
Prostitution
Causes of Prostitution
Health Hazards
Dowry System
Social Deviance
Suicide
MANAGEMENT OR PREVENTION OF SOCIAL PATHOLOGY
Management of Social Constraints
Developmental Approach
Educational Approach
Legal Approach
Management of Social Evils
Developmental Approach
Educational Approach
Legal Approach
Rehabilitation Approach
Management of Social Deviance
Educational Approach
Rehabilitation Approach
Legal Approach
Social Security
Social Defence
SOCIAL RESEARCH
Interview Method
Aims of Interview
Types
Steps of Interview
Advantages
Disadvantages
Questionnaire Method
Requisites
Advantages
Disadvantages
Case Study Method
Advantages
Disadvantages
OPERATIONAL RESEARCH
Phases in Operational Research
MEDICOSOCIAL WORKER
Activities
To the Doctor
To the Patient
To the Family
To the Community
Miscellaneous Activities
PERSONAL HYGIENE
Advantages
Rules (Principles) of Personal Hygiene
Habits Affecting the Health (Lifestyle)
Eating
Drinking
Smoking
Chewing
Drugs
Exercise
Meditation
Sleep
Relaxation
Sex
Other Healthful Habits
CHAPTER 27:
Information, Education and Communication
INFORMATION
EDUCATION
COMMUNICATION
Sender
Message
Media
Audience
Feedback
STEPS IN IEC: PLANNING, IMPLEMENTATION AND EVALUATION
Planning
Preparatory Activities
Implementation of IEC Activities
Monitoring
Evaluation
TYPES OF COMMUNICATION
One Way Communication
Two Way Communication
Verbal Communication
Nonverbal Communication
Formal Communication
Informal Communication
Visual Communication
Telecommunication and Internet
BARRIERS OF COMMUNICATION
Physiological Barriers
Psychological Barriers
Environmental Barriers
Cultural Barriers
HEALTH EDUCATION
Objectives
Health Education vs Health Propaganda (Publicity)
APPROACHES IN HEALTH EDUCATION
Regulatory Approach
Merit
Demerits
Service Approach
Health Education Approach
Primary Health Care Approach
CONTENTS OF HEALTH EDUCATION
Principles of Health Education
PRACTICE IN HEALTH EDUCATION
Audiovisual Aids
Auditory Aids
Visual Aids
Combined Audiovisual Aids
Levels in Health Education
METHODS IN HEALTH EDUCATION
Individual and Family Level
Group Level
LECTURE
Criteria for Good Lecture
Criteria for Good Teacher
Demerits
Flip Chart
Flannelgraph
Exhibits
DEMONSTRATION
Discussion Methods
Rules of Group Discussion
DEMERITS
Panel Discussion
Advantages
Disadvantages
Symposium
Seminar
Buzz Group or Buzz Session
Workshop
Conference
Role Playing (Sociodrama)
Brainstorming
Brainstorming is Done in Four Stages
Snowballing
Tutorial
Colloquy
Debate
Community Level (Approach)
Domains of Learning Process
SOAP Technique
Body Language
Anatomy of Lesson Plan
THE DELPHI METHOD
SWOT Analysis
Structure of SWOT Analysis (Fig. 27.2)
CHAPTER 28:
Human Genetics
MULTIPLICATION
CHROMOSOMES
Genotype and Phenotype
CHROMOSOMAL ABNORMALITIES
DEOXYRIBONUCLEIC ACID
POPULATION GENETICS
CLASSIFICATION OF GENETIC DISORDERS
Chromosomal Disorders
Monogenic Disorders (Mendelian Diseases)
Autosomal Dominant Diseases
Autosomal Recessive Diseases
Sex-linked Dominant Diseases
Sex-linked Recessive Diseases
Polygenic Disorders
PREVENTION AND CONTROL OF HEREDITARY DISORDERS
Health Promotive Measures
Eugenic Measures
Euthenics
Genetic Counseling
Other General Measures
Specific Measures
Early Diagnosis and Treatment
CHAPTER 29:
Preventive Geriatrics
POPULATION OF THE AGED
THEORIES OF AGING PROCESS
Somatic Mutation Theory
Autoimmune Theory
Hayflick's Theory
HEALTH PROBLEMS OF THE AGED
Physiological Problems
Psychological Problems
Social Problems
Pathological Problems
CARE OF THE AGED
Primary Prevention
Health Promotion
Specific Protection
Secondary Prevention
Early Diagnosis and Treatment
Tertiary Prevention
Disability Limitation
Rehabilitation
OLD AGE SOCIAL AND INCOME SECURITY
Introduction
Background
Social Security Net
Indira Gandhi National Old Age Pension Scheme
Annapurna Scheme
HELPAGE INDIA
NATIONAL POLICY ON OLDER PERSONS
BENEFITS GIVEN TO SENIOR CITIZENS OF INDIA
CHAPTER 30:
Mental Health
MAGNITUDE OF THE PROBLEM
CAUSATIVE FACTORS
TYPES OF MENTAL DISORDERS
Mental Deficiency or Mental Retardation
Behavioral Disorders
Mental Diseases
Psychosomatic Disorders
PREVENTION AND CONTROL OF MENTAL ILLNESS
Primary Prevention
Secondary Prevention
Tertiary Prevention
CHAPTER 31:
Adolescent Health
CHANGES DURING ADOLESCENCE
IMPORTANCE
Key Facts
CHALLENGES IN ADOLESCENT HEALTH IN INDIA
IMPACTS OF ADOLESCENCE
ADOLESCENT HEALTH PROBLEMS
Malnutrition
Teenage Pregnancy
Risk Behavior
Sexually Transmitted Infections
SERVICES IN ADOLESCENT HEALTH CLINICS
RECOMMENDATIONS
CONCLUSION
ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH
Key Interventions
CHAPTER 32:
Alcoholism and Drug Addiction
DEFINITION
Physical Dependence
Psychological Dependence
Addiction as a Disease
Types of Drug Abuse
Reasons of Drug Abuse
Prevalence
IDENTIFICATION OF DRUG ABUSERS
Dependence Producing Drugs
Alcohol
Opioids
Cannabinoids
Sedatives or Hypnotics
Cocaine
Stimulants
Hallucinogens
Tobacco
Volatile Solvents
Other Drugs
Health Hazards
Prevention and Control of Drug Abuse
Individual Level for the Addict
Family Level
Community Level
SECTION 7: HEALTH ADMINISTRATION AND ORGANIZATION
CHAPTER 33:
Health for All
MEANING
HISTORICAL PERSPECTIVE
IMPORTANCE
Milestones
Health Policy Indicators
Health Care Indicators
Socioeconomic Indicators
Health Status Indicators (Demographic Goals)
CHAPTER 34:
Health Care
THREE-TIER SYSTEM OF HEALTH CARE
Primary Level of Health Care
Secondary Level of Health Care
Tertiary Level of Health Care
PRIMARY HEALTH CARE
Attributes
Elements of Primary Health Care (i.e. Components)
Principles of Primary Health Care
Equitable Distribution
Community Participation
Intersectoral Co-ordination
Appropriate Technology
Organizational Framework of Health Care Systems
PUBLIC HEALTH SECTORS
Primary Health Care
Village Level (Grass-root Level)
Subcenter Level
Primary Health Center Level
Functions of the Primary Health Center
INDIAN PUBLIC HEALTH STANDARDS FOR PRIMARY HEALTH CENTERS
Objectives
Minimum Requirements (Assured Services) at the Primary Health Center for Meeting the IPHS
Essential Infrastructure
Manpower
Drugs
Transport Facilities
Laundry and Dietary Facilities for Indoor Patients
Waste Management of Primary Health Center
Quality Assurance
Monitoring
Accountability
Job Responsibilities of the Members of the Health Team
Medical Officer of Primary Health Center
HEALTH WORKER FEMALE
Record Keeping
Antenatal Care
Care at Home
Care at the Clinic
Intranatal Care
Postnatal Care
Family Planning Services
Care of Infants
Births and Deaths
Notification
Training
Health Education
Health Care
Miscellaneous
HEALTH WORKER MALE
Record Keeping
Role in the Control of Communicable Diseases
Malaria
Leprosy
Tuberculosis
Other Communicable Diseases
Improvement of Environmental Sanitation
Immunization
Family Welfare Services
Miscellaneous Activities
HEALTH ASSISTANT FEMALE
HEALTH ASSISTANT MALE
Community Health Center
Staff Pattern of Community Health Center
Services Provided
INDIAN PUBLIC HEALTH STANDARDS FOR COMMUNITY HEALTH CENTERS
Objectives
Service Delivery in Community Health Centers
Minimum Requirements for the Delivery of Above-mentioned Services
Equipment
Drugs
Manpower
Support Manpower
Investigative Facilities
Physical Infrastructure
Hospitals
Other Agencies
Employees State Insurance Hospitals
Central Government Health Scheme
Railway Hospitals
Private Sector
INDIGENOUS SYSTEM OF MEDICINE
CHAPTER 35:
National Rural Health Mission—2005-2012
OBJECTIVES
STATE OF PUBLIC HEALTH IN INDIA
NATIONAL RURAL HEALTH MISSION—A VISION
GOALS
STRATEGIES
Core Strategies
Supplementary Strategies
PLAN OF ACTION
Accredited Social Health Activist
Strengthening Subcenters
Strengthening Primary Health Centers
Strengthening Community Health Centers (30-50 beds)
District Health Plan
Implementation of Total Sanitation Campaign
Strengthening Disease Control Programs
Public-Private Partnership
New Health Financing Mechanisms
Reorientation of Medical Education
Administrative Set-up of NRHM
TARGETS OF THE NRHM (BY THE YEAR 2012)
JSY and JSSY Schemes
PROGRESS UNDER NRHM (AS ON DECEMBER 2011)
AUTO-DISABLE SYRINGES
Advantages of AD Syringes
Instructions
Disposal of AD Syringes
CHAPTER 36:
National Urban Health Mission
RATIONALE
GOAL
STRATEGIES
TARGETS UNDER NATIONAL URBAN HEALTH MISSION
Coverage and Duration of National Urban Health Mission
Definition of Slum
INSTITUTIONAL FRAMEWORK UNDER NATIONAL URBAN HEALTH MISSION
Urban Social Health Activist (USHA)
Functions of USHA
Functions of Mahila Arogya Samiti
Functions of Auxillary Nurse Midwife of Primary Urban Health Center
COMMUNITY RISK POOLING
Uses of this Pooling
URBAN HEALTH INSURANCE MODEL
Benefits
PRIMARY URBAN HEALTH CENTER
Staff Pattern of Primary Urban Health Center
Functions of Primary Urban Health Center
Referral Units
INTRASECTORAL COORDINATION
MONITORING AND EVALUATION
CHAPTER 37:
Health Planning and Management
PLANNING
Formulation of Action Plan
Execution (Implementation)
Monitoring
Evaluation
Operational Research
MANAGEMENT (NETWORK ANALYSIS)
Objectives
Methods
Program Evaluation and Review Technique
Critical Path Method
Differences between PERT and CPM
COST BENEFIT ANALYSIS
Principles
Costs
Benefits
Merits
Demerits
COST-EFFECTIVE ANALYSIS
Merits
Demerits
MANAGER
CHAPTER 38:
National Health Planning
BHORE COMMITTEE REPORT, 1946
MUDALIAR COMMITTEE REPORT, 1962
CHADAH COMMITTEE REPORT, 1963
MUKERJI COMMITTEE REPORT, 1965
MUKERJI COMMITTEE REPORT, 1966
JUNGALWALA COMMITTEE REPORT, 1967
KARTAR SINGH COMMITTEE REPORT, 1973
SRIVASTAV COMMITTEE REPORT
NATIONAL DEVELOPMENTAL PLANS
First Five-Year-Plan (1951-1956)
Second Five-Year-Plan (1956-1961)
Third Five-Year-Plan (1961-1966)
Fourth Five-Year-Plan (1969-1974)
Fifth Five-Year-Plan (1974-1979)
Sixth Five-Year-Plan (1980-1985)
Seventh Five-Year-Plan (1985-1990)
Eighth Five-Year-Plan (1992-1997)
Ninth Five-Year-Plan (1997-2002)
Tenth Five-Year-Plan (2002-2007)
ORGANIZATION OF INDIAN HEALTH ADMINISTRATION
Central Level
Union Ministry of Health and Family Welfare
Directorate General of Health Services
Central Council of Health and Family Welfare (CCHFW)
State Level
Functions
District Level
For Urban Areas
For Rural Areas
Panchayati Raj
Village Level
RURAL DEVELOPMENT
Community Development Program
Integrated Rural Development Program
Village Level Worker (Gram Sevak)
CHAPTER 39:
National Health Policy
PRIORITY AREAS OF THE POLICY
Other Strategies of NHP, 1983
Targets
NATIONAL HEALTH POLICY, 2002
Relevance
Objectives
Goals
MILLENNIUM DEVELOPMENT GOALS
NATIONAL HOUSING POLICY
NATIONAL NUTRITION POLICY
Strategies
Direct (Short-term) Strategies
Indirect (Long-term) Strategies
Administration
NATIONAL POPULATION POLICY-2000: AN OVERVIEW
Goals
Reproductive Health Targets
Child Health Targets
General Health Targets
NATIONAL POLICY FOR CHILDREN
NATIONAL POLICY FOR OLDER PERSONS
CHAPTER 40:
National Voluntary Health Agencies/Organizations
VOLUNTARY HEALTH AGENCIES
Advantages
Limitations of Voluntary Health Agencies
Functions of Voluntary Health Agencies
VOLUNTARY HEALTH ASSOCIATION OF INDIA
VOLUNTARY HEALTH AGENCIES IN INDIA
Indian Red Cross Society
Tuberculosis Association of India
Family Planning Association of India
Hind Kusht Nivaran Sangh
Voluntary Health Association of India
Indian Council for Child Welfare
Bharat Sevak Samaj
Central Social Welfare Board
Kasturba Memorial Fund
All India Blind Relief Society
CHAPTER 41:
International Health Organizations
FIRST INTERNATIONAL SANITARY CONFERENCE (1851)
PAN AMERICAN SANITARY BUREAU (1902)
OFFICE INTERNATIONAL d'HYGIÈNE PUBLIQUE (1907)
HEALTH ORGANIZATION OF THE LEAGUE OF NATIONS (1923)
UNITED NATIONS RELIEF AND REHABILITATION ADMINISTRATION
WORLD HEALTH ORGANIZATION
Birth
Constitution
Objectives
Membership
Organizational Profile
Regional Offices
WHO Regional Organizations (Fig. 41.1)
Functions of WHO
Health Services
Health Information and Literature
Health Research (Biomedical Research)
UNICEF
Regional Offices
Functions
Child Health
Child Nutrition
Family and Child Welfare
Child Education
UNITED NATIONS DEVELOPMENT PROGRAM
FOOD AND AGRICULTURAL ORGANIZATION
INTERNATIONAL LABOR ORGANIZATION
Functions
UNITED NATIONS FUND FOR POPULATION ACTIVITIES
UNITED NATIONS EDUCATIONAL SCIENTIFIC AND CULTURAL ORGANIZATION
UNITED NATIONS HIGH COMMISSION FOR REFUGEES
WORLD BANK
UNITED NATIONS JOINT PROGRAM ON AIDS
UNITED NATIONS INTERNATIONAL DRUG CONTROL PROGRAM
UNITED NATIONS ENVIRONMENT PROGRAM
INTERNATIONAL ATOMIC ENERGY AGENCY
WORLD FOOD PROGRAM
Beneficiaries
Nutritive Value
CHAPTER 42:
Bilateral Agencies
COLOMBO PLAN
UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT
SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION
DANISH INTERNATIONAL DEVELOPMENT AGENCY
DANIDA Assisted National Leprosy Eradication Program
DANIDA Assisted Revised National Tuberculosis Control Program
DANIDA Assisted National Program for Control of Blindness
NON-GOVERNMENT (NON-UN) AGENCIES
Ford Foundation
Activities
Rockefeller Foundation
Activities
COOPERATIVE FOR AMERICAN RELIEF EVERYWHERE
Red Cross
Freedom from Hunger
Aga Khan Foundation
Save the Children Fund
Oxfam
Other Voluntary Organizations
CHAPTER 43:
National Health Programs
RELATED TO COMMUNICABLE DISEASES
RELATED TO NONCOMMUNICABLE DISEASES
RELATED TO NUTRITION
OTHER HEALTH PROGRAMS
NATIONAL ANTIMALARIA PROGRAM
History
NATIONAL MALARIA ERADICATION PROGRAM
Preparatory Phase
Attack Phase
Consolidation Phase
Active Surveillance
Severe and Complicated Cases of Malaria
Passive Surveillance
Setbacks (Resurgence of Malaria)
Causes
Modified Plan of Operation of Malaria Control
Objectives
Urban Malaria Scheme
Operational Details
MPO Achievement
Roll Back Malaria
Goals
REVISED NATIONAL DRUG POLICY (2010) FOR TREATMENT OF MALARIA
Aims of the Policy
Chemoprophylaxis
NATIONAL FILARIA CONTROL PROGRAM
Elimination of Lymphatic Filariasis in India
Objectives
Salient Features of ELF Strategy
Mass Drug Administration
NATIONAL KALA-AZAR CONTROL PROGRAM (NKCP)
NATIONAL JAPANESE ENCEPHALITIS CONTROL PROGRAM (NJECP)
NATIONAL DENGUE FEVER/DENGUE HEMORRHAGIC FEVER CONTROL PROGRAM
NATIONAL LEPROSY CONTROL PROGRAM
NATIONAL LEPROSY ERADICATION PROGRAM
Multidrug Treatment
Multibacillary Leprosy
Paucibacillary Leprosy
Infrastructure
Leprosy Control Unit (LCU)
Survey Education Treatment Centers
Urban Leprosy Centers
Mobile Leprosy Treatment Unit
Progress of National Leprosy Eradication Program
Program Assistance
Modified Leprosy Elimination Campaign (MLEC)
Regimen for Paucibacillary Cases
Regimen for Multibacillary Cases
Leprosy Elimination Monitoring
NATIONAL GUINEA WORM ERADICATION PROGRAM (NGEP)
UNIVERSAL IMMUNIZATION PROGRAM
NATIONAL POLIOMYELITIS ERADICATION PROGRAM (NPEP)
Historical Perspective
Strategies of Polio Eradication
Routine Immunization
Supplementary Immunization
Acute Flaccid Paralysis (AFP) Surveillance
Components of AFP Surveillance
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP)
National TB Control Program
Objectives of NTCP
Organization and Administration
Central Level Organization
District Level Organization
Peripheral Organization
NATIONAL ACUTE RESPIRATORY INFECTIONS CONTROL PROGRAM (NARICP)
Strategy
Administrative Set-up
NATIONAL DIARRHEAL DISEASES CONTROL PROGRAM (NDDCP)
NATIONAL AIDS CONTROL PROGRAM (NACP)
Phase I (From 1992 to 1999)
Phase II (From 1999 to 2006)
Aims
Objectives
Target Intervention
CARE OF THE PEOPLE LIVING WITH AIDS (PLWA)
STI Treatment
Condom Programming/Promotion
Multisectoral Collaboration
Public Private Partnership
Holistic IEC and Social Mobilization
Safe Blood
PHASE III (From 2006 to 2011)
Integrated Counseling and Testing Center (ICTC)
Functions
Types of ICTCs
Counseling
HIV Testing at the ICTC
Prevention of Parent to Child Transmission (PPTCT) Services
Integration between ICTCs and TB Services
AIDS—Vaccine Initiative
Low Cost Care and Support
Evidence-based Planning
Monitoring and Evaluation
‘3 BY 5’ INITIATIVE
NATIONAL PROGRAM FOR THE CONTROL OF BLINDNESS
Objectives
Operational Strategies
Administrative Set-up
Procurement and Supplies
Program Components
NPCB Achievement
Revised Strategy
Targets for Tenth Five Year Plan
External Assistance
‘Right to Sight’ Initiative (Vision 2020)
NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF DEAFNESS
Objectives
Strategies
Components of the Program
Expected Benefits of the Program
NATIONAL CANCER CONTROL PROGRAM (NCCP)
Functions of the Organizations
NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF DIABETES, CARDIOVASCULAR DISEASES AND STROKE (NPDCS)
Magnitude of the Problem
Objectives
NATIONAL MENTAL HEALTH PROGRAM (NMHP)
Introduction
Magnitude of the Problem
Aim
Objectives
Strategies
Components of NMHP
Organization
DISTRICT MENTAL HEALTH PROGRAM (DMHP)
Objectives
Components
Services
Comments
Current Status
NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAM (NIDDCP)
Aim
Objectives
Administrative Set-up
NATIONAL PROGRAM FOR CONTROL AND TREATMENT OF OCCUPATIONAL DISEASES
Burden of Occupational Diseases and Injuries
NATIONAL VITAMIN ‘A’ PROPHYLAXIS PROGRAM
Aim
Strategy
NATIONAL NUTRITIONAL ANEMIA CONTROL PROGRAM (NNACP)
NATIONAL SPECIAL NUTRITION PROGRAM
NATIONAL BALWADI NUTRITION PROGRAM (NBNP)
NATIONAL MID-DAY SCHOOL MEAL PROGRAM
NATIONAL INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME
NATIONAL TOBACCO CONTROL PROGRAM
NATIONAL FAMILY WELFARE PROGRAM (NFWP)
Evaluation of Family Planning
NATIONAL REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH-PROGRAM)
Historical Background
Objectives
Interventions/Strategies of RCH Program
Maternal Health (Safe Motherhood)
Obstetric Care
Infection Control Measures
Nutrition Promotion
Child Health (Child Survival)
Reproductive Health
Management Strategies of RCH Program
Bottom-up Planning
Decentralized Training
Management Information and Evaluation System (MIES)
IEC and Community Participation
Highlights of this New Approach
REPRODUCTIVE AND CHILD HEALTH PROGRAM-II (RCH-II)
AIM
Goals
Lacunae of RCH-I
Objectives
COMPONENTS OF RCH-II
Population Stabilization
Strategies
Maternal Health
Essential Obstetric Care
Emergency Obstetric Care
Newer Schemes
Janani Suraksha Yojana (JSY)
Objective
Eligibility
Benefits
Micro Birth Plan Maintained by ASHA
Janani Shishu Suraksha Karyakrama (JSSK)
Newborn Care and Child Health
Objectives
Strategies
Adolescent Health
Control of RTIs/STIs
Urban Health
Tribal Health (Vulnerable Population)
Strategies
Services
Monitoring and Evaluation
Management Information and Evaluation System (MIES)
ALL INDIA HOSPITAL POSTPARTUM PROGRAM
Objectives
Rationale
NATIONAL WATER SUPPLY AND SANITATION PROGRAM
MINIMUM NEEDS PROGRAM
Components of the MNP
Basic Principles of MNP
Rural Health
Rural Water Supply
Rural Electrification
Elementary and Adult Education
Rural Nutrition
Improvement of Urban Slums
Rural Housing
Rural Roads
Rural Sanitation
TWENTY POINT PROGRAM (20-PP)
SECTION 8: ALLIED SUBJECTS
CHAPTER 44:
Emerging and Re-emerging Infectious Diseases
EMERGING INFECTIOUS DISEASES
Diseases due to New Agents
Human Monkeypox
New Types of Diarrheal Diseases—Three Types
Legionnaires’ Disease or Legionellosis
Ebola Hemorrhagic Fever
AIDS
Hanta Virus Pulmonary Syndrome
Creutzfeldt-Jakob Disease (Spastic Pseudoparalysis)
Hepatitis E
Severe Acute Respiratory Syndrome
Hepatitis C
Diseases due to New Variants of Known Pathogens
Diseases Caused by an Infectious Agents but Resulting in Noncommunicable Diseases
RE-EMERGING INFECTIOUS DISEASES
Malaria
Kala-azar (Visceral Leishmaniasis)
Dengue Fever
Plague
Predisposing Factors for the Epidemic
Before the Onset of Epidemic
During the Epidemic
CONTROL OF EMERGING AND RE-EMERGING DISEASES
CHAPTER 45:
Disaster Management
DEFINITION
IMPACT
CLASSIFICATION OF DISASTERS
Natural Disasters
Natural Phenomena Beneath the Earth's Surface (Tectonic)
Natural Phenomena at the Earth's Surface (Topological)
Natural Phenomena above the Earth's Surface
Man-made Disasters
DISASTER MANAGEMENT CYCLE
Disaster Impact
Response
Rehabilitation
Mitigation
Preparedness
CHAPTER 46:
Integrated Disease Surveillance Project: 2004-2009
SURVEILLANCE
Project
Objectives
Types of Surveillance in Integrated Disease Surveillance Project (Table 46.1)
Surveillance Actions
Warning Signs of an Impending Outbreak
Epidemic Response
Intensifying the Information, Education and Communication Activities by the Following Measures
Monitoring and Evaluation
CHAPTER 47:
Bioterrorism
HISTORICAL BACKGROUND
EVOLUTION OF CHEMICAL AND BIOLOGICAL WEAPONS
Merits
Demerits
Top Biological Weapons
Bacillus anthracis
Yersinia pestis
Smallpox Virus
Clostridium botulinum
Vibrio cholerae
Ebola Virus
Mycotoxin
Newer Trends
Delivery of Biological Weapon
Combating Biological Weapons Incident/At Risk Group
Steps to be Taken
Future Suggestions (Prevention and Control Measures)
Finally
CHAPTER 48:
Global Warming
HISTORY OF GLOBAL WARMING
HAZARDS OF GLOBAL WARMING (FIG. 48.1)
WHO IS THE WORST POLLUTER?
KYOTO PROTOCOL
ACTION NEEDS TO BE TAKEN NOW
CONTAINMENT MEASURES
CHAPTER 49:
Integrated Management of Childhood Illness
OBJECTIVES
COMPONENTS
PRINCIPLES
ASSESS AND CLASSIFY THE SICK CHILD
IDENTIFICATION OF THE TREATMENT
Urgent Prereferral Treatment
COUNSEL THE MOTHER
ANNEXURE I
ANNEXURE II
CHAPTER 50:
Telemedicine in Public Health
INTRODUCTION
DEFINITION
AIM OF TELEMEDICINE
UTILITY OF TELEMEDICINE
TYPES OF TECHNOLOGY
Store and Forward
Two-way Interactive Television
Infrastructures of Telemedicine Centers
Telecommunication Technologies
TELEMEDICINE IN INDIA
Advantages of Telemedicine in India
CURRENT EFFORTS IN INDIA
TEN Commandments for Success of Telemedicine
Challenges
CHAPTER 51:
Tobacco and Health
HISTORY
PREVALENCE OF SMOKING
PUBLIC HEALTH IMPORTANCE
TYPES OF TOBACCO
Cigarettes
Beedis
Hookah
Dissolvable Tobacco
Gutka
COMPOSITION OF SMOKE
Health Hazards of Tobacco
Occupational Health Hazards of Tobacco Industry
Health Impact on Beedi Workers
Health Hazards due to Tobacco Smoking
HEALTH BENEFITS OF SMOKING
Quitting Smoking
Prevention and Control of Health Hazards of Smoking
Legislative Measures
NATIONAL TOBACCO CONTROL PROGRAM (NTCP)
CHAPTER 52:
Public Health Acts
THE CONSUMER PROTECTION ACT, 1986
REGISTRATION OF BIRTHS AND DEATHS ACT, 1969
Limitations in Registration
Recommendations for the Improvement
Annexure
SOME STALWARTS AND THEIR CONTRIBUTION TO COMMUNITY MEDICINE
EDWARD JENNER (1749-1823)
SIR EDWIN CHADWICK (1800-1890)
LOUIS PASTEUR (1822-1895)
JOSEPH LISTER (1827-1912)
ROBERT KOCH (1843-1910)
RONALD ROSS (1857-1932)
CALENDAR OF IMPORTANT DATES AND EVENTS
LIST OF WORLD BREASTFEEDING WEEK THEMES SINCE 1992
LIST OF WORLD HEALTH DAY THEMES
GOALS TO BE ACHIEVED BY 2000-2015
MILESTONES IN VACCINATION
INDEX
TOC
Index
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