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Essentials of Community Medicine: A Practical Approach
Lalita D Hiremath, Dhananjaya A Hiremath
CHAPTER 1:
Present Health Status
DISEASE BURDEN
REASONS FOR HIGH DISEASE BURDEN
COMMUNICABLE DISEASES
CHRONIC NONCOMMUNICABLE DISEASES AND CONDITIONS
Nutritional Deficiencies
MATERNAL AND CHILD HEALTH
Burden of Occupational Diseases and Injuries
Clinical Diagnosis and Community Diagnosis (Table 1.5)
NOTIFIABLE DISEASES
CHAPTER 2:
Family
FAMILY
Definition
Types of Family
Nuclear Family
Extended Family
Joint Family
Three Generation Family
Special Objectives
Method of Study
Family—a Dynamic Unit
Family Cycle
GENERAL INFORMATION FOR STUDENTS
CHAPTER 3:
Economics
POVERTY LINE
PER CAPITA INCOME
OVERCROWDING
Accepted Standards
Floor Space Accepted Standard
Sex Separation
Housing
Housing Standards
Social Classification
Methods of Social Classification
CHAPTER 4:
Communicable Diseases
COMMUNICABLE DISEASE
Definition
Definition of Infection
Case
Epidemic (Epi—upon, demos—people)
Endemic (En—in, demos—people)
Sporadic
Pandemic
Disease
Illness
Sickness
TUBERCULOSIS
Sites Affected
Economic Burden of Tuberculosis
Epidemiological Indices
Epidemiology
Communicability
Host Factors
Environmental Factors
Case Finding
Definitions
Case Finding Tools (Table 4.2 to 4.7)
Chemoprophylaxis
Primary
Secondary
Treatment
Drug Regimens Currently used in India
Conventional Regimens
Important Definitions
Smear +ve TB
Smear −ve TB
Adherence
New Cases
Relapse
PEDIATRIC TUBERCULOSIS
Pediatrics DOTS
Failure Case
Return after Default
Transfer In
Transfer Out
Cured
Treatment Completed
Died
Directly Observed Therapy Short-course (DOTS)
Principles
Follow-up
Sputum Examination
Structure of the RNTCP
National Level (Deputy Director General—TB)
State Level (State Tuberculosis Officer)
District Level (District Tuberculosis Officer)
Sub-district Level (Tuberculosis Unit)
Peripheral Health Level
Difference in National Tuberculosis Program and Revised NTCP (Table 4.8)
Reasons for Dropout of the Treatment
National TB Control Program
Objectives of NTCP (1962)
Long-term Objectives
Short-term Objectives
Disinfection of Sputum
DOTS-Plus Strategy
Components
Strategy and Focus
Green Light Committee Initiative
HIV Infection and Risk of Tuberculosis
LEPROSY
History
Milestones
Burden of Leprosy
World
India
Essential Indicators for Leprosy
Prevalence Rate (Point Prevalence Rate)
New Case Detection Rate
Disability Rate Among New Detection
Proportion of Children among New Detection
Multibacillary (MB) Rate
Proportion of Single Skin Lesion (SSL) Case Rate
Cohort Cure Rate MB/PB
Epidemiology
Agent (Mycobacterium leprae)
Host
Environmental and Social Factors
Mode of Transmission
Clinical Features
Lepromatous Leprosy
Diagnosis
Clinical Examination
How should One Test for Sensation?
Remember
What are the General Principles of Nerve Palpation?
How should We assess Nerve Function?
How is Voluntary Muscle Testing done?
Bacteriological Examination
Bacterial Index (BI)
Morphological Index (MI)
Histamine Test (Table 4.11)
Sweat Test (Table 4.12)
Lepromin Test
Features of Lepra Reactions (Reversal Reaction) (Table 4.15)
Clinical Difference between Reversal Reaction and Relapse (Table 4.16)
Treatment of Reversal Reaction
Antileprosy Drugs and their Characteristics (Table 4.17)
Patient Grouping for MDT (Table 4.18)
Dosage Schedule for MDT (Table 4.19)
Treatment of ENL Reaction
Completion of Treatment and Cure
Side Effects of Anti-leprosy Drugs (Table 4.20)
LEPROSY CONTROL
Leprosy Control Programs
Candidate Vaccines
Health Education
Leprosy Educational Messages
Rehabilitation
Leprosy Organizations in India
National Leprosy Eradication Program (NLEP)
Strategies
Infrastructure
Modified Leprosy Elimination Campaigns
Action Plan of MLEC (Table 4.23)
Special Action Projects for the Elimination of Leprosy
Global Leprosy Elimination Program
Elements of the Intensified Program
FILARIASIS
Burden of Disease
Epidemiology
Human Filarial Infections
Agents
Vectors
Host
Environmental Factors
Clinical Manifestations
Lymphatic Filariasis
Survey
Control Measures
Chemotherapy
Vector Control
National Filaria Control Program
National Health Policy
DIARRHEA AND DYSENTERY
Definition
What is Not Diarrhea?
Dysentery
Gastroenteritis
Problem of Diarrheal Disease
Causes of Diarrhea (Table 4.24)
Diarrhea Control Program
Short-term
Long-term
CHOLERA
Epidemiology
Agent
Clinical Features
Atypical Presentation
Complications
Investigations
Control of Cholera
Rehydration Therapy
Assessment of Dehydration (Table. 4.27)
Treatment of Mild Dehydration (Table 4.28)
Treatment of Severe Dehydration (Flow chart 4.3)
Intravenous Rehydration
Maintenance Therapy (Table 4.30)
Adjuncts to Therapy
Disinfection
Diarrheal Diseases Control Program
Investigation of an Epidemic
Verification of Diagnosis
Confirmation of the Existence of an Epidemic
Defining the Population at Risk
Rapid Search for all Cases and their Characteristics
Evaluation of Ecological Factors
Further Investigation of Population at Risk
Data Analysis
Formulation of Hypotheses
Testing of Hypotheses
Writing the Report
SCABIES
Epidemiology
Agent
Mode of Trans
Host
Environmental and Social Factors
Clinical Features
Complications
Variants
Control of Scabies
SEXUALLY TRANSMITTED DISEASES
What are Sexually Transmitted Diseases?
Why is STD Control an Important Component of HIV/AIDS Prevention?
What are the Symptoms of STDs? At Least Half of STDs in Women do not produce any Symptoms
How can One Protect Oneself from STDs?
How can Reinfection of STDs be prevented?
What are the Approaches to STD Management?
Etiological Diagnosis
Clinical Diagnosis
What is the Syndrome Approach?
The Steps Involved in Adopting a Syndromic Approach
Syndromic Case Management necessitates Clinical Examination of the Patient
Syndromic Case Management
Roles and Responsibilities of the Doctors while giving Quality Care for Patients with STD
Advantages of the Syndromic Case Management
Syndromic Case Management
Treatment for the Most Common STD Associated Syndromes
Treatment of Urethral Discharge
Genital Ulcers
Treatment of Vaginal Discharge
Treatment of Lower Abdominal Pain in the Female
National STD Control Program
CHAPTER 5:
Noncommunicable Diseases
CORONARY HEART DISEASE
Definition
Manifestations
Measurement the Burden of Disease
Epidemiology
Risk Factors for CHD
Nonmodifiable Risk Factors
Modifiable Risk Factors
Complications of Myocardial Infarction
Medical Treatment
For Angina
For Unstable Angina and Myocardial Infarction
Percutaneous Transluminal Coronary Angioplasty (PTCA)
Prevention and Control
Population Strategy
Specific Intervention
Legislation
Secondary Prevention
Tertiary Prevention
HYPERTENSION
Prevalence
Risk Stratification
Pharmacologic Treatment Initiation
OBESITY
Prevalence
Epidemiological Factors
Endocrine Disorders
Drug Intake
Assessment of Obesity
Broca's Index
Body Mass Index
Corpulence Index
Ponderal Index
Lorentz's Formula
Fat Fold Thickness (Skin Fold Thickness)
Total Body Mass
Clinical Features of Obesity
Complications
Treatment
Prevention and Control
Primordial Prevention
Secondary Prevention
Tertiary Prevention
RHEUMATIC HEART DISEASE
Prevalence
Epidemiological Factors
Host and Environmental Factors
Clinical Features
Diagnosis
Prevention and Control
Primary Prevention
Secondary Prevention
Tertiary Prevention
MENTAL HEALTH
Prevalence
Classification
Etiology
Organic Conditions
Prenatal Causes
Perinatal Causes
Postnatal Causes
Social Pathological Causes
Environmental Factors
Warning Signals of Poor Mental Health
Prevention and Control
Primary Prevention
Secondary Prevention
Tertiary Prevention
National Mental Health Program
Aims
Objectives
Strategies
DIABETES MELLITUS
Latent Diabetic
Black Zone
Clinical Classification of Diabetes Mellitus as Adopted by WHO
Epidemiology
Agent
Host
Environmental Factors
Social Factors
Clinical Features
Complications
Investigations
Prevention and Care
High-risk screening
Primary Prevention
Secondary Prevention
Treatment
Tertiary Prevention
National Diabetes Control Program
Objectives
CANCER
Prevalence
Sex Differences
CAUSES OF CANCER
Environment
Genetic
Primary Prevention
Health Education Regarding “Danger Signals”
Secondary Prevention
Treatment for Cancer
NATIONAL CANCER CONTROL PROGRAM (NCCP)
Basic Steps
Goals of NCCP
District Cancer Control Program
Carcinoma of Breast
Carcinoma of Lung
CHAPTER 6:
Maternity and Child Health
REPRODUCTIVE AND CHILD HEALTH PROGRAM
Definition of RCH
Components of RCH (Fig. 6.2)
MAJOR ELEMENTS OF RCH PROGRAM
Reproductive Health Elements
Child Survival Elements
State Committee on Voluntary Action
Contents of Kits Supplied to Subcenter and First Referral Unit (FRU)
Under RCH Program
Methods to Estimate Requirements for MCH Services
ANTENATAL CARE
Objectives of Antenatal Visit
Prenatal Services
Prenatal Advice
Specific Protection
MATERNAL AND CHILD HEALTH
RCH-II and Family Planning
Program Implementation Plan (PIP)
Janani Suraksha Yojana
Important Features of JSY
Mamta Scheme—An Example of Public Private Partnership in Health Care
Health Care Services for the beneficiaries under the Scheme
Eligibility Criteria for Beneficiaries under the Scheme
Registration of Beneficiaries under the Scheme
Prevention of Patient to Child Transmission (PPTCT)
Prevention of Parent to Child Transmission of HIV Infection
Various Types of Antiretroviral Regimens
Role of maternal and child health services in the prevention of HIV infection in infants and young children program.
Integration of PPTCT within Postnatal MCH Services
Key Points
Infant Feeding Formula (Table 6.2)
INTRANATAL CARE
Care at Birth
Five Cleans
POSTNATAL CARE
Objectives of Postnatal Care
Warm Chain
High-Risk Infants
MALNUTRITION
Definition
Classification
Nutritional Problems (Table 6.3)
Epidemiology
Conditioning Influences
Cultural and Social Factors
Infections
Health and Other Services
PROTEIN-ENERGY MALNUTRITION
Definition
Types of PEM
Marasmus
Clinical Features
In Kwashiorkor (Moonface)
Clinical Features
Signs
Tick Sign
Flag Sign
Classification of PEM
Gomez's Classification (Weight for Age)
Dr Udani's Classification (Calorie Deficiency Classification)
Waterlow's Classification defined Two Groups for PEM (Table 6.4)
Harward's Classification
Jellyfish Classification
NSIAP (National Subcommittee of Indian Academy of Pediatric)
Waterlow's Classification
Epidemiology of Malnutrition
Poverty Cycle
Vicious Cycle
Agent Factor
Host Factors
Social Problems
Environmental Factors
Examination of the Case
Body Measurement Techniques
Weight
Weighing Procedure (Fig. 6.3)
Height or Length (Fig. 6.4)
Length
Height (Fig. 6.5)
Midarm Circumference
Head and Chest Circumference
General Procedures for Treatment of Severe PEM
Initial Treatment Phase
Complications
Preventive Measures
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Rehabilitation
Calculation of Expected Weight of the Child
Calculation of Expected Height of the Child
Surface Area According to Weight
Calculation of Pediatrics Doses
BREASTFEEDING
A to Z Benefits for Baby
Advantages to Mother
CHAPTER 7:
Reproductive and Child Health
INTRODUCTION
Qualities of Good Contraceptives
Cafeteria Choice
Conventional Contraceptive
Contraceptive Failure Rate (CFR) (Table 7.1)
Pregnancy Rate
Methods of Family Planning (Flow chart 7.1)
Newer Contraceptives
Anti-fertility Vaccines
No Scalpel Vasectomy
Emergency Contraceptives
Emerging Oral Contraception
Give Specific Instructions
Important
Give Advice on Common Problems
Explain Specific Reasons to Return to the Health Care Provider
Introduction to Injectable Contraceptives
Mechanism of Action
Advantages and disadvantages of Injectable Contraceptives
Advantages
Disadvantages
SUBCUTANEOUS DMPA AND HOME INJECTION
Centchroman
Family Planning Insurance Scheme
Medical Methods of Abortion
Mifepristone and Misoprostol
Side Effects
Criteria
Contraindications
Future Fertility
MANUAL VACUUM ASPIRATION (MVA)
Methods of Uterine Evacuation
Surgical Methods of Evacuation
Types of Vacuum Aspiration
Mechanism of MVA
Key Aspects of MVA Mechanism
Uses of MVA Equipment
Advantages of MVA
CALCULATION OF THE EFFECTIVE COUPLE PROTECTION RATE (ECPR)
Effective Protection
Pearl Index
Important Facts about Contraceptives (Tables 7.5 and 7.6)
CHAPTER 8:
Immunization
NATIONAL IMMUNIzATION SCHEDULE
Immunization of Pregnant Woman
Reactions after Vaccination
Complications
Determine Needs and Requirement
Estimation of Eligibles
Estimation of Number of Contacts
Difference between EPI and UIP
Expanded Program of Immunization (EPI)
Universal Immunization Program (UIP)
National Immunization Schedule (Tables 8.1 and 8.2)
Estimation of Requirements of Syringes and Needles
Estimation of Requirements of Sterilization Equipment
Estimation of Vaccine Needs
Estimation of Cold Chain Requirements
Determine Training Needs
Estimation of Requirements of Immunization Cards
Manpower Needs
Enumerate Eligibles
Obtain Vaccines
Estimation of Vaccine Requirements
Maintain Vaccines
Maintain Equipment
Vaccine
BCG
Vaccine
Potency
Protection
Dosage:
Route of Administration
Complication
Contraindications
Oral Polio
National Immunization Schedule
Development of Immunity
Oral Polio Vaccine (OPV)
Failure of Three Dose Regimen
Failure of OPV
Complications
Contraindications
Storage
Salk Polio Vaccine
Advantages
Strategies for Polio Eradication
Current Four Basic Strategies to Eradicate Polio
Routine Immunization
National Immunization Days (NIDs)/Pulse Polio Immunization (PPI) Program
National Immunization Days
Surveillance of Acute Flaccid Paralysis (AFP)
Objective
Components
Virological Classification Scheme (Flow chart 8.1)
Process of AFP Surveillance (Flow chart 8.2)
Conduct Extensive House-to-House Immunization Mopping-up Campaigns
Line Listing of Cases
Aim of line listing of cases
Intensive Pulse Polio Immunization (IPPI)
Strategies Involved to Achieve Intensification of PPI
Vaccine Vial Monitoring
Measles Vaccine
Age
Storage
Administration
Reactions
Immunity
Contacts
Contraindications
Adverse Effects of Vaccine
Combined Vaccine
Immunoglobulin
Urban Measles Campaign
Diphtheria Immunization
Combined or Mixed Vaccines
Single Vaccines
Antisera
Advantages
Composition of DPT Vaccines (Table 8.4)
Storage
Interval between Doses
Mode of Administration
Reactions
Neurological Complications
Contraindications
Tetanus Toxoid
Aim
Two Preparations
Monovalent
Passive Immunization
ATS (Equine)
Active and Passive Immunization
Elimination of Neonatal Tetanus
Anti-rabies Vaccine (Table 8.5)
Cell Culture Vaccine
Pre-exposure Prophylaxis
Re-exposure to Animals after Anti-rabies Vaccination
Adverse Reactions
Advice to Patients
Anti-Snake Venom
Prepared by
Newer Vaccines
HIV Vaccine
Leprosy Vaccine
Chickenpox Vaccine
Rubella Vaccines
Influenza Vaccines
Hepatitis B Vaccines
Malaria Vaccines
Meningococcal Vaccines
CHAPTER 9:
Nutrition
INTRODUCTION
Dietetics
Balanced Diet
An Indian Reference Man
An Indian Reference Woman
Assessment of Nutritional Status
Assessment of the Energy Requirement for Family
Cereals and Millets
Milling Process Deprives
Parboiling
Pellagra
Pulses (Legumes)
Germination and Fermentation
Lathyrism
Manifestation (in Different Stages)
Intervention
Vegetables
Fruits (Fructua—to Enjoy)
Composition of Fruits per 100 gm (Table 9.6)
Nuts and Oil Seeds
Sweet Food and Sweetening Agents
Nutrient Requirements during Pregnancy (Tables 9.7 to 9.14)
Rich Sources of Essential Nutrients
Protein Requirements
Principles in Calculating Balanced Diet
India
BALANCED DIETS (Table 9.15)
Balanced Diet for Children (Table 9.16)
Average Weight of Vegetables (Table 9.17)
Approximate Weight of Foods Equal to 1 Level Katori (Bowl) of 150 ml Volume (Table 9.18)
Average Weight of Nuts and Spices (Table 9.19)
Recommended Dietary Allowances for Indians (Table 9.20)
Approximate Nutritive Value of Some Common Food Preparations (Table 9.21)
CHAPTER 10:
Medical Entomology and Worm Infestations
ARTHROPODS
Arthropods of Medical Importance
Class: Insecta (Flow chart 10.1)
Distinctive Characters
Class: Archnida (Flow chart 10.2)
Distinctive Characters
Class: Crustacea (Flow chart 10.3)
Distinctive Characters
Mosquito
General Description
Mosquito-borne Diseases
Mosquito Control Measures
Anti-larval Measures
Anti-adult Measures
Protection against Mosquito Bites
Ticks
Families of Medical Importance (Flow chart 10.5)
Public Health Importance of Ticks (Flow chart 10.6)
Control Measures (Flow chart 10.7)
Houseflies
Life History
Diseases Transmitted
Routes of Transmission
Control Measures for Houseflies (Flow chart 10.8)
Spread of Diseases (Flow chart 10.9)
Control Measures
PUBLIC HEALTH IMPORTANCE OF WORM INFESTATION
Ascariasis (Table 10.2)
Symptoms of Ascariasis
Prevention
Enterobius vermicularis (Table 10.3)
Symptoms
Prevention
Trichuris trichiura (Table 10.4)
Symptoms
Prevention
Wuchereria bancrofti (Table 10.5)
Symptoms
Prevention
Ancylostoma duodenale(Table 10.6)
Symptoms
Prevention
Strongyloides stercoralis(Table 10.7)
Symptoms
Prevention
CHAPTER 11:
Disinfection
DEFINITIONS (DISINFECTANT OR GERMICIDE)
Disinfectant
Antiseptic
Deodorant
Detergent
Sterilization
Disinfection
Types of Disinfection
Concurrent Disinfection
Terminal Disinfection
Precurrent Disinfection
Disinfecting Agents
Natural Agents
Physical Agents
Chemical Agents
Natural Agents
Sunlight
Air
Physical Agents
Burning
Hot Air
Boiling
Autoclaving
Radiation
Chemical Disinfectants
Phenol and Related Compounds
Quaternary Ammonia Compounds
Halogens and their Compounds
Miscellaneous
CHAPTER 12:
Insecticides and Rodenticides
INSECTICIDES AND PESTICIDES
Classification
DDT (Dichloro-diphenyl-trichloroethane)
Properties
Action
Application
HCH (BHC) Hexachlorocyclohexane
Action
Application
Malathion
Dosage
Mineral Oil
Dosage
Paris Green (Copper aceto-arsenite)
Dosage
CHAPTER 13:
Environmental Models
CHLOROSCOPE/CHLORINOMETER
Procedure
DRY AND WET BULB THERMOMETER (HYGROMETER)
Procedure
MAXIMUM AND MINIMUM THERMOMETER
Procedure
KATA THERMOMETER (FIG. 13.2A)
Used for Measuring
Procedure
GLOBE THERMOMETER (FIG. 13.2B)
Procedure
Sling Psychrometer (Fig. 13.3)
Procedure
Gully Trap
SOAK PIT
SLOW SAND FILTER (FIG. 13.6)
Rapid Sand Filter (Fig. 13.7)
CHAPTER 14:
Water Analysis
DETERMINATION OF TOTAL HARDNESS
Theory
Procedure
Example
Calculations
BACTERIOLOGY OF WATER
Bacteriological Examination of Water
Plate Count
Detection of Coliform Bacteria and E. coli
Detection of Fecal Streptococci
Examination for Clostridium perfringens
Tests for Pathogenic Bacteria
STEPS IN WELL DISINFECTION
Find the Volume of Water in a Well
Find the Amount of Bleaching Powder Required for Disinfection
Procedure
Dissolve Bleaching Powder in Water
Delivery of Chlorine Solution into the Well
Contact Period
Orthotolidine Arsenite Test
CHAPTER 15:
Bacteriology of Milk
BACTERIA IN MILK
Types of Bacteria in Milk
Bacteriological Examination
Viable Count
Test for Coliform Bacteria
Methylene Blue Reduction Test
Phosphatase Test
Turbidity Test
Examination for Specific Pathogens
CHAPTER 16:
Staining, Culture Media and Microscopy of Slides of Public Health Importance
GRAM STAIN
Aim
Requirement
Procedure
Result
ZIEHL-NEELSEN STAIN
To demonstrate acid fast bacteria
Procedure
Result
ALBERT STAIN
Aim
Requirement
Procedure
Result
CULTURE MEDIA
Types of Media
Simple Media
Complex Media
Synthetic or Defined Media
Enrichment Media (Liquid Media)
Selective Media
Indicator Media
MICROSCOPIC SLIDES
Mycobacterium tuberculosis
Identification
Mycobacterium leprae
Identification
Treponema pallidum
Identification
Neisseria meningitidis
Identification
Clinical Features
Complications
Treatment
Corynebacterium diphtheriae
Identification
Neisseria gonorrhoeae
Identifications
Clostridium tetani
Identification
Clinical Features
Complications
Treatment
Leptospira
Identification
Clinical Features
Treatment
CHAPTER 17:
Economics
INTRODUCTION
Type of Hospital Waste
The High-risk Waste
General Wastes
Hazards and Risks from Hospital Waste Exposure
Indiscriminate Disposal of Infectious Hospital Waste is Hazardous in Many Ways
HOSPITAL WASTE DISPOSAL
Categories of Biomedical Waste (Table 17.1)
Objectives of Plan
Immediate Objectives
Long-term Objectives
PLANNING AND ORGANIZATION
Organization
Responsibilities
Staff Appraisal on Hospital Waste Management
Waste Disposal Strategy
Collection of Waste with Source Segregation
Storage
Transportation
Temporary Storage
Final Disposal of Waste
INCINERATORS
Site for Incinerator
Standards for Incinerators
Operating Standards
Emission Standards
Inertization
Legislative Framework
Summary of Biomedical Waste Rules
What You should Know and Do
Plastics
Problems
Proposed Method for Disinfection of Commonly Used Articles, Materials/Surfaces in Order of Preference (Table 17.3)
CHAPTER 18:
National Rural Health Mission (2005-2012)
INTRODUCTION
GOALS
STRATEGIES
Core Strategies
Supplementary Strategies
PLAN OF ACTION
Component (A): Accredited Social Health Activists
Component (B): Strengthening Sub-Centers
Component (C): Strengthening Primary Health Centers
Component (D): Strengthening ChCs for First Referral Care
Component (E): District Health Plan
Component (F): Converging Sanitation and Hygiene under NRHM
Component (G): Strengthening Disease Control Programs
Component (H): Public-Private Partnership for Public Health Goals, including Regulation of Private Sector
Component (I): New Health Financing Mechanisms
Component (J): Reorienting Health/Medical Education to support Rural Health Issues
INSTITUTIONAL MECHANISMS
TECHNICAL SUPPORT
Program Management Support Center
Health Trust of India
ROLE OF STATE GOVERNMENTS UNDER NRHM
FOCUS ON THE NORTH EASTERN STATES
ROLE OF PANCHAYATI RAJ INSTITUTIONS
ROLE OF NGOs IN THE MISSION
MAINSTREAMING AYUSH
FUNDING ARRANGEMENTS
TIMELINES (FOR MAJOR COMPONENTS)
OUTCOMES
National Level
Community Level
MONITORING AND EVALUATION
Is NRHM a New Program of the Government of India?
What is the Institutional Setup at National, State and District Levels?
National urban health mission
Goal
Core Strategies
Components of Urban Health Mission (UHM)
Targets
Urban Health Delivery Model
At Community Level (Urban Social Health Activist, USHA)
Essential Service to be Rendered by the USHA
Performance Based Incentive Package for USHA
Primary Urban Health Center
Staffing Pattern
CHAPTER 19:
Sanitation of Camps
INTRODUCTION
CAMP SITE
ACCOMMODATION AND EQUIPMENT
Water
FOOD AND COOKING ARRANGEMENTS
DISPOSAL OF REFUSE AND EXCRETA
Dry Camp and Kitchen Refuse
Liquid Waste
Disposal of Feces
DISPOSAL OF STABLE LITTER
CHAPTER 20:
Indian Systems of Medicine
INTRODUCTION
AYURVEDA SYSTEM OF MEDICINE
SIDDHA SYSTEM OF MEDICINE
Introduction and Origin
Basic Concepts
Diagnosis and Treatment
UNANI SYSTEM OF MEDICINE
Origin and Development
Fundamental Principles
Diagnosis and Treatment
HOMEOPATHY
YOGA
NATUROPATHY
ALLOPATHY
Methods
CHAPTER 21:
Adolescent Health
INTRODUCTION
Population Profile: Ages 10 to 24 Years in India
Characteristics
Early Adolescence (10 to 13 years)
Middle Adolescence (14 to 16 Years)
Late Adolescence (17 to 19 Years)
PHYSICAL CHANGES DURING ADOLESCENT
PUBERTY CHANGES IN ADOLESCENT
Puberty in Girls
Psychological and Behavioral Changes
Impact of Adolescence
Adolescent Health Problems
EMOTIONAL PROBLEMS
EDUCATIONAL PROBLEMS
Reasons for Adolescent Reluctant to seek Help
Prevention
Syllabus for Adolescent Health Education
Life Skills
Adolescent Friendly Health Center Services
Criteria for Adolescent Friendly Health Worker
Criteria for Adolescent Friendly Health Center
Adolescent Girls Scheme
BENEFICIARIES
Scheme I: Girl-to-Girl Approach
Scheme II: Balika Mandal
Interventions
Training
CHAPTER 22:
Integrated Disease Surveillance Project (2004-2009)
PROJECT OBJECTIVES
SPECIFIC OBJECTIVES
PHASING OF IDSP COVERING THE STATES OF INDIA
Project Activities
Diseases and Conditions Covered under IDSP (Table 22.1)
SENTINAL SURVEILLANCE UNDER IDSP
REGULAR PERIODIC SURVEY
NATIONAL SURVEILLANCE UNIT
STATE SURVEILLANCE UNIT
DISTRICT LEVEL UNIT
DISTRICT SURVEILLANCE UNIT (FLOW CHARTS 22.1 TO 22.4)
Functions of the District Surveillance unit
Managerial
Data Handling
DISTRICT EPIDEMIOLOGICAL CELL
LEVELS OF RESPONSE TO DIFFERENT TRIGGERS (TABLE 22.2)
Malaria Triggers
Trigger 1
Trigger 2
Cholera triggers
Trigger 1
Trigger 2
Typhoid Fever Triggers
Trigger 1
Trigger 2
Polio Trigger
Plague Triggers
Japanese Encephalitis Triggers
Dengue Triggers
Trigger 1
Trigger 2
Triggers for Syndromic Surveillance
When to Sample?
Whom to Sample During a Classical Outbreak?
Rule of Thumb Regarding the Number of Specimens to take during a Cholera Outbreak
How many Specimens to take?
Transport Medium
What is a Viral Transport Medium?
Vacutainers
Collecting Blood for Cultures
To Avoiding Hemolysis for Blood Specimens
Handling and Transporting Blood for Cultures
Handling and Transporting Serum
Collecting and Handling Cerebrospinal Fluid
Collecting a Sputum
Handling and Transportation of Respiratory Specimens
Collecting Stool Specimens for Parasites
Collecting stool Specimens for Bacteria
Collecting Stool Specimens for Viruses
Rectal Swabs
Collecting and Handling Stool Specimens
Collecting Serum
Triple-packaging of Specimens: Two Goals
Early Warning Signals for an Outbreak (Flow chart 22.6)
Steps in Outbreak Response (Flow chart 22.7)
Step 1: Verifying the Outbreak
Step 2: Sending the Rapid Response Team
Declaring the Outbreak Over
Review of the Final Report
Control Measures for an Outbreak
Sources of Information to detect Outbreaks
Outbreaks versus Epidemics
SURVEILLANCE OF NONCOMMUNICABLE DISEASES
Aims
NCD Risk Factors
Program for Control and Treatment of Occupational Diseases
List
Etiological Classification of Occupational Disorders
Proposed Projects for Occupational Diseases under National Program for Control and Treatment of Occupational Diseases
Global Strategy of Occupational Health (Fig. 22.1)
Monitoring and Evaluation
Monitoring
Evaluation
CHAPTER 23:
Integrated Management of Neonatal and Childhood Illnesses
INTRODUCTION
Problem Statement
COMPONENTS OF IMNCI IN INDIA
IMNCI STRATEGY IN INDIA
Timeline of IMNCI
The IMNCI-PLUS
CHAPTER 24:
Community-based Rehabilitation
INTRODUCTION
HARD FACTS
NEED OF REHABILITATION SERVICE
Seven National Levels Institutes
Government Rehabilitation Services
Objectives
District Rehabilitation Center (DRC) Project
Regional Rehabilitation Training Center (RRTC)
National Information Center on Disability and Rehabilitation (NICDR)
Proposed Program for Rehabilitation of the Disabled in the Ninth Five-year Plan
Role of Primary Health Centers for Disability Rehabilitation
Model Method of Implementation of CBR Using Primary Health Centers
Manpower
Functions
Tasks
Manpower
Functions
Orientation of Medical Officers Working in Primary Health Centers to Disability Management
Expected Benefits of the Program
CHAPTER 25:
Social Security
INTRODUCTION
WORKFORCE IN INDIA
Organized and Unorganized Sectors
FUNCTIONS OF SOCIAL SECURITY DIVISION
List of Subjects
EPFO Programs at a Glance (Table 25.1)
New Initiative in Social Security
CHAPTER 26:
Swine Flu
INTRODUCTION
Outbreak in Human, 2009
TRANSMISSION
SIGNS AND SYMPTOMS
Cause of Death
Prevention
Prevention in Swine
Facility Management
Herd Management
CHAPTER 27:
Hospital Statistics
DAILY ANALYSIS
MONTHLY REPORTS
CENSUS
DEATH RATE
CHAPTER 28:
Biostatistics
INTRODUCTION
Definitions of Statistics
Quantitative Medicine
Science of Variation
Science of Averages
Use of Biostatistics
COLLECTION AND PRESENTATION OF DATA
Frequency Table
Construction of a Frequency Table
GRAPHICAL REPRESENTATION OF DATA
Graphs
Bar Diagram (Fig. 28.1)
Proportional Bar Diagram (Fig. 28.2)
Histogram (Fig. 28.3)
Frequency Polygon
Pie Diagram (Fig. 28.4)
The Ogive
CENTERING CONSTANTS (MEASURES OF CENTRAL TENDENCY)
Arithmetic Mean
By Definition
Median
Mode
MEASURES OF VARIATION
Range
Mean Deviation (MD)
Standard Deviation (SD)
Coefficient of Variation (CV)
Quartile Deviation (QD)
Percentile
Tests of Statistical Comparison of Two Groups
Tests of Statistical Significance (Flow chart 28.2)
Test of Significance (for Large Size)
Standard Error of Mean
Uses of SE of Mean
Standard Error of difference between Two Means
Formulae
Test of Significance (for Small Sample Size)
t-Distribution
Criteria for Applying t-test
t-tests for Unpaired Data
Standard Error of Difference
t-tests for Paired Data
Steps for Paired t-test
Standard Error of Proportion (Large Sample Size)
Standard Error of Difference between Two Proportions (Large Sample)
Steps for Calculation
Probability of a Larger Value of ‘t’ (Table 28.1)
Normal Distribution
Normal Curve
Characteristics of the Normal Curve
Table of the Unit Normal Distribution (Table 28.2)
Chi-square Test (χ2-Test)
Table of Chi-square (Table 28.3)
Formula
Fallacies in Biostatistics
Causes
Vital Statistics
Definition
Measures of Population
Geometrical Progression Method
Measures of Vital Statistics
Measures of Fertility
Measures of Mortality
Morbidity Statistics
INTERNATIONAL DEATH CERTIFICATE’ CAUSE OF DEATH (TABLE 28.4)
CHAPTER 29:
Problems
ENVIRONMENTAL PROBLEMS
Problems
BIOSTATISTICS
Limitations of the Mean
CORRELATION AND REGRESSION
Problems
DEMOGRAPHY
EPIDEMIOLOGICAL and NUTRITIONAL EXERCISES
Miscellaneous Problems
CHAPTER 30:
Visits
INTEGRATED COUNSELING AND TESTING CENTER (ICTC)
VISIT TO BLIND SCHOOL
Admission Criteria
Government Authority
Syllabus for the Blind
Staffing Pattern
Specific Program for Prevention of Blindness
National and International Agencies
A VISIT TO DEAF AND DUMB SCHOOL
Staffing Pattern
Rules and Regulations
VISIT TO DISTRICT HEALTH LABORATORY
Staffing Pattern
Functions
Staining Procedure for Malarial Smear
VISIT TO PRIMARY HEALTH CENTEr (PHC)
Functions of the PHC
Staffing Pattern
At the PHC Level
At the Sub-center Level
POSTPARTUM CENTER
Introduction
Functions of Postpartum Unit
Department of Obstetrics and Gynecology
Monitoring and Evaluation Aspects
Institutional Level Monitoring and Evaluation
Guidelines for Constitution of Coordination Committee
Broad Functions
DELIVERY OF INTEGRATED SERVICES FOR MATERNAL AND CHILD HEALTH, FAMILY PLANNING, NUTRITION AND IMMUNIzATION
THE BABY FRIENDLY HOSPITAL INITIATIVE
What is BFHI?
Why this Program?
What is New About it?
What is this Program All About? Can it be Simply Described in a Few Words?
The Ten Steps
The Five Basic Skills
What are the Benefits of Making My Hospital Baby Friendly?
What are the Investments Needed and What is the Cost Involved?
What should I do to get My Hospital Recognized as Baby Friendly Hospital?
WORLD BREASTFEEDING WEEK
What are Our Problems?
Delayed Start
What can We do for the World Breastfeeding Week (WBW)?
Promote BFHI Concept
ANGANWADI
INTEGRATED CHILD DEVELOPMENT SCHEME
Objectives
Package of Services
Organizational Set-up
Anganwadi Worker
Mukhya Sevika (MS)
Child Development Project Officer
Achievements
Scheme for Adolescent Girls (Kishori Shakti Yojna)
VISIT TO DISTRICT TUBERCULOSIS CENTER
National Tuberculosis Program (NTP)
Organization
VISIT TO DISTRICT REHABILITATION CENTER
Services Provided
At Village Level
At PHC/CHC Level
DRC Level
National Program for Rehabilitation of Persons with Disabilities
Objectives
VISIT TO PLACES OF NATURAL CALAMITIES
Disasters
Phases of a Disaster (Fig. 30.3)
Effect of Disasters on Health (Table 30.5)
Examples of Some Disasters
SCHOOL HEALTH SERVICE
Benefits of School Health Programs
Objectives of School Health Service
School Health Program in India
Aspects of School Health Service
VISIT TO DISTRICT LEPROSY CENTer
District Infrastructure (Table 30.6)
Main Activities
Goal of National Health Policy 2002 “Elimination of Leprosy by 2005”
Project Phase II 2000 Onward
Project Phase II Objectives
Project Phase II Components
Appendix
GOALS TO BE ACHIEVED BY 2000-2015
THEMES OF THE WORLD NO TOBACCO DAYS
World Diabetes Day
INTERNATIONAL DECADES
IMPORTANT ACTS RELATED TO HEALTH
Acts
YEARS OF LAUNCHING NATIONAL HEALTH PROGRAMS
WORLD HEALTH DAY
What is the World Health Day?
LIST OF WORLD HEALTH DAY THEMES
IMPORTANT INTERNATIONAL EVENTS AND DAYS
POLICIES
National Policies Related to Health
ACRONYMS
INDEX
TOC
Index
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