SECOND YEAR B.

Sc NURSING

COMMUNITY HEALTH NURSING –I

KUHS EXAMINATION
PREVIOUS MODEL QUESTIONS AND ANSWERS

UNIT – INTRODUCTION
I. LONG ESSAYS
I. Define health. Explain the determinants of health?
ANS:
Health: Health is a state of complete physical, mental and social well-being , not merely an
absence of disease or infirmity (WHO)
Determinants of Health :
Health is multifactorial. The factor which influences health lies both within the individual and
externally the environment in which he lives. The important determinants of health are
1) Biological (genetic) : physical mental ,genetic makeup )
2) Behavioural and sociocultural determinants : life style , cultural , behavioural
personal - habits & addiction ( smoking and alcoholism)
3) Environmental determinants ( internal and external) -
4) Socioeconomic – economic status, education , occupation , political system
age

II. SHORT ESSYS

1) Dimensions of Health
ANS :
1) Physical dimension
2) Mental dimension
3) Social dimensions
4) Spiritual dimension
5) Emotional dimension
6) Vocational dimension
.Physical Dimensions : Physical health means perfect functioning of the body in which each
organ is working in harmony with the maximum capacity. Physical health is achieved by the
exercise, healthy diet, adequate rest and sleep and no smoking or alcohol intake.

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 To maintain proper physical health there is need for taking safety precautions, and regular
follow up with the health care providers.
Signs of physical health
▪ A good complexion,
▪ A clean skin.
▪ Bright eyes.
▪ Not too fatty
▪ A sweet breath.
▪ A good appetite
▪ Sound sleep
▪ Regular activities of bowels and bladder.
▪ Smooth, easy, and coordinated bodily movements
2. Mental Dimensions :
Mental health is a state of balance between body and mind. Earlier the body and mind were
considered two separate entities But these are interrelated as physical illness can result mental
illness and vice versa.. How mental illness influence physical health has been shown in fig:
Mental illness Poor nutrition intake Decreased immune system
(depression )
Poor hygiene Prone to infection

Physical illness
Characteristics of mentally healthy person :
1. Mentally healthy person will be capable of making personal and social adjustment.
2. Mentally healthy person is free from internal conflicts.
3. He faces problems and tries to solve them intelligently.
4. He has good self control balances rationally and emotionally.
5. He knows himself his needs problems and goals.
6. He has strong sense of self esteem.
7. He searches for identity.
8. He lives a well balanced life means able to maintain the balance between work rest and
recreation.

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 3. Social Dimension :

An individual is socially healthy if he is able to maintain harmonious relationship with other

members of society in which he lives.
Social health rooted in “positive material environment” and “positive human environment”
which is concerned with the social network of the individual. The social dimension of health
includes;
▪ Communication
▪ Intimacy
▪ Respect
▪ Equality
4. Spiritual Dimensions :
Spirituality means in touch with deeper self and exploration the purpose of life, as people
believe in some forces that transcend physiology and psychology of human beings. It includes
love , charity, purpose , principles , ethics, integrity, hope of life. Meditations, prayers, or
spiritual gatherings are organized to maintain spiritual health.
5. Emotional Dimensions:
Emotional health is closely related to the mental health and is considered as an important
element of health. Mental and emotional aspects of health are now viewed as two separate
entities for human life. Cognition is related to the mental health whereas emotional health is
related to the feelings of a person
Emotional health includes;
▪ An emotionally healthy person has a positive thinking and is capable of coping and
adjusting self.
▪ An emotionally healthy person participates in all the activities which are related to
personal growth and his self esteem.
▪ Emotionally well people have the ability to express feelings freely and manage feelings
effectively.
▪ They are also aware of and accept a wide range of feelings in themselves and others
6. Vocational Dimension:
➢ The choice of profession, job satisfaction, career ambitions and personal performance are
all important components of this dimension

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 ➢ To be occupationally well, a person is ultimately doing exactly with what they want to do
in life and are comfortable with their future plans.
Vocational dimension of health can be assessed by ;
➢ Assessing the satisfaction level at job
➢ Facilities attached to the job
➢ Behaviour of the management and administrator and of the colleague and job
7.Other dimensions :
A few other dimensions also suggested such as :
➢ Cultural dimensions
➢ Socio-economic dimensions
➢ Environmental dimensions
➢ Educational dimensions
➢ Nutritional dimensions
➢ Preventive dimensions

1. Levels of Prevention

ANS:
Prevention is the action aimed at eradicating, eliminating or minimizing the impact of disease
and disability, or if none of these are feasible, retarding the progress of the disease and disability.
There are four levels of prevention
1) Primordial prevention
2) Primary Prevention
3) Secondary Prevention
4) Tertiary Prevention
1)Primordial prevention
Primordial prevention is defined as prevention of risk factors themselves, beginning with
change in social and environmental conditions in which these factors are observed to develop,
and continuing for high risk children, adolescents and young adults.
➢ It is the prevention of the emergence or development of risk factors in countries or
population groups in which they have not yet appeared.

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 ➢ The main intervention in primordial prevention is through individual and mass
education.
➢ Primordial prevention, a relatively new concept, is receiving special attention in the
prevention of chronic diseases. For example, many adult health problems (e.g. obesity,
hypertension) have their early origins in childhood, because this is the time when lifestyles are
formed (for example, smoking, eating patterns, physical exercise).
➢ Primordial prevention begins in childhood when health risk behaviour begins. Parents,
teachers and peer groups are important in imparting health education to children.
Examples:
▪ National policies and programs on nutrition involving the agricultural sector, the food
industry, and the food import- export sector.
▪ Comprehensive policies to discourage smoking
▪ Programs to promote regular physical activity
▪ Making major changes in lifestyle
2.Primary prevention:
▪ Primary prevention can be defined as the action taken prior to the onset of disease, which
removes the possibility that the disease will ever occur.
▪ It signifies intervention in the pre-pathogenesis phase of a disease or health problem.
▪ Primary prevention may be accomplished by measures of “Health promotion” and
“specific protection”
▪ It includes the concept of "positive health", a concept that encourages achievement and
maintenance of "an acceptable level of health that will enable every individual to lead a socially
and economically productive life".
▪ Primary prevention may be accomplished by measures designed to promote general
health and well-being, and quality of life of people or by specific protective measures.
▪ Primary prevention achieved by Health promotion and Specific protection

Health Promotion
▪ Health education

▪ Environmental modifications
▪ Nutritional interventions

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 ▪ Life style and behavioral changes
Specific Protection
▪ Immunization and seroprophylaxis chemoprophylaxis
▪ Use of specific nutrients or supplementations
▪ Protection against occupational hazards Safety of drugs and foods
▪ Control of environmental hazards, e.g. air pollution
Approaches for Primary Prevention:
The WHO has recommended the following approaches for the primary prevention of chronic
diseases where the risk factors are established:
1) Population (mass) strategy
2) High -risk strategy
Population (mass) strategy:
▪ “Population strategy" is directed at the whole population irrespective of individual risk
levels. For example, studies have shown that even a small reduction in the average blood
pressure or serum cholesterol of a population would produce a large reduction in the incidence of
cardiovascular disease
▪ The population approach is directed towards socio-economic, behavioral and lifestyle
changes
High -risk strategy:
▪ The high -risk strategy aims to bring preventive care to individuals at special risk.
▪ This requires detection of individuals at high risk by the optimum use of clinical
methods.
Secondary prevention: It is defined as “ action which halts the progress of a disease at its
incipient stage and prevents complications.”
The specific interventions are: Early diagnosis (e.g. screening tests, breast self examination,
pap smear test, radiographic examinations, case finding programme, etc) and adequate
treatment.

➢ Secondary prevention attempts to arrest the disease process, restore health by seeking out
unrecognized disease and treating it before irreversible pathological changes take place, and
reverse communicability of infectious diseases. It thus protects others from in the community

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from acquiring the infection and thus provide at once secondary prevention for the infected ones
and primary prevention for their potential contacts.
Early diagnosis and treatment
➢ WHO Expert Committee in 1973 defined early detection of health disorders as “ the
detection of disturbances of homoeostatic and compensatory mechanism while biochemical,
morphological and functional changes are still reversible.”
➢ The earlier the disease is diagnosed, and treated the better it is for prognosis of the case
and in the prevention of the occurrence of other secondary cases.
4.Tertiary prevention:
➢ It is used when the disease process has advanced beyond its early stages.
➢ It is defined as “all the measures available to reduce or limit impairments and disabilities,
and to promote the patients’ adjustment to irremediable conditions.”
➢ Intervention that should be accomplished in the stage of tertiary prevention are disability
limitation, and rehabilitation.
➢ Disability limitation: Disease Impairment Disability Handicap
Impairment: Impairment is “any loss or abnormality of psychological, physiological or
anatomical structure or function.”
Disability: Disability is “any restriction or lack of ability to perform an activity in the manner
or within the range considered normal for the human being.”
Handicap: Handicap is termed as “a disadvantage for a given individual, resulting from an
impairment or disability, that limits or prevents the fulfillment of a role in the community that is
normal (depending on age, sex, and social and cultural factors) for that individual.”
Rehabilitation: Rehabilitation is “the combined and coordinated use of medical, social,
educational, and vocational measures for training and retraining the individual to the highest
possible level of functional ability.”
Rehabilitation may be
➢ Medical rehabilitation
➢ Vocational rehabilitation
➢ Social rehabilitation
➢ Psychological rehabilitation
➢ Strategy for Prevention

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 ➢ Identify Populations at High Disease Risk (based on demography / family history, host
factors..)
➢ Assess Exposure
➢ Conduct Research on Mechanisms (including the study of genetic susceptibility)
➢ Apply Population-Based Intervention Programs
➢ Evaluate Intervention Programs
➢ Modify Existing Intervention Programs

2.Cold Chain System

Definition : A system of storing and transporting the vaccine, at a low temperature from the
place of manufacture to the actual vaccination site is called cold chain
Importance of Cold Chain
1) Obtaining the vaccines from the manufacturers
2) Storing and transporting the vaccines
3) Maintaining the supply of vaccines
4) Having information about essential equipments, supply of electricity etc
5) Keeping the vaccine at low temperature
6) Protecting the vaccine from sunlight exposure
7) Maintaining the potency of vaccines. Components of cold chain
Components of Cold Chain
1) Apparatus/ equipments
2) Supplies
3) Manual efforts
4) Transportation
5) Communication
1)Apparatus / equipments
• 2 categories
1. Apparatus which keep the vaccine at 4 to 8 degree Celsius
2. Equipments which freezes the vaccines
Types of equipments
1. Vaccine carriers

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 2. Cold packs
3. Day carriers
4. Refrigerators
5. Walk in cooler
6. Others
Vaccine Carrier
▪ They are suitable to carry small quantities of vaccine to health sub centers, villages and
small towns. i.e. 16 to 20 vials at a time.
▪ A square box made up of heat resistant material and light in weight
▪ Four packs of ice are kept in these, along all four sides
▪ Vaccines can kept up to 2 to 3 days
Cold boxes
▪ This can transport large quantities of vaccines by vehicle to outreach sites.
▪ Box sizes are 5 liters and 20 liters
▪ It can preserve vaccine for up to 1 week without any power supply.
Cold packs/ ice packs
▪ Flat bottles of plastic, which are filled with water. No salt should be added in the water.
▪ These are used in the vaccine carriers after freezing with water
Day Carriers
▪ These equipments are used to keep the vaccine for A DAY.
▪ Capacity is hold 6-8 vials for 12 hours.
▪ These include boxes of thermocol and thermos flasks contain 2 ice packs.
Refrigerator
Types: Deep freezer, Small Deep Freezer or ILRs
▪ Deep freezer: 300liters
▪ ILR 300/240liters
▪ Used in all district level.
▪ It is also used to make ice packs and for storing OPV & measles vaccines
Do’s and Don’ts for use of ILR/ Freezer
Do’s

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 ▪ Keep the equipment in cool room away from direct sunlight and at least 10cm away from
the wall.
▪ Keep the equipment well
▪ Fix permanent electric connection through voltage stabilizer
▪ Keep vaccines neatly with space between the stacks for circulation of air.
▪ Keep the equipments locked and open only when necessary.
▪ Defrost periodically
▪ Supervise the temperature record
▪ Take immediate action if the equipments fail
▪ Vaccines if kept in cartons make holes on the sides cartons for cold air to circulate.
Don’ts
▪ Do not keep any object on these equipments
▪ Do not store any other drug
▪ Do not open unless necessary
▪ Do not keep food or drinking water in them
▪ Do not keep more than one month’s requirements at PHC level and three months
requirement at district level
▪ Do not keep date expired vaccines

Walk in cooler (WIC)

▪ This is refrigerator of the size of a room in which all types of vaccines can be kept safe
▪ It is used in district health centers
Supplies
▪ Supplies are the vaccines and solvents
▪ They should kept at low temperature
Manual efforts
▪ People working with the manufacturer, health officers, health workers and those storing
and transporting the vaccines, work together to maintain cold chain.
Transportation
▪ To maintain the potency of vaccine rapid means of transport should be used in a specific
temperature.

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 ▪ Refrigerators should be arranged in the trucks with a heat resistant equipments.
▪ Aero planes are used to save time.
Communication
▪ All information and orders associated with cold chain should be immediately and clearly
sent and received.
Methods of controlling cold chain
1) Keep the vaccine in appropriate conditions as suggested by manufacturer
2) Follow all the precautions while transporting vaccines
3) Record the temperature of storage place twice a day and preparing the temperature chart
4) Maintain the equipment of cold chain and the appropriate functioning of its components,
conducting potency tests from time to time
5) Keep communication system effective and latest
6) Train all the people associated with vaccination, about the maintenance and control of
cold chain.

2.Health Promotion Measures

ANS:
Health promotion is the process of enabling people to increase control over and to improve
health
The important interventions in this area are:
1) Health education
2) Environmental modification
3) Nutritional intervention
4) Lifestyle and behavioural changes
According to Ottawa Charter incorporates five key action areas in health promotion .They are :
1) Build healthy public policy
2) Create supportive environment for health
3) Strengthen community action for health
4) Developing personal skills
5) Re-orient health services

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 1. Healthy Public Policy:

A Healthy Public Policy is characterized by a concern for health and equity and an
accountability for health impact.
Health should be made a priority item on the agenda of policy-makers in all sectors.
Policy-makers should be made aware of the health consequences of their decisions. They
should create pro- health policies, whether in the area of development, legislation, taxation etc.
All relevant government sectors like agriculture, trade, education, industry and finance
need to give important consideration to health as an essential factor during their policy
formulation.
2. Create Supportive Environment:
▪ The overall guiding principle is the need to encourage reciprocal maintenance - to take
care of each other, our communities and our natural environment.
▪ Supportive environments cover the physical, social, economic, and political environment
▪ Supportive environments encompass where people live, work and play.
▪ All development activities should aim for a healthy environment – healthy buildings,
roads, workplaces, homes, surroundings and schools.
3. Strengthen Community Action: Community Participation
Community participation is a social process whereby groups with shared needs living in
a defined geographic area actively pursue identification of their needs, take decisions and
establish mechanisms to meet these needs .
Full community participation occurs when communities participate in equal partnership
with health professionals as stakeholders in setting the health agenda.
At the heart of this process is the empowerment of communities - their ownership and
control of their own endeavors and destinies.
This requires full and continuous access to information, learning opportunities for
health, as well as funding support.
4. Develop Personal Skills:
❖ Skills which can promote an individual’s health include those pertaining to identifying,
selecting and applying healthy options in daily life.

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 ❖ Health promotion supports personal and social development through providing
information, education for health, and enhancing life skills. By so doing, it increases the
options available to people to exercise more control over their own health and over their
environments, and to make choices conducive to health.
❖ Enabling people to learn, throughout life, to prepare themselves for all of its stages and to
cope with chronic illness and injuries.
Developing /increasing personal health skills
▪ Information and education for personal and family health.
▪ Take account of values, beliefs and customs of the community.
▪ Continuous process at all stages of life.
▪ Guided and supported in developing skills (not imposed on them).
▪ Build on existing knowledge and attitudes.
5. Reorient Health Services
Reorienting health services is primarily about the health sector changing from focusing
primarily on clinical and curative services to increasingly focus on health promotion and
prevention
Health care system must be equitable and client-centered
Reorienting health services challenges the medical approach to health, which focuses
only on treatments for disease and illness.
It recognizes the impacts of all the determinants upon health and views health as more
than just absence of disease, but a positive state which should be actively pursued.

II.DEFINE THE FOLLOWING:

1) Community health nursing: Community health nursing is a synthesis of nursing and

public health practice applied for promoting and preserving the health of the people.
(ANA 1980)
2) Health: Health is a state of complete physical, mental and social well-being , not merely
an absence of disease or infirmity (WHO)
3) Positive Health: A person who is healthy physically, mentally, socially and spiritually is
said to be in a state of positive health. . ie, highest standard of health . (AH. Suryakantha)

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III. DIFFERENTIATE BETWEEN

1) Levels of care and Levels of prevention

Sl.No Levels of care Levels of prevention

1. The intensity of effort required to It signifies intervention in the
diagnose, treat, preserve or maintain an prepathogenesis phase of a disease or
individual's physical or emotional status. health problem
2. Primary , secondary and tertiary care Primordial, primary , Secondary and
Tertiary prevention

2) Primordial Prevention and Primary Prevention

Sl.No Primordial prevention Primary prevention

It is the prevention of the emergence or Primary prevention is defined as action
development of risk factors in a population taken prior to the onset of disease, which
1.
or groups in which they have not yet removes the possibility that a disease will
appeared ever occur.

.Efforts are directed towards discouraging It signifies intervention in the

2. children from adopting harmful lifestyles prepathogenesis phase of a disease or
through individual and mass health health problem Two approaches used in
education primary prevention are population strategy
and high risk strategy

3) Killed Vaccine and Live Vaccine

Sl.No Killed Vaccine Live Vaccine

1. Killed (inactivated) vaccines are made Live virus vaccines use the weakened
from a protein or other small pieces taken (attenuated) form of the virus. A live

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 from a virus or bacteria. virus vaccine helps the body's immune
Eg: Inactivated poliovirus vaccine(IPV), system recognize and fight infections
rabies vaccine, Hepatitis A virus vaccine , caused by the non-weakened form of
Pertussis Vaccine the virus.
Eg:MMR and Varicella (Chickenpox )
vaccines , smallpox , Yellow Fever
2. Killed vaccine (An inactivated vaccine) is L ive vaccines use pathogens that are still
a vaccine consisting of virus particles, alive (but are almost always attenuated,
bacteria, or other pathogens that have been that is, weakened).
grown in culture and then lose disease
producing capacity.

4) Primary Prevention and Secondary Prevention

Sl.No Primary Prevention Secondary Prevention

1. Primary prevention is defined as action It is defined as “action which halts the

taken prior to the onset of disease, which progress of a disease at its incipient stage
removes the possibility that a disease will and prevents complications.”
ever occur.
2. It signifies intervention in the .Secondary prevention attempts to arrest
prepathogenesis phase of a disease or the disease process, restore health by
health problem seeking out unrecognized disease and
Two approaches used in primary treating it before irreversible pathological
prevention are population strategy and changes take place, and reverse
high risk strategy communicability of infectious diseases.
.Primary prevention may be accomplished
by measures of “Health promotion” and
“specific protection”

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 5) Vaccination and Chemoprophylaxis

Sl.No Vaccination Chemoprophylaxis

1. Vaccination is inoculation with a vaccine , Chemoprophylaxis is chemoprevention;
in order to protect from a particular disease the prevention of disease using food
or strain of disease supplements or drugs

6) Inactivated Polio Vaccine and OPV

Sl.No Inactivated polio vaccine OPV
1. Killed formalized virus Live attenuated virus

2. Given IM or SC prevents paralysis , but

does not prevent re infection by mild Given orally
polio viruses
3. Expensive Cheaper

4. Does not require stringent conditions Request to be stored and transported at sub
during storage and transportation zero temperature , unless stabilized

UNIT II : ENVIRONMENTAL HEALTH

I LONG ESSAY:
1) Define safe and wholesome water. Describe prevention and management of water
pollution.
ANS:
Safe and Wholesome water: is defined as that which is free from pathogenic agents, free from
harmful chemical substances, pleasant to taste, colorless and odorless.
PREVENTION AND MANAGEMENT OF WATER POLLUTION:

Disposal of excreta and sewage:

• In rural areas disposal of excreta is by having sanitary latrines such as borehole ,water
seal, septic tank latrines and sulabhshauchalya. In towns and cities, human excreta and waste
water are moved through sewerage system to a sewage treatment plant.

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 Purification of water:
a) Purification on large scale: it employs 3 methods: storage, filtration and disinfection.
Storage: the water from source is stored in big reservoirs for 10-15 days. During this period
90%of the suspended impurities settle down in 24 hours.
Filtration: it further removes the bacteria and other impurities.
• Two types of filters are slow sand and rapid sand filters.
• In both these filters, large sand beds are prepared and water is allowed to filter through
these sand beds, leaving impurities behind on the sand beds. The slow sand filters take
more time to filter but water is 99%pure. The rapid sand filter takes less time.
Disinfection: it kills all the rest of pathogenic organisms. This is done by chlorination of water.
b) Purification on small scale: the methods are:
Sedimentation: the water is stored in large vessel. The suspended particles settles down within
24 hours Alum is added to the water .Alum collects all the impurities together and settles down
quickly. Clean water is poured to other vessel. This water can be filtered and disinfected to make
it safer.
• Filtration: The water is stored in the filter which has one to three filter candles. The filter
candles are made of porcelain. Water filters through these candles .Any kind of Impurities
including bacteria and eggs of parasites gets removed by these candles.
• Chemical Disinfection: Usually by chlorination, by adding bleaching powder, chlorine
solution or chlorine tablets.
• Other disinfectants: Iodine and potassium permanganate.
• Boiling: Boiling of water in a covered vessel for 10-15 minutes .It kills all organisms.
• Water Protection Law: to prevent contamination of water , the act (Prevention and Control
of Pollution ) was passed in 1974.This acts provide power to central and State water Boards for
controlling water pollution.

PREVENTION:
• Identifying sources of water pollution.
• Creating awareness among the families , community leaders and people about water
pollution and its effects on their health

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 • Giving information to the people to make observations about any change in the quality of
water , its odour , turbidity and taste and report to the concerned authority and take necessary
corrective measures

2) Define sewage. Explain modern sewage treatment

ANS:
Sewage: It is a waste water from a community containing solid and liquid excreta derived from
houses , street , factories and industries
MODERN SEWAGE TREATMENT
Treatment can be divided in to 2 stages:
➢ Primary treatment
➢ Secondary treatment
Primary treatment:
Screening : sewage arriving is first passed through a metal screen which obstructs large
floating objects such as pieces of wood , rags , masses of garbage and dead animals.
• Removal is necessary to prevent the clogging of the treatment plant
• Screen consists of vertical or inclined steel bars usually set 5 cm apart

Grit chamber :
• Sewage is passed through a long narrow chamber called the grit chamber .This chamber
is 10 to 20 meters in length
• The function of grit chamber is to allow the settlement of heavier solids such as sand and
gravel, while permitting the organic matter to pass through .
• The grit which collects at the bottom of the chamber is removed periodically
Primary sedimentation:
• Sewage is now admitted into a huge tank called primary sedimentation tank .It is very
large tank.
• There are various designs in primary sedimentation tank – the commonest is the
rectangular tank.
• Sewage is made to flow slowly across the tank at a velocity of 1-2 feet per minute
• The sewage spends for about 6-8 hours in the tank.

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 • Sedimentation of the suspended matters occurs during this period.
• The organic matter which settles down is called sludge and is removed by mechanically
operated device without disturbing the operation in the tank.
• While this is going on, a small amount of biological action also takes place in which the
microorganisms present in the sewage attack complex organic solids and break them down into
simpler soluble substances and ammonia.
• A certain amount of fat and grease rise to the surface to form scum which is removed
from time to time and disposed off.
• When the sewage contains organic trade wastes, it is treated with chemicals such as lime,
aluminum sulphate and ferrous sulphate.
Secondary treatment
• The effluent from the primary sedimentation tank still contains a proportion of organic
matter in solution or colloidal state, and numerous living organisms.
• It has a high demand for oxygen and can cause pollution of soil or water.
• It is subjected to further treatment , aerobic oxidation, by one of the following methods :
➢ Trickling filter method
➢ Activated sludge process
Trickling Filter Method
• The trickling filter or percolating filter is a bed of crushed stones or cinker, 1 to 2 m (4-8
ft.) deep and 2 to 30 m (6-100 ft) in diameter, depending upon the size of the population.
• The effluent from the primary sedimentation tank is sprinkled uniformly on the surface of
the bed by a revolving device.
• The device consists of hollow pipes each of which have a row of holes.
• The pipes keep rotating, sprinkling the effluent in a thin film on the surface of the filter.
• Over the surface and down through the filter, a very complex biological growth
consisting of algae, fungi, protozoa and bacteria of many kinds occurs.
• This is known as zoogleal layer”.
• As the effluent percolates through the filter bed, it gets oxidized by the bacterial flora in
the zoogleal layer.
• The trickling filters are very efficient in purifying sewage.
• Wind blows freely through the beds supplying the oxygen needed by the zoogleal flora.

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 • The biological growth or zoogleal layer lives, grows and dies.
• The dead matter sloughs off, breaks away and is washed down the filter. It is a light
green, flocculent material and is called “humus”.
• The oxidized sewage is now led into the secondary sedimentation tanks or humus tanks.

Activated Sludge Process

• It is the modern method of purifying sewage, in place of the trickling filter.

• The “heart” of the activated sludge process is the aeration tank.
• The effluent from the primary sedimentation tank mixed with sludge drawn from the final
settling tank (also known an activated sludge or return sludge; this sludge is a rich culture
of aerobic bacteria).
• The mixture is subjected to aeration in the aeration chamber for about 6 to 8 hours.
• The aeration is accomplished either by mechanical agitation or by forcing compressed air
continuously from the bottom of the aeration tank.
• This method. also known as ‘diffuse aeration
• During the process of aeration the organic matter of the sewage gets oxidized into carbon
dioxide, nitrates and water with the help of the aerobic bacteria in the activated sludge.
• Activated sludge plants occupy less space, require skilled operations

❖ Secondary Sedimentation

• The oxidized sewage from the trickling filter or aeration chamber is led into the
secondary sedimentation tank where it is detained for 2-3 hours
• The sludge that collects in the secondary sedimentation tank is called ‘aerated sludge’ or
activated sludge, because it is fully aerated.
• It differs from the sludge in the primary sedimentation tank in that it is practically
inoffensive and is rich in bacteria, nitrogen and phosphates.
• It is a valuable manure, if dehydrated
• Part of the activated sludge is pumped back into the “aeration tanks” in the activated
sludge process and the rest pumped into the sludge digestion tanks for treatment and disposal.

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 Sludge Digestion: Biggest problem of sewage treatment is the treatment and disposal of
resulting sludge
• There are number of methods for sludge disposal
• Digestion : sludge incubated under favorable conditions of temperature and PH , it
undergoes anaerobic digestion in which complex solids are broken down into water , carbon
dioxide , methane and ammonia
• The volume of the sludge is reduced
• It takes 3 – 4 weeks or longer for complete sludge digestion
• Sludge digestion carried out in sludge digestion tank
• Methane gas , byproduct of sludge digestion can be used for heating and lighting process
• Sea disposal – pumping into the sea
• Land – sludge can be disposed of by composting with town refuse
1. Sources of Water .
➢ Rain
➢ Surface water
• Impounding reservoirs
• Rivers and stream
• Tanks, ponds and lakes
➢ Ground water
• Shallow wells
• Deep wells
• Springs

Purification of Water on a Small Scale:

A ) Household Purification of Water : There are 5 methods
1) Boiling
2) Chemical disinfection
3) Filtration
4) UV irradiation
5) Multi stage reverse osmosis purification of water
Household purification of water

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 i. Boiling – rolling boil for 10-20 min Kills bacteria/ spores/ cysts/ ova
• Removes temporary hardness, taste can be altered
• No residual protection
• Should be stored in same container where boiled
ii. Chemical disinfection:
• Bleaching powder
• Chlorine solution
• High test hypochlorite
• Chlorine tablets
• Iodine
• Potassium permanganate
▪ Bleaching Powder: if freshly made=33% available Cl, un stable(on exposure to
air/light/moister losses Cl content. Stored in dark, cool, dry place in closed container)
▪ Chlorine solution : prepared from bleaching powder. 4 kg of bleaching powder with 25 %
available chlorine mixed with 20 lit of water gives 5% solution of chlorine.
▪ High test hypochlorite: Perchloron-More stable.
▪ Chlorine Tablets: (Halazone Tablet). Good but costly. Single tablet of 0.5 g is sufficient
to disinfect 20 lit of water.
Iodine:- emergency disinfection of water.
- 2 drops of 2% ethanol solution is sufficed for 1 lit of water.
- contact time needed 20-30 min.
- High cost
- Physiologically active (thyroid activity)
Potassium permanganate: No longer used
Changes color/smell/taste of water.
iii. Filtration
Ceramic filters –Pasteur Chamberland filter, Berkefeld filter, Katadyn filter.
- Main part is candle ( Porcelin /infusorial earth)
- In Katadyn: Surface covered with silver catalyst, bact. destroyed in contact with silver
ion (oligodynamic action)
- can remove bacteria, not viruses
c) Ultraviolet Irradiation: can destroy bacteria, Viruses, yeast, fungi, algae, protozoa

22
 - Mercury vapor arc lamps emitting UV rays at a wave length of 254 nanometer
- Water should be free from turbidity/ colloidal suspended constituents
- Short exposure required, no foreign matter added, no taste /odour change
- No residual effect
d) Multistage reverse osmosis purification of water:- Remove total dissolved solid,
hardness, heavy metals, bacteria, viruses, protozoa, cysts.
- Clarity cartridge removes suspended particles (dust/mud/sand)
- The reverse osmosis cartridge removes dissolved solid/hardness/heavy metals/
microorganism.
B) Disinfection of Wells
Steps in Well Disinfection of Well:
➢ Find volume of water in the well
➢ Find amount of bleaching powder required for disinfection
➢ Dissolve bleaching powder in water
➢ Delivery of chlorine solution into the wells
➢ Contact period - of1 hour is allowed before water is drawn from well.
➢ OTA test - if free residual chlorine is less than 0.5 mg/litre then chlorination procedure
should be repeated.
SHORT NOTES:
1. Methods of disposal of human excreta.
Un sewered areas
• Service type latrines( conservancy system)
• Non service type( sanitary latrines)
• Latrines suitable for camps and temporary use.
Non service type( sanitary latrines)
• Bore hole latrine
• Dug well latrine
• Water seal latrine
➢ PRAI type
➢ RCA type
• Sulabshauchalaya
• Septic tank
23
• Aqua privy
. Latrines suitable for camps and temporary use.
➢ Shallow trench latrine
➢ Deep trench latrine
➢ Pit latrine
➢ Bore hole latrine
Sewered Area;
Primary treatment
▪ Screening
▪ Removal of grit
▪ Plain sedimentation Secondary treatment
Secondary treatment
▪ Trickling of filters
▪ Activated sludge process
Other methods
▪ Sea out fall
▪ River outfall
▪ Sewage farming
▪ Oxidation ponds
Cartage (Conservancy system)
▪ Example: Bucket latrine
▪ Disadvantages:
➢ Smell
➢ Flies
➢ Health risk to people handling the excreta
➢ Health risk from food crops fertilized with raw excreta
Criteria for a sanitary latrine
▪ Excreta should not contaminate the ground and surface water.
▪ Excreta should not pollute the soil.
▪ Excreta should not be accessible to flies, rodents, animals
▪ Excreta should not create a nuisance due to odor or unsightly appearance
. Bore hole latrine

24
 ▪ The latrine consists of a circular hole 30 to 40cm in diameter, dug vertically into the ground
to a depth of 4 to 8 m, most commonly 6m.
▪ A concrete squatting plate with a central opening and foot rests is placed over the hole
▪ A suitable enclosure is put up to provide privacy
▪ Bore hole latrine 30-40 cm diameter 4 to 8 m depth
Dug well latrine
▪ A circular pit about 75 cm in diameter and 3 to 3.5 m deep.
▪ The pits may be lined with pottery rings to prevent caving in of the soil.
▪ A concrete squatting plate is placed on the top of the pit and the latrine is enclosed with a
superstructure.
▪ 75 cm diameter 3 to 3.5 m deep
Water Seal Latrine
Two types
▪ The PRAI type evolved by Planning, Research and Action Institute, Luck now
▪ The RCA type designed by the Research cum action projects in Environmental sanitation of
the Ministry of Health.
Essential Features of RCA latrine
➢ Location
➢ Squatting plate
➢ Pan
➢ Trap
➢ Connecting pipe
➢ Dug well S
➢ superstructure Maintenance
RCA latrine
• Location 15m
➢ Squatting plate
➢ Made of an impervious material
➢ It is made of cement concrete with minimum dimensions of 90 cm square and 5 cm
thickness at the outer edge.
➢ There is a slope half inch towards the pa
Pan and Trap

25
 ❖ The length 42.5cm. The width of the front portion of the pan has minimum of 12.5 cm
and the width at its widest portion is 20cm.
❖ The trap is bent pipe about 7.5cm in diameter and is connected with the pan.
❖ It holds water and provides the necessary water seal.
❖ The water seal is the distance between the level of water in the trap and the lowest point
in the concave upper surface of the trap.
❖ The depth of the water seal in the RCA latrine is 2cm.
Connecting pipe:
Connecting pipe 7.5 cm in diameter and at least 1m in length with a bend at the end.
Dug well: The dug well or pit is usually 75 cm in diameter and 3 to 3.5 m deep and is covered.
Superstructure
➢ The desired type of superstructure may be provided for privacy and shelter.
Septic Tank
Features of a septic tank
• Capacity: The minimum capacity of a septic tank should be at least 500 gallons
• Length: The length is usually twice the breadth.
• Depth: The depth of aseptic tank is from 1.5 to 2m.
• Liquid depth: The recommended liquid depth is only 1.2m.
• Air space A minimum air space of 30cm between the level of liquid in the tank and the
undersurface of the cover
• .Bottom: The bottom is sloping towards the inlet end.

• Inlet and outlet: There is an inlet and outlet which is submerged.

• Cover The septic tank is covered by a concrete slab of suitable thickness and provided
with a manhole. Retention period Septic tanks are designed to allow a retention period of 24
hours.
Sulab Shauchalaya
❖ The invention of a Patna based firm
❖ It consists of specially designed pan and a water seal trap.
❖ It is connected to a pit 3 feet square and as deep.
Latrines Suitable For Temporary Use and Camps
Shallow trench latrine :

26
 ❖ The trench is 30cm wide and 90-150cm deep
❖ Its length depend on the number of users;3-3.5 m for 100 people.
❖ The trench is 1.8 to 2.5 m deep and 75-90cm wide.
Water Carriage System:
Types
❖ Combined sewer system and
❖ Separate sewer system.
Sewage:
❖ Sewage is waste water from a community containing solid and liquid excreta.
❖ The average amount of sewage which flows through the sewerage system in 24 hours is
called the dry weather flow.
Aims of sewage purification
➢ To stabilize the organic matter so that it can be disposed off safely.
➢ To convert the sewage water into an effluent of an acceptable standard of purity which
can be disposed off into land, rivers or sea.
Strength of sewage
▪ Biochemical oxygen demand (BOD)
▪ Chemical oxygen demand (COD)
▪ Suspended solids
2. Importance of Food Hygiene.

▪ Food Hygiene, otherwise known as Food Safety can be defined as handling, preparing
and storing food or drink in a way that best reduces the risk of consumers becoming sick from
the food-borne disease. The principles of food safety aim to prevent food from becoming
contaminated and causing food poisoning
If food or drink is not safe to eat, you cannot eat or drink. The easiest example of this is
safe drinking water. We would never drink water that did not come from a reputable source.
Every day, people worldwide get sick from the food or drink they consume. Bacteria,
viruses and parasites found in food can cause food poisoning.
There is no immediate way of telling if food is contaminated because you cannot see,
taste or smell anything different from the norm.

27
 Food poisoning can lead to gastroenteritis and dehydration or potentially even more
serious health problems such as kidney failure and death.
This risk is especially significant for those in the high-risk category: Small children/
babies, pregnant moms, the elderly and immunocompromised, especially HIV infections and
cancer patients.
Food hygiene and safety prevent germs from multiplying in foods and reaching
dangerous levels.
Ensures daily healthy family living.
Keeping one healthy and preventing the additional cost of buying medication and medical
check-ups.
Hand washing accounts from 33% of all related food poisoning cases. It is therefore
important to maintain good personal hygiene practice. This is something we are taught early in
our childhood, yet hand washing is still a critical problem in the kitchen
Cross-contamination is a major cause of food poisoning and can transfer bacteria from
one food to another (usually raw foods to ready to eat foods).
It is crucial to be aware of how it spreads so you will know how to prevent it. Good food
hygiene is therefore essential for food factories to make and sell food that is safe to eat.
The first step is for the management and staff to have the knowledge and understand of
what food hygiene and food safety is.

3).Methods of Food Preservations:

Drying: Keeping food in air or sunlight for drying , resulting in the reduction of water activity
The foods which can be dried are apples, peas, mangoes, bananas, raisins etc
1) Smoking: heat is used to dry the food without cooking and aromatic hydrocarbon of
smoke preserve the food Eg: meat , fish
2) Freezing: commonest method in which low temperature is used for preserving the food
3) Canning: in which fruits and vegetables are cooked and sealed in sterile cans and as a
form of pasteurization, the cans are boiled to kill any remaining microorganisms.
There are certain foods which require only boiling for short timings, while other foods require
boiling for longer time period, even some foods require pressure canning

28
For example. Strawberries require only short boiling cycle and tomatoes require long boiling
cycle and use of additives.
4) Jellying .Jellying is the way in which the food which is solid is cooked to form a gel with
or without adding a material such as sipunculid worms.
There are some foods which require addition of pectin (jellying agent) to form a jell such
as agar, gelatin, but in some foods pectin is naturally present.
5) Vacuum Packing: Vacuum packing is the method of preserving the food in which air
tight bags or bottles are used for storing the food.
The vacuum created in the container reduces the oxygen demand of bacteria for their
survival i.e. inhibit the aerobes and delay the growth of bacteria. Thereby, preventing the
spoilage
6) Salting :- Salting method is used to preserve the food. Salting technique draws the
moisture from food by osmosis. Even nitrites and nitrates are used to preserve the food which
inhibit specific group of micro-organisms e.g. meat.
7) Pickling :-Pickling method is one in which the food is preserved by using an edible
antimicrobial liquid. It includes two processes :
A) Chemical pickling.B) Fermentation pickling.
Chemical pickling: In chemical pickling, the agents such as brine, vinegar, vegetables oil and
many other oils are used.
In commercial pickling, sodium benzoate is used for preserving the food
Fermentation Pickling: When the food is fermented, it produces preserving agent, the process
of production of lactic acid. Examples of fermentation pickling are curtido or kinchi etc.
9) Irradiation: The food is exposed to ionizing radiations (high energy electrons or x- ray
from accelerators or gamma rays).
This process of irradiation is also known as cold Pasteurization, so called because heat is
not used for preserving food, but radiations safety precautions are used.
Irradiation of food does not cause food to become radioactive and worldwide over 40
countries, approximate 50,000 tons of food items such as spices and condiments are irradiated
annually.
10) Use of sugar as a preservation method: The food which need to be preserved is cooked
in sugar to the point of crystallization and the outcome product is then dried and stored, such as
apples, peaches, apricots, plums etc. are preserved by this method.

29
 Even sugar in syrup form is also used to preserve the food. E.g :Muraba of amla, apples
etc.
Sometimes alcohol is combined with sugar to preserve food. The food is preserved due to high
sucrose concentration, which creates too high osmotic pressure, not allowing the microorganisms
to grow or survive.
11) Jugging :This method is used to store meat after cutting in small pieces with gravy or brine
in air tight container.
12) Enriched atmosphere : This method of preservation is used to preserve grain. At the
bottom of grain, a block of dry ice is kept and excess of gases is burped. By this method, grain
can be preserved for 5 years.

4. Standards of Ventilation;

Standards of Ventilation-: Most of the standards of ventilation have been based on the
efficiency of ventilation in removing body odour.
1) Cubic Space-: minimal fresh air supply ranging from ‘300’ to ‘3000' c.ft. per hour per
person - De Chaumont advocated a fresh air supply of 3000 c.ft per person per hour.
2) Air Change-: Air change is more important than the cubic space requirement. - It is
recommended that in the living rooms, there should be 2 to 3 air changes in one hour; in work
rooms and assemblies 4 to 6 air changes.
▪ If the air is changed more frequently. i.e. More than 6 times in one hour, it is likely to
produce a draught and should be avoided.
▪ The number of air changes per hour is calculated by dividing the total hourly air supply
to the room by the cubic capacity of the room
▪ a space of 1,000 to 1,200 c.ft. per person is quite sufficient.
3) Floor space-:Floor space per person is even more important than cubic space. - The
optimum floor space requirements per person vary from 50 to 100 sq.ft.

5. Methods of Waste Disposal :

Methods of waste disposal

1) Dumping

30
 2) Controlled tipping
3) Incineration
4) Composting
5) Manure pit
6) Burial
Dumping: Refuse is dumped in low lying areas partly as a method of reclamation of land but
mainly as an easy method of disposal of dry refuse.
As a result of bacterial action, refuse decreases considerably in volume and is converted
gradually into humus. .
Controlled Tipping
• Controlled tipping or sanitary landfill is the most satisfactory method of refuse disposal
where suitable land is available.
• It differs from ordinary dumping in that the material are placed in a trench or other
prepared area, adequately compacted, and covered with earth at the end of the working day.
• The term "modified sanitary landfill" has been applied to those operations where
compaction and covering are accomplished once or twice a week.
Three methods are used in this operation :
1) The trench method: Where leveI ground is available. - A long trench is dug out - 2 to 3 m
(6-10 ft.) deep and 4 to 12 m. (12-36 ft.) wide, depending upon local conditions. The refuse is
compacted and covered with excavated earth.
2) The ramp method : This method is well suited where the terrain is moderately sloping.
(3) The area method: This method is used for filling land depressions, disused quarries and
clay pits. - The refuse is deposited, packed and consolidated in uniform layers up to 2 to 2.5 m
(6-8 ft.) deep. - Each layer is sealed on its exposed surface with a mud cover at least 30 cm (12
inches) thick. - Such sealing prevents infestation by flies and rodents and suppresses the nuisance
of smell and dust.
Incineration
• Disposing hygienically by burning or incineration.
• It is the method of choice where suitable land is not available.
• Hospital refuse which is particularly dangerous is best disposed of by incineration.
• A preliminary separation of dust or ash is needed.

31
 • All this involves heavy outlay and expenditure, besides manipulative difficulties in the
incinerator.
Composting : Composting is a method of combined disposal of refuse and night-soil or sludge.
• It is a process of nature whereby organic matter breaks down under bacterial action
resulting in the formation of relatively stable humus-like material, called the compost which has
considerable manurial value for the soil.
• The principal by-products are carbon dioxide, water and heat.
The following methods of composting are now used : -
➢ Bangalore method (Anaerobic method)
➢ Mechanical composting (Aerobic method) 1)
Manure Pits
• The problem of refuse disposal in rural areas can be solved by digging 'manure pits' by
the individual householders.
• The garbage, cattle dung, straw, and leaves should be dumped into the manure pits and
covered with earth after each day‘s dumping.

• Two such pits will be needed, when one is closed, the other will be in use.
• In 5 to 6 month's time, the refuse is converted into manure which can be returned to the
field.
Burial : This method is suitable for small camps.
• A trench 1.5 m wide and 2 m deep is excavated, and at the end of each day the refuse is
covered with 20 to 30 cm of earth.
• When the level in the trench is 40 cm from ground level, the trench is filled with earth and
compacted, and a new trench is dug out.

5) Types of Ventilation:

❖ Natural ventilation
❖ Mechanical Ventilation
❖ Natural ventilation

32
 ▪ Is ventilation that occurs primarily through open windows and doors and by infiltration
through cracks in the building envelope, such as walls, around windows and any penetration
through the walls.
▪ Natural ventilation is driven by wind or pressure and/or temperature differences between
inside and outside a building
▪ One of the biggest advantages of natural ventilation is that it does not cost any money to
run.
❖ Mechanical ventilation and electronic climate control can be quite costly, and may
contribute significantly to the overall energy costs involved with running a building.
❖ No use of energy also makes natural ventilation an environmentally friendly choice.
❖ Natural ventilation systems tend to be easier to maintain, as well, with no parts to break
or go wrong, they can't disturb occupants of the building with interruptions in ventilation or add
to the operating costs for the ventilation system
Three forms of natural ventilation are:
❖ Through ventilation
❖ Cross ventilation
❖ Back to back ventilation

Through ventilation: In this method the windows are opposite to each other, so that a current of
air may pass straight through the room.
Cross ventilation: In this method the windows are so placed that a current of air may pass
diagonally across the causing airflow across the space. Positive pressure on the windward and/or
a vacuum on the lee side of the building cause air movement across the room(s) from the
windward to the lee side provided the windows on both sides of the room are open.
Back to back ventilation: Neither through ventilation nor cross ventilation takes place. It is
considered to be unhygienic type of ventilation, since the same air tends to be repeatedly used
without being replaced.
Mechanical Ventilation or forced ventilation
Outside air is delivered indoors typically with a fans, which draws air from outside and forces it
through ducts to the place where occupants are located.
Mechanical ventilation can exacerbate infiltration and/or exfiltration
Three forms of artificial/mechanical ventilation are:-

33
 ▪ Exhaust (extractor/vacuum) system
▪ Pressure (plenum/propulsion) system
▪ Balanced system
▪ Air conditioning
Exhaust (extractor/vacuum) system: Fans draw air out of the building in openings high up in
the outside walls. The air thus drawn out is replaced by fresh air through windows and other
inlets.
The fans may be placed directly in windows or outside walls or in ducts which lead the air
outside. It is a system that is useful for the removal of dust, smoke and fumes in some factories.
But the method has the disadvantage that the flesh-air to replace the foul (vitiated) air must find
its own way into the building.
Pressure (plenum/propulsion) system: Unlike the exhaust system, this forces the air into a
building and therefore control of entering air is possible, the fresh entering air displaces the used
up air. The advantage of this method is that the source of air-entry can be controlled and its
purity thereby ensured.
Balanced system:
▪ This is a combination of the exhaust and plenum system.

▪ Air is drawn in through ducts by means of a centrifugal fan and extracted at suitable points
by exhaust fan. When this system of ventilation is employed there should be no natural
inlets or outlets. 04/21/16 27
▪ A balanced ventilation system usually has two fans and two duct systems. It facilitates
good distribution of fresh air by placing supply and exhaust vents in appropriate places.
Air conditioning is generally employed with this type of ventilation and the temperature and
humidity can be controlled. It is suitable for factories where a control of humidity and
temperature is necessary to the processes being carried out; as for example in cotton factories. It
is also suitable for cinema halls.

6).Large Scale Purification of Water:

A) Storage
B) Filtration

34
 ➢ Slow sand filter
➢ Rapid sand filter
C) Disinfection
➢ Chlorination
D) Other agents
▪ Ozonation
▪ Membrane processes
Storage
▪ In natural or artificial reservoirs
▪ Effects of storage:
▪ Physical: gravity – 90% suspended impurities settle down in one day
▪ Chemical: oxidizing action
▪ Biological: only 10% bacteria remains at the end of 1 week
▪ Optimum period of storage: 2 weeks
Filtration
• Water passed through porous media
1. Slow sand filter

2. Rapid sand filter

Slow Sand (Biological) Filters :
Elements of slow sand filter
1. Filter Box
a) Supernatant water
b) Sand bed
c) Under drainage system
2. Filter control valves
Supernatant water
➢ Depth: 1 to 1.5 m
➢ Promotes downward flow of water through the sand bed
➢ Waiting time of 3-12 hours for raw water to undergo partial purification by sedimentation
and oxidation
Sand bed

35
 ❖ Depth, 1 m (sand of diameter 0.2-0.3 mm), 0.3m (gravel with 0.2 - 1 cm diameter)
❖ Sedimentation - The supernatant water acts as a settling reservoir. Settle-able particles
sink to the sand surface.
❖ Mechanical straining - Particles too big to pass through the gap between the sand grains
are retained.
❖ Vital/ Biological/ Zoogleal/ Schumtzdecke layer - Slimy, gelatinous layer over sand bed
containing threadlike algae, bacteria and diatoms .It is the ‘Heart’ of the slow sand filter
Formation of Vital Layer
▪ Suspended particles are retained by adhesion to the biological layer
▪ Removes organic matter, holds back bacteria and oxidizes ammoniacal nitrogen in to
nitrates
Under drainage system • Depth: 0.15 m
▪ At the bottom of filter bed
▪ Porous pipes: Outlet for filtered water as well as support to the filter media above
▪ Rate of filtration 0.1-0.4 m3/hr/m3
Filter control valves - To regulate the flow of water in and out
▪ Filter cleaning

▪ Increased bed resistance --- Necessary to open the regulating valves fully --- Scrapping
top portion of sand bed up to 2 cm depth
▪ After 3-4 years new filter bed is constructed
Advantages of Slow Sand Filter
1) Simple to construct and operate
2) Construction is cheaper than rapid sand filters
3) Physical, chemical and bacteriological quality of filtered water is very high (99.9 to 99.99
per cent and E. Coli by 99 to 99.9 per cent)
Rapid Sand Filter
▪ Gravity type (Open)/ Paterson’s
▪ Pressure type (Closed)/ Candy’s
Steps of Rapid Sand Filter
1. Coagulation - Addition of Alum (5-40 mg/litre)
. Rapid mixing

36
 • Mixing chamber
• Violent mixing of alum (minutes)
Flocculation
• Flocculation chamber
• Slow stirring of water by paddles (30 minutes)
• Flocculent precipitate of Aluminum Hydroxide entangles all particulate, suspended
matter along with bacteria
Sedimentation
▪ Sedimentation chamber
▪ Flocculent ppt. settle down (removal is done from time to time)
▪ Clear water above goes for filtration
Filtration
▪ Filter bed
▪ “Effective size” of the sand particles is 0.4-0.7 mm
▪ Graded gravel, 30 to 40 cm
▪ Depth of the water on the top of the sand bed is 1.0 to 1.5 m
▪ Rate of filtration is 5-15 m3/m2/hr

▪ Remaining alum flocculation forms a slimy layer over sand bed, it holds back bacteria,
oxidize organic matter
▪ washing: by air bubbles or water when flocculation layer becomes very thick, takes
about 15 minutes
❖ Advantages of Rapid Sand Filter
1) Rapid sand filter can deal with raw water directly. No preliminary storage is needed
2) The filter beds occupy less space
3) Filtration is rapid, 40-50 times that of a slow sand filter
4) The washing of the filter is easy
5) There is more flexibility in operation
Disinfection
Criteria for satisfactory disinfectant:
❖ Not influenced from properties of water within short time
❖ Should not be toxic and colour imparting or leave the water importable

37
❖ Available, cheap, easy to use
❖ Residual concentration to deal with recontamination
❖ Detectable by rapid, simple techniques in small concentration
Action of Chlorination
▪ Kills pathogenic bacteria (no effect on spores and viruses)
▪ Oxidize iron, manganese and hydrogen sulphide
▪ Reduces taste and odours
▪ Controls algae
▪ Maintains residual disinfection
Principles of Chlorination
1) Water should be clear, free from turbidity
2) Chlorine demand: Chlorine needed to destroy bacteria, to oxidize organic matter and to
neutralize the ammonia in water
3) Free residual chlorine for a contact period of 1 hour is essential
4) Breakpoint: Point when chlorine demand of water is met and free residual chlorine
appears
5) Breakpoint chlorination: Chlorination beyond the breakpoint. The principle of break
point chlorination is to add sufficient chlorine so that 0.5 mg/L free residual chlorine is present in
the water after one hour of contact time
6) Dose of Chlorine = Chlorine demand + Free residual chlorine
7) Minimum recommended concentration of free chlorine is 0.5 mg/L for 1hr
Methods of Chlorination
▪ Chlorine gas (Paterson's chloronome)
▪ Chloramine
▪ Perchloron or high test hypochlorite (HTH)
Super Chlorination
▪ Method of choice for highly polluted waters
▪ High dose of chlorine is added
▪ After 20 minutes of contact, dechlorination is done with sodium sulphate/ sodium
thiosulphate to reduce the taste of excess chlorine
Tests to Measure Residual Chlorine
▪ Orthotolidine Test - Yellow colour- In 10 seconds - free chlorine

38
 ▪ In 15 min - both free and combined chlorine
▪ OrthotolidineArsenite (OTA) Test - Yellow colour
▪ Tests both free and combined chlorine separately
▪ Yellow colour due to nitrites, iron, manganese are overcome
Other Disinfection Methods
➢ Ozone
➢ Strong oxidizing agent
➢ Strong virucidal
➢ No residual effect
Should be used with chlorination
• UV Rays
• Water should be clear
• No residual effect
• Expensive
Membrane Processes
• High-pressure processes
• Lower-pressure processes
High-pressure processes
• Reverse osmosis
• Rejects monovalent ions and organics of molecular weight >50 daltons
• Pore sizes <0.002 μm
• Desalination of brackish water and seawater
• Nanofiltration
Low-pressure processes
❖ Ultra filtration
❖ Reject organic molecules of molecular weight above about 800 daltons
❖ Pore sizes 0.002 - 0.03 μm
❖ Microfiltration
❖ Pore sizes 0.01-12 μm
❖ capable of sieving out particles greater than 0.05 μm
❖ used for water treatment in combination with coagulation

39
 DIFFERENTIATE BETWEEN:
1. Food Poisoning and Food Adulteration

Sl.No Food Poisoning Food Adulteration

1. Food poisoning is an acute gastroenteritis The addition or subtraction of any substance

caused by ingestion of food or drink to or from food, so that the natural
contaminated with either living bacteria composition and quality of food substance
or their toxins or inorganic chemical is affected
substance and poison derived from plants
and animals
2. Caused by Bacterial (Caused by ingestion Addition of Sand, marble chips, stones,
of foods contaminated with living bacteria mud, other filth, talc, chalk powder, water,
or their toxins.) mineral oil and harmful color.
Nonbacterial-Caused by chemicals such
as arsenic, certain plant and sea food and
contamination of food by chemicals eg.
fertilizers, pesticides cadmium Mercury
etc.
3. Diarrhea, nausea, vomiting, abdominal Immediate side effects like diarrhea,
cramps, fever. dysentery, and vomiting.

2. Sewage and Sullage

Sl.No Sewage Sullage

1. It is the liquid waste from the community Liquid waste from the bathroom
,kitchen, washing places, wash basin etc
2. It includes sullage ,discharge from It is merely the waste water and does not
kitchens, industrial waste create bad smell

3. Arthropod borne diseases and rodent borne diseases

Sl.No Arthropod Borne Diseases Rodent Borne Diseases

1. The arthropod generally is unharmed by Rodent-borne viruses are maintained in

40
 the infection, and the natural vertebrate nature by transmission between rodents,
partner usually has only transient which become chronically infected.
viremia with no overt disease.
2 Caused by a group of viruses spread to It is usually caused by a bite or scratch from
people by the bite of infected arthropods an infected rat or other rodents such as mice,
(insects) such as mosquitoes and ticks squirrels and gerbils. It can also be caught by
These infections usually occur during handling infected animals and ingesting food
warm weather months, when or drink contaminated with rodent feces or
mosquitoes and ticks are active urine.
3. Examples are: Chikungunya dengue, Leptospirosis, plague, lymphocytic
Yellow Fever, and Zika. choriomeningitis (LCMV)

4. Slow Sand Filter and Rapid Sand Filter

Sl.No Slow Sand Filter Rapid Sand Filter

1 Occupies large area Occupies Small area
2 Rate of filtration: 0.1-0.4 cu.m/m sq./hr 5-15cu,m/m.sq/hr
3 Size of sand: 0.2-0.3 mm 0.4-0.7mm
4 Washing by scrapping the sand bed Backwashing.

5 Shallow Well and Deep Well

Sl.No Shallow Well Deep Well

1 Taps water from above the first Taps water from below the 1st impervious
impervious layer layer
2 Moderately hard Much hard
3. Often grossly contaminated Purer water
4 Usually goes dry in summer A source of constant supply.

LIST THE FOLLOWING:

1) Control Measures of Noise Pollution.

41
 a) Careful planning of cities: -division of cities into zones ,separation of residential areas by
means of green belts
b) Control of vehicles- indiscriminate blowing of the horn and use of pressure horn should
be prohibited.
c) Improve acoustic insulation of buildings- installation that produce noise or disturb the
occupants within dwellings should be prohibited. Buildings should be sound proof
d) Industries and railway: protective green belts must be laid down between the installations
and residential area.
e) Protection of exposed person: workers regularly rotated from noisy area to comparatively
quiet posts in factories.
f) Periodic audiogram checkups and use of ear plugs, ear muffs are also essential
g) Legislation: workers have the right to claim compensation if they have suffered to losof
ability to understand speech
h) Education: through all available medias.

Give Reason:
1.Global warming
ANS: Global warming is an aspect of climate change, referring to the long-term rise of the
planet's temperatures. It is caused by increased concentrations of greenhouse gases in the
atmosphere, mainly from human activities such as burning fossil fuels, deforestation and farming

2. Water pollution is common in urban areas

ANS:

Water pollution is common in urban areas because of urbanization and industrialization. the
sources of pollution are sewage , industrial and trade waste, agricultural pollutants and physical
pollutants such as heat and radioactive substances. Urbanization leads to degradation of urban
waterways. Construction is a major source of sediment erosion. Petroleum hydrocarbons from
automobile source causes air pollution

42
UNIT III : PRIMARY HEALTH CARE

LONG ESSAYS:

1). Define primary health care. Explain the principles and elements of primary health
care?
ANS:
Primary health care is essential health care and technology based on practical scientifically
sound and social acceptable methods and technology made universally accessible to individuals
and families in the community by means acceptable to them, through their full participation and
at the cost that the community and country can afford. (By Alma Ata International Conference,
1978)

Principles of primary health care

1) Equitable distribution
2) Community participation
3) Intersectoral coordination
4) Appropriate technology
5) Focus on Prevention
1.Equitable distribution
➢ First key principle in the primary health care

➢ Ensures that individuals with more compromised health conditions will receive more
health services
➢ Commitment to health equity focuses not only on ensuring program inputs but also
reducing differences in health outcomes
➢ Access to health care - horizontal equity & vertical equity
➢ Horizontal equity - “equal access for equal needs”
➢ Equal resources
➢ Equal access to health care
➢ Equal utilization of health services
➢ Equal health
➢ Vertical equity - unequal should be treated in proportion of their inequality

43
 ➢ Individuals with more need should have more treatment
➢ The central theme of “need” therefore determines equity
Aspects of equity in health and health care:
▪ Equity in access to health care
▪ Equity in health Effective coverage
2.Community Participation
▪ Involvement of the individuals, families and community
▪ Determines both collective needs and priorities
▪ Important role in formulating a health problem, make informed choices ,objectives with
community priorities
▪ Universal coverage cannot be achieved without the involvement of the local community
▪ Bare foot doctors:
▪ In China, lack of availability of rural health services was addressed from 1965 to 80 by
development of bare foot doctors.
▪ Rural farm workers were given basic heath training to provide combination of traditional
and western medicine.
▪ Regarded as model for development of community health workers
Advantages of community participation:
▪ Increases program acceptance and leadership
▪ Ensures that the program meets the local needs
▪ Cost of implementing the program may be reduced by using the local resources
▪ Uses local/ familiar organizations and hence problem solving is efficient
▪ Commitments to the decision is facilitated
▪ Key to the sustainability
Planning Steps in Community Participation
Identification and prioritization of the problems Planning together Implementation
by community members Evaluation by community members.
Examples of community participation in India:
▪ Village health guides, trained dais, ASHA
▪ Selected by the local community and trained locally
3.Inter Sectoral Coordination

44
 ▪ “Primary care involves in addition to the health sector, all related sectors and aspects of
national and community development”
▪ Includes sustainable participation that combine inter organizational cooperative working
alliances Possibly, but not necessarily, in collaboration with the health sector
Pre-requisites for Intersectoral Coordination:
▪ Proper orientation of policies and programme
▪ Formation of joint coordination committee at each level
▪ Defining role and responsibilities of participatory agencies
▪ Participatory decision making
▪ Developing formal system of interaction, discussion and debate
▪ Sharing of the problems faced in implementation
▪ Spelling out strategies and procedure
▪ Joint evaluation and monitoring
Difficulties facing intersectoral co-ordination:
▪ Create conflicts of interest and disequilibrium
▪ Power struggles
▪ Agencies must be able to compromise and impose change on the normal working patterns
▪ Cultural changes may occur within organizations
▪ Co-ordination may turn out to be more expensive in terms of time, money and manpower.
▪ Irrespective of the disadvantages, intersectoral coordination is the key principle outlined
by WHO if Health for All has to be achieved
▪ An outstanding example of the intersectoral coordination at the grass root level -
Anganwadi as a part of ICDS programme
Examples of intersectoral co-ordination-India:
▪ Convergence with Indian system of medicine (AYUSH)
▪ Co-ordination with rural health practitioners
▪ Co-ordination with non-governmental and civil organizations
4.Appropriate Technology
“Technology that is scientifically sound, adaptable to local needs and acceptable to those who
apply it and those for whom it is used and is maintained by the people themselves in keeping
with the principle of self reliance with the resources the country and the community can afford”
▪ Designed to meet specific health needs

45
 ▪ Criteria for choosing which needs should be addressed - include magnitude of the
population affected, the degree of morbidity or mortality caused by the health condition
▪ Lack of solutions that are effective, safe, acceptable, affordable, accessible, and
sustainable.
An appropriate technology should be: (WHO-1989)
▪ Scientifically valid
▪ Adapted to local needs
▪ Acceptable to users and recipients
▪ Maintainable with local resources
5. Focus on Prevention
Three levels of prevention/ intervention in health care :
a) Primary
- Health promotion
- Specific protection
b) Secondary prevention
- Early Detection/ Diagnosis
- Treatment
c) Tertiary prevention
- Disability limitation
- Rehabilitation
Preventive and promotive services rather than curative services should be the central focus on
PHC.
Elements of Primary Health Care :
Alma Ata Declaration has outlined 6 essential components of primary health care :
1) Education to the people concerning prevailing health problems and methods of
preventing and controlling them
2) Promotion of food supply and proper nutrition
3) Adequate supply of safe water and basic sanitation
4) Maternal and child health care and family planning
5) Immunization against the major infectious diseases
6) Prevention and control of locally endemic disease
7) Appropriate treatment of common diseases and injury

46
 8) Provision of essential drugs
1) SHORT ESSAYS :

1. Define primary health care. What are the elements of primary health care?

ANS :
Primary Health Care
Primary health care is essential health care and technology based on practical scientifically
sound and social acceptable methods and technology made universally accessible to individuals
and families in the community by means acceptable to them, through their full participation and
at the cost that the community and country can afford. (By Alma Ata International Conference,
1978)
Elements of Primary Health Care :
Alma Ata Declaration has outlined 6 essential components of primary health care :
1) Education to the people concerning prevailing health problems and methods of
preventing and controlling them
2) Promotion of food supply and proper nutrition
3) Adequate supply of safe water and basic sanitation
4) Maternal and child health care and family planning
5) Immunization against the major infectious diseases
6) Prevention and control of locally endemic disease
7) Appropriate treatment of common diseases and injury
8) Provision of essential drugs

1) DEFINE THE FOLLOWING

Primary Health Care :

▪ Primary health care is essential health care and technology based on practical
scientifically sound and social acceptable methods and technology made universally accessible
to individuals and families in the community by means acceptable to them, through their full
participation and at the cost that the community and country can afford. (By Alma Ata
International Conference, 1978)

2) DIFFERENTIATE BETWEEN

47
 1) Sub Centre and Primary Health Centre

Sl.No Sub Centre Primary Health Centre

1. It is the most peripheral and first contact Primary health care is a whole-of-society
point between the primary health care approach to health and well-being centered
system and the community. . on the needs and preferences of individuals,
families and communities
2 A Sub-centre provides interface with the It addresses the broader determinants
community at the grass-root level, of health and focuses on the comprehensive
providing all the primary health care and interrelated aspects of physical,
services mental and social health and wellbeing.
3 One sub centre 3000 population in tribal 1 PHC per 20,000 populations in hilly ,
areas, and per 5000 population in normal tribal & backward areas, and per 30,000
areas. populations in normal or plain areas.
4. Sub centre –no of staffs -2 ( one female No of staffs in primary health centre is 15
health worker and MPHW) male

UNIT IV : EPIDEMIOLOGY

LONG ESSAYS:

1. Define epidemiology .Enlist the methods of epidemiology. Explain the steps of

descriptive Epidemiology
ANS:
Definition:
Epidemiology has been defined as : “ The study of the occurrence and distribution of
health related events, states, and process in specified populations, including the study
of the determinants influencing such processes , and the application of this knowledge
to control relevant health problems.

48
 Methods:
A. Observational study
a. Descriptive—it includes case report, case series, correlation/ecological study, cross-
sectional/prevalence studies.
b. Analytical—can be of following type
 Group based—the unit of study is population as group, e.g. ecological study
 Individual based
i. Cross-sectional
ii. Retrospective—this can be case control study
iii. Prospective—this is cohort study, also called follow-up study.
B. Experimental study: Includes,
a. Randomized Controlled Trials or Clinical Trials.
b. Field trials: with healthy people as unit of study.
c. Community trials or Community intervention studies: with communities as unit of
study.
Steps of Descriptive Epidemiology:

• Defining the population to be studied.

• Defining the disease under study.
• Describing the disease by time, place and person.
• Measurement of disease.
• Comparing with known indices.
• Formulation of an etiological hypothesis.
✓ Defining the population to be studied:
❖ A defined population should not only be in terms of total no., but also in terms of age, sex,
occupation, etc. The defined population- i) could be a whole geographic region or a
representative sample ii) could be a specially selected group- based on age, sex, occupation,
etc iii) should be large enough so that it is meaningful iv) should be stable without migration
into or out v) should not be different from other communities in the region.
✓ Defining the disease under study: This is different from the clinician’s definition of a
disease. the epidemiologist defines the disease which can be measured and identified in

49
 the defined population with a degree of accuracy . The definition of a disease should be
precise and valid. By this, epidemiologists would be able to identify the diseased and non
diseased people and also be able to get accurate information about the disease in a
population.
✓ Describing the disease by time, place and person: The primary objective of descriptive
epidemiology is to describe the occurrence and distribution of disease (or health related
events or characteristics within population) by time, place and person, and identifying those
characteristics associated with presence or absence of disease in individuals.
✓ Measurement of disease: Measurement of disease in terms of mortality, morbidity, and
disability.
Morbidity has two aspects; incidence and prevalence. Descriptive studies may use cross
sectional or longitudinal design.
✓ Measurement of disease: The essence of epidemiology is to make comparisons and ask
questions. By making comparisons between different populations, and subgroups of the same
population, it is possible to arrive at clues to disease etiology.
✓ Formulation of an etiological hypothesis: An Epidemiological hypothesis should specify the
following:
 The population- the characteristic of the person to whom the hypothesis applies.
 The specific cause being considered.
 The expected outcome- the disease.
 The time-response relationship- the time period that will elapse between exposure to the
cause and observation of the effect.

2. Define cohort study. Explain the types and elements of cohort study
Definition:
▪ It is an observational analytical study in which individuals are identified on the basis of
presence or absence of exposure to a suspected risk factor for a disease and followed over
time to determine the occurrence of subsequent outcome. This is also called ‘cause to
effect study’ as the outcome of interest has not occurred at the initiation of investigation
Types:
• Prospective cohort study: The study subjects are classified on the basis of presence or
absence of exposure and followed up to find the development of the outcome of interest.

50
• In this type, exposure may or may not have occurred but outcome must not have occurred
at the beginning of the study.
• Retrospective (historical) cohort study: The subjects are also classified on the basis of
presence or absence of exposure but in this type both the exposure and the outcome of
interest have already occurred at the banging of the study. A historical cohort study
depends upon the availability of good data or records that allow reconstruction of the
exposure of cohorts to a suspected risk factor and follow-up of their outcome (e.g.
mortality or morbidity) over time. The study can be carried out quickly and with limited
resources.
• Combined cohort study having both retrospective and prospective design.
• Inserting case control with cohort study (nested case control).
Elements:
✓ Selection of study subject
✓ Selection of comparison group
✓ Obtaining information on exposure
✓ Follow-up
✓ Analysis and interpretation.
✓ Selection of Study Subject: Initially the members of cohort must be free from the
disease under study. The study subjects can be drawn from general population and special
group.
✓ Selection of Comparison Group: The comparison group (unexposed or reference
cohort) should be as similar as possible to exposed cohort with respect to all factors that
may relate to the disease except to the variable under the investigation. Comparison
group is required to compare the difference in the rate of disease occurrence among two
groups.
✓ Obtaining Information on Exposure: The goal is to obtain complete, comparable and
unbiased information. Exposure information should be collected in such a manner that
the study group can be classified according to degree of exposure. Information about the
exposure may be obtained from number of sources like,
 From cohort members by interview or mailed
 Questionnaire.
 Review of available records.

51
  Medical examination or special test.
✓ Follow-Up: At the beginning of the study, method should be developed to obtain data for
assessing the outcome. The entire study participant should be followed up from point of
exposure.
✓ Analysis: The basic analysis of data from a cohort study involves the calculation of
incidence rate of a specified outcome among both the group and estimation of risk. The
common measurement of analysis are following:
 Relative risk (true measurement of risk)
 Attributable risk (measurement of potential impact)
 Population attributable risk (measure of impact in population).
3. Define epidemiological triad. Describe the dynamics of disease transmission of
tuberculosis.

ANS:

Definition :

The occurrence and manifestations of any disease, whether communicable or non -

communicable, are determined by the interactions between the agent, the host and the
environment, which together constitute the epidemiological triad.

Communicable diseases are transmitted from the reservoir/ source of infection to susceptible
host.
Chain of infection:

Reservoir of infection may be a case or carrier, but the source of infection may be faeces
or urine of patients or contaminated food, milk or water. Thus the term “source” refers to
the immediate source of infection. The reservoir may be of three types:
1. Human reservoir
2. Animal reservoir- When the source of infection is not the human beings but the source of
infection is either animals or birds. eg: Rabies, Yellow fever
52
3. Reservoir in non-living things.- The natural habitat for the infectious agent is sometimes the
soil or inanimate objects . For example soil acts as a source of infection as it harbours the
infectious agent in case of anthrax , tetanus etc.
1. Human Reservoir: the natural habitat of infectious agent for humans (host) is man itself. It
may be a Case or Carrier.

*Cases: It is defined as “a person in the population or study group identified as having the
particular disease, health disorder or condition under investigation.

*Carrier: It is defined as “an infected person or animal that harbours a specific infectious agent
in the absence of discernible clinical disease and serves as a potential source of infection for
others”. Carrier may be;

Type:

- Incubatory
- Convalescent
- Healthy
Duration:
- Temporary
- Chronic
Portal of exit:
- Urinary
- Intestinal
- Respiratory
3. Mode of transmission: Communicable diseases may be transmitted from the reservoir or
source of infection to a susceptible individual depending on the infectious agent, portal of entry
and the local ecological conditions.
The mode of transmission of infectious diseases may be classified as;
A. Direct Transmission
 Direct contact
 Droplet infection
 Contact with soil
 Inoculation into skin or mucosa

53
  Transplacental

B.Indirect Transmission:

 Vehicle – borne
 Vector – borne
-Mechanical
-Biological
 Air-borne
-Droplet nuclei
-Dust
 Fomite – borne
 Unclean hands and fingers.
2.Susceptible host:
4 stages are there.
- Portal of entry
- Site of election
- Portal of exit
- Survival in the environment.

4. Define Epidemiology .Enlist the measurements in Epidemiology. Describe the

methods of Epidemiology.
ANS:
Epidemiology has been defined as : “ The study of the occurrence and distribution of
health related events, states, and process in specified populations, including the study of
the determinants influencing such processes , and the application of this knowledge to
control relevant health problems.
Measurements of epidemiology
a) Measurement of mortality
b) Measurement of morbidity
c) Measurement of disability
d) Measurement of natality

54
 e) Measurement of presence, absence or distribution of the characteristic or attributes of the
disease.
f) Measurement of medical needs, health care facilities, utilization of health services, and
other health related events
g) Measurement of presence, absence or distribution of the environmental and other factors
suspected of causing the disease.
h) Measurement of demographic variables.

Methods:
C. Observational study
c. Descriptive—it includes case report, case series, correlation/ecological study, cross-
sectional/prevalence studies.
d. Analytical—can be of following type
 Group based—the unit of study is population as group, e.g. ecological study
 Individual based
i. Cross-sectional
ii. Retrospective—this can be case control study
iii. Prospective—this is cohort study, also called follow-up study.
D. Experimental study: Includes,
d. Randomized Controlled Trials or Clinical Trials.
e. Field trials: with healthy people as unit of study.
f. Community trials or Community intervention studies: with communities as unit of
study.
5. Define epidemiology .Explain descriptive epidemiology.

ANS: Epidemiology has been defined as : “ The study of the occurrence and distribution of
health related events, states, and process in specified populations, including the study of the
determinants influencing such processes , and the application of this knowledge to control
relevant health problems.

Descriptive Epidemiology:

55
This study is concerned with disease distribution and frequency in human population in
relation to time, place and persons and identifies the characteristics with which the disease in the
question is related. In this study the investigator tries to get the answer of questions about a
disease or health related events.
Types of descriptive study
• Case series: This kind of study is based on reports of a series of cases with no specifically
allocated control group.
• Community diagnosis or needs assessment.
• Epidemiological description of disease occurrence.
• Descriptive cross-sectional studies or community surveys (‘prevalence’ study)
• Ecological descriptive studies: When the unit of observation is an aggregate (e.g. family, clan
or school) or an ecological unit (a village, town or country) the study becomes an ecological
descriptive study.
The planning phase of a descriptive cross sectional study:
The following steps should be followed in conducting
a descriptive epidemiological survey:
• Formulation of study objectives
• Planning of methods
– Study population
– Variables
– Methods of data collection
• Methods of recording and processing data
• Comparing with known indices.
Steps of Descriptive Epidemiology:

• Defining the population to be studied.

• Defining the disease under study.
• Describing the disease by time, place and person.
• Measurement of disease.
• Comparing with known indices.
• Formulation of an etiological hypothesis.
✓ Defining the population to be studied:

56
 A defined population should not only be in terms of total no., but also in terms of age,
sex, occupation, etc. The defined population- i) could be a whole geographic region or a
representative sample ii) could be a specially selected group- based on age, sex,
occupation, etc iii) should be large enough so that it is meaningful iv) should be stable
without migration into or out v) should not be different from other communities in the
region.
✓ Defining the disease under study:
✓ This is different from the clinician‘s definition of a disease. the epidemiologist defines
the disease which can be measured and identified in the defined population with a degree
of accuracy
✓ Describing the disease by time, place and person: The primary objective of descriptive
epidemiology is to describe the occurrence and distribution of disease (or health related
events or characteristics within population) by time, place and person, and identifying
those characteristics associated with presence or absence of disease in individuals.
✓ Measurement of disease: Measurement of disease I terms of mortality, morbidity, and
disability.
Morbidity has two aspects; incidence and prevalence. Descriptive studies may use cross
sectional or longitudinal design.
✓ Measurement of disease: The essence of epidemiology is to make comparisons and ask
questions. By making comparisons between different populations, and subgroups of the
same population, it is possible to arrive at clues to disease etiology.
✓ Formulation of an etiological hypothesis: An Epidemiological hypothesis should
specify the following:
 The population- the characteristic of the person to whom the hypothesis applies.
 The specific cause being considered.
 The expected outcome- the disease.
 The time-response relationship- the time period that will elapse between exposure
to the cause and observation of the effect.
6. Define epidemiological triad. List common nutritional problems in India. Explain
the epidemiology of obesity.

57
 ANS: The occurrence and manifestations of any disease, whether communicable or non -
communicable, are determined by the interactions between the agent, the host and the
environment, which together constitute the epidemiological triad.

SHORT NOTES:

1. Descriptive epidemiology

ANS: This study is concerned with disease distribution and frequency in human population in
relation to time, place and persons and identifies the characteristics with which the disease in the
question is related. In this study the investigator tries to get the answer of questions about a
disease or health related events.
Types of Descriptive Study
• Case series: This kind of study is based on reports of a series of cases with no specifically
allocated control group.
• Community diagnosis or needs assessment.
• Epidemiological description of disease occurrence.
• Descriptive cross-sectional studies or community surveys (‘prevalence’ study)
• Ecological descriptive studies: When the unit of observation is an aggregate (e.g. family, clan
or school) or an ecological unit (a village, town or country) the study becomes an ecological
descriptive study.
The planning phase of a descriptive cross sectional study:
The following steps should be followed in conducting
a descriptive epidemiological survey:
• Formulation of study objectives
• Planning of methods
– Study population
– Variables
– Methods of data collection
• Methods of recording and processing data
• Comparing with known indices.
Steps of Descriptive Epidemiology

• Defining the population to be studied.

58
• Defining the disease under study.
• Describing the disease by time, place and person.
• Measurement of disease.
• Comparing with known indices.
• Formulation of an etiological hypothesis.
✓ Defining the population to be studied:

A defined population should not only be in terms of total no., but also in terms of age, sex,
occupation, etc. The defined population- i) could be a whole geographic region or a
representative sample ii) could be a specially selected group- based on age, sex, occupation, etc
iii) should be large enough so that it is meaningful iv) should be stable without migration into
or out v) should not be different from other communities in the region.
✓ Defining the disease under study: This is different from the clinician‘s definition of a
disease. the epidemiologist defines the disease which can be measured and identified in the
defined population with a degree of accuracy
✓ Describing the disease by time, place and person: The primary objective of descriptive
epidemiology is to describe the occurrence and distribution of disease (or health related events
or characteristics within population) by time, place and person, and identifying those
characteristics associated with presence or absence of disease in individuals.
✓ Measurement of disease: Measurement of disease in terms of mortality, morbidity, and
disability.
Morbidity has two aspects; incidence and prevalence. Descriptive studies may use cross
sectional or longitudinal design. The essence of epidemiology is to make comparisons
and ask questions. By making comparisons between different populations, and subgroups
of the same population, it is possible to arrive at clues to disease etiology.
✓ Formulation of an etiological hypothesis: An Epidemiological hypothesis should
specify the following:
 The population- the characteristic of the person to whom the hypothesis applies.
 The specific cause being considered.
 The expected outcome- the disease.
 The time-response relationship- the time period that will elapse between exposure to the
cause and observation of the effect.

59
 2. Investigation of an Epidemic

ANS: An epidemic investigation calls for inference as well as description. It is called for after
the peak of epidemic has been occurred.
Objectives:
• To identify the magnitude of the epidemic outbreak or involvement in terms of time, place
and person.
• To determine the particular conditions and factors responsible for the occurrence of the
epidemic.
• To identify the cause, source of infection and modes of transmission to determine measures
necessary to control the epidemic.
• To make recommendations to prevent recurrence.
Steps of Epidemic Investigations:
a. Verification of diagnosis
b. Confirmation of existence of an epidemic
c. Defining the population at risk
d. Rapid search for all cases and its characteristics
e. Data analysis
f. Formulation of hypothesis
g. Testing of hypothesis
h. Evaluation of ecological factors
i. Further investigation of population at risk
j. Writing the report.
3. Case Control Study

In this study an investigator starts with diseased subjects and look back to study the exposure to
the suspected factor. The diseased subjects taken for the study are called cases and another group
without disease called comparison group are taken to compare the rate of exposure to the
suspected factor in these two categories.
Features of a case control study:
• Both exposure and outcome have occurred before the beginning of the study.

60
• Proceeds from effect to cause.
• Use a control or comparison group to support or refute an inference.
Steps of case control study:
 Statement of the hypothesis
 Selection of cases and control
 Matching between cases and controls
 Measurement of exposure
 Analysis and interpretation.

Statement of the hypothesis

 This should be based on hypothesis which has been formulated from previous descriptive
study or from previous experience.
 Selection of Cases and Control
 Defining the cases: The cases should be defined beforehand to avoid bias in the study.
Diagnostic criteria and eligibility criteria should be established for cases.
 Sources of cases: The cases can be taken from hospital or community.
 Selection of control: The controls should be similar to cases as much as possible in
respect of different variables except for presence or absence of the disease under study.
Controls are not needed in the study in which hypotheses are not tested. Selection of
controls depends on the nature of study.
Source of control: The controls can be taken from hospital, relatives, neighbours or general
population.
Matching between Cases and Controls
The controls should be similar to cases as much as possible in respect of different variables and
matching can ensure this. Matching can be done various ways:
▪ Individual matching: Each control may be so selected that he or she should be similar to
the study subject in respect of different variables. This type one to one control can be
taken from spouse, sibling, friends, neighbor, fellow worker, etc. This one to one close
matching may not be possible if we wish to control more than two or three variables
simultaneously.
▪ Group or stratified matching: If control is taken as group and matching is done with
study group for different variable like age, sex, occupation, etc. Called group matching.

61
Measurement of exposure: Measurement criteria must be defined clearly and same criteria
should be used for measuring variables among the cases and controls.
Analysis and interpretation: A variety of statistical test are available some commonly used test
are described
below:
• Frequency distribution of all variables: It is advisable to start the analysis by examining
the frequency distribution of variables.
• Summary of frequency distribution: Summary statistics of frequency distribution such as
mean percentage, rate, of relevant variables can be calculated.
• Association between variables: Analysis is done by finding and comparing the rates of
exposure to a suspected factor among cases and controls. Simple methods of cross
tabulation with a pair of variable may reveal association.
4. Dynamics of disease transmission
ANS: Communicable diseases are transmitted from the reservoir/ source of infection to
susceptible host.
Chain of infection:

Reservoir of infection may be a case or carrier, but the source of infection may be faeces
or urine of patients or contaminated food, milk or water. Thus the term “source” refers to
the immediate source of infection. The reservoir may be of three types:
4. Human reservoir
5. Animal reservoir
6. Reservoir in non-living things.
3. Human Reservoir: It may be a Case or Carrier.

*Cases: It is defined as “a person in the population or study group identified as having the
particular disease, health disorder or condition under investigation.

62
*Carrier: It is defined as “an infected person or animal that harbours a specific infectious agent
in the absence of discernible clinical disease and serves as a potential source of infection for
others”. Carrier may be;

Type:

- Incubatory
- Convalescent
- Healthy
Duration:
- Temporary
- Chronic
Portal of exit:
- Urinary
- Intestinal
- Respiratory
3. Mode of transmission: Communicable diseases may be transmitted from the reservoir or
source of infection to a susceptible individual depending on the infectious agent, portal of entry
and the local ecological conditions.
The mode of transmission of infectious diseases may be classified as;
A. Direct Transmission
 Direct contact
 Droplet infection
 Contact with soil
 Inoculation into skin or mucosa
 Transplacental
B. Indirect Transmission:
 Vehicle – borne
 Vector – borne
-Mechanical
-Biological
 Air-borne
-Droplet nuclei

63
 -Dust
 Fomite – borne
 Unclean hands and fingers.
4.Susceptible host:
4 stages are there.
- Portal of entry
- Site of election
- Portal of exit
- Survival in the environment.
5. Measurement of morbidity: Morbidity has been defined as “any departure, subjective or
objective, from a state of physiological well- being. Three aspect of morbidity are
commonly measured by morbidity rates or morbidity ratios.
1. Incidence: It is defined as “the number of new cases occurring in a defined
population during a specified period of time”.
i.e., Number of new case of specified disease during given time period 1000
Population at risk during that period
2. Prevalence: The total number of all individuals who have an attribute or disease at a
particular time divided by population at risk of having attribute or disease at that point
of time.

6. Epidemiological triad

ANS: The occurrence and manifestations of any disease, whether communicable or non
communicable, are determined by the interactions between the agent, the host and the
environment, which together constitute the epidemiological triad
✓ Agent: The agent is defined as an organism, a substance or a force, the presence or lack
of which may initiate a disease process or may cause it to continue. There may be single
or multiple agents for a disease. These may be classified into:
• Living or biological agents.
• Nonliving or inanimate, classified further as nutrient, chemical and physical agents.
A. Biological:
Helminthes

64
 • Protozoa, of which about 20 are parasitic in man
• Fungi
• Bacteria
• Viruses.
B. Nutrient agents:
The known agents in relation to food and nutrition are energy, protein, carbohydrate, fat,
vitamins, minerals, water and fiber.
C. Chemical agents: They are chemical substances of two types:
1. External agents such as lead, arsenic, alcohol, dust, stone particles and carbon.
2. Internal agents produced in the body itself as a result of metabolic disorders or
dysfunction of endocrine glands. Examples are urea (uremia) in renal failure and ketone
bodies (ketoacidosis) in diabetes mellitus.
D. Physical agents: Important ones are atmospheric pressure, temperature, humidity,
friction, mechanical force, radiation, light, electricity, sound and vibration.
✓ Host : The host is the man himself. The characteristics of a human being that determine
how he reacts to the agents in the environment are called host factors.
✓ Environment: The environment of man is of two types—internal and external.
 Internal environment is comprised by the various tissues, organs and organ systems
within the human body. Fault in functioning of one or more component parts results in
disharmony or disease.
 External environment is all that, which is external to the individual human host” and is
comprised by those things to which one is exposed after conception.
 Physical environment is the space around man containing gases (air), liquids (water) and
solids (food, refuse, soil and various objects at the place of work or living). The physical
factors include soil, climate, seasons, weather, humidity, temperature, machinery and
physical structures.
 Biological environment means the universe of all living things that surround man, except
the human beings. It comprises both animals and plants.
 Social environment comprises all human beings around the host (the man) and their
activities and interactions.

DEFINE THE FOLLOWING

65
 1. Infant Mortality Rate
ANS :
Infant mortality rate is the number of infants below one year age dying every year per 1000live
births
2. Carriers :
ANS:
A carrier is defined as an infected person or animal that harbours a specific infectious agent in
the absence of discernible clinical disease and serves as a potential source of infection for others.
3. Quarantine
ANS:
Quarantine has been defined as the limitation of freedom of movement of such well persons or
domestic animals exposed to communicable diseases for a period of time not longer than the
longest usual incubation period of the disease, in such a manner as to preventive effective contact
with those not so exposed.

4. Reservoir
ANS:
A reservoir is defined as any person, animal, arthropod, plant, soil or substance ( or combination
of these) in which an infectious agent lives and multiplies , on which it depends primarily for
survival , and where it reproduces itself in which manner that it can be transmitted to a
susceptible host .
In short, the reservoir is the natural habitat in which the organism metabolizes and replicates

DIFFERENTIATE BETWEEN:

1. Case Control Study and Cohort Study

Sl.No Case Control Study Cohort Study

1. Proceed from effect to cause Proceed from cause to effect

2. Starts with diseased population Start with people exposed to the factor
under study
3. Case control provide information about Useful for evaluating more than one
one outcome only outcome related to single exposure

66
 4. Allow to study the range of exposure Usually focus on one exposure only

5. Suitable for study of a rare disease Impractical to consider cohort study for
rare diseases

6. For rare exposure study, case control Suitable for rare special exposure study
may not suitable one
7. Cannot estimate the incidence of a Can provide accurate estimate of incidence
disease, so only can give estimate of of an disease—possible to find RR and
relative risk (odd’s ratio) attributable risk
8. Time, cost, involvement is more Time, cost, involvement is more
9. No problem of drop-out but record based Being a follow-up study there is more
information chance of drop-out
10. Less number of subjects Large number of subjects
11. Quick results Long follow up
12. Inexpensive Expensive

2. Morbidity and mortality

Sl.No Morbidity Mortality

1. The state of being unhealthy or diseased Mortality is the state of being mortal
2. It refers to Count of ill health in a Count of number of deaths in a population
population
3. Morbidity is measured in terms of It is expressed as the number of deaths per
frequency, duration and severity 100 people per year.
4. Based on the type of disease, gender, age, Child mortality rate, crude death rates,
etc. infant mortality rate, the maternal mortality
rate, etc.

3. Pandemic and Sporadic

Sl.No Pandemic Sporadic

1 Pandemic refers to an epidemic that has Occurs cases irregularly, haphazardly from
spread over several countries or time to time, and generally infrequently

67
 continents, usually affecting a large (scattered about )
number of people. Eg: Polio, Tetanus
Eg: Influenza pandemic, Cholera,
Covid-19

Sl.No Cases Carrier

1 A person in the population or study An infected person or animal that harbours
group identified as having the particular a specific infectious agent in the absence
disease, health disorder or condition discernible clinical disease and service as a
under investigation potential source of infection for others

Definitive Host and Intermediate Host

Sl.No Definitive host Intermediate host

1 It is in which the parasite attains maturity Hosts in which the parasite is in a larval or
or passes its sexual stage are primary or asexual state are secondary or intermediate
definitive host host

Incidence and Prevalence

Sl.No Incidence Prevalence

1 Number of new cases of diseases during Number of existing cases of a disease are a
a specified period of time given point of time
2 Population at risk (denominator ) Population at risk(denominator )
3 It focus whether the event is a new case Presence or absence of disease. Time
time of onset of disease period is arbitrary ;rather a snapshot in
time
More useful for studies of causation Useful in the study of the burden of chronic

68
 diseases and implication of health services

Incubation Period and Convalescent Period

Sl.No Incubation Period Convalescent Period

1. The period between infection and clinical Convalescence is the gradual recovery of
onset of the disease, health and strength after illness or injury.
The incubation period occurs in an acute It refers to the later stage of an infectious
disease after the initial entry of the disease or illness when the patient recovers
pathogen into the host (patient) and returns to previous health, but may
continue to be a source of infection to
others even if feeling better.

Descriptive Epidemiology and Analytical Epidemiology

Sl.No Descriptive epidemiology Analytical epidemiology

1 Descriptive studies are the first phase of Analytical studies are carried out to test the
epidemiological investigation. hypothesis
2. These studies are concerned with These hypothesis are formulated on the
observing the distribution of disease or basis of information gathered from
health related characteristics in human descriptive method
population needed to formulate a
hypothesis to be tested.

Epidemic and Pandemic

Sl.No Epidemic Pandemic

1 Unusual occurrence of disease / health An epidemic usually affecting a large
related behaviour / events in a proportion occurring over a wide
community geographic area like entire nation, section

69
 of a nation
Eg:CHD, CA Lung Eg: influenza pandemic of 1918, 1957,
covid-19

Rates and Ratio

Sl.No Rates Ratio

1. Measure the occurrence of some Express a relation in size between two
particular event (disease) in a population random quantities
during a given period of time
2. Compress elements like numerator , Numerator is not a component of
denominator , time specification and denominator
multiplier
3 Rate is expressed per 1000or 10, 000 etc Ratio is expressed as a a:b or a/b
Eg: death rate= no of death rates ina year/ Eg: Sex ratio
midyearpopulationx1000

Vehicle borne transmission & Vector borne transmission

Sl.No Vehicle borne transmission Vector borne transmission

1. Refers to the transmission of pathogens Vector transmission occurs when a living
through vehicles such as water, food, and organism carries an infectious agent on its
air. Water contamination through poor body (mechanical) or as an infection host
sanitation methods leads to itself (biological), to a new host.
waterborne transmission of disease.
2. Direct (sneezing)and indirect contact Direct contact ( bitten by a tick)
(touching contaminated linen ) Airborne – inhaling contaminated droplets

UNITV:EPIDEMILOGY AND NURSING MANAGEMENT COMMON

COMMUNICABLE DISEASES

70
LONG ESSAYS

1. List the aims of epidemiology .Explain the epidemiology of malaria.

ANS:

Aims of Epidemiology:

• To define the magnitude and occurrence of disease conditions in man

• To identify the etiological factors responsible for the above conditions
• To provide data necessary for planning, implementation and evaluation of programs
aimed at preventing, controlling and treating disease, and to the setting up of priorities
among those services.
Epidemiology of Malaria:
• Malaria is a protozoal disease caused by infection with parasites of the genus
plasmodium and transmitted to man by certain species of .infected female anopheles
mosquito .
• The epidemiology of malaria is a complex outcome of variable disease transmission
patterns that mainly depends upon an intricate relationship between agent, host and
environment.
• Malaria in man is caused by 4 distinct specious of malaria parasite-
Epidemiological Determinants

Agent Vector – Female Anopheles Mosquito

Plasmodium- Agent
Malaria in man is caused by four distinct species of the malaria parasite.
• Plasmodium vivax,
• Plasmodium falciparum,
• Plasmodium malariae & Plasmodium ovale.
• The severity of malaria is related to the species.
• The malaria parasite undergoes two cycles of development.
• Human Cycle (Asexual Cycle).
• Mosquito Cycle (Sexual Cycle).

71
 • Man is the intermediate host and mosquito the definitive host.
• Asexual Cycle
• The asexual cycle begins when an infected mosquito bites a person and injects
sporozoites.
• Man is the reservoir of agent of malaria. the person is reservoir of infection if he has both
the sexes of gametocyte in blood and is mature to undergo development in mosquito .
• The communicability of malaria depends upon the maturation, viability of gametocytes,
which should be in sufficient density to infect the mosquito.
▪ Host factors
▪ Age
▪ Malaria affects all ages.
▪ Newborn infants have considerable resistance to infection due to a high concentration of
foetal haemoglobin during the first months of life.
▪ Gender
▪ Males are more frequently exposed more than females due to their outdoor life.
▪ Females are better clothed than males.
▪ Race
▪ Individuals with AS haemoglobin (single cell trait) have milder illness.
Pregnancy
• Pregnancy increases the risk of malaria in women.
• Malaria during pregnancy may cause intra uterine death in fetus.
• It may cause pre mature labour or abortion
Socio-Economic Development
• Malaria demonstrated relationship between health and socio-economic development.
• It is observed that malaria has disappeared from most developed countries due to
socio economic development.
Housing -Ill ventilated and ill-lighted provide ideal indoor resting places for mosquitoes.
Population Mobility
• Labourers connected with engineering, irrigation agricultural and other projects,
migrating nomads are more disposed to develop malaria.
Occupation - Malaria is predominantly a rural disease and has direct connection with agriculture
and related occupation.

72
Human Habits - Human habits such as sleeping out of doors, nomadism, absence of personal
protection measures increase the risk of contracting malaria.
Immunity
• Epidemic malaria is influenced by the immune status of the population.
• Immunity is acquired only after repeated exposure over several years.
Environmental Factors:
 Rainfall
 Wind
 Temperature- the temperature in the insect vector required for the development of
parasite is 20 – 30 degree Celsius
 Humidity of 60% Is Required To Line The Mosquito Their Life Span
 Irrigation Channels
 Garden Pools
 Stagnant water in coolers
Mode of transmission:
Man-mosquito –man , other means of transmission are from infected person to healthy person
by:
 Sharing of needles of infected drug addicts
 Blood transfusion
 Needle stick injury
 From infected mother to newborn- it is rare
Prevention and control
It is required to reduce the morbidity and mortality. The health guides and multipurpose workers
need to be fully trained to detect and treat cases of malaria and refer to hospital , if required.
 Diagnosis and treatment
 Chemoprophylaxis
 Mass drug administration
 Mosquito control measures – anti larval and anti adult measures
 Protection against mosquito
 Reduction of mosquito breeding sites
 Health education

73
  Integrated approach – Bioenvironmental and personal protection measures should be used
to achieve reduction in malarial health problem
 Role of national anti-malaria programme

2. Define epidemiology .Explain the epidemiology of tuberculosis.

ANS:

Definition :Epidemiology has been defined as : “ The study of the occurrence and distribution
of health related events, states, and process in specified populations, including the study of the
determinants influencing such processes , and the application of this knowledge to control
relevant health problems.

Epidemiology of tuberculosis:
Epidemiology of tuberculosis:
Definition: TB is defined as an infectious disease caused by mycobacterium
tuberculosis commonly known as Koch’s Bacillus tubercle bacilli.or acid-fast bacilli
.which most commonly affects the lungs, but TB bacteria can attack any part of the body
such as the kidney, spine, and brain. if not treated properly , T.B disease can be fatal.
TB kills 5000 people a day, 2-3 million each year. India is the highest TB burden country
in the world.
 Agent: TB is caused by bacteria mycobacterium tuberculosis also known as acid fact
bacilli, tubercle bacilli.
 Source of infection: There are two sources of infection human source and bovine source
 Human case whose sputum is positive for tubercle bacilli and bovine is infected with milk.
 Communicability : Patients are remain infective as long as they remain untreated
 Host factors:
 Age : T.B affects all the ages
 Sex :More prevalent in males
 Heredity : T.B is not a hereditary disease
 Nutrient : Malnutrition is widely predispose to T.B
 Immunity : Man has no inherited immunity against T.B
 Reservoir: Humans are the main reservoir
 Incubation period: It varies, may be 3- 6 weeks .

74
 Social and environmental factors: poor quality of life, poor housing, over- crowding,
population explosion, under nutrition, lack of education, large families, Early Marriage
and social stigma
Mode of Transmission: Tuberculosis is carried in airborne particles, called droplet nuclei,
of 1– 5 microns in diameter. Infectious droplet nuclei are generated when persons who
have pulmonary or laryngeal TB disease cough, sneeze, shout, or sing. TB is spread from
person to person through the air
Diagnosis: sputum examination, Mantoux test, X ray
Clinical features: Coughing that lasts three or more weeks, Coughing up blood, Chest
pain, or pain with breathing or coughing, Unintentional weight loss, Fatigue.
Prevention and control of Tuberculosis : It consist of steps like early detection of
cases, chemotherapy (treatment/DOTS), immuno prophylaxis(BCG) and health education.
 Early diagnosis
- Sputum examination
- Radiography
- Tuberculin test
 Treatment
- Bactericidal drugs: Rifampicin, INH,Streptomycin, Pyrazinamide
- Bacteriostatic drugs : Ethambutol, Thioacetazone
For treatment of TB, 2 phases are considered to be effective
a) Intensive Phase: This is the phase, when the patient is acutely ill. During this phase, a
combination of drugs are given to kill off the bacilli in the early course of treatment
which last for 1,2 or 3 months . In short course, chemotherapy regimen of 6months, the
intensive phase is of 2 months.
b) Continuation Phase : This continuation phase in short course, chemotherapy is 4months
.the medicines are given to patients twice a week and are administered under supervision.

3. List the intestinal infections. Describe the epidemiology of poliomyelitis

ANS:

Intestinal Infections

75
  Poliomyelitis
 Viral Hepatitis
 Acute diarrheal diseases
 Typhoid fever
 Food poisoning
 Ascariasis
 Hookworm infestation

Epidemiology of Poliomyelitis

Poliomyelitis is an acute viral infection caused by an RNA virus. polio can occur sporadically,
endemically or epidemically.
Epidemiological Determinants :
Agent: The causative agent of poliomyelitis is poliovirus which 3 serotypes 1,2,3..
Reservoir of Infection: Man is the only known reservoir of infection
Infectious Material: The virus is found in the faeces and oro-pharyngeal secretions of an
infected person
 Period of communicability : The cases of polio are infective 7-10days before and after
the onset of symptoms in the faeces , the virus is excreted commonly for 2 to 3 weeks,
sometimes as long as 3 to 4 months
Host factor: Infant and children under 3 years.( infancy and childhood).
Sex: Males affected more than females .i.e., occurrence of disease is 3:1 in males and females
Environmental factors :
 Rainy season
 Contaminated water , food, flies
 Over crowding
 Poor sanitation
Mode of transmission:
 Faeco oral route – Directly spread through fingers which are contaminated with polio
virus or indirectly by milk, water, food, flies & articles

76
  Droplet infection- Personal contact with infected person will facilitate the spread of
infection
Incubation period: Usually 7 to 14 days (range 3 to 35 days)
Clinical Manifestations: Asymmetrical flaccid paralysis, fever, anorexia, vomiting, nausea,
malaise, headache, sore throat, abdominal pain, constipation stiffness of neck and back muscles,
difficulty in swallowing, weak or diminished deep tendon reflexes before the onset of paralysis.
Prevention and Control of Poliomyelitis :
 Immunization
- Inactivated Polio Vaccine(IPV)
- Oral Polio Vaccine (OPV)
 Early diagnosis and treatment of cases
 Surveillance
 Isolation
 Environmental sanitation
 Hand washing
 Pulse polio campaign/ immunization

4.List the methods of epidemiology. Explain the epidemiology of rabies.

Methods:

A. Observational study
Descriptive—it includes case report, case series, correlation/ecological study, cross-
sectional/prevalence studies.
Analytical—can be of following type
 Group based—the unit of study is population as group, e.g. ecological study
 Individual based
i. Cross-sectional
ii. Retrospective—this can be case control study
iii. Prospective—this is cohort study, also called follow-up study.
B. Experimental study: Includes,
g. Randomized Controlled Trials or Clinical Trials.
h. Field trials: with healthy people as unit of study.

77
 i. Community trials or Community intervention studies: with communities as unit of
study.
Epidemiology of rabies

Rabies ,also known as hydrophobia is an acute , highly fatal viral disease of the central nervous
system, caused by Lyssavirus type 1.
Epidemiological determinants:
Agent : The causative organism is Lyssavirus type 1.of family Rhabdoviridae
 The virus is excreted through saliva of the affected animals. Saliva of rabid animal is the
source of infection.
 Rabies occurs in 3 epidemiological forms such as urban, wild life and bat rabies
 One rabid dog is capable of biting a large number of humans &animals.
Host factor:
 Warm blooded mammals including man is at high risk for rabies
 Dog Handlers
 Hunters
 Veterinarians
 Laboratory staff working with rabies virus
Environmental factor :
 Rabid dog population- stray dogs, bats ,
 Jackal , fox, hyena are wild life carriers which are the main reservoir and transmitter of
rabies
Mode of transmission:
 By bite of an infected animal
 Open scratch or wound in contact with infectious material such as blood or saliva of an
infected animal.
 human to human in case of corneal transplant from an infected individual
 By mucus membrane – when it comes in contact with infected material.
 Aerosols
Incubation period: 3-8 weeks
Clinical manifestation: Fever, headache, muscle aches, loss of appetite, nausea, fatigue,
irritability, confusion, agitation, abnormal thoughts, posture change, convulsions, paralysis etc

78
Prevention and control of rabies
 Early diagnosis and treatment
 Isolation
 Reduce anxiety and pain
 Hydration
 Intensive care
 Vaccination
SHORT ESSAYS:
1) List any six intestinal infections. Explain the prevention of worm infestation

ANS :
Intestinal Infections
 Poliomyelitis
 Viral Hepatitis
 Acute diarrheal diseases
 Typhoid fever
 Food poisoning
 Ascariasis
 Hookworm infestation
Prevention of worm infestation:
 Prevention of round worm infestation can be done by interrupting its transmission.
 Sanitary disposal of human excreta,
 Reduction of fecal contamination of the soil,
 Provision of safe drinking water,
 Food hygiene,
 Good personal hygiene,
 Improving habits of hand wash before & after defecation,
 Avoidance of open field defecation are important means of prevention
Pinworm
The preventive measures include:

 Maintenance of personal hygiene,

79
  Careful hand washing with soap & water after defecation & before meal,
 Keeping short nails, cleaning nails with soap & old tooth brush,
 Treatment of all infected family members,
 Wearing of tight pants to the children,
 Laundering of infected clothing etc

Hook Worm

 Simple habits of improved personal hygiene,

 Avoiding contact of contaminated soil by using foot wear,
 Use of sanitary latrine for the sanitary disposal of feces to prevent soil pollution
 Change in farming practice, that is not to use raw feces or untreated sewage as fertilizer
and improving use of health facilities for diagnosis & treatment
Tapeworm
 Treatment of infected person,
 Meat inspection,
 Consumption of meat with proper cooking,
 Adequate sewage treatment & disposal creating awareness about preventive aspects by
health education

1. Epidemiology of Swine flue

ANS:

A human respiratory infection caused by an influenza strain that started in pigs

Agent: H1N1 swine influenza virus strain
Host factors:
▪ Occurs in every age-group. Population does not have immunity to virus complications
higher in people with underlying diseases such as asthma, cardiac diseases, and renal
diseases and in pregnancy.
▪ Obesity has also found to predispose to severe disease

Environmental factors: Influenza viruses are highly resilient in the environment. Low
temperature and low humidity favour aerosol transmission, explaining the seasonal nature of

80
influenza in temperate climates. In tropical climates influenza infections are associated with
increased rainfall. The best environment for a novel virus is a population without pre-existing
immunity to it, enabling it to spread pandemic ally

Mode of transmission: Through droplets from coughing or sneezing, and through direct or
indirect contact with the respiratory secretions of an infected person

Incubation period: 1-7 days

Clinical features: Mild respiratory illness with fever, cough, sore throat, dyspnea, rhinorrhea,
myalgias, chills, headache and fatigue

Prevention control and treatment: Supportive care, Personal protective measures, Shielding
one’s mouth and nose while coughing or sneezing, Frequently washing one’s hands with soap,
Isolation and social distancing, Home quarantine, School closure and cancellation of mass
gathering, Chemoprophylaxis, vaccination, National Influenza Surveillance Network.

2.Prevention and control of AIDS

ANS:

There are four basic approaches to control AIDS:

 Prevention,
 Antiretroviral treatment,
 Specific prophylaxis and primary health care.
 Prevention: Prevention of AIDS can achieve through health education and prevention of
transmission of blood borne diseases
 Antiretroviral therapy: There is no cure or treatment for AID now, treatment with
antiretroviral drugs can decrease multiplication of virus and increase quality of life
 Post exposure prophylaxis: Comprehensive steps and services to prevent HIV Infection
in an exposed person
 Specific prophylaxis: Treatment of opportunistic infections or manifestations due to
AIDS
 Primary health care: AIDS touches all aspects of primary health care including mother
and child, family planning and health education.

81
 3. DOTS therapy

Directly observed treatment, short-course is the name given to the tuberculosis control
strategy recommended by the World Health Organization.
It is used to ensure the person receives and takes all medications as prescribed and to
monitor response to treatment.
Under DOTS (Directly Observed Therapy Short Term) the patient has to take the TB
medication in front of a DOTS agent.
The DOTS agent is usually a volunteer from the patient’s community, and may be a
family member.
DOTS does not say which drugs should be taken.
DOTS apply when any TB drugs are taken with the patient being observed by a DOTS
volunteer.
DOTS has five main components:
▪ Government commitment (including political will at all levels, and establishment of a
centralized and prioritized system of TB monitoring, recording and training),
▪ Case detection by sputum smear microscopy, Standardized treatment regimen directly of
six to nine months observed by a healthcare worker or community health worker for at least
the first two months, Drug supply, A standardized recording and reporting system that
allows assessment of treatment results
▪ Drug regimen: New Cases and those which exhibit no resistance are offered a six month,
short course of the four first line drugs; Isoniazid-H: Rifampicin-R, Pyrazinamide-Z,
and Ethambutol-E.
▪ The drugs are administered through daily weight band based doses of Fixed Dose
Combinations, consisting of HRZE for the intensive phase of two months and HRE for the
continuation phase of four months

4.Prevention and control of communicable disease

▪ Communicable disease: an illness due to a specific infectious agent or its toxic

products capable of being directly or indirectly transmitted from man to man, animal to animal
or from the environment (air,dust,soil,water,food) to man or animal

82
 Prevention and control of diseases:

 Wash your hands often, This is especially important before and after preparing food,
before eating and after using the toilet,
 Immunization can drastically reduce the chances of contracting many diseases, get
vaccinated, Only take antibiotics when necessary,
 Stay at home if you have signs and symptoms of an infection,
 Be smart about food preparation,
 Pay special attention to cleaning the 'hot zones' in your home,
 Don't share personal items,
 Avoid sharing drinking glasses or dining utensils,
 Travel wisely,
 Keep your pets healthy,
 Controlling the reservoir ,
 Early Diagnosis, precise treatment,
 Epidemiological Investigation- study time place & person distribution of the disease,
 Breaking the chain of Transmission,
 Better housing, water-supply, sanitation. nutrition and education,
 Legislative measures- to formulate and effective implementation of measures, health
education.
5.Mode of transmission of HIV

ANS:

 HIV transmitted through blood and blood products, sexual contact, mother to baby through breast
milk and during delivery.
 Blood and blood products: Transmission of HIV can occur during transfusion of blood
components (i.e., whole blood, packed red cells, fresh-frozen plasma, cryoprecipitate, and
platelets) derived from the blood of an infected individual. Depending on the production
process used, blood products derived from pooled plasma can also transmit HIV and other
viruses
 Sexual contact: Having unprotected anal sex, penis-vagina sex, and even oral sex
(though rarely) can transmit HIV

83
  Mother to baby:HIV can transmit from mother to baby through breast milk and during
delivery.
 Sharing needles, use of unsterilized razor and blades. Semen, vaginal fluids can spread
HIV.

DEFINE THE FOLLOWING

1) Endemic: It refers to the constant presence of a disease or infectious agent within a given
geographic area of population group., without important from inside.
2) Zoonoses: An infection or infectious disease transmissible under natural conditions from
vertebrate animals to man. e.g. Rabies, plaque.
3) Carriers: A carrier is defined as an infected person or animal that harbors a specific
infectious agent in the absence of discernible clinical disease and serves as a potential
source of infection for others.
4) Communicable disease :An illness due to a specific infectious agent or its toxic products
capable of being directly or indirectly transmitted from man to man , animal to animal ,
or from the environment (through air, dust, soil, water, food ) to man or animal.
5) Eradication: Eradication is an absolute process an “all or none” phenomenon, restricted
to termination of an infection from the whole world. eg: smallpox

DIFFERENTIATE BETWEEN :
Brucellosis & Salmonellosis

Sl.No Brucellosis Salmonellosis

1. Brucellosis is a zoonotic infection caused Salmonellosis is a symptomatic infection

by the bacterial genus Brucella caused by bacteria of the Salmonella type
2. Mostly caused by unpasteurized dairy Commonly caused by contaminated food or
products. water.
3. Symptoms may include joint and muscle Symptoms include diarrhoea, fever, chills
pain, fever, weight loss and fatigue. and abdominal pain.
4. Incubation period 1-3 weeks but variable 6-72 hours

84
 Mantoux test & Schick test

Sl.No Mantoux test Schick test

1. Test is a tool for screening for Is a skin test used to determine whether or
tuberculosis and for tuberculosis not a person is susceptible to diphtheria
diagnosis
2. Test for immunity to tuberculosis using Test for previously acquired immunity to
intradermal injection of tuberculin diphtheria, using an intradermal injection of
diphtheria toxin.
3. Results read by size of induration and Results read by presence or absence of
erythema induration and erythema
4. A positive result indicates TB exposure Positive results shows lack of
immunity/susceptibility of diphtheria

Scrub typhus &Murine typhus

Sl.No Scrub typhus Murine typhus

1. Infection caused to Orientiatsutsugamushi Murine typhus is due to Rickettsia typhi

2. Spread by chiggers/mites Spread by fleas

3. Transovarial infection No trans ovarian transmission of flea

4. Transmitting from mite to rats commonly Transmitting from rat to rat

5. Incubation 10-12 days 1-2 weeks

Source & Reservoir

Sl.No Source Reservoir

1. A source of infection is the person, A reservoir is any animate or inanimate

animal, object or substance from which substance in which an infectious agent
an infectious agent passes or multiplies or develops in person, animal,
disseminated to the host arthropode, plant, soil and any substance
Eg: Hookworm- soil contaminated with Man
infective larvae

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Amoebiasis & Ascariasis
Sl.No Amoebiasis Ascariasis
1. Results from infection of the large Results from infection of the small
intestine intestine
2. Caused by a protozoan parasite called Caused By A Helminth Parasite Called
Entamoeba Histolytica Ascaris Lumbricoids
3. Occur at any age Occur at more in children
4. Transmitted through faeco-oral route, Transmitted mainly through faeco-oral
sexual route and by vectors route
5. Incubation period is 2 to 4 weeks Incubation period is about 2 months

Anophelusmosquito & Culex Mosquito

Sl.No Anophelusmosquito Culex Mosquito

1. Eggs laid single Laid in clusters or rafts, each raft

Eggs are boat-shaped and provided with containing 100-250 eggs
lateral floats Eggs are oval-shaped and not provided
with lateral floats
2. Larvae –rest parallel to water surface Suspended with head downwards at an
No siphon tube angle to water surface
Palmate hairs present an abdominal Siphon tube present
segments No palmate hairs
3. Pupae – Siphon tube is broad and short Siphon tube is broad and short

4. Adults – When at rest , inclined at an When at rest the body exhibits a hunch
angle to surface back
Wings spotted Wings unspotted
Palpi long in both sexes Palpi short in females

List The Following

1. Eight zoonotic disease

ANS

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 ▪ Scrub typhus,
▪ Brucellosis,
▪ Salmonellosis,
▪ Anthrax,
▪ KFD,
▪ Rabies,
▪ Yellow fever,
▪ Leptospirosis,
▪ Japanese encephalitis

2. Eight sexually transmitted disease

ANS:
▪ Chancroid,
▪ condylomataacuminata (CA),
▪ Nongonococcal urethritis (NGU),
▪ Lymphogranulomavenereum (LGV),
▪ Syphilis,
▪ Gonorrhea (gono),

▪ Herpes genitalis (hg) and hiv infection

3. Mosquito born disease in India

 Malaria,
 Dengue fever
 West Nile virus,
 Chikungunya,
 Lymphatic filariasis
 Japanese encephalitis

87
UNIT VI : EPIDEMIOLOGY AND NURSING MANAGEMENT OF NON
COMMUNICABLE DISEASES:

LONG ESSAY

1) Define malnutrition and list the nutritional problems in India. Explain in detail
about protein energy malnutrition

ANS :
Definition
It is a health problem occurring due to relative or absolute deficiency or excess of
nutrients in human body and causing pathological changes.
Malnutrition can be defined as the condition due to absence, deficiency or excess of one
or more essential nutrients.
Nutritional problems in India
1) Protein Energy Malnutrition
- Kwashiorkor
- Marasmus
- Marasmic kwashiorkor
2) Low Birth Weight
3) Vitamin A deficiency
4) Xerophthalmia
5) nutritional anaemia
6) Iodine Deficiency Disorder
7) Endemic Fluorosis
8) Lathyrism
9) Chronic diseases like diabetes mellitus, cancer
10) Obesity
11) Eating disorders like anorexia nervosa and bulimia nervosa
Protein Energy Malnutrition (PEM)
Malnutrition
Malnutrition as "the cellular imbalance between the supply of nutrients and energy and
the body’s demand for them to ensure growth, maintenance, and specific functions.“ (WHO)

88
 Malnutrition is the condition that develops when the body does not get the right amount
of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ
function.
Kwashiorkor It is the body’s response to insufficient protein intake but usually sufficient
calories for energy
Marasmus Represents simple starvation. The body adapts to a chronic state of
insufficient caloric intake
Protein Energy Malnutrition It is a group of body depletion disorders which include
kwashiorkor, marasmus and the intermediate stages
PEM is also referred to as protein-calorie malnutrition
. Also called the 1st National Nutritional Disorder
It is considered as the primary nutritional problem in India
The term protein-energy malnutrition (PEM) applies to a group of related disorders that
include marasmus, kwashiorkor, and intermediate states of marasmus-kwashiorkor
PEM is due to “food gap” between the intake and requirement.
Aetiology:
Different combinations of many etiological factors can lead to PEM in children. They are
❖ Social and Economic Factors
❖ Biological factors
❖ Environmental factors
❖ Role of Free Radicals & Aflatoxin
❖ Age of the Host
❖ Amongst the Social, Economic, Biological and Environmental Factors the common
causes are:
▪ Lack of breast feeding and giving diluted formula
▪ Improper complementary feeding
▪ Overcrowding in family
▪ Ignorance
▪ Illiteracy
▪ Lack of health education
▪ Poverty
▪ Infection

89
 ▪ Familial disharmony
Clinical Features
The clinical presentation depends upon the type, severity and duration of the dietary
deficiencies. The five forms of PEM are:
1. Kwashiorkor (Protein Malnutrition Predominant)
2. Marasmic-kwashiorkor (Protein and Calorie Deficiency)
3. Marasmus (Deficiency in Calorie intake)
4. Nutritional dwarfing
5. Underweight child
Kwashiorkor
The term kwashiorkor is taken from the Ga language of Ghana and means "the
sickness of the weaning”.
Williams first used the term in 1933, and it refers to an inadequate protein intake with
reasonable caloric (energy) intake
Kwashiorkor, also called wet protein-energy malnutrition, is a form of PEM
characterized primarily by protein deficiency.
This condition usually appears at the age of about 12 months when breastfeeding is
discontinued, but it can develop at any time during a child’s formative years.
It causes fluid retention (edema); dry, peeling skin; and hair discoloration.
Kwashiorkor was thought to be caused by insufficient protein consumption but with
sufficient calorie intake, distinguishing it from marasmus.
Etiology
Kwashiorkor can occur in infancy but its maximal incidence is in the 2nd yr of life
following abrupt weaning.
Kwashiorkor is not only dietary in origin. Infective, psycho-social, and cultural factors
are also operative.

Symptoms
▪ Changes in skin pigment
▪ Decreased muscle mass
▪ Diarrhea Failure to gain weight and grow, Fatigue
▪ Hair changes (change in color or texture)
▪ Increased and more severe infections due to damaged immune system

90
 ▪ Irritability
▪ Large belly that sticks out (protrudes
▪ Lethargy or apathy
▪ Loss of muscle mass
▪ Rash (dermatitis)
▪ Shock (late stage)
▪ Swelling (edema
Clinical Features
▪ Kwashiorkor. Edema in lower leg and usually in face and lower arms.
▪ Irritability
▪ Poor appetite
▪ Moon face
▪ Sparse, silky , easily pulled out hairs.
▪ Hepatic enlargement due to accumulation of fat. [hepatomegaly]
▪ Hypo pigmentation [hair]
▪ Skin- hyper pigmentation, flaky paint dermatosis, follicular keratosis.
▪ Infections – diarrhoea, respiratory infections, skin infections.
▪ Signs of vitamin deficiencies
▪ Cardiomyopathy & failure
Marasmus
The term marasmus is derived from the Greek marasmus, which means wasting.
Marasmus involves inadequate intake of protein and calories and is characterized by
emaciation.
Marasmus represents the end result of starvation where both proteins and calories are
deficient.
Marasmus represents an adaptive response to starvation, whereas kwashiorkor represents
a to starvation maladaptive response
In Marasmus the body utilizes all fat stores before using muscles.
Definition
It is a condition caused by decreased intake of total calories. A deficiency of total calories
is called marasmus and is often accompanied.
Etiology

91
 • Seen most commonly in the first year of life due to lack of breast feeding and the use of
dilute animal milk.
• Poverty or famine and diarrhoea are the usual precipitating factors
• Ignorance & poor maternal nutrition are also contributory
Clinical features
Loss of subcutaneous fat
Muscle wasting present
Weight for height is low
Often have diarrhoea
Quiet & apathetic
Child looks older than his age
No edema or hair changes
Alert but miserable
Hungry
Diarrhoea & Dehydration
MARASMIC-KWASHIORKOR
A severely malnourished child with features of both marasmus and Kwashiorkor.
Also there is pale skin and hair, and the child is unhappy
The features of Kwashiorkor are severe edema of feet and legs and also hands, lower
arms, abdomen and face.
There are also signs of marasmus, wasting of the muscles of the upper arms, shoulders
and chest so that you can see the ribs.
Nutritional Dwarfing Or Stunting
Some children adapt to prolonged insufficiency of food-energy and protein by a marked
retardation of growth
Weight and height are both reduced and in the same proportion, so they appear
superficially normal
Underweight Child
They are at risk for respiratory and gastric infections
. They may have reduced plasma albumin
Children with sub- clinical PEM can be detected by their weight for age or weight for
height, which are significantly below normal.
Investigations for PEM
Full blood counts
Blood glucose profile

92
 Septic screening
Stool & urine for parasites & germs
Electrolytes, Ca, PH & ALP, serum proteins
CXR & Mantoux test
Exclude HIV & malabsorption
Non-Routine Tests
Hair analysis
Skin biopsy
Urinary creatinine over proline ratio
Measurement of trace elements levels, iron, zinc & iodine
Assessment of PEM
1) Growth chart
2) Comparison of weight of child with the weight of normal child of same age
3) Comparison of height of child with height of normal child at same age
4) weight/ height
Prevention & control of malnutrition
A. Under nutrition
1) .Identification of affected individuals – survey
through clinical examination & body measurements
2) .Special feeding programmes – disaster relief agencies provide special feeding
programme in which about 400-600kcal/person/days.
3) Health education
4) Promotion of breast feeding and improvement in infant and child feeding practices.
5) Improving the purchasing power of people.
6) Educating the selection of right kind of food.
7) Correction of harmful taboos and dietary prejudices.
8) .Decreasing the infectious diseases by appropriate measures.
9) Kitchen gardening.
10) Proper planning of budget with expenditure on food.
Prevention and control of Over nutrition
1) Identification of people having obesity
2) Creating awareness among public regarding dietary habits

93
3) Regular physical exercise
4) Surgical treatment
5) Health education
6) Food intake according to energy requirement
Prevention of malnutrition
At family level
Exclusive breast feeding
Timely meaning
Proper weaning foods
Immunization
Milk, meat, eggs, foods with high biological value to be provided.
Family planning
adequate spacing
improve literacy .
Community level
❖ Early detection of malnutrition
❖ Timely intervention
❖ Growth monitoring [growth chart]
❖ primary health care
❖ Immunization
❖ Nutrition education
❖ Family planning
❖ income generation activities
❖ Fortification and supplementation of foods
National level
❖ Nutritional supplementation
❖ Nutritional surveillance
❖ Nutritional planning
❖ National programmes.
Complications
1) Hypoglycemia
2) Hypothermia

94
 3) Hypokalemia
4) Hyponatremia
5) Heart failure
6) Dehydration & shock
7) Infections (bacterial, viral & thrush)
Principles of management
1) Treat/prevent hypoglycemia
2) Treat/prevent hypothermia
3) Treat/prevent dehydration
4) Correct electrolyte imbalance
5) Treat/prevent infection
6) Correct Micronutrient Deficiencies
7) Initiate re-feeding
8) Achieve Catch up Growth
9) Sensory stimulation &emotional support
10) Prepare for follow-up after recovery
Short Notes
1) Control of blindness
2) Prevention of cancer
ANS :
Cancer :
As a group of diseases characterized by an abnormal growth of cells , ability to invade
adjacent tissues and even distant organs , and the eventual death of the affected patient if the
tumor has progressed beyond that stage when it can be successfully removed
Prevention of cancer :
Primary Prevention
a) Control of tobacco and alcohol consumption
b) Personal hygiene
c) Radiation
d) Occupational exposures
e) Immunization
f) Foods, drugs and cosmetics

95
 g) Air pollution
h) Treatment of precancerous lesions
i) Legislation
j) Cancer education – an important area of primary prevention is cancer education. It
should be directed at “ high -risk ’’ groups..The aim of cancer education is to motivate people to
seek early diagnosis and early treatment.
Secondary Prevention
a) Cancer registration
- Hospital Based Registries
- Population based registries
b) Early detection of cases
c) Treatment
Seven steps to prevent cancer
1) Don’t use tobacco
2) Protect your skin from sun
3) Eat healthy diet
4) Maintain a healthy weight and be physically active
5) Practice safer sex and avoid risky behaviors
6) Get immunized (HPV and hepatitis vaccine)
7) Know your family medical history and get regular cancer screenings

3) Prevention of accidents
ANS :
Definition
• Accidents are unexpected, unplanned occurrence of an event which may involve injury.
 Unpremeditated event resulting in recognizable damage.( WHO 1956)
 Occurrence in a sequence of events which usually produce unintended injury, death or
property damage.
Prevention of accidents
 Multi-sectorial approach for prevention.
 Data collection:

96
 ❖ Reporting system for accidents
❖ Special surveys for accidents
➢ Risk factors
➢ Circumstances
➢ Chain of event
 No effective system of prevention without data collection.
 Safety education
 “Accident is a Disease – Education is its Vaccine”
➢ Should start from school days
➢ Drivers trained for vehicle maintenance and safe driving.
➢ Education about traffic rules
➢ Training in First Aid.
Promotion of Safety measures: –
 Helmets
 Seatbelts
 Leather clothing and boots
 Alcohol and other Drugs:
❖ Alcohol - 30-50 % of RTA
❖ Alcohol and drugs like
❖ Barbiturates,
❖ Amphetamine must be avoided
 Primary care
➢ Planning, organization and management of trauma treatment and emergency care
➢ Emergency care should begin at the site, continue during the transport and conclude in
the hospital.
➢ Trauma care hospitals in all major cities.
Elimination of causative factors
❖ Improper roads
❖ Speed limits
❖ Marking danger points
❖ Fire guards
❖ Use of safety equipments

97
 ❖ Safe storage of drugs, poison and weapon.
❖ Enforcement of Law of Medical fitness of driver
❖ Alcohol conc. In blood (80 mg/100 ml limit in India) Driving test
❖ Seat belt wearing
❖ Speed limit
 Enforcement of Law
➢ Helmets
➢ Vehicle inspection
➢ Periodic examination of drivers
 Rehabilitation
➢ Medical
➢ Social
➢ Occupational
 Accident Research
Some approaches are also include
 Educational approach
 Constructional approach
 Legal approach
 Multi-sectoral approach
 Care and rehabilitation approach
4) Explain causes and prevention of blindness
ANS:
❖ Blindness as visual acuity of less than 3/60 ( Snellen ) or its equivalent .(WHO )
❖ In other words “inability to count fingers in day light at a distance of 3 meters ’’ is to
indicate less than 3/60 or its equivalent. This means that the test subject sees the same line of
letters at 20 feet that a normal person sees at 20 feet.
❖ Causes and Prevention of Blindness
Causes -World
Developed countries:
▪ Accidents
▪ Glaucoma
▪ Diabetes

98
 ▪ Vascular diseases [ hypertension]
▪ Cataract and degeneration of ocular tissues especially of the retina, and hereditary
conditions.
➢ Emerging cause :
➢ Glaucoma
➢ Age – related macular degeneration
➢ Diabetic retinopathy
➢ Corneal ulcer
Leading causes of childhood blindness Region
✓ Xerophthalmia - vitamin A Distribution
✓ Congenital cataract
✓ Congenital glaucoma
✓ Optic atrophy due to meningitis
✓ Retinopathy of prematurity
✓ Uncorrected refractive errors
INDIA –
❖ Cataract (62.6%)
❖ Refractive error (19.70%)
❖ corneal blindness (0.90%)
❖ Senile cataract
❖ Glaucoma (5.80%)
❖ Surgical complication (1.20%)
❖ Posterior capsular Opacification (0.90%)
❖ Posterior segment disorder (4.70%)
❖ Congenital disorder
❖ Uveitis
❖ Retinal detachment
❖ Tumor
❖ Diabetes , HTN, Diseases of the nervous system, leprosy
❖ Epidemiological determinants
❖ Age
❖ Sex
❖ Malnutrition
❖ Occupation
❖ Social class
❖ Social factors
Prevention and control of blindness

99
 Changing concepts in eye health care
Primary eye care.
❖ Epidemiological approach
❖ Team concept
Establishment of national programmes
1. Assessment
▪ Assessing the people suffering from eye problems – blindness
▪ To assess the magnitude, geographic distribution
▪ Causes for setting up the priorities and development of planning& interventions in
order to reduce the suffering.
Methods of intervention
❖ Primary eye care –wide range of eye conditions can be treated or prevented with at
grass root level by locally trained health workers who are first to make contact with the
community.
❖ They are also trained to refer the difficult cases nearest PHC or district hospital .
❖ Secondary care –involves definite management of common blinding conditions cataract,
trichiasis, entropion, ocular trachoma, glaucoma
❖ It is provided in PHC’s and district hospitals where eye departments are established. may
involve the use of mobile eye clinics
❖ Tertiary care –national or regional hospitals and medical colleges and institutes of
medicine.
❖ Rehabilitation comprise education of blind in the special schools & utilization of their
services
Specific programmes
2. INTERVENTION
❖ Promotion of personal hygiene
❖ Improvement of Sanitation
❖ Good Dietary Habits
❖ Establishment of Eye Banks
❖ Mobile Eye Units
Intervention includes specific programmes such as
A. Trachoma control programme
B. Evaluation
C. school eye health services
D. Vitamin A prophylaxis
E. Occupational eye health services.
Trachoma control programme

100
 ✓ Trachoma control programme was launched in 1963 & later on in 1976.
✓ It was emerged with national programme for control of blindness.
✓ Mass campaign treatment with tetracycline.-
✓ Improving intake of Vitamin A in Diet.
✓ Improving personal hygiene
✓ Adequate and safe water supply
✓ health education.
✓ Evaluation
✓ Time to time evaluation
❖ To assess the effectiveness of programme and also to plan & intervene in order to achieve
the results by modifying the responsible factors for blindness of environmental & socio
economic conditions.
❖ School eye health services
The school children should be assessed for refractive errors, squint, trachoma etc.
The students should be educated about various aspects related to eye health.
These include:
- Good posture
- Proper lighting
- Avoidance of glare
- Proper and adequate reading distance.
❖ Vitamin A Prophylaxis
Vitamin A orally to children under 5 years – to prevent blindness.
Under vitamin A prophylaxis , 20,000 IU of Vitamin A is given at an interval of 6 months
between 1 to 6 years of age.
❖ Occupational eye health services
❖ Eye problems occurring at industries, factories etc.
❖ It can be prevented and controlled by preventing eye injuries through use of protective
devices .
❖ Proper illumination of working area
❖ Reducing stress at work
❖ Improving safety features of machines
❖ First aid services at work place

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 ❖ Adequate referral system
3. Long term measures
FACTORS RESPONSIBLE :
✓ Improving quality of life
✓ Improving sanitary conditions
✓ Intake of foods rich in vitamin A
Health education – Important long term measure.
✓ To create community awareness of the problem
✓ To motivate the community
✓ To accept total eye health care programmes
✓ To secure community participation

5) Prevention and control of coronary artery disease

ANS:
❖ Coronary artery disease is also known as ischemic heart disease. It is the impairment of
heart function due to inadequate blood supply to heart muscles for its functioning, which is
caused by blockage or narrowing of coronary artery.
Prevention and control of coronary artery disease:
1) Early diagnosis and treatment
2) Dietary modification
3) Physical activity and exercise promotion
4) Regular check up & follow up for high blood pressure
5) Health education
The strategies recommended to prevent coronary artery disease :
1) Population strategy
2) High risk strategy
3) Secondary prevention
1)Population strategy : The strategy based on mass approach mainly focusing on the control
of underlying causes in the whole population. this includes the alteration in life style associated
with CHD. The recommended strategies are
❖ Specific intervention – it includes the intervention in specific areas such as :
a. Dietary changes

102
 b. Smoking prohibition or making the area smoke free

c. Blood pressure maintenance

d. Regular physical activity

❖ Primordial Prevention : It involves to preserve the eating pattern & life styles
associated with low levels of CHD. Primordial prevention includes all the preventive measures
adopted to prevent the emergence and spread of CHD risk factors and life styles that have not yet
appeared.
2) High Risk Strategy : High risk strategy involves identifying the high risk individuals
(smoke, a history of CHD,DM, obesity , oral contraceptives etc ) and providing the specific
advice to take positive action against all the identified risk factors.
3) Secondary Prevention :The aim of secondary prevention is to prevent the recurrence
and progression of CHD. The disease can be controlled by early diagnosis and by making use of
drugs. surgery is advised, if required.
Define the following
1) Malnutrition :
It is a health problem occurring due to relative or absolute deficiency or excess of
nutrients in human body and causing pathological changes.
Malnutrition can be defined as the condition due to absence, deficiency or excess of one
or more essential nutrients.
2) Obesity :
Obesity means the deposition of adipose tissue due to either increase in number of fat
cells or size or combination of both. Obesity is expressed in terms of body mass index
3) Stroke:
Stroke is rapidly developed clinical signs of focal disturbance of cerebral function, lasting
more than 24 hrs or leading to death , with no apparent cause other than vascular origin. (WHO)
4) Accident:
Accident is defined as unexpected, unplanned occurrence of an event which may involve
injury.
5) Fluorosis

103
 Fluorosis is a disease caused by deposition of fluorides in the hard and soft tissues of the
body. It is usually characterized by discoloration of teeth and crippling disorders.

Give reasons for the following

1.Oral cancer is amenable to primary prevention
ANS:
 Tobacco chewing and use elimination at community level
 Health education and awareness
 Motivation for lifestyle modification
 Legislative measures: banning or restricting tobacco

UNIT VII: DEMOGRAPHY

SHORT ESSAYS
1) Define demography. Explain briefly the demographic trends in India
ANS:
Demography is derived from the Greek words, “demos” which means people and “graphy
’’means study .
Demography is the”scientific study of human population in which includes study of changes in
population size, composition and its distribution”

Demographic trends in India

Introduction
 India is a fast growing country in terms of population growth. the population was about
20 crores in 1881 while in the beginning of the 20th century, i.e. , in 1991 the population
of India was about 23 crores. On March 2011, India’s population was 1210 million. India
ranks second in terms of population. It is estimated that it would reach 1400 million by
2026
Definition of demographic trends
 A popular term for any measurable change in the characteristics of a population over
time—e.g., increased or decreased concentration of a particular ethnic group, sex ratio,
etc (Medical Dictionary )

104
  Demographic trends are changes in the size of segments of the population
 Examples
 An increase in people over the age 65
 A growing immigrant population.
 A popular term for any measurable change in the characteristics of a population over
time—e.g., increased or decreased concentration of a particular ethnic group, sex ratio,
etc.
The important demographic trends in India are
 Demographic Indicators
 Age and sex Composition
 Age Pyramids
 Sex Ratio
 Dependency Ratio
 Density of Population
 Urbanization
 Family Size
 Literacy and Education
 Life Expectancy
 Demographic Indicators
They are divided into 2 parts:-
1) Population statistics
➢ Include indicators that measure the population size, sex ratio, density and dependency
ratio.
2) Vital statistics
➢ Include indicators such as birth rate, death rate, and natural growth rate, life expectancy
at birth, mortality and fertility rates.
Age and sex Composition – Population Pyramid
➢ In the age group 0-14 years male population is about 1.3 per cent more than female,
whereas in the age group 60+ percentage of female population is 0.6 per cent more than
male population.

105
 ➢ The proportion of population in the age group 0-14 years are higher in rural areas
(32.4%) than in urban areas for both male and female population.
Age pyramid
 This age structure of a population is best representation .Such a representation is called an "Age
Pyramid". The age pyramid of India is typical of developing countries i.e with broad base and
tapering top

Sex Ratio

 Is defined as “the number of females per 1000 males”. In 2011 , sex ratio was 940
 It plays a vital role in any population analysis study.
 The sex composition is affected by the differentials in mortality conditions of males and
females; sex selective migration and sex ratio at birth.
Causes of Sex Ratio
 Strong male child preference
 Child marriage
 Economic dependence
 Consequent gender Inequities
 Neglect of the girl child
 Female infanticide
Dependency ratio
 A country’s population can be divided into three groups – old dependents, young
dependents and economically active.
 Old dependents: anyone over the age of 65.
 Young dependents: anyone under the age of 15.
 Economically active: anyone between the age group of 16-65. who normally work and
pay taxes.
➢ The ratio of the combined age groups 0-14 plus 65 years and above to the 15-65 years
age group is referred to as the total dependency ratio.
➢ It is also referred to as the societal dependency ratio.
➢ It reflects the needs of the society to provide for their younger and older population.
Dependency Ratio = Children 0-14yrs + population more than 65yrs of age x100
Population of 15 to 64 yrs

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Factors influencing high dependency ratio:
 Increasing Life Expectancy
 Falling Death Rates
 Rising birth rates
 Immigration of dependents
 Emigration of economically active
Density of population
 One of the most important indices of population concentration.
 In the Indian census, density is defined as the number of persons, living per square
kilometer.
 Density of population continuously increasing in India
Factors affecting density of population:
 Climate of the specific region/place
 Amount of rainfall
 Availability of water and electricity
 Natural composition of land
 Type of surface layer of land
 Stage of economic development
 Transportation facilities
 Sociocultural environment
 Security to life and property
Urbanization
 Urban population is the number of persons residing in urban localities.
 In India urban areas refers to: towns, all places having 5000 or more inhabitants, a
density of not less than 1000 persons per square mile or 390 per square kilometer, at least
three fourths of the adult male population employed in pursuits other than agriculture.
Family size : Total number of children a woman has given birth at a point in time . In 2008 , it
was 2.6
Literacy and Education
 The benefits that accurate to a country by having a literate population are
multidimensional.

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  Spread of literacy is generally associated with modernization.
 It was decided in 1991 census to use the term literacy rate for the population relating to
seven years age and above.
 A person who can merely read but cannot write is not considered literate.
 The literacy rate taking in account the total population in the denominator has now been
termed as “ crude literacy rate”.
 The literacy rate calculated taking into account the 7years and above population in the
denominator is called effective literacy rate.
 In India Kerala occupies the top rank with 93.91% literacy rate.
Life Expectancy
 Life expectancy : at a given age is the average number of years which a person of that age
may expect to live according to the mortality pattern prevalence in that country.
 Indicator of country’s level of development & overall health status of the population.”
 As per the National Health Profile 2019,
 The average life expectancy of Indians is 68.7 years.
 Male life expectancy is 67.4 years
 Female life expectancy is 70.2 years.

SHORT NOTES
1) Demographic Cycle
1) High stationary (first stage ): this stage is characterized by a high birth rate and high
death rate ,no any change in size and population .population of 1920 in India
2) Early expending (second stage) : The death rate begins to decline (starts decreasing
)and birth rate no change . Initial increase in population. (South Asia And South Africa)
3) Late Expanding (Third Stage): The Birth Rate begins to decline while the death rate
still decreases. . Continue increase in population .In a developing country like Singapore,
this trend is going on. India also at this stage.
4) Low stationary (fourth stage ) : This stage is characterized by a low birth rate & low
death rate .stability in population . This trend is found in developed countries.
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 5) Declining (fifth stage ):in the declining stage birth rate is lower than the death rate ,fall
in population. This is happening in Hungary and Germany.

Define the following

1) Demography : Demography is the”scientific study of human population in which
includes study of changes in population size, composition and its distribution”
2) Life Expectancy: At a given age is the average number of years which a person of that
age may expect to live according to the mortality pattern prevalence in that country.

UNIT VIII: POPULATION CONTROL

LONG ESSAYS

1) Enlist the methods of contraception. Explain the permanent methods of contraception.

ANS:

Definition: Preventive methods to help women avoid unwanted pregnancies.

1. Spacing methods/ Temporary methods

2. Terminal methods/permanent methods

I . Spacing methods:

1. Barrier methods - a) Physical methods b) Chemical methods c) Combined methods

2. Intra Uterine devices - a) First generation b) Second generation c) Third generation

3. Hormonal methods - a) Oral pills b) Depot formulations

4. Post – conceptional methods - a) Menstrual induction b) Menstrual regulation

5. Miscellaneous - a) Abstinence b)Coitus interruptus c)Safe period d) Natural family planning methods
(Breast feeding ,Birth control vaccine )

II. Terminal methods: Female sterilization – Tubectomy & Male sterilization - Vasectomy

Male sterilization

• Vasectomy - simple operation

• Can be performed in every PHC, by trained doctors under local anesthesia.

• A piece of vas (1 cm) is removed after clamping.

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 • The ends are ligated & then folded back on themselves & sutured into position, so that the cut
ends face away from each other.

Complications:

• Operative
• Sperm granules:
• Spontaneous recanalization
• Auto immune response
• Psychological

Causes of failure:

• Most common cause is mistake in the identification of vas – instead of vas, some other structure
in the spermatic cord like thrombosed vein or thickened lymphatic may be operated.

Post operative advise:

 The client should be told that he is not sterile immediately after the operation; at least 30
examination is negative. ejaculations may be necessary before the seminal

 To use contraceptive until aspermia has been established.

 To avoid taking bath for at least 24 hours after operation

 To wear a T-bandage or scrotal support for 15 days

 To keep the site clean & dry

 To avoid cycling & lifting heavy weights for 15 days

 To have the stitches removed on the 5th day.

Female sterilization: Tubectomy. Two procedures are common- laparoscopy & minilaparotomy .

Laparoscopy: Technique of female sterilization through abdominal approach with a specialized

instrument called Laparoscope. The abdomen is inflated with gas,(CO2, nitrous oxide) and the instrument
is introduces into the abdominal cavity to visualize the tubes. Once the tubes are accessible, the
Fallopian Rings/Clips are applied to occlude the tubes.

Patient selection:

• Laparoscopy is not advisable for post partum clients for 6 weeks following delivery.

• Can be done as a concurrent procedure to MTP.

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 • Hb % should not be less than 8.

• There should be no associated medical disorders like heart disease, respiratory disease, diabetes
& hypertension.

• Client should be kept in hospital for a minimum of 48 hours after the operation.

Follow up care:

• Cases should be followed up by LHV in their respective areas, once between 7-10 days of
operation & once again between 12-18 months after the operation.

Complications:

• Usually uncommon

• Puncture of large blood vessels

• Infections

Minilaparotomy:

• Also known as minilap operation/Pomeroy technique.

• Modification of abdominal tubectomy.

• Simpler procedure requiring a smaller abdominal incision of only 2.5 – 3 cm conducted under
local anaesthesia.

• Suitable to be performed at PHCs & for mass campaigns.

Advantages:

• More safe

• Efficient

• Easy to perform

2) Define family planning. Explain spacing methods.

ANS:

Definition: A way of thinking & living that is adopted voluntarily, upon the basis of knowledge, attitudes
& responsible decisions by individuals & couples, in order to promote the health & welfare of the family
group and thus contribute effectively to the social development of the nation.

Spacing methods:

1. Barrier methods - a) Physical methods b)Chemical methods c) Combined methods

2. Intra Uterine devices - a) First generation b) Second generation c) Third generation

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3. Hormonal methods - a) Oral pills b) Depot formulations

4. Post – conceptional methods - a) Menstrual induction b) Menstrual regulation

5. Miscellaneous - a) Abstinence b)Coitus interruptus c)Safe period d) Natural family planning methods
(Breast feeding ,Birth control vaccine )

I . Barrier methods: Also known as occlusive method. Aim – to prevent live sperm from meeting the
ovum.

a) Physical methods – Condom, Female condom, Diaphragm, Vaginal sponge

b) Chemical methods

• Foams – foam tablets, foam aerosols

• Creams, jellies & pastes

• Suppositories – inserted manually

• Soluble films– C films inserted manually

II. Intra uterine devices: Devices placed in uterine cavity.

• First generation IUDs - Comprise the inert or non medicated devices, made of polyethylene.

• Second generation IUDs - Made of polyethylene, but copper is added into these.

• Third generation IUDs - Contains hormones ,released slowly in the uterus

III. Hormonal contraceptives:

Classification:

A. Oral pills

✓ Combined pill

✓ Progestogen only pill(POP)

✓ Post – coital pill

✓ Once a month pill(long acting pill)

✓ Male pill

B. Depot(slow release) formulations

✓ Injectables

✓ Subcutaneous implants

✓ Vaginal rings

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Mode of action of oral pills

✓ MOA of combined pill is to prevent the release of the ovum from the ovary. This is achieved
by blocking the pituitary secretion of gonadotrophin that is necessary for ovulation.

IV. Post conceptional methods/Termination

1. Menstrual regulation- It consists of aspiration of uterine contents 6 to 14 days of a missed

period

2. Menstrual induction- This is based on disturbing the normal progesterone- prostaglandin

balance by intra-uterine application of 1-5mg solution of prostaglandin F2.

3. Oral abortifacient: Mifeprestone in combination with misoprostol- 95% successful in

terminating pregnancies of up to 9 weeks with minimum complications.

V. Miscellaneous

• Abstinence
• Coitus interruptus
• Safe period
• Natural family planning methods:
• Breastfeeding
• Birth control vaccines

SHORT NOTES

1. Intra uterine devices

ANS:

• Devices placed in uterine cavity

First generation IUDs: Comprise the inert or non medicated devices, made of polyethylene. Available in
different sizes and shapes such as coils, spirals, loops. Lippes loop is most popular.

Second generation IUDs: Made of polyethylene, but copper is added into these. Copper enhances the
contraceptive effect. Varity of devices developed .

Third generation IUDs: Contains hormones ,released slowly in the uterus. Progestasert & LNG
20(Mirena).

Mechanism of action of IUD:

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 • First generation IUD: Act as a foreign substance which cause cellular and biochemical changes
in the endometrium and uterine fluids. These changes impair the viability of the gamete & thus
reduce its chances of fertilization.

• Second generation IUDs: Medicated IUDs produce local effects. Copper seems to enhance the
cellular response in the endometrium. It also affects the enzymes in the uterus. It alters the
biochemical composition of the cervical mucus & thus affect the sperm motility, capacitation &
survival.

• Third generation IUDs: Hormone releasing IUDs increase the viscosity of the cervical mucus &
thereby prevent the sperm from entering the cervix. They also maintain high progesterone levels
in the endometrium & low levels of estrogen – making endometrium unfavorable for
implantation.

Advantages :

• Simplicity - No complex procedures in insertion, no need of hospitalization.

• Insertion takes only a few minutes

• Once inserted, IUD remains in place as long as required.

• Inexpensive

Ideal IUD Candidate :

• Who has borne at least one child

• Has no history of pelvic diseases

• Has normal menstrual periods

• Is willing to check the IUD tail

• Has access to follow up & treatment of potential problems

• Is in a monogamous relationship

Timing of insertion

• Most suitable time is during menstruation or within 10 days of the beginning of a menstrual
period.

• During this period, insertion is technically easy because, the diameter of the cervical canal is
greater at this time.

2. Emergency contraception

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ANS:

Meaning : It is a safe way to prevent pregnancy after unprotected sex. Also known as emergency post
coital contraception..

Definition : Emergency contraception refers to methods of contraception that can be used to prevent
pregnancy after unprotected sexual intercourse.

Uses:

• Unprotected intercourse

• Contraceptive failure

• Incorrect use of contraceptives

• In cases of sexual assault

Methods of Emergency contraception:

1. Emergency contraceptive pills (ECPs)- Also known as emergency hormonal contraception(EHC).

Also known as Morning After Pills. These are intended to disrupt or delay ovulation or fertilization.

2. Intra uterine devices(IUDs) - Copper T IUD that can be used up to 5 days after unprotected sex to
prevent pregnancy. Insertion of an IUD is more effective.

3. Combined oral contraceptive pills /Yuzpe Method- It uses combined oral contraceptive pills. Taken
in two doses. Each dose must contain estrogen(100-120mcg ethinyl estradiol) and progestin(0.50-0.60 mg
levonorgestrel. The first dose should be taken as soon as possible after unprotected intercourse(preferably
within 72 hours) & the second dose should be taken 12 hours later. If vomiting occurs within 2 hours of
taking a dose, it should be repeated.

3. Population explosion

ANS:

Definition: it is defined as the sudden & rapid increase in the size of a population.

It is more prominent in underdeveloped & developing countries.

Causes:

 Accelerating birthrate
 Decrease in death rate
 Decrease in infant mortality rate

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  Increase in life expectancy
 Advancement in medical technology
 Improvement in public health
 Lack of education
 Increased immigration
 Industrialization
 Urbanization

Effects:

 Over population
 Unemployment
 Shortage of food
 Illiteracy
 Increased crime rate
 Poor health

Effects on environment:

 Generation of waste
 Air pollution
 Water pollution
 Deforestation
 Depletion of ozone layer
 Extinction of species
 Land/soil degradation
 Climatic changes

Measures to control:

Social measures: minimum age of marriage, rising the status of women, spread of education, adoption,
change in social outlook, social security

Economic measures: more employment for women, development of agriculture & industry, increase the
standard of living

Other measures: late marriage, self control, family planning, facilities for recreation, publicity.

DEFINE THE FOLLOWING

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 1) net reproduction rate
2) safe period
3)

DIFFERENTIATE BETWEEN THE FOLLOWING

1. Eligible Couple & Target Couple

Sl.No Eligible couple Target couple:

1. Refers to a currently married couple, wherein Refers to the couples who have had 2-3living
the wife is in the reproductive age, which is children, or newly married couples, and family
usually assumed to lie between the ages of 15- planning was largely targeted to them.
49.

LIST DOWN THE FOLLOWING

1. Temporary methods of contraception

ANS:

Spacing methods:

1. Barrier methods - a) Physical methods b)Chemical methods c) Combined methods

2. Intra Uterine devices - a) First generation b) Second generation c) Third generation

3. Hormonal methods - a) Oral pills b) Depot formulations

4. Post – conceptional methods - a) Menstrual induction b) Menstrual regulation

5. Miscellaneous - a) Abstinence b)Coitus interruptus c)Safe period d) Natural family planning methods
(Breast feeding ,Birth control vaccine )

GIVE REASONS FOR THE FOLLOWING

1. Emergency contraception is a post coital contraception

ANS:

• It is a safe way to prevent pregnancy after unprotected sex.

• Also known as emergency post coital contraception. is advocated as an emergency method

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 • Emergency contraception refers to methods of contraception that can be used to prevent
pregnancy after unprotected sexual intercourse.

• Recommended within 72 hrs of an unprotected intercourse

• Recommended for use within 5 days, but are most effective the sooner they are used.

• Two methods – IUD within 5 days or hormonal tablets ( Levonorgestrel)

Used in cases of :

• Unprotected intercourse

• Contraceptive failure

• Incorrect use of contraceptives

• In cases of sexual assault

UNIT IX: INFORMATION EDUCATION AND COMMUNICATION

LONG ESSAYS

1) Define health education. Explain the aims & objectives. Enumerate the principles.

ANS:

Definition : The process by which individuals & groups of people learn to behave in a manner conducive
to the promotion, maintenance or restoration of health.

Aims & objectives:

• To encourage people to adopt & sustain health promoting lifestyle & practices.

• To promote the proper use of health services available to them.

• To arouse interest, provide new knowledge, improve skills and change attitudes in making
rational decisions to solve their own problems.

• To stimulate individual & community self reliance and participation to achieve health
development through individual and community involvement at every step from identifying the
problems to solving them

Principles of health education:

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Health education brings together the art & science of medicine, and the principles and practice of general
education.

• Credibility :It is the degree to which the message to be communicated is perceived as

trustworthy by the receiver

• Interest: A psychological principle that people are unlikely to listen to those things which are
not to their interest.

• Participation : Psychological principle of active learning.

• Motivation: In every person, there is a fundamental desire to learn, awakening this desire is
called motivation.

• Comprehension: The level of understanding, education & literacy of people to whom the
teaching is directed.

• Reinforcement: Few people can learn all that is new in a single period. Repetition at intervals is
necessary.

• Learning by doing: Learning is an action process, not a memorizing one.

• Known to unknown : In health education, we must proceed from the particular to general, from
simple to complicated, from easy to more difficult

• Setting an example: Health educator should set an example.

• Good human relations: Sharing of information, ideas and feelings happen most easily between
people who have a good relationship.

SHORT NOTES

1) Role of nurse in IEC

ANS:

Definition: IEC is an approach which attempts to change or reinforce a set of behavior in a target
audience regarding a specific problem in a predefined period of time.

Role of nurse in IEC

G- Greet client in friendly manner & make them feel at ease

A- Ask client about needs & reassure them

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T- Tell all information he/she needs

H- Help to make informed decision & ensure that they are clear with the decision

E- Explain the relevant factors related to decision made & summarize the decision

R- Return visits should be planned

Role of nurse in IEC

1. At community level

✓ Assessing – needs of people

✓ Informing- target audience

✓ Persuading- about personal benefits

✓ Motivating- to make informed choices

✓ Encouraging – to adopt, & motivate others

2. At individual level

✓ Provide opportunity to develop personality, knowledge, skills & confidence

✓ Increase awareness

✓ Reinforcement to sustain behavioral change

✓ Proper communication

3. In general :

✓ Gain confidence of people

✓ Arouse interest in people about good health

✓ Motivate to bring about changes in life

✓ Prepare to utilize available resources

✓ Develop a sense of responsibility among people towards good health of the nation

DIFFERENTIATE BETWEEN THE FOLLOWING

1. Charts & Posters

Sl.No Charts Posters

1 Graphic teaching materials including Graphical aids with short, quick & typical
diagrams, posters, pictures, maps & graphs messages with attention capturing paintings
2 An illustrative visual media for depicting a Poster should have a covering flap.

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 logical relationship between main ideas & Simple in depiction, dramatic action packed short
supporting facts. message, colorfulness.
3 Chart should be 50x 75 cm or more in size.
Should be captioned in bold letters.
4 Use short phrases rather than large
sentences. Write different contrasting
features with different color marker pens.
Types -Tree chart, Stream chart, chart,
Flow chart
References :

1. Park. K. Text book of Preventive & Social Medicine, M/s Banarsidas Bhanot
Publishers Jabalpur, Latest edition.
2. Gulani.K.K. Community Health Nursing. Principles & practice. Kumar Publishing
House, New Delhi.
3. Swarankar K. Community Health Nursing, N.R. Brothers, Indore. Sridhar Rao.
Principles of Community Medicine. AITBS Publishers, New Delhi.
4. Neelam Kumari. A Text Book of Community Health Nursing-I, S.Vikas& Company,
Jalandhar.
5. Community Health Nursing Manual, TNAI Publication, Green Park, New Delhi.
Latest edition National & International Journals on Public Health .
6. www.http// slideshare

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