Question 1

Briefly describe new philosophy of health. Write determinants of health

New philosophy of health

1. Health is a fundamental human right
2. Health is the essence of productive life, and not the result of ever increasing expenditure of medical care
3. Health is intersectoral
4. Health is an integral part of development
5. Health is central to the concept of quality of life
6. Health involves, state and international responsibilities
7. Health and its maintenance is a major social investment
8. Health is a world wide social goal

DETERMINANTS OF HEALTH
The factors which influence health lie both within the individual and externally in the society in which he or
she lives are collectively known as determinants of health
1. Heredity
a). physical and mental traits are determined by an individuals genes
b). disease of genetic origin
e.g.: mental retardation, hemophilia
2. Environment
a) Internal(tissue & organ)
b) External (macro environment)
Those things which man is exposes to after conception
• Physical – water, housing
• Biological-man, animal, microorganism
• Psychosocial-stress , family
3. Life style
• the way people live
• cultural pattern
• personal habits - harmful life style-smoking
Healthy life style-exercise
4. socio-economic condition
a) Economic status
Determines purchasing power, standard of living, quality of life family size & pattern of disease and deviant
behavior in the community
b) Education (especially female education)
Illiteracy poverty poor health
c) Occupation
Employment promotes health
Unemployment ill health

5. Health and family welfare services

• Immunization
• Safe water supply
• MCH service
6. Other factors
Health related factors e.g. agriculture, Education, social welfare
Question 2.
Describe levels of health care, write features of ideal health care delivery system

Levels of health care

Health care services are normally organized at three levels , each level supported by a higher level
to which the patient can be referred

1. Primary health care

First level of contact between the individual and the health system. Essential health care is
provided.
E.g.: thana health complex and their union sub centers

2. Secondary health care

More complex problems are dealt with, care comprises essentially of curative services. Eg: district
hospitals
First referral level of health systems

3. Tertiary healthcare
Super specialist care provided by regional or central level institutions
Eg: medical college hospitals
Referral support for primary and secretary levels

Features of an ideal health care delivery system

1. Appropriateness: whether the service is needed at all in relation to essential human needs at all in
relation to essential human needs, priorities and policies

2. Comprehensiveness: optimum mix of preventive curative and promotional service

3. Adequacy: if the service is proportionate to the requirement

4. Availability: ratio between administrative unit and the health facility

E.g.: doctor population ratio

5. Accessibility: Geograpghic ac

6. Affordability: Cost of health care should be within the individual and the state.

7. Feasibility – Operational efficiency of certain procedures, logistic support, man power

Question 3

Define screening. write comparison between screening test and diagnostic test

Definition of screening

The search for unrecognized disease or defect by means of rapidity applied tests, examinations or
other procedures in apparently health individuals

Eg:pap smear for cervical cancer

Chest x-ray for TB

Comparison between screening test and diagnostic test

Screening test Diagnostic test
1. Done on apparently health 1.Done on those with indications or sick
2. Applied to groups 2.applied to single patients, disease consider
3. Based on one criterion 3.based on evaluation of a number of symptoms,
signs, and laboratory findings
4. Less accurate 4.less accurate
5. Less expensive 5.more expensive
6. Not a basis for treatment 6.used for basis for treatment
7. The initiative comes from the investigator 7.the initiative comes from a patient with a com-
or agency providing care plaint
Question 4
Write importance of studying community medicine, what is family medicine?

Importance of studying community medicine

1.Community medicine is the total health care be it physical, mental, and social for the individual,
the family, the community and the nation as a whole through collaborative and coordinated efforts
or integration of various discipline and profession to achieve community health prospective
2.It is concerned with the identification and assessment of health needs of the people, health
problems affecting them and to devise appropriate measures to meet these requirements as best as
possible with available resources
3.The working concept of community medicine is concerned with the delivery of comprehensive
health care to the people
4.Since community medicine is oriented towards people, there is also profound concern within
organization of health care and with factors influencing its distribution, use and effectiveness

Family medicine
A field of specialization in medicine which is neither diseased nor organ oriented. It is a family
oriented medicine or health care centered on the family as the unit, from first contact to the ongoing
care of chronic problems
Question 5
Define disaster; describe pre disaster preparedness activities of a hospital

Disaster
“Any occurrence that causes damage, economic disruption, loss of human life and deterioration in
health and the health services on a scale sufficient to warrant an extraordinary response from
outside the affected community or area

Pre disaster preparedness of hospital

1. Improvement of hospital site and building
• Make road access easier
• Make more open spaces at hospital premises
• Find out and correct architectural or engineering false if any
• National building code should be followed while construction new building
• Provisions for exits and alternative exits
2. Improvement of utility services
• Overhauling of electricity, gas, water supply and telecommunication systems
• Alternative arrangements of above service s if present system fails
• Arrangement of citizen band radio network
• Manpower training with above service
3. Improvement of emergency and casualty department
• Make size and site of emergency department more accessible
• Installation of resuscitating and life saving equipment
• Stocking of life saving medicine eg: gauz, bandages etc…
• Establishment of new operating theaters
• Make mobile health team standby
• Arrangement of special training for emergency doctors, nurses and staff
• Establishment of a fully pledged casualty/trauma center if fund is available
• Modernization of blood bank and transfusion system
Question 6
Define epidemiology. Write objectives and uses of epidemiology

Epidemiology
“Study of the distribution and determinants of health related states or events in specified
populations and the application of this study to the control of health problems”

Objective s of epidemiology
*according to the international epidemiological association
1. To describe the distribution and size of disease problems in human populations

2. To identify etiological factors in pathogenesis of disease

3. To provide data essential to the planning implementation and evaluation of services fort the
prevention ,control and treatment of disease and to the setting up of priorities among those services

*ultimate objectives of epidemiology

1. To eliminate or reduce the health problem or its consequences

2. To promote the health and well being of society as a whole by preventing of its occurrence in the
future

Uses of epidemiology

1) Describe causation of disease

2) To know the natural history of disease
3) Describes people’s health status
4) Evaluation of intervention program
5) Evaluation of health care services
Question 7
Classify epidemiological study methods. Compare case, control and cohort study

Epidemiological study methods

1. Observational studies
a) Descriptive studies
b) Analytical studies
1) Ecological
2) Cross sectional
3) Case control
4) cohort

2. Experimental or intervention studies

1) Clinical trials
2) Field trials
3) Community trials

Descriptive epidemiology
Concerned with observing distribution of disease or health related characteristics in human
populations and identifying the characteristics with which disease in question seems to be
associated.
Analytical epidemiology
Subject of interest is the individual within the population
• case control study
• Cohort study
Experimental epidemiology
• Randomized control trials
• Non randomized or non experimental trials

Compare case control and cohort study

Case control Cohort study
1. proceeds from effect to cause 1.Proceeds from cause to effect
2. Starts with the disease 2. Starts with people exposed to risk factors
or suspected cause
3. Test weather the suspected cause occurs 3. test weather disease occurs more
more frequently in those with the disease frequently in those exposed to it than those
than those with out the disease similarly exposed
4. Usually first approaches of a testing of a 4. reserved for testing precisely formulated
hypothesis hypothesis
5. Involves fewer number of subjects 5. involves large number of subjects
6. yield relatively quick results 6. long follow up period needed involving
delayed results
7. Suitable for study of rare disease 7.in appropriate when the disease or
exposure under investigation is rare
8.Generally yields only relative risk(Odd 8.yeilds incidents rates, relative risks as
ratio) well as attributable risks
9. Can not yield information about diseases 9. Can yield information about more than
other than that selected for studying one disease out come
10.relatively in expensive 10. relatively expensive

Question 8
What are the public health emergencies?

‘Any incident that causes break down of public health by any means is called public health
emergency’
1. Any epidemic outbreak
• Cholera

2. Natural calamities
• Cyclone
• Flood
• Tsunami

3. Accidents
• Serious road traffic accidents
• Aircraft crash
Question 9
Define endemic, epidemic, pandemic and sporadic with examples.

Endemic ( En= In, Demos=people)

It refers to the constant presence of a disease or infectious agent within a given geographic area or
the population group, without importation from outside, may also refer to the “Usual” or Expected
frequency of the disease within such a area or population group.
E.g.:-Cholera is endemic in Bangladesh
Malaria in hill tracks
Goiter at Rangpur

Epidemic (Epi=Upon, Demos= people)

The unusual occurrence in a community or region of disease, specific health related behavior (Eg:-
smoking) or their health related events(traffic accidents) clearly in excess of “expected occurrences”
Eg:- Communicable – measles, Cholera, Chicken pox
Non communicable disease – IHD, Lung cancer
Health related behavior – smoking

Pandemic

An epidemic usually affecting a large proportion of the population occurring over a wide
geographical area, Such as e section a nation, entire nation, a continent or the world.
Eg:- Influenza pandemic of 1918 and 1957
Cholera in 1962 (Still continuing)
Acute hemorrhagic conjunctivitis 1917 and 1981

Sporadic

When a disease occurs irregularly, haphazardly from time to time and generally infrequently with
out having common sources of infection.
Eg:- Polio
Tetanus
Herpes - zoster
Question 10
Write levels of disease prevention, why prevention is better than cure

Levels of disease prevention

1. Primordial prevention
• Prevention of emergence or development of risk factors in countries or population groups in
which they have not yet appeared
• The main intervention is through individual and education
eg: adult health problems (obesity, hypertension,) by encouraging healthy lifestyle in
childhood

2. Primary prevention
It signifies intervention in prepathognic phase of disease or health problem
a) Health promotion
• health education
• nutritional intervention
• environmental modification
• lifestyles and behavioral changes
b) Specific changes
• Immunization
• protection against accident
• chemoprophylaxis
• protection against occupational hazards

3.Secondary prevention

“Action which cause the progress of a disease at its incipient stage and prevents
complications.”

The specific interventions are early diagnosis and treatment

The methods employed for early diagnosis
1) case finding measures
2) screening surveys
3) surveillance techniques
4) Periodic examinations
5) Selective examination of people at high risk
4. Tertiary prevention
“All measures available to reduce or limit impairments and disabilities ,minimize sufferings caused
by existing departures from good health and to promote the patients adjustment to irremediable
condition

It signifies intervention in the late pathogeneses phase

a) Disability limitation
b) Rehabilitation
Why prevention is better than cure
1. Preventive measures are taken prior to the onset of a disease to remove all possibilities of disease
and damage.
2. Includes early diagnosis and treatment.
• Prevents secondary complications
• further disability
• development of secondary cases
• mortality
3. Prevention requires fewer resources
4. Prevents loss of man power
5. Side effects not present
6. Less costly
Question 11
Define statistics, write its uses

Statistics :
The science of collection, presentation, analysis, and interpretation of numerical data

Uses of statistics
1. To define - Normal
Healthy eg : pulse rate
2. To define the difference between means and proportions of normal at two places or in different
periods
Eg: Mean height - urban & rural
Mean IDD - in northern area
3. To find out variability
Eg : weight increases / decreases proportion to height

4. To produce action of a drug

Eg: drug given to produce changes

5. To find out relative potency of a new drug with respect to standard drug

6. To test usefulness of vaccine in the field

1% attack or death prevented

7. Role of a aetiological factor

Eg: IDD is confirmed by rate of goiter before and after giving iodized salts
 Question 12
Define and classify data

Data
Discrete observations of attributes or events that carry little meaning when considered alone

Classification of data
1. on the basis of source
• primary data-data obtained directly from a individual
eg: data about health and sickness of a population
• secondary data –data obtained from outside source
e.g.: census used during studying hospital records

2. on the basis of nature

A) Variables
1. continuous variables
eg: height in feet
2. discrete variables
eg: number of beds in a hospital
B) Attributes (qualititative)
e.g. occupation, sex

3. on the basis of processing

• ungrouped – weight of 4 boys in kg’s 20,22,18,16
• grouped- height of 10 boys in feet 4’X4 , 4.5’X4, 5’X2
Question 13
How can u collect and present data

Methods of collecting data

1. document reviews
2. observation
• naturalistic observation
• performance observation
• habitual observation
a) participants observations
b) non participants observation
3. asking questions
a) interviewing
b) mail questionnaire

4. measurement
5. combined method

presentation of data
1. tabulation
1) simple
2) complex
2. charts and diagrams
a) bars and charts
• simple bar charts
• multiple bar charts
• component bar charts
b) histogram
c) frequency polygon
d) line diagram
e) pie chart
f) pictogram
3. statistical maps
• spot map
• scatter map
Question 14
Write formula of growth rate calculation and population doubling time calculation

Growth rate = CBR – CDR / 10

CBR = Crude birth rate
CDR = Crude Death Rate

Population doubling time = 70/growth rate of population

Question 15
Write the measures of central Tendency and measures of dispersion

Measure of central tendency

Characteristics that describe the middle or most commonly occurring value in a
series

1. Mean
i. Arithmetic mean
It’s the sum of all the values in a series divided by the number of
values in the series

X = ∑ Xi
¯¯¯
n

X = Arithmatic mean
∑ = The sum of
Xi = Each of the values in a series
n = The number of values in the series

2. Median: Value which divides the distribution to equal two values

The data is first arranged in an ascending or descending order of magnitude

and the value of the middle observation is located

72 76 76 78 80 82 83 84
II
Median

If the number of values are even the arithmetic mean of the two middle
values are taken

72 76 76 77 78 80 82 83 89 90
I___I
I
(78 + 88)/2 = 79

3. Mode
Mode is the value which occurs most frequently in a distribution of data
76 80 72 76 74 79 76 81 76
Mode = 76

Measures of dispersion
It’s the measure of the variation of the observation
1) Range

Def:- The difference between the highest and the lowest values in a series
2) Mean deviation
Def:- It is the average of the deviations from the arithmetic mean.

__
M.D = ∑(X – X )
¯¯¯¯¯¯¯¯¯
n

3) Standard deviation
Root mean square deviation.

SD=
 Question 16
Define and classify sampling

Sampling
The process, method or technique of selecting sample.

Methods of sampling
1. random sample
It is are which is drawn in a such a way that every individual in the population has known and non zero
chance of being selecting in the sample

2. simple random sample

It is one which is selected in such a way that every individual in the population has the equal chance of
being selected in the sample

3. stratified random sample

It is one which deliberately drawn in a systemic way so that even portion of the sample represents a
corresponding strata of the universe

4. cluster sample
It is one which groups of elements rather than single elements are selected at random

5. systemic random sample

It is done by selecting the first unit at random and subsequent unit s is selected at a certain interval

6. two stage sample

In this type selection takes place in 2 stages
 Question 17
What are the sources of health information, write differences between data and information

Sources of health information

1. Census
2. registration of vital events
3. Sample – registration system
4. Notification of diseases
5. Hospital records
6. disease registers
7. record linkage
8. Epidemiological surveillance
9. Environmental health data
10. Health man power statistics
Difference between data and information
• data consists of discrete observation s of attributes or events that carry no meaning when
considered alone: data as collected from operating health care systems or institutions are in-
adequate for planning
• information is data transformed into formation by reducing them, summarizing and adjust-
ing them for variations such as age ,sex, composition of population so that comparison over
time and place are possible
Question 18
Define balance diet, calculate energy requirement of a student weighing 60kg

Balanced diet
Diet which contains a variety of foods in such quantities and proportions
that the need for energy, amino acids, vitamins, minerals, fats, carbohydrates and other nutrients are
adequately met for maintaining health, vitality and general well being and also makes a small
provision for extra nutrients to withstand short duration of leanness

Energy requirement

Energy requirement of 60kg student

Energy requirement per kg per 24 hrs for men =45 kcal/24hrs/kg
Energy requirement per kg per 24 hours for women = 40 kCal/24hrs/kg
Weight s of student =60kg
Daily energy requirement of 60kg male student =45 X 60
=2700kcal/24hrs
Daily energy requirement of 60kg female student =40 x 60
=2400kcal/24hrs
Question 19
What are the common nutritional problems in Bangladesh? How can you prevent PEM?

Common nutritional problems in Bangladesh

1. Protein energy malnutrition
a. Kwashiokor
b. Marasmus

2. Vitamin A deficiency
a. Night blindness
b. Xeropthalmia
c. Total blindness

3. Nutritional anaemia
a. iron deficiency anaemia
b. Folate, Vitamin B12 deficiency anaemia
c.
4. Iodine deficiency disorders
a. Goiter

5. Khesari dhal intoxication

a. Neurolathyrism

How can you prevent PEM

*According to the UNICEF
G – For growth monitoring
O – For oral re hydration
B – For breast feeding
I – For immunization
F – For female education
F – For food supplementation
F – Family spacing

*According to the FAO/WHO

• Health promotion
• Specific protection
• Early diagnosis and treatment
• Rehabilitation
Question 20
Briefly discuss ante-natal care.

Definition
It is the care of woman during pregnancy

Objectives
1. To promote, protect and maintain the health of the mother during pregnancy
2. To detect high risk cases and give them special attention
3. To foresee complications and prevent them
4. To remove anxiety and dread associated with delivery
5. To reduce maternal and infant mortality and morbidity
6. To teach the mother elements of child care, nutrition, personal hygiene and
environmental sanitation
7. To sensitize the mother to the need for family planning including advise to cases seeking
medical termination of pregnancy
8. To attend to the under fives accompanying the mother
Question 21
Tabulate EPI schedule for Bangladesh

Disease TB POLIO Diptheria, MEASLES Hepatitis-B

Tetanus,
Pertusis
Vaccines BCG OPV DPT Measles Vacc. Hepatitis-B
vaccine
First dose After birth. After birth 6 Wks after 9 Months after 6 Wks After
birth. birth. birth .
Number of Single 4- Doses 3- Doses Single 3-Doses
doses
Quantity of 0.05ml 2/3 drops 0.5ml 0.5ml 0.5ml
each dose
Interval ---------------- 4-Wks 4-Wks --------------- 4-Wks
between
doses
Route/Site ID,left deltoid Per oral IM thigh SC thigh IM thigh
Time of 1 year 1 year 1 year After 290 1 year
completion days
Vitamin-A ----------------- ---------------- 1 drop of 1 capsule with -----------------
capsule - 25000IU measles -
within DPT1 vaccine
&DPT3

*BCG and measles vaccines have to be reconstituted in prescribed dilutents before

administration
Question 22.
Define reproductive health care. What are the areas of reproductive health care?

A state of complete physical, mental and social well being and not merely the absence of disease or
infirmity in all matters relating the reproductive system and the functions and processes.

Areas –Avoiding unwanted pregnancies

Postponing birth
Services for safe pregnancies and deliveries
Fertility regulation
Treatment of abortion patient
Managing reproductive mortality
Prevention, control and Tx of STD/AIDS.
Managing maternal and adolescent health
Involvement of female education
Employment and empowerment programme
Question 23.
How can you prevent occupational health hazards. Write offensive trades.

1. Medical measures
2. Engineering measures
3. Legislative measures

1. Medical measures –
1. Pre placement examination –
Each worker is subjected to a thorough medical examination which includes CXR, ECG, blood
examination wire, vision etc. at the time of employment
2. Periodic health examination.
3. First aid and medical care.
4. Notification - Certain occupational diseases. E.g.: Pb poisoning, silicone are notifiable
5. Working environment
Periodic environment of working environment. All aspects – temp. , lighting, noise, ventilation, humidity,
cubic space, air pollution should receive attention.
6. Health education.
7. Maintenance of records

2. Engineering measures –
1. Location – all industries should be located in an industrial area which should be sufficiently away from the
residential area.
2. Proper designing factory building
3. Good house keeping
4. Enclosures – dangerous machines or parts should be protected by enclosing it
5. Personal protective equipment – working clothes, helmets, goggles, eye shields, foot, leg, arm protection.
6. Control of dust, fumes, gases and other offensive material.
7. Substitution – replacement of a harmful material of poisonous chemical by harmless or non – poisonous
one
8. Mechanization – all the processes should be mechanized to the fullest possible extent to avoid danger.
9. Periodical monitoring – environmental surveys, including testing the factor air for toxic substances.

3. Legislation –
1. Factory laws should be strictly followed.
2. Industried health regulations should be strictly observed.
3. Smoking should be dis allowed.

Offensive trades –
Any trade which is a source of nuisance from public health point of view; or any trade which is ugly to look,
smell or sound is likely to injure health in someway.

1. Slaughtering of animals
2. Tannery and leather processing industries
3. Keeping domestic animals
4. Animal trading
5. Gut scrapping
6. Fat melting or boiling or grease factory
7. Bone boiling and drying in fertilizer factory and for pigment production
8. Brick fields, fertilizer, lime factories
9. Acid producing factory
10. All dusty mills – rice, flour, sugar, wool, cotton, jute, tobacco factory, rayon mills, paper mills.
Question 24.
What are the STDs? How can you prevent them?

Group of communicable diseases caused by a wide range of bacterial, viral, protozoal and fungal
infections transferred predominantly through sexual contact.

Bacterial – Gonorrhea
Syphilis
Chancroid
Lymphogranuloma venereum
Non – gonococcal urethritis
Cervicitis and PID
Granuloma inguinali
Viral – Anogenital herpes
Hepatitis B
AIDS
Genital warts
Genital molluscum contagiosum
Fungal – Genital candidiasis
Protozoal – Trichomonas vaginalis
Arthropods – Pubic pediculosis
Scabies

Prevention & Control

1. Early diagnosis & treatment
2. Health & sex education
3. Control of prostitution
4 Case follow up-For gonorrhoea,culture of secretions & serological tests.
5. Contact tracing-If repeated infections, PID,sexually active female
6. Preventive measures-Condom,1%-Teracycline eye ointment(for ophthalmic neonatorum)
7. Religious upliftment
8. Legislative measures

25. Briefly discuss investigation of an epidemic

It is to describe the magnitude of the out break and to determine how and why the outbreak took
place as well as to suggest measures for its control and prevent future occurrence

Step1 –Confirm diagnosis through history clinical exam& labtests.

Step2 –Confirm epidemic reviewing records.
Step3 –Characterize epidemic in terms of time, place & person
Step4 –Develop hypothesis in terms of agent , source, mode of transmission,
environmental factors
Step5 –Testing hypothesis using different statistical tests & procedures.
Step6 –Drawing conclusion & compilation of report.
Step7 –Institution of control measures
a) Treatment of cases.
b) Prevent spread- isolation, chemoprophylaxis, vaccine, control tracing
c) Surveillance of the population at risk.
Question 26.
Define Medicalstatistics. What are the vital events of life?

Facts systematically collected and compiled in numerical form related to or derived from records of
vital events such as births, deaths, marriage, divorces, sicknesses that occur in our community.

Vital Events – Birth

Death
Marriages
Divorce
Sicknesses
Fertility
Morbidity
Natality
Question 27.
Tabulate levels of prevention and modes of intervention

1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention

1. Primordial – Prevention of development of risk factors

2. Primary - Intervention in pre-pathogenesis phase
By, 1. Health promotion
2. Specific protection
3. Secondary – Action which halts the progress of a disease and its incident stage and prevents
complications
4. Tertiary - All measures available to reduce giant impairments and disabilities

Modes of intervention -
1. Health promotion
2. Specific protection
3. Early Dx and Tx
4. Disability limitation
5. Rehabilitation
Question 28.
Write Short notes on a). Incubation period
b). Carrier

A).Incubation period.
Def.. The time interval between invasion by an infectious agent & appearance of the first symptoms
Imp: 1- Helpful in tracing the source of infection & contacts.
2- Useful in determining the period of quarantine
3- Helps to know the preventive measures by immunization
4-Helps to identify the point source or propagated epidemics
5- Useful in estimating the prognosis of a disease.
Types:
1.Minimum incubation period.
2.Median incubation period.
3.Estimate of average incubation period.
B)Carrier
An infected person or animal that harbors a specific infectious agent in the absence of discernible
clinical disease and serve as a potential source of infection for others.

Classification -
a) By Types
1. Incubator y – Who sheds the infectious agent during the incubation period of disease.
Eg; Measles, Mumps, Polio
2. Convalescent – Who continues to shed the disease agent during the period of convalescence.
Eg: Typhoid fever, dysentery, cholera, diphtheria, and whooping cough.
3. Healthy – Victims of sub-clinical infections and shed the disease agent.
Eg: polio myelitis, cholera, diphtheria, salmonellosis, etc.

b) By duration
1. Temporary – incubation, convalescent and healthy
2. Chronic – Typhoid, hepatitis B, malaria, dysentery, gonorrhea

c) By portal of exit
1. Urinary
2. Intestinal
3. Respiratory
4. Nasal
5. Others – Skin eruptions, open wounds, blood.
Question 29.
Define demography. What are the demographic processes?

It is the scientific study of human population.

Processes –
1. Fertility
2. Mortality
3. Mobility
4. Migration
5. Social mobility
Question 30.
Write basic principles and essential components of primary health care.

Principles
1. Equitable distribution of health services
2. Community participation
3. Multi sectorial approach
4. Appropriate technology .

Elements -
1. Health education
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and sanitation
4. MCH an FP
5. Immunization
6. Prevention and control of endemic diseases
7. Appropriate Tx for common diseases and injuries
8. Provision of essential drugs.
Question 30.
What are the pregnancy induced danger signs and symptoms. Who are risky infants?

1. Anti partum hemorrhage

2. Hypertension
3.Tachycardia.
4. Respiratory distress
5. Proteinuria.
6.Convulsions
7.Ankle edoema
8.Fever
9.Restlessness
10.Early rupture of membrane with per vaginal discharge of liquer amnii
High risk infants
1. Birth weight less than 2.5kg
2. Twins
3. Birth order 5 or more
4. Artificial feeding
5. Weight below 70% of the expected weight
6. Failure to gain weight during 3 successive months
7. Children with PEM, diarrhea
8. Working mother one parent

Anti natal lab tests –

1. Blood – Rh and ABO grouping
2. Hb examination
3. Urine – Sugar and albumin.
Pregnancy test
4. InVx for hepatitis B, HIV
5. VDRL for syphilis
6. Ultrasonography
31. Define Arthropod. Classify arthropod borne disease.

It is invertebrate insects with jointed legs

Arthropod borne diseases –

Mosquitoes – Malaria, Filaria, Viral encephalitis, Viral fever (eg: dengue, west niles), viral
hemorrhagic fever, (eg: yellow fever, dengue)

House fly – Typhoid and paratyphoid, diarrhea, dysentery, cholera, gastro enteritis, amoebiosis,
helminthic infestations, poliomyelitis, anthrax

Sand fly – Kala azher

Louses – Epidemic typhoid, relapsing fever, Trench fever, pediculosis

Tsetse fly – Sleeping sickness

Black fly – onchocerciasis

Reduvid bud – Chagas disease

Rat flea – Bubonic plague, Endemic typhoid, Chigerosis, hymenolepsis

Tick—1.Hard-Tick typhus, viral encephalitis, viral fevers, viral hemorrhagic fevers

2.. Soft – Q. fever, relapsing fever-

Mite 1. Trombiculid mite- Scrub typhus, Rickettsial pox

2 Itch mite – scabies

Cyclops – Fish tape worm disease

Cockroaches – Enteric pathogens

Question 32.
How can you control housefly and mosquito

Housefly –
1. Environmental control – a). Storing garbage, kitchen waste and other refuses in bins with tight
lids lids
b) Efficient collection, removal and disposal of refuse by incineration,
compostity and sanitary landfill.
c) Provision of sanitary latrines

d) Stopping open air defaecation

e) Stopping general sanitation

2. Insecticidal control
3. fly papers
4. using meshes
5. Health education

Mosquito control _
1. Anti larval – a) Environmental control-Filling,leveling &drainage of breeding places
b) Chemical control-Mineral oils, Paris green, Synthetic insecticides
c) Biological control-Small fish which feed on mosquito larvae.

2. Anti adult measures – a) Residual sprays

b) Space sprays
c) Genetic control

3. Protection against mosquito bite – a) Nets

b) Screening
c) Repellants
Question 33.
Write new concept of health. Why good health is good investment

1.Biomedical concept – A person is considered healthy if he was free from disease or absent from
disease.

2.Ecological concept – It is a dynamic equilibrium between man and his environmental disease
maladjustment of the human organism to the environment

3.Psychological concept – Health is not only a biomedical phenomenon, but one which is
influenced by social, psychological, cultural, economic and political factors of the people concerned

4.Holistic concept – A synthesis of all of the above concepts

Question 34.
What are the components of health education? Write basics of communication

1. Information – It is informing, disseminating scientific knowledge, about health to the people and
as well as collecting information from people.

Information are collected through, a) Observation

b) Interviewing people
c) Using documents and records

2. Learning – Continuous, dynamic and ongoing process requiring some basic ingredients (e.g.: a
stimulus, a trial response, and rewarding consequence of trial response)

3. Motivation – Every person has a desire to learn, and awakening of this is called motivation

Basics of communication –

1.Motivation
2. Repitition
3.Reinforcement
4.Citing examples from day to day life.
Question 35.
Write short notes on a) Pneumoconiosis
b) GOBI FFF

A) Pneumoconiosis – A disease caused by chronic inhalation of dust within the size range of 0.5 to
3micron which may gradually cripple a man by reducing his working capacity due to lung fibrosis
and other complications.

Types – Silicosis – Due to chronic inhalation of silica and silicon dioxide

Anthracosis – Due to coal dust
Byssinosis – Due to cotton fiber dust
Bagassosis – Sugar cane dust
Asbestosis – Asbestos dust
Farmers lung – hay or grain dust

B) GOBI FFF – The unicef has put forward a set of strategies for child health revolution

G – Growth monitoring
O – Oral rehydration
B – Breast feeding
I – Immunization
F – Female education
F – Frequent feeding
F – Family planning
Question 36.
Define control, elimination and eradication.

Control -means ongoing operations aimed at reducing,

,
1. Incidence of disease
2. Duration and risk of transmission
3. Effects of infection – physical and psycho social
4. Financial burden to the community.

Elimination –It is the interruption of transmission of disease

Eradication – it is the termination of all transmission of infection by extermination of the infectious

agent.

Question 37:- Write short notes on i.)WHO ii.) UNICEF

WHO
• World health organization is a speacialised, non political agency of the united nations with
headquaters in Geneva.
• Birth of WHO – Origin in April 1945
• Structure – It consist of 3 structural groups
1. The world health assembly
2. The executive board
3. The secretariat
• Membership - -By 1996 the organization had 190 member states and 2 associate members,
At present the organization has 192 member states
• Activities
1. Prevention and control of specific diseases
2. Developmental and comprehensive services
3. Family health
4. Environmental health
5. health Statistics
6. Bio-Medical research
7. Health literature and information
8. Corporation with other organizations

• Constitution – The constitution of the WHO was drafted in 1946 by an international health
conference of 51 member nations of the United Nations in New York and came into force on
the 7th April 1948
• Objectives – The constitution of the WHO defines the organization and objectives are the
attainment by all the people of the world the highest possible level of health. The
organization is now striving to achieve a common objective, the goal of health for all

UNICEF
• UNICEF (United Nations International Children Emergency Fund) is one of the
specialized organizations of the United Nations
• It was established on December 11, 1946 by the United Nations
 • In 1953 the general assembly gave it a new name,UNITED NATIONS CHILDRENS
FUND
• Regional office : New Delhi (INDIA)
• Organization: 2 Parts
1. Governing body (The Executive Board) – Composed of 36 members from the
region
2. Secretariat – Is the staff of UNICEF
• Content of service
1. Child health
2. Child nutrition
3. family and child welfare
4. Education : Formal and Non formal
Question 38: Define disaster. How can you prevent a catastrophe?

Define catastrophe?
Any occurrence that causes damage, economic disruption, loss of human life and deterioration in
health and the health services on a scale sufficient to warrant an extraordinary response from
outside the affected area

To minimize the catastrophe

4. Prevention and alleviation of consequences
a. Forecasting the disaster using modern technology
b. Promoting community preparedness by such activities like first aid
exercises

5. Immediate emergency care

6. Management of the aftermath

• Environmental sanitation
• Public health monitoring and prevention of epidemics
• Vaccination against six major child disease
• Food and nutrition

7. Rehabilitation and reconstruction

Question 39
What are the determinants and indicators of health

Determinants of health
1. Heredity
2. Environment
3. Life style
4. Socio-economic considerations
5. Health and family welfare services
6. Other factors
Indications of health
1) Mortality indicator
i. Crude death rate
ii. Expectation of life
iii. Infant mortality rate
iv. Child mortality rate
v. under 5 proportionate mortality rate
vi. Maternal mortality rate

2) Morbidity indicator
3) Disability rates
4) Nutritional state indicator
5) Health care delivery indicators
6) Environmental indicators
7) Socio-economic indicators
8) Indicators of quality of life.
9) Utilization rates
!0) Health policy indicators
Question 40
Briefly describe different methods of Epidemiological study

1) Observational studies
a)Descriptive studies
b)Analytical studies.
1.Ecological study.
2.Cross-sectional study.
3.Case-control study.
4.Cohort study.

2)Experimental or intervention studies

1.Clinical trials.
2.Field trials.
3.Community trials.

a. Descriptive Epidemiology – Descriptive studies are concerned with observing the

distribution of disease or health related characteristics with which disease in question
seem to be associated
b. Analytical epidemiology – In analytical studies the subject of interest is the
individual within the population. Analytical studies comprises to distinct types of
observational studies
i. Case control study
ii. Cohort study
c. Experimental epidemiology – In modern usage experimental epidemiology is often
equated with randomized control trials
Types
o Randomized control trials
o Non randomized or non experimental trials
Question 41
Classify Data, How can you present Data

Classify data
1. On the basis of source
• Primary data
• Secondary data

2. On the basis of nature

• Variables
• Attributes

3. On the basis of processing

• Ungrouped
• Grouped
Methods of Data presentation
• Tabulation
• Charts and diagrams:
a)Bar charts- Simple bar chart.
Multiple bar chart.
Component bar chart.

b)Histogram.
c)Frequency polygon.
d)Linegram.
e)Pie chart.
f)Pictogram.

• Statistical maps
a)Shaded maps.
b)Dot maps.
Question 42
What are the measures of central tendency? Find out standard deviation 10, 20, 30

There are 3 main measures of central tendency

1) The mean
2) The median
3) The mode

1) The mean
Arithmetic mean:It’s obtained by adding up the individual observations & dividing the summation
by the number of observations.

2) The median
When all the observation arranged in ascending or desecing order the middle observation is known .

3) The mode
This is the most frequently occurring observation in a series

The standard deviation

The standard deviation is the root mean square deviation.

Calculation
SD= ∑(X-X2)
----------
n

x x x-x (x-x)
10 20 -10 100
20 20 0 0
30 20 10 100
Question 43
Briefly describe scabies

Scabies
Scabies is an infectious disease of the skin caused by the mite sarcotopes scabei
It is characterized by pruritc papular lesions along the burrows containing the mites and their eggs

Clinical features
Intense itching, more at night, initially between the fingers or on the buttocks or genitals, and later
all over the body, where the mite burrows, the head , neck , palm , and sole are spared ,except in
infants

Mode of spread of scabies:

1. Close contact with the infected person
2. Contaminated clothes

Diagnosis of scabies
1. Patients complains of itching , which is coarse at night
2. Examination reveals follicular lesions at the affected sites
3. Secondary infections leads to crusted papules and pustules
4. Searching for parasite in te skin debris under microscope

Control of scabies
• Sanitation control
a) Improvement of sanitation
b) Improvement of personal hygine
• Chemical control -
Benzyl benzoate, emulsion
Question 44
Write epidemiology and prevention of tetanus

Epidemiology of tetanus
A) occurrence
Tetanus is found world wide with high incidence in some parts of the tropics.

B) Ecological triad

1. Agent: Clostridium tetani

2. Host:
• Age and sex → all ages and both sexes are susceptible to tetanus. But males are more prone
to this disease.
• occupation: agricultural workers
• high risk groups: female and infants
• immunity-first attack does not confer immunity against second attack

3. Environmental and social factors

Tetanus is an outcome of environmental hazard

There is a direct relationship with fertile soil and a warm climate

C) natural history
1. Reservoir: man and animals

2. Source of infection
• Soil
• Dust
• Earth
• Human and animal excreta

3. Carrier
• air
• dust

4. Mode of transmission
Not communicable from person to person. But one may get tetanus, if the injured area is
contaminated by spores
Methods
• trivial wounds
• nail pricks
• after operation
• after burn
• after circumcision

5. Incubation period: 6 – 10 days.

Prevention
1. Active immunization with tetanus toxoid.
2. Passive immunization with Human tetanus hyperimmunoglobulins, 250-500IU
3. Active-Passive immunization.
4. Antibiotic therapy.

Question 45
What are the levels of disease prevention?

Levels of prevention
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention

Primordial prevention
Prevention of the emergence or development of risk factors in factors in countries or population
groups in which they have not yet appeared

Primary prevention
It signifies intervention in the pre pathogenesis phase of a disease or health problem

Secondary prevention
It may be defined as “action which halts the progress of a disease at its incipient stage and prevents
complications

Tertiary prevention
It may be defined as “all measures available to reduce or limit impairments and disabilities,
minimize suffering caused by existing departures from good health and to promote the patients
adjustment to irremediable conditions
Question 46
What is communicable disease? Write principles of prevention of communicable disease
Definition
Communicable disease is a disease which can be transmitted from one host or reservoir to another
through transference of a sufficient quantity of the causative agent

Principles of prevention
A) Controlling the reservoir
• early diagnosis and treatment
• notification
• epidemiological investigation
• isolation
B) Interruption of transmission of disease
C) Measures taken in hospital
• Immunization
• Chemoprophylaxis
• Non specific measures
Question 47
What is disaster? How can you reduce consequences of disaster

Disaster
According to WHO “any occurrence that causes damage ,economic disruption ,loss of human life
and deterioration in health and the health services on a scale sufficient to warrant an extra ordinary
response from outside the affected community

Reduction of consequences

A)pre disaster preparedness

1) Improvement of hospital site & building.

2) Improvement of utility services
3)Improvement of emergency & casualty department.

B)Measures during disaster & aftermath

1)Send mobile health team to disaster scene as soon as possible.
2)Assembling of trauma team.
3)Readiness of extra beds & OTs.
4)Setting of triage.
5)Quick DX of problem, resuscitation .
6)Referral of casualties according to casualties.
7)Controlling of traffic

C)Post disaster measures

1)Follw up programme for casualties.
2)Physio therapy & psycho therapy.
3)Social therapy & occupational therapy.
4)Special measures to prevent communicable diseas outbreak.
5)special measures to prevent nutritional problems.
6)Evaluation of total disaster preparedness & response programme & correction of faults as far as
possible.
Question 48
Write 4 diseases with their causative agents and vector

Causative agent vector

Malaria plasmodioum vivax mosquitio-anophiles
Kalazaar leishmaniadonovani sand fly
Plague yersenia pestis rodents
Shigellosis shigella house fly
Question 49
Write 4 media and methods of health education

Media of health education

A) Traditional media
• Folk plays.
• Puppet shows

B) Visual media
• chalk and black board
• charts ,maps ,graphs
• posters ,journals ,papers , pampletes
• text book ,work book
• photographs
• flannel graph
• exhibits

C) Auditory media
• Tape
• Recorders
• Microphones
• Radio
• Amplifiers
• Ear phones

D) Combined AV media
• Closed circuit TV
• Computer
• Sound film cinema

Methods of health education

1. Two way method or Socratic methods
• Panel discussion.
• Group discussion.
• Brain storming.
2. One way method or didactic.
Lecture.
Talkes.
Demonstrations.

Question 50
Briefly describe health care delivery system in Bangladesh

Health care delivery system of Bangladesh is based on primary health care concept health services
are usually organized at three level ,primary ,secondary ,and tertiary care levels, each level being
supported by referral services at the next higher level

primary level health care

This is the first level of contact b/w an individual and the health care delivery system. A majority of
the health complaints and problems of the community can be met satisfaction at this level in
Bangladesh the upazila health complex and union health sub centers constitute this level.

Secondary level health care

This level deals with comparatively more complicated health problems which are beyond the scope
and capacity of the primary level .those level serves as the first referral level in the health system .
The secondary level health care is provided by the district hospital

Tertiary level health care

This level deals with a super specialist care provided by the regional /central level serves as the
referral to primary and secondary level.

In Bangladesh there are regional medical college hospitals and national level hospital
Question 51
What are the water borne diseases

Water borne diseases

1. Those caused by the presence of an infective agent
• viral →viral hepatitis A,hepatitis E, poliomyelititis, rota virus norwalkvirus
• bacterial → typhoid and paratyphoid fever ,bacillary dysentery ,esch.coli diarrhea cholera
• protozoal→amoebiasis,giardiasis
• Helmenthic→round worm , thread worm ,hydatid disease
• leptospiral→leptospirosis.

2. Those due to the presence of an aquatic host

• snail→Schistosmiasis
• cyclops→Guinworm,fish tape worm
Question 52
How can you ensure safe water for rural community?

1. Safe drinking water should be collected from tube well. for this adequate supply of tube well
must be ensured, in Bangladesh rural water supply project of UNICEF is serving the purpose of safe
water drinking supply

2. Proper maintenance of the tube well s also a part of safe water supply programmed

3. In lacking or shortage of tube well bathing ,washing, cleaning , etc…can be done by the water of
pond , spring or such kind of any source

4. Health education of the village people regarding water pollution and provision of safe water

5. Disinfection of wells with bleaching powder.

6. Filtration – Chamberland filter,Berkefeld filter.

7. Boiling-“rolling boil” for 5-10 minutes..

Question 53
Manage case of rabies dog bite

Once the disease is established therapy is symptomatic

1. Isolation: the patient should be isolated in a quiet, darkened room protected as far as possible
from external stimuli, such as bright light , noise or cold
2. Local treatment of wound:
a)Cleansing-thoroughly with soap water or antiseptics.
b)Local application of anti rabies serum.
c)Antibiotics & Antitetanus measures(PenicillinG ,TT/ TIG)
d)Observe the animal for 10 days .If the animal shows signs & symptoms the animal should be
humanly killed.
3. Immunization
a)Active-HDCV or Inactivated sheep brain vaccine.
b)Passive-Anti rabies human immunoglobulins.
c)Active-Passive immunization.
Community medicine Clinical medicine

it is preventive , promotive curative and 1. it is a treatment of diverse individual

rehabilitative health care
it serves the individuals and families at the 2. it serves the individual at his personal
community level level
it is field oriented 3.it is hospital oriented
team work is extremely necessary 4. team works needed only in few occasion
field trial and surveys are very important 5. only clinical trial is needed
skill is very important in controlling 6. Skill is necessary to tackle emergency
epidemics
monitoring condition is poor 7. monitoring condition is rich
surveillance is needed for control of disease 8. surveillance is not required
treatment is done as apart of prevention 9. Preventive care depends upon the good
will of the patient

Question 54
Differentiate community medicine and clinical medicine. \Write 4 public health emergencies
Question 55
Draw organogram of upazila health complex, what are the services available at upazilla
health complex
Question 56
What is behavior? What are the factors for human behavior name 3 behavioral problems?

Behavior
Human behavior is the result of physical and mental (body and mind ) interacting in complicated
ways

Behavioral problems
1) Antisocial problems – stealing, lying, gambling, cruelty, sexual offences, destructiveness

2) Habit disorders - Thumb sucking, nail biting, bed wetting, masturbation

3) Personality disorders – Jealousy, temper tantrums, timidity, shyness, day dreaming, fear and
anxiety, unsociability, hysterical manifestations

4) Psychosomatic complaints – Tremors, headache, asthma, depression, delusions,

hallucinations

5) Educational difficulties – Backwardness in studies, school phobia, school failures etc

Factors human behavior

1) Health behavior
• Compliance behavior
 • Avoidance behavior

2) Illness behavior
3) Treatment behavior

Question 57
What is rational use of drugs? What is essential drug?

According to WHO rational use of drugs requires that patients receive medications appropriate to
their clinical need s in doses that meet their own requirements for an adequate period of time and
the lowest cost to them and their community

Criteria assessing rational use of drug

1. only the essential drugs should be prescribed (decide whether the drug is really necessary or
not at all)
2. prescribe the effective preparation (selected drug) which provides aspect therapeutic benefit
3. prescribe it at the right time
4. quantity of drug should be enough
5. patient compliance : the patient should follow the instruction of the physician
6. prescribe easily available ones
7. prescribe a cost effective drug
Question 58
Name 5 occupational health hazards , how can you prevent them

Occupational hazard s
• Physical hazards
• Chemical hazards
• Biological hazards
• Mechanical hazards
• Psychological hazards

Medical measures Engineering measures Legislations

Pre placement examinations Design of building Factory laws and by laws
has been framed to govern
the conditions in the
industries and protect
workers from industrial
hazards
Eg: factory(amendment act)
Workman’s compensation
act)
Periodical examination Good house keeping
Medical and health care General ventilation
services
Notification of occupational Mechanization
diseases
Supervision of working Substitution
environment
Maintenance and analysis Dust control
of records
Health education and Enclosure of the harmful
counseling material
Isolation of the offensive
process
Protective devices
Environmental monitoring
Statistical monitoring
research

Question 59
Classify vitamins? Name deficiency disorder of vitamin A

Classification
1. Fat soluble vitamins
• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K

2. Water soluble vitamins

a) Vitamin B complex
• Thiamin (Vitamin B1)
• Riboflavin (Vitamin B2)
• Niacin (nicotinic acid)
• Biotin
• Pyridoxine (Vitamin B 6)
• Pantothenic acid
• Folic acid
• Lipoic acid
• Vitamin B 12(cobalamin)

b) Ascorbic acid (vit C)

Deficiency disorder of vitamin-A
1. Ocular: Xeropthlmia,Night blindness.
2. Extra ocular
• Follicular hyperkeratosis
• Increased susceptibility to infections due to squamous metaplasia of respiratory,urinary &
vaginal epithelium.
3. Growth failure

Question 60.
Discuss the changing concepts of health

Changing concepts of health.

1. Biomedical concepts
2. Ecological concepts
3. Psychological concepts
4. holistic concepts

1. Biomedical concepts –
A person was considered as healthy if he was free from disease or absence of disease

Concept is based on ‘germ theory of disease’

Criticism:-
Role of environment, social, psychological and cultural aspects were ignored

2. Ecological concepts

An ecologist’s view of health is equilibrium, man and his environment and disease.
• Imperfect man
• Imperfect environment

3. Psycological concepts
Health is not a biomedical phenomenon but also one which is influenced by social, psychological,
cultural, economical and political factors are concerned.

4. Holistic concepts
According to this concept all sectors of the society have an effect on health.
1. Vehicle borne
2. Vector bone – a) mechanical
2. Biological
3. 3. Air bone - a) Droplet nuclei
i. b) Dust
1. Fomite borne
4. Unclean hands and fingers
Question 61.
Write down the mode of transmission of communicable disease. How can you prevent
communicable disease?

Communicable disease:-
An illness due to specific infectious agents or its toxic products, being directly or indirectly
transmitted from man to man, animal to man, animal to animal or from environment to animal or
man.

A. Direct transmission
1. Direct contact
2. Droplet infection
3. Contact with soil
4. Inoculation into skin or mucus
Transplacental (Vertical)

B. Indirect transmission
1. Vehical borne
2. Vector borne.
a) Mechanical
b) Biological
3. Air borne
a) Droplet nuclei
b) Dust

Prevention of communicable disease

A).CONTROLLING THE RESERVOIR

Early diagnosis and treatment
Notification
Epidemiological investigations
Isolation

B).INTERRUPTION OF TRANSMISSION OF DISEASE

C). MEASURES TAKEN IN HAST

Immunization
Chemoprophylexin
Non specific measures
Question 62
Describe the stages of demographic cycle

The history of world population since 1650 suggest that there is a demographic cycle of 5 stages
through which a nation passes

1st stage (High stationary)

This stage is characterized by a high birth rate and a high death rate, which cancel each other and
the population remain stationary.
India till the 1920s.

2nd stage (Early expanding)

The death rate begins to decline while the birth rate remain unchanged leading to an increased
population growth.
South Asia and Africa

3rd stage (Late expanding)

Death rate decline still further and the birth rate tends to fall. Population continues to grow
Bangladesh, India, China,and Srilanka.

4th stage (Low stationary)

In this stage both the death rate and the birth rate fall, as a result growth of population becomes
stationary
UK, Denmark, Sweden

5th stage (Declining)

Population begins to decline because birth rate is lower than death rate.
Germany, Hungary
Question 63
Common nutrition problems of Bangladesh, Why breast feeding is better than artificial
feeding.

Common nutritional problems in Bangladesh.

1). Protein energy malnutrition (PEM)
* Kwashiokor
* Marasmus
2). Vitamin A deficiency
* Night blndness
* Xeropthalmia
* Total Blindness
3). Nutritional Anaemia
* Iron Deficiency
* Folate and VitB12 Deficiency
4). Iodine deficiency disorders
* Iodine deficiency Goiter
5).Khesari dhal intoxication.
* Neurolathyrism

Why breast feeding is better then artificial feeding

B →best for baby
R→ reduces allergy for body
E→ eccconomical
A→antibodies
S→stool is inoffensive
T→available at proper temp

F→ fresh
E→emotional bonding between mother and baby
E→easy to use
D→ easily digestible
I→ immediately available
N→nutritionally balanced
G→Gasteroenteritis greatly reduced
Question 64
Classify disaster ,write effects of natural disaster

Types of disaster
1. Man made - war
Riot
Famine
Nuclear accident

2. Natural disaster - cyclone

Flood
Earth quake
Tsunami

Effects of natural disaster

1. Deaths
A great number of people and animals

2. Severe injuries
Bodily injuries, bone fracture, loss of organs etc..

3. Malnutrition
Scarcity of food will cause malnutrition

4. Risk of infection
By water pollution and environmental pollution
Water pollution →flood
deterioration of sanitation by human excreta, dead bodies of animals and humans

5. Mass movement
Many people need shelter in tidal wave, cyclone, etc...

6. Others
1, Destruction of houses and educational institute, roads, markets
2. Damage of stored food, clothing, and water supply
3. Economical dead lock
4. Psycological damage
Question 65
Risk of high risk mothers and babies

High risk mothers

1). Elderly primi (30yrs& above)
2). Height below 140cm
3). Malpresentaions, breech, transeverse lie
4). Primigranida, Granal multipreda
5). Pre-eclampsia &. Eclampsia
6). Prolonged pregnancy (14 days-after expected date of delivery.
7). Antepartum hemorrhage, threatened abortion.
8). Anemia.
9) Previous still birth, intrauterine death, manual removal of placenta.
10) Twins , hydraminous.
11) Previous repeated abortions
12) Prolonged labor
13) Manual removal of placenta
14)Birth spacing shorter than one year.
15)Ay associated general diseases-cvs diseases, kidney diseases,DM ,tuberculosis, liver diseases

High risk babies

1. Birth weight less than 2.5kg
2. Twins
3. Birth order 5 and more
4. Artificial feeding.
5. Weight below 70% of expected weight
6. Children with knee ache
7. Diarrhea
8. Working mother, Single parent
Question 66
Write the causes of clinical STD’s and how to prevent them

Causes of clinical STD’s

1. Prostitution
2. Broken families
3. Divorce, separation or stranded family life
4. Easy money – prostitution
5. Emotional immaturity of teenagers
6. Low I.Q
7. Sexual disharmony
8. Urbanization
9. Industrialization
10. Low economic condition
11. Alcoholism
12. less education
13. Homosexuality
14. Use of O.C.P and of condoms
15. Greater sexual encounters

Prevention and control of STD’s

1. Early accurate diagnosis by screening, contact tracing and cinster testing
2. Effective treatment and close follow up
3. Personal prophylaxis
4. Condoms, vaccine
5. Partner notification
6. Health and sex education
7. Screening – all risk patients should be screened
8. Support services
9. STD Clinic
10. Primary health care
11. Laboratory services
12. Social welfare measures
Question 67
Tabulate health care delivery system of Bangladesh, what is comprehensive health care

Comprehensive health care

‘As the provision of preventive, curative, promotive and rehabilitative health services from womb
to tomb to every individual residing in a defined geographic area’

Health care delivery system of Bangladesh

SUPER SPECIALIZED CARE

↑
TERTIARY HEALTH CARE
↑
SECONDARY HEALTH CARE
↑
PRIMARY HEALTH CARE

Village
↓
District hospital
↓
Regional teaching hospital
↓
National special institution
Question 68
How can you investigate an epidemic? What are the public health emergencies?

Principle reasons-1) To control the epidemic.

2) To prevent further epidemic.

Step-1 : Confirm Dx through history clinical exam, & lab tests

Step-2 : Confirm epidemic reviewing records.
Step-3 : Characterize epidemic in terms of time, place & person
Step-4 : Develop hypothesis in terms of agent, source,mode of transmission, environment
Step-5 : Testing hypothesis using different statistical tests & procedures
Step-6 : Drawing conclusions & compilation of report
Step-7 : Institution of control measures
a)Treatment of cases.
b)Prevention-Isolation, chemoprophylaxis, vaccine, contact tracing, etc.
c)Surveillance of the population at risk.

Public health emergencies

Any incident which causes break down of public health by any means.
1. Epidemic out break
2. Natural disaster, cyclone, blood
3. Accidents
4. Road, transport, aircraft accident

Question 69
What is primordial prevention?

“Prevention of the emergencies or development of risk factors in countries or population group in

which they have not appeared.”

Main intervention in primordial prevention is through individual and education

e.g.: obesity, hypertension

They are developed by smoking, food habits , lifestyle

Question 70
Write measures of central tendency. Measures of dispersion, central tendency, for 2,3,3,4

Measures for central tendency

1. Mean
2. Median
3. Mode

Mean
Obtain observation are first added together and then divided by the number of observations
2,3,3,4 =12/4 = 3
Median
Middle most value of the series
2,3,3,4

(3+3)/2=3
Mode
Commonly occurring value in distribution of data

2,3,3,4 = 3

Measurement of dispersion
Scattering of values of the variable it measures the variation of the observation
1) Range
2)Mean deviation
3)Standard deviation
Question 71
What is balanced diet, tabulate food composition of any 3 foods?
Defn :A diet which contains a variety of foods ion such quantities and proportions that the need for
energy aminoacids vitamins, minerals, fats, carbohydrates and other nutrients is adequately
met for maintaining health, vitality and general well-being and also makes a small provision
for extra nutrients to withstand short duration of leanness.

Criteria of a balanced diet

Easily available
Satisfy taste and appetite
Diet should be palatable
It should be easily digestible and absorbable
Vitamins and minerals should be there
Certain amounts of fibers there

Nutrition value

Raw rice Wheat Maize dry

Protein 6.8 11.81 11.1
Fat 0.5 1.5 3.6
Carbohydrate 78.2 71.2 66.2
Thiamine 0.06 0.45 0.42
Minerals 0.6 1.5 1.5
Energy ( kCal) 345 346 342
Question 72
Briefly describe epidemiology of diarrhea? How can you prevent diarrhea.

Epidemiology of diarrhea
1. Occurrence
It occurs in almost all the countries of the world, Specially in 3rd world countries.

2. Ecological triad
Agent:-

Gastrointestinal :- Ecoli, Rotavim, Salmonella, Campyhobacter

Cholera :- Vibrio Cholerae

Bacillay Dysentry :- Shigella

Amoebic Dysentry :- Entamoeaba histolitica

Host:-
Age : - All ages
Sex : - Both sexes

Environment : - More dense population

Poor sanitation

Natural History

Reservoir : - cases and carriers

Source of infection : - Stools, Vomit
Infection period : - varies with organisms
Transmission : - Vehicle transmission
Person to person transmission (Orofaecal)
Mechanical (House fly)
Fomites (Inanimate objects)

Prevention of diarrhea
1. Verification and diagnosis
2. Notification (Locally or internationally)
3. Early case findings
4. Establishment of treatment
5. Rhydration therapy
6. Adjunct therapy
7. Epidemiological investigations
8. Sanitation measures
9. Chemoprophylaxis
10. Vaccination
11. Health education
Question 73
Give the pen picture of good school environment

1. The school should be situated in a safe place, in an area free from excessive noise and other
nuisances such as smoke or soot.

2. Buildings should be well constructed so as minimizing accidents

3. The classrooms should be adequate in size, well lighted and ventilated

4. The blackboard, ceilings and walls should be glare proof

5. Sanitary facilities for disposable of waste should be provided

6. Adequate supply of safe water for drinking and washing

7. Adequate facilities for recreation such as common room, play ground

How can you prevent Scabies

1. Sanitation control

2. Improvement of sanitation

3. Improvement of personal hygiene

4. Early diagnosis and treatment

5. Isolation of infected patients

6. Chemical control

7. Benzyl benzoate 25% emulsion

Question 74
How to reduce the Growth rate of Bangladesh

1. Reduce early marriage

2. Develop the standard of living
3. Increase the level of literacy
4. Increase family planning habits
5. Proper spacing between children
6. Proper education
7. Using contraceptive methods
8. Proper education about contraceptives
Question 75
Classify family planning (Contraceptive) methods, what are the criteria of an ideal
contraceptive method

A). Permanent methods( Terminal methods )

B). Temporary methods( Spacing methods )

A Permanent methods/Terminal methods

Male sterilization : - Vasectomy
Female sterilization : - Tubectomy

B. Temporary methods/Spacing methods

1. Barrier methods
 Physical – Condoms, vaginal diaphragm, Cervical cap
 Chemical - Cream, Jelly
 Combined both chemical and physical

2. Mechanical methods
Intrauterine contraceptive devise (IUCD)

3. Hormonal methods
Oral pills - Combined pill, mini pill, Male pill, post coital pill
Depot preparations - Depot provera, S/C, Implant

4. Post concept ional methods

MR – Menstrual regulation
Menstrual induction
Abortion

5. Traditional methods
A). Behavioral - Incomplete coitus
Sex without coitus
Abstinance
B). Natural methods - Safe period

Criteria of ideal contraceptive methods

1). Effective
2). Safe and free from side effects
3). Acceptable to all
4). Inexpensive and easy to get
5). Simple to administer
6). Independent of coitus
7). Reversible
8). Require little or no medical supervision.
Question 76
What are the water borne diseases, How can you ensure safe water for flood affected areas

A). Infective water borne disease

Viral →Hepatitis, poliomyelitis, Rotavirus

Bacterial →Cholera, Typhoid, bacillary dysentery, Ecoli diarrhea

Protozoal →Amoebiasis, Giardiasis

Helminth →Round worm, whip worm, hydatid disease

B). Non infective water borne disease

Arsenicosis, due to arsenics

Constipation due to Pb, Zn, Fe
Goiter due to low iodine
Dental carries due to fluoride deficiency

Safe water for flood area

1. Water by boiling
2. Water by filtering
3. Using chlorine tablets with drinking water
4. Distribution of mineral water (Bottled)
5. Tube well water is safe
Question 77
What are the methods and media of health education, Barriers of health education?

Methods of health education

1. Two way method or Socratic Method

Questions are asked and answers are obtained
2. One way method or Didactic method
Delivery of lecture no exchange of ideas

Media of health education

1. Spoken words
Didactic - Lecture, projectors, chalk and black board
Socratic - Seminar, Group discussion

2. Visual media
Photography, slides, text books, chart, maps, graphs

3. Mass media
Television, film, radio, Health magazines

Barriers of health education

1. Socio-cultural barrier
Religion, superstition, habits

2. Environmental
Noise, congestion, invisibility

3. Physical
Deaf and dumps
Physical abnormalities

4. Psychological
Emotional disturbances
Neurosis