DFX (DAMS FMGE Xpress) Season-3

Infant bornPSM
to HIV mother

Dr. Kashish Grover

MD (PSM)
Faculty at DAMS

Instagram: @kays_psm
Data Presentation
Qualitative Data Quantitative Data
Histogram Bar diagram

Frequency polygon Spot Map

Frequency curve Pie chart

Line diagram Pictogram

Scatter plot
Measurement of central tendency Normal Curve
Mean

Median

Mode
Data Distribution
Normal Distribution Skewed Distribution Bimodal Distribution

Left Skewed Right Skewed

Box and Whisker Plot
Measurement of variability
4. Standard error
1. Range

2. Interquartile Range
5. Coefficient of variation

3. Standard deviation

6. Z score
Test of significance
Sampling and sample size calculation
Random Simple Random
sampling

Systematic Random

Stratified Sampling

Cluster sampling

Non- Convenient sampling

Random
sampling
Quota sampling

Snowball sampling
Hypothesis Testing and p value
Index
Human Development Index Physical Quality of Life Index Global Hunger Index Multidimensional Poverty Index
Concept of Health and disease
Quarantine Level of Prevention Done for Mode of intervention Special
point
Primordial Prevention

Isolation

Primary Prevention

Active surveillance
Secondary Prevention

Passive surveillance

Tertiary Prevention
Sentinel surveillance
 Epidemiological triad Advanced Epidemiological triangle

Wheel of causation
Epidemiological triangle
Sustainable Development Goals Goal-3
Morbidity indicators
Factors affecting Incidence and Prevalence
Incidence Prevalence
Incidence Prevalence

Good cure

Highly virulent

Treatment prolonging
life but not curing
Relationship between incidence and prevalence disease

Good immunization
coverage, PrEP, PEP
Mortality Indicators
Indicator Special point Formula

Crude death rate No. of deaths in year × 1000

Mid-year Population
Specific death rate No. of deaths in year in a specific group × 1000
Mid-year Population of that specific group
Proportional mortality rate No. of deaths in year from specific disease × 100
Total deaths
Case fatality rate No. of deaths from a particular disease × 100
Total cases of same disease
Survival rate No. of patients alive after 5 years × 100
Total cases of same disease
Standardised
 Ecological study Case control study Cohort study
Study Designs • a/k/a Correlational study
• Weakest study design
• Unit of study is
population
• Ecological Fallacy is
drawback. Characters
Case report Case series ascribed to a group may
not be possessed by an
individual
Retrospective cohort study
Cross Sectional Study
• a/k/a snapshot study
because no follow up. It is
based on single
examination of cross-
section of population
• Gives prevalence
• Gives distribution of study
• No information about
natural history of disease
• Cant comment on
temporal association
 Calculations
Indicator Formula Special point

Odds ratio AD
BC
Relative risk I (E)
I (NE)
RR>1 I(E) > I(NE)

RR=1 I(E) = I(NE)

RR<1 I(E) < I(NE)

attributable risk I (E) - I (NE)

I (E)

Proportional I (T) - I (NE)

attributable risk I (T)
RCT Blinding
Single Blinding
Total
Double Blinding
population

Random sampling Triple Blinding

Sample
population
External Validity
Randomization

Group A Group B Internal Validity

Group B Group A
Confounding
Ways to Control Confounding Level of evidence

Effect modifier
Bradford hill’s criteria
1. Specificity:
2. Consistency:
3. Temporal association:
4. Strength of association:
5. Dose response relationship
6. Reversibility
7. Plausibility
8. Coherence
Bias in epidemiological studies
1. Recall bias 5. Attrition bias

2. Interviewer bias 6.Hawthorne effect

3. Berkson’s bias 7.Lead time bias

4. Neyman bias 8.Publication bias

9.Selection bias
Concept of screen time and lead time

D+ D-
A B C D E
T+ TP FP

Disease First point Final Usual Outcome T- FN TN

onset of critical of time of
diagnosis diagnosis diagnosis
Cut off value
ROC curve
Obesity Skin fold thickness
1. BMI

2. Broca’s Index

3. Ponderal index

4. Corpulence index

5. Lorentz index
NCD Rule of halves
DAMS PSM
WHO-STEPS Approach Kashish Grover

Biochemical

Physical

Questionnaire

Tracking of BP Most Common Cancer 90-70-90

RDA
Energy Protein Dietary Reference Indian Man Reference Indian
fibre Woman
Male Sedentary Age

Moderate Weight

Heavy Height

Female Sedentary BMI

Moderate 8 hours of work, 7 hours of sleep, free of disease, physically active

Heavy RDA (Recommended Dietary Allowance)

Pregnant

Lactating EAR (Estimated Average Requirement)

RDA
Calcium Zinc Iodine Iron Folate Vitamin A Vitamin C Vitamin D
(mg/d) (mg/d) (mcg/d) (mg/d) (mcg/d) (mcg/d) (mg/d) (IU/d)

Male 1000 17 150 19 300 1000 80 600

Female 1000 13 150 29 220 840 65 600

Pregnant 1000 14.5 250 40 570 900 +15 600

Lactating 1200 14 280 23 330 950 +50 600

Elderly 1200 17 150 19 300 1000 80 800

male
Elderly 1200 13 150 19 200 840 65 1200
female
Milk Food standard
Test of Milk

Before pasteurization

After pasteurization

Energy, fat and protein content Breast Milk

Lactose content
 Food adulterants and toxins
Disease Toxin: Food item Special points

Lathyrism BOAA Khesari dal Prevention is

(Lathyrus sativus) a) Banning crop
Beta Oxalyl Amino Alanine b) Vitamin c prophylaxis
c) removal of toxin (steeping method and
parboiling)
d) genetic modification
Epidemic dropsy Sanguinarine Contamination of mustard oil Test done for detection are:
with argemone mexicana oil Nitric acid test and paper chromatography test

Endemic ascites Pyrrolizidine Millets are adulterated with De-weeding of Jhunjhunia plants
crotalaria seeds (locally known
as Jhunjhunia)
Ergotism Ergot fungus Jowar, rye bajra Ergot infested grains can be easily removed by
(Claviceps purpurea) floating them in 20% salt water.
Aflatoxicosis Aflatoxin Mainly groundnut also maize, Keep moisture content below 10%
parboiled rice Food grains should be stored after drying only
 Vitamins
Vitamin Source Deficiency Special points

Vitamin A

Vitamin B1

Vitamin B3

Vitamin D

Vitamin C
 Minerals
Source Deficiency Special points

Iron

Iodine

Fluorine

Zinc
Demographic cycle
Stage-1 Stage-2 Stage-3 Stage-4 Stage-5
High stationery Early Expanding Late Expanding Low stationery Declining
Definitions and Population pyramid
a) Demographic transition

b) Epidemiological transition

c) Demographic window

d) Demographic dividend

e) Demographic trap

f) Carrying capacity
Growth rate Sex ratio

Dependency ratio Literacy rate

Fertility indicator
Birth rate General fertility rate Age specific fertility rate

Total fertility rate Gross reproduction rate Net reproduction rate

Survey
census CRS-Civil Registration system

SRS-Sample Registration system NFHS-National Family Health Survey

Lippes loop CuT 380 A CuT 375 Chhaya Antara

Progestasert Mirena Condom OCP

Maternal Mortality Rate Maternal Mortality Ratio

Maternal Mortality Direct cause Indirect cause

Neonatal Mortality Rate Infant Mortality Rate

Still birth rate Perinatal Mortality Rate Under 5 Mortality Rate

No. of Expected pregnancy
ANC visits IFA tablet

Td
Growth of baby Colostrum

Mid Upper Arm Circumference

Growth Chart
Healthful school environment School health Services Under Ayushman Bharat
Rapid and slow sand filter
Chlorination Horrocks apparatus
Air pollutants

Kyoto protocol
Meteorological environment
Kata thermometer Sling Psychrometer

Dry bulb and wet bulb thermometer

Anemometer

Globe thermometer
Methods of Waste disposal
1. Dumping
2. Controlled tipping or sanitary landfill

3. Composting
Banglore method Mechanical composting
4. Incineration

5. Manure pit

6. Burial
Mosquitoes

Anopheles Culex Aedes Mansonia

Egg
 Anopheles Culex Aedes Mansonia
larvae

Breeding

Disease
caused
Adult
Sandfly Rat flea Trombiculid mite

Itch mite
Mosquito control measures

Anti-larval measures Anti-adult measures Personal protection

1. Environmental control 1. Residual spray 1. Mosquito nets

2. Chemical control

2. Space spray
3. Biological control
2. Repellents

3. Genetic control
Biomedical Waste Management Blue category
White category
Yellow category

Blood spillage Mercury spillage

Red category
 Pneumoconiosis
Lung diseases caused by dust

Inorganic dust Organic dust

Silica dust Sugarcane dust

Coal dust Mouldy hay

Asbestos Compost

Iron

Beryllium
Factories Act ESI Act
Disaster cycle Triage
Hallmark of Primary care Principle of Primary Health Care
 Sub Centre PHC CHC
Population
Plains
Hilly/ tribal
Type

Staff

Beds
Maintained
by
ASHA MPHW (M) Urban health care facility

MPHW (F)
Health committees
1) Bhore Committee 5) Jungalwalla Committee

2) Mudailar Committee 6) Kartar Singh Committee

3) Chadha Committee 7) Krishnan Committee

4) Mukherji Committee 8) Shrivastava Committee

Cost Analysis Input output
Cost Benefit Analysis

Cost effective Analysis

Cost utility Analysis

Cost minimization Analysis

Inventory Control Work sampling
Family cycle Family Types
Formation Marriage Birth of 1st child Nuclear Family

Extension Birth of Birth of last child

1st child
Joint Family
Complete Birth of last 1st
child leaves
extension child home

Contraction 1st child leaves Last child leaves 3 generation Family

home home
Complete Last child leaves Spouse dies
Contraction home Problem Family

Dissolution Spouse dies Death of partner

Broken Family
Barriers of communication Chalk and talk
Kashish Grover, PSM Faculty
Physiological

Environmental
Demonstration

Panel discussion
Panel discussion

Focus group discussion

Focus group discussion
 Kashish Grover, PSM Faculty

GATHER approach SPIKES Approach

WHO UNDP

UNICEF

UNFPA
FAO

ILO
 Kashish Grover, PSM Faculty

Time trend of disease

Epidemic
 Kashish Grover, PSM Faculty

Disease timeline
a. Incubation period

b. Serial Interval

c. Generation Time

d. Communicable period

e. Window period
Type of vaccine
Live vaccine Killed vaccine Toxoid/ protein

Polysaccharide

Recombinant
National Immunisation Schedule

At birth
At 6 weeks
At 10 weeks
At 14 weeks
At 9 months
At 16-24 months
At 5 year
At 10 year
At 15 year
Pregnancy
Open vial policy VVM-Vaccine Vial monitor

Shake test
TB Classification based on drug resistance
1) Mono- Resistance

2) Poly Drug Resistance

3) Rifampicin Resistance (RR)

4) Multi Drug Resistance (MDR)

5) Pre Extensive Drug Resistance (Pre-XDR)

6) Extensive Drug Resistance (XDR)

 Treatment guidelines
Drug Sensitive TB Drug resistant TB
Shorter regimen Longer regimen
IP-6 Months CP-5 Months

H-Mono
Malaria Malaria indicators
Annual Blood Examination Rate
Diseases under NVBDCP Vivax treatment
Annual Parasite Incidence

Annual Falciparum Incidence

Slide Positive Rate

Slide Falciparum Rate

Falciparum treatment Chemoprophylaxis
North East: ACT-AL Other than North East: ACT-SP
Short term Long term
Artemether 80 mg Artesunate 4 mg/ kg

Lumefantrine 480 mg Sulphadoxime 25mg/ kg

Pyremathamine 1.25 mg/kg

Primaquine 0.75mg/kg Primaquine 0.75mg/kg

Filariasis/ JE/ Kala Azar
Filariasis Japanese Encephalitis Kala Azar
• Nocturnal Periodicity: mf appears
in blood at night
• DEC Provocation Test: 100 mg DEC
given, mf peak in blood within 15
min
• Prevention: MDA in endemic areas
Ivermectin DEC Albendazole
• Treatment: DEC 6mg/kg/ day for
12 days
DEC only effective for mf, not adult
• Transmission Assessment Survey
Done after 5 to 6 rounds of MDA to
take decision to stop MDA
Rabies
Categories of animal bite wound

Category I

Category II

Category III
 Pre Exposure Prophylaxis Post Exposure Prophylaxis

3 doses Vaccine ID: 0, 3, 7, 28 days IM: 0, 3, 7, 14, 28 days

Immunoglobulins: Dose:
0, 7 and booster on day 21 or 28
Indications: ❑ Human: 20IU/Kg
❑ Equine: 40IU/Kg
❑ All category III
Re Exposure Prophylaxis ❑ All immunocompromised Category II and III patient
Administration:
2 doses ❑ As much as possible immunoglobulins dose should be infiltrated
carefully to wounds
0, 3 days ❑ No need to give 7 days after bite
✓ If within 3 months nothing to be ❑ RIG must be brought to room temperature before administering
given just wound washing
✓ If immunoglobulins given in last
episode no need to repeat
immunoglobulin even if it’s a
category III bite
STD, Scrub typhus, SAFE Scrub typhus
Colour syndromes Drugs
Kit 1 Grey Urethral or cervical or Azithromycin, Cefixime
anorectal discharge
@kays_psm
Kit 2 Green Vaginal discharge Secnidazole,
Fluconazole
Kit 3 White Genital ulcer Penicillin, Azithromycin
Non herpetic
Kit 4 Blue Genital ulcer Azithromycin,
Non herpetic Doxycycline

(penicillin allergic)
Kit 5 Red Genital ulcer herpetic Acyclovir

Kit 6 Yellow Lowe abdominal pain Metronidazole,

SAFE Strategy
Cefixime, Doxycycline

Kit 7 Black Inguinal bubo Azithromycin,

Doxycycline
Thank you!
 04-06-2024

Health Programmes
JSY Cash incentive
Janani Suraksha Yojana
for
1400 600 1000 400
institutional
delivery 600 600 400
700
DAMPS PSM Kashish Grover
PMMVY Cash incentive of Rs 1. Rs 3000: early registration of pregnancy and
5000 in 2 instalments at least 1 ANC
Pradhan Mantri Matru
on first child 2. Rs 2000: after child birth, birth registered, and
Vandana Yojana Rs. 6000 if 2nd girl child all due vaccines till age of 14weeks under UIP
WCD ministry
JSSK
Janani Shishu Suraksha Free transport, diagnosis, delivery, drugs, diet, blood
Karyakaram
NSSK
Navjat Shishu Suraksha Training of health workers and doctors in newborn care.
Karyakaram

Health Programmes
SUMAN Assured, dignified and respectful delivery of quality healthcare services at no cost and
Surakshit Matritva
zero tolerance for denial of services to any woman and newborn visiting a public
Ashwasan health

LaQshya
Improve labour room Quality

DAMPS PSM Kashish Grover

PMSMA
free ANC to pregnant women on the 9th of every month
Pradhan Mantri Surakshit
Matritva Abhiyan
•Green: no risk factor detected
•Red: with high risk pregnancy
•Blue: Pregnancy Induced Hypertension
•Yellow: pregnancy with co-morbid conditions such as
diabetes, hypothyroidism, STIs

1
 04-06-2024

Health Programmes
HBPNC Home visits by
Home delivery: 7 visits 0, 3, 7, 14, 21, 28, 42 days
ASHA NVD at institution: 6 visits 3, 7, 14, 21, 28, 42 days

LSCS: 5 visits 7, 14, 21, 28, 42 days

HBYCC Home visits by 5 visits 3, 6, 9, 12, 15 month

Home Based Young Child ASHA
Care DAMPS PSM Kashish Grover

RBSK Diseases, Deficiency,

Rashtriya Bal Swasthya Screening of 4 Ds
birth Defects,
Karyakaram in 0 to 18 year old
Development delays

RKSK For adolescent Mental health Sexual and reproductive health

Rashtriya Kishore Swasthya 10 to 19 year old Life skills Injuries and violence Nutrition and NCD
Karyakaram

Health Programmes
Anemia 6×6×6 strategy Age group Iron Folic Frequency
acid
Mukt • 6 beneficiary age group
6 m to 59 m 20 mg 100 mcg Bi weekly 50 ml bottle
Bharat • 6 intervention
5-9 years
• 6 institutional mechanism 45 mg 400 mcg weekly Pink tablet

National • Biannual albendazole given 10-19 years weekly Blue tablet

deworming • 1-2 year: half tablet (200 mg) 20-49 years
60 mg 500 weekly
day DAMPS PSM Kashish Grover
• 2-19 year: full tablet (400 mg) Pregnant Daily Red tablet
mcg
Mission Universal immunization coverage Lactating Daily
Indardhanush 12 vaccine preventable diseases:
Ujala Ujjwala Ujjawala
Diphtheria, pertussis, tetanus, polio
Hep B, JE, Rota, TB, HiB, PCV, MR
Abhiyan Change of bedsheets according to
Indardhanush
VIBGYOR in ESI hospitals
LED bulbs LPG Child
cylinder trafficking